Evaluation of the Adnexal Masses in Hysterectomized Women: An Observational Study

Document Type : Original Article

Authors

1 Deapartment of Obstetrics and Gynecology, Sri Balaji Medical College and Research Institute, Tirupati, Andhra Pradesh, India

2 Deapartment of Obstetrics and Gynecology, Sri Venkateswara Medical College, NTR University of Health Sciences, Tirupati, Andhra Pradesh, India

3 Department of Urology, Sri Venkateswara Institute of Medical Sciences, SVIMS University, Tirupati, Andhra Pradesh, India

Abstract

Background and aim: To evaluate the clinical, pathological and surgical characteristics of adnexal masses in     hysterectomized women with one or both ovaries conserved.
Material and methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology over twenty months, including 80 hysterectomized women with one or both adnexa preserved and later presented with subsequent adnexal masses. The previous surgical histories of these patients, present clinical and pathological characteristics of ovarian cysts, and possible management options were evaluated.
Results: Among the study's 224 hysterectomized women presented to the Gynaecology Outpatient Department (OPD), 80 women with adnexal masses were included. Among the 80 hysterectomies, most were abdominal hysterectomies. Moreover, most patients underwent hysterectomy between 40 and 50 years of age. Symptomatic Fibroid uterus was the most common indication for hysterectomy. Among the 80 women in, 68.8% women, both ovaries were preserved. The most common presenting symptom was pain abdomen. Adnexal masses are evaluated by clinical examination, Radiological imaging modalities, and tumour markers depending on the need. Among the 80 women, 43.8% needed surgical intervention, 48.8% managed with conservative treatment, and 7.5% were referred to Oncology. Benign ovarian epithelial tumours were the most common type among surgically treated.
Conclusions: The management of adnexal masses in hysterectomized women should be individualized, depending on the presenting symptoms, the size of the adnexal mass, radiological findings, tumour markers, and expected future complications.

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Main Subjects


[1]  Sharma C, Sharma M, Raina R, Soni A, Chander B, Verma S. Gynecological diseases in rural India: A critical appraisal of indications and route of surgery along with histopathology correlation of 922 women undergoing major gynecological surgery. Journal of mid-life health. 2014;5(2):55-61. https://doi.org/10.4103%2F0976-7800.133988.
[2]  Hammer A, Rositch AF, Kahlert J, Gravitt PE, Blaakaer J, Søgaard M. Global epidemiology of hysterectomy: possible impact on gynecological cancer rates. American journal of obstetrics and gynecology. 2015;213(1):23-9. https://doi.org/10.1016/j.ajog.2015.02.019.
[3]  Thompson JD, Birch HW. Indications for hysterectomy. Clinical obstetrics and gynecology. 1981;24(4):1245-58.
[4]  Sharma U, Schumann SA. Ovary-sparing hysterectomy: Is it right for your patient?. The Journal of Family Practice. 2009;58(9):478-80.
[5]  Chao X, Liu Y, Ji M, Wang S, Shi H, Fan Q, et al. Malignant risk of pelvic mass after hysterectomy for adenomyosis or endometriosis. Medicine. 2020;99(15):e19712. https://doi.org/10.1097%2FMD.0000000000019712.
[6]  Holub Z, Jandourek M, Jabor A, Kliment L, Wágneroá M. Does hysterectomy without salpingo-oophorectomy influence the reoperation rate for adnexal pathology? A retrospective study. Clinical and Experimental Obstetrics & Gynecology. 2000;27(2):109-12.
[7]  Zalel Y, Lurie S, Beyth Y, Goldberger S, Tepper R. Is it necessary to perform a prophylactic oophorectomy during hysterectomy?. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1997;73(1):67-70. https://doi.org/10.1016/S0301-2115(97)02702-4.
[8]  Sangam JH, Singh A, Sinha H. Analysis of Adnexal Mass in Women with Previous Hysterectomy-An observational study. Thai Journal of Obstetrics and Gynaecology. 2020:244-50. https://doi.org/10.14456/tjog.2020.31.
[9]  Movva N, Kavya M. Ovarian Cysts in Post Hysterectomy Cases–An Overview. Sch Int J Obstet Gynec. 2021;4(5):182-6. https://doi.org/10.36348/sijog.2021.v04i05.002.
[10] Öksüzoğlu A, Özyer Ş, Yörük Ö, Aksoy RT, Yumuşak ÖH, Evliyaoğlu Ö. Adnexal lesions after hysterectomy: A retrospective observational study. Journal of the Turkish German Gynecological Association. 2019;20(3):165-9. https://doi.org/10.4274%2Fjtgga.galenos.2018.2018.0051.
[11] Farhat N, Altaf B. Experience with pelvic masses following hysterectomy for benign diseases. Biomedica. 2004; 20 (Jul-Dec): 106-9.
[12] Shiber LD, Gregory EJ, Gaskins JT, Biscette SM. Adnexal masses requiring reoperation in women with previous hysterectomy with or without adnexectomy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2016;200:123-7. https://doi.org/10.1016/j.ejogrb.2016.02.043.
[13] Lalooei A, Hashemi SR, Khosravi MH. Histopathological distribution of ovarian masses occurring after hysterectomy: a five-year assay in Iranian patients. Thrita. 2016;30:5(1): e33131. http://dx.doi.org/10.5812/thrita.33131.
[14] Casiano ER, Trabuco EC, Bharucha AE, Weaver MA, Schleck MC, Melton III LJ, et al. Risk of oophorectomy after hysterectomy. Obstetrics and gynecology. 2013;121(5). https://doi.org/10.1097%2FAOG.0b013e31828e89df.
[15] Falconer H, Yin L, Grönberg H, Altman D. Ovarian cancer risk after salpingectomy: a nationwide population-based study. JNCI: Journal of the National Cancer Institute. 2015;107(2):1-6. https://doi.org/10.1093/jnci/dju410.