Incidental Gynecological Premalignant and Malignant Lesions in Patients Undergoing Hysterectomy for Benign Indications.

OBJECTIVE

To determine the frequency and clinicopathological features of incidental premalignant and malignant gynecological lesions detected after hysterectomies performed for benign indications, and to identify associated risk factors.

METHODOLOGY: This retrospective study reviewed 1,047 hysterectomies performed for benign conditions at a tertiary center in Ankara, Turkiye, over a ten years period (January 2006-December 2015). Demographic characteristics, preoperative assessments, surgical indications, and histopathological outcomes were analyzed. Incidental lesions were defined as pre-malignant or malignant pathologies identified postoperatively without prior clinical suspicion. Statistical analyses were performed using chi-square and t-tests.

RESULTS

Incidental pre-malignant or malignant lesions were identified in 6% (n=63) of cases, including cervical dysplasia/HSIL (0.9%), borderline ovarian tumors (1.1%), endometrial adenocarcinoma (0.5%), leiomyosarcoma (0.5%), and high-grade serous ovarian carcinoma (0.6%). Postmenopausal women had a significantly higher incidence than premenopausal women (9.2% vs. 3.8%, p<0.001). Patients with incidental findings were older than those with benign pathology (55.4 ± 11.2 vs. 52.7 ± 9.6 years, p=0.034). Larger myomas were associated with uterine sarcoma (172 ± 92 mm vs. 71 ± 39 mm, p<0.001). Ovarian malignancies were detected in 2.4% of cases without suspicious ultrasound features and in 14.8% of cases with ≥2 malignancy criteria (p=0.013). Serous tubal intraepithelial carcinoma (STIC) was identified in 0.28% (n=3).

CONCLUSION

Incidental pre-malignant or malignant lesions were present in 6% of hysterectomies performed for benign indications. Age, menopausal status, myoma size, and suspicious imaging features were significant predictors. Preoperative evaluation may not completely exclude the possibility of occult pathology; therefore, this risk should be discussed during preoperative counseling.