Unexpected risk of gynecological malignant and premalignant disease in women undergoing hysterectomy for pelvic organ prolapse

  • Mustafa Ayhan Ekici Department of Gynecology and Obstetrics, Bolu Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey http://orcid.org/0000-0002-0745-0907
  • Ali Can Onal Department of Pathology, Bolu Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey http://orcid.org/0000-0001-6078-7325
Keywords: Pelvic organ prolapse, uterovaginal prolapse, hysterectomy, malignancy


Aim: To investigate the incidence of unexpected malignant and premalignant gynecological pathological findings among women who underwent hysterectomy due to pelvic organ prolapse (POP).

Methods: In this retrospective study, the medical reports of women who underwent hysterectomy for POP between 2007 and 2019 were investigated to reveal unexpected malignant and premalignant lesions. The possible relationship between pathological results and other variables was evaluated statistically.

Results: The hysterectomy was performed by abdominal (160, 30.53%), laparoscopic (62%, 11.83%) and vaginal approaches (302, 57.63%) in 524 patients with POP indication. Thirty five patients (6.67%) had unexpected premalignant or malignant pathological findings found on hysterectomy specimens. Simple hyperplasia was found in 18 patients (3.44%), complex hyperplasia in two patients (0.38%); CIN-1 (LSIL) low grade cervical intraepithelial dysplasia in nine patients (1.7%), CIN-II, moderate dysplasia in two patients (0.38%); CIN-III, severe dysplasia in one patient (0.19%); vaginal carcinoma in two patients (0.38%) and endometrial carcinoma in one patient (0.19%). In the vaginal hysterectomy group, the incidence of unsuspected gynecological malignancy was founded at the rate of 0.57% (3/524) and the percentage of the group was significantly higher than laparotomic and laparoscopic hysterectomy groups. Statistically significant difference was not found between the groups with respect to unexpected uterine malignancy.

Conclusion: Women without abnormal vaginal bleeding do not have high risk of premalignant or malignant pathological reporting after uterovaginal prolapse surgery, however it should not be neglected.