Unexpected pathological findings in uterine prolapse: a 12‐month audit

After any gynaecological operation it is common practice for excised tissue to be sent for histological examination whatever the indication. In an increasingly cost conscious climate the need for every excised specimen to be studied histologically has been questioned (Brooks & Hughes, 1987; Alun-Jones et al. 1990). Conversely the rise in medical litigation and the need to confirm clinical diagnoses may halt this trend towards selective histopathology. Vaginal hysterectomy and pelvic floor repair for uterine prolapse is an example of an operation where significant pathology is not anticipated in the excised specimen. However, many patients with prolapse are elderly and are therefore at risk of developing a gynaecological malignancy. Since most uterine carcinomas arise from the cervix or endometrium, it is from these areas that routine blocks are taken for microscopic examination (any macroscopically abnormal areas are also sampled). We have examined the surgical files of the Northern General Hospital, Sheffield, over a 12-month period to study the frequency of unexpected pathology in patients with uterine prolapse. A total of 5.52 hysterectomy specimens were received by the laboratory during the 12-month study period (1/10/90-30/9/ 9 l) , of which 37 1 were removed for a variety of benign conditions, 9.5 for malignancy and 86 for uterine prolapse. Table 1 shows the pathological lesions found in the specimens removed for prolapse. Incidental lesions, such as endometrial polyps or fibroids requiring no further treatment, were found in 4.5 of the 86 specimens. Significant lesions, defined as those which would require an alteration from the routine clinical management, were identified in two of the 86 specimens (2.3%). One of these was an endometrioid adenocarcinoma, Grade 3, arising in the endometrial cavity of a 55-year-old woman. The tumour was 2 cm in diameter and infiltrated more than half the depth of the myometrium. As a direct result of this unexpected finding, this patient has since received radiotherapy. The second was a well differentiated squamous cell carcinoma of the cervix from a SO-year-old woman, 1 cm in