Incidental gynaecological malignancy in women who underwent hysterectomy for utero-vaginal prolapse: a 3-year institutional case study

Fathima M. Seles, Rajavelu Indira


Background: Pelvic organ prolapse is common is almost 50% of women over the age of 50years. The objective of the present study was to estimate the number of incidental gynaecological malignancies in women who underwent hysterectomy for utero-vaginal prolapse.

Methods: 354 women who presented with asymptomatic utero-vaginal prolapse were included in this study. Women who were symptomatic with bleeding per vaginum, lower abdominal pain or excessive white discharge and preoperative screening tests such as VIA/VILI, colposcopy, Pap smear and radio-imaging showing any gynaecological lesions were excluded from this study.

Results: Histopathological examination of the hysterectomy specimen showed premalignant lesion in 13 cases accounting to 3.7% (11 cases of CIN I, 1 case of CIN II, 1 case of CIN III) and malignant lesions in 5cases accounting for 1.4% (4 cases of endometrial adenocarcinoma and 1 case of cervical squamous cell carcinoma).

Conclusions: Asymptomatic women with utero-vaginal prolapse may have pre-existing premalignant and malignant lesions. Therefore, all women undergoing hysterectomy should be preoperatively screened with transvaginal ultrasound, endometrial biopsy and pap smear to rule out malignancy, as the management differs for patients with co-existing gynecological malignancies.


Asymptomatic women, Cervical carcinoma, Endometrial carcinoma, Gynecological malignancies, Hysterectomy, Incidental, Unexpected, Utero-vaginal prolapse

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Elbiaa AMA, Abdelazim IA, Farhali MM, Hussain M, Omu AE. Unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Menopause Review.2015;14(3):188-91.

Grigoriadis T, Valla A, Zacharakis D, Protopapas A, Athanasiou S. Vaginal hysterectomy for uterovaginal prolapse: what is the incidence of concurrent gynecological malignancy?. Int Urogynecol J. 2015;26(3):421-5.

Renganathan A, Edwards R, Duckett JR. Uterus conserving prolapse surgery-what is the chance of missing a malignancy?. Int Urogynecol J. 2010;21(7):819-21.

Wan OY, Cheung RY, Chan SS, Chung TK. Risk of malignancy in women who underwent hysterectomy for uterine prolapse. Aus NZ J Obstet Gynaecol. 2013;53(2):190-6.

Vanichtantikul A, Tharavichitkul E, Chitapanarux I, Chinthakanan O. Treatment of Endometrial Cancer in Association with Pelvic Organ Prolapse. Case Reports Obstet Gynecol. 2017;2017.

Yoshino K, Kobayashi E, Endo M, Kakuda M, Okada A, Tomimatsu T, et al. A case of laparoscopic surgery for endometrial cancer in a patient previously treated with a transvaginal mesh procedure for pelvic organ prolapse. Gynecol Minimally Inv Therap. 2017;6(4):211-3.

Frick AC, Walters MD, Larkin KS, Barber MD. Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse. Am J Obstet Gynecol. 2010;202(5):507-e1.

Salmon HA, Smith JH, Balsitis M. Is microscopic assessment of macroscopically normal hysterectomy specimens necessary?. J Clin Pathol. 2002;55(1):67-8.

Ramm O, Gleason JL, Segal S, Antosh DD, Kenton KS. Utility of preoperative endometrial assessment in asymptomatic women undergoing hysterectomy for pelvic floor dysfunction. Int Urogynecol J. 2012;23(7):913-7.

Mahnert N, Morgan D, Campbell D, Johnston C, As-Sanie S. Unexpected gynecologic malignancy diagnosed after hysterectomy performed for benign indications. Obstet Gynecol. 2015;125(2):397-405.

Foust-Wright C, Weinstein MM, Pilliod R, Posthuma R, Wakamatsu MM, Pulliam SJ. Uterine Pathology in Hysterectomies Performed for Treatment of Pelvic Organ Prolapse. J Minim Inv Gynecol. 2014;21(6):S95-6.

Mahajan G, Kotru M, Batra M, Gupta A, Sharma S. Usefulness of histopathological examination in uterine prolapse specimens. Aus NZ J Obstet Gynaecol. 2011;51(5):403-5.

Cliby WA, Dodson MK, Podratz KC. Uterine prolapse complicated by endometrial cancer. Am J Obstet Gynecol. 1995;172(6):1675-83.