Unexpected malignant uterine pathology: incidence, characteristics and outcome in a large single-center series of hysterectomies for presumed benign uterine disease

Objective:

Hysterectomy presents a frequently used therapeutic option for benign gynecological conditions. The purpose of this study was to assess the incidence and characteristics of unforeseen malignant pathologies of the uterine corpus in a large population-based, single center cohort, and to discuss implications for clinical routine.

Methods:

All patients treated with hysterectomy for presumed benign conditions at the Tübingen University Women's Hospital between 2003 and 2016 were identified. Patient's charts were reviewed and in case of an unexpected malignancy, specialized pathology review of tumor tissue was performed. Clinicopathological data were recorded and statistical analysis was carried out.

Results:

A total of 10.756 women underwent benign hysterectomy during the specified period of time. In 33/10.756 (0.31%) an unexpected diagnosis of endometrial carcinoma was made and confirmed upon review pathology. 27/33 (81.8%) EC were diagnosed as FIGO stage IA, 5/33 (15.2%) as FIGO stage IB and 1/33 (3%) as FIGO stage II disease. Disease-specific death occurred in one patient, who was initially diagnosed with high-risk disease. Data on unexpected findings of uterine sarcoma and MMMT are currently under investigation and will be available for presentation at the DGGG conference.

Conclusion:

Our study shows, that unexpected diagnosis of EC corpus upon primarily benign hysterectomy is fairly uncommon (0.31%). In cases of unexpected EC diagnosis, tumors tend to be early stage disease, making preoperative diagnosis difficult. Therefore, preoperative planning of benign hysterectomy should be undertaken with care and in case of inconclusive findings an appropriate surgical approach should be selected.