Unexpected malignancy rate of 1630 hysterectomies performed for benign indications: A 10-year retrospective analysis

OBJECTIVE Hysterectomy is one of the most common operations in gynecology. This study aimed to investigate the incidence of occult gynecologic malignancies in women undergoing hysterectomy for benign indications. METHODS In this retrospective study, the medical records of patients who underwent hysterectomy for benign indications between 2009-2019 were evaluated using the hospital’s electronic system. RESULTS During the study period, 1630 cases underwent hysterectomy for benign indications. The mean age of the patients was 48.4±6.9 years. The most common indications for hysterectomy were leiomyoma (n=788, 48.3%) and abnormal uterine bleeding (n=539, 33.1%). In the final histopathological evaluation results, malignancy was identified in 12 cases (0.73%), and the mean age of these cases was 50.41±12 years. These malignancies included four leiomyosarcomas (33.33%), one endometrial sarcoma (8.33%), two endo-metrial adenocarcinomas (16.66%), four ovarian carcinomas (33.33%), and one ovarian fibrosarcoma (8.33%). Preoperative endometrial sampling was performed in 1160 cases (71.16%). All of the occult malignant cases had preoperative endometrial sampling and no malignancy was observed in the endometrial pathology results. CONCLUSION Unexpected malignancy rate in women who underwent hysterectomies for benign indications was 0.73%, and 58.3% of them were related to the uterus, and 41.6% were related to ovarian tissues. Occult uterine and ovarian malignancies may be observed in hysterectomies performed for benign indications. Detailed preoperative evaluation is essential to avoid the increased risk of mortality and morbidity caused by late diagnosis of malignancy. © 2021, Turkish Society for Radiation Oncology.