Histopathological analysis of endometrial lesions and its correlation with age in Khyber Pakhtunkhwa region of Pakistan

Objective: To determine the frequency and histopathological pattern of endometrial lesions identified on hysterectomy specimen and correlate it with different age groups.Methodology: This prospective cross-sectional study was carried out at Departments of Pathology and Gynecology & Obstetrics, Hayatabad Medical Complex, Peshawar from July 2015 to July 2020. A total of 587 hysterectomy specimens were included in the study and included both vaginal and abdominal hysterectomies. The grossing protocol of hysterectomy specimen was cervix: two sections, body & fundus of uterus: two sections and one section from both ovaries & fallopian tubes. One to multiple sections were obtained from leiomyomas & ovarian/uterine masses and cysts depending on their sizes. Tissue sections after staining with hematoxylin and eosin (H&E) were examined microscopically by expert histopathologists and reported.Results: Out of 612 abdominal and vaginal hysterectomy specimens, 587 were included in the study. Thirty-three (5.6%) belonged to age group 21 - 30 years, 218 (37%) to age 31 - 40 years, 268 (45.6%) to age 41 - 50 years, 51 (8.7%) to 51 - 60 years and 17 (2.9%) belonged to age over 60 years. Two thirty-one (39.35%) patients had leiomyomas and 190 (32.36%) adenomyosis. While 62 (10.5%) patients revealed dual pathology i.e. both leiomyomas and adenomyosis. Fifty-seven (9.7%) had endometrial polyps, 27 (4.59%) had endometrial cancer, 11 (1.87%) had chronic endometritis, 9 (1.53%) had simple cystic hyperplasia.Conclusion: Leiomyoma and adenomyosis were the most common benign lesions. The peak incidence was in 31-40 years age group. These two lesions most frequently occurred together. Histopathology is mandatory for confirming diagnosis. Routinely done ultrasound examination of gynecological patients is not enough for confirmation of adenomyosis.