Clinicopathological Analysis of Uterine Leiomyoma Variants in Hysterectomy Specimens: A Cross-Sectional Study

Abstract

Uterine leiomyomas, commonly known as fibroids, are the most prevalent benign tumors of the female reproductive system, often presenting in women during their reproductive years. This study aimed to analyze the clinicopathological characteristics of various leiomyoma types in hysterectomy specimens. Conducted as a prospective, cross-sectional study at a tertiary care hospital over two years, the study included 403 cases of leiomyomas from a total of 680 hysterectomy specimens. Data on patient demographics, clinical symptoms, and histopathological findings were systematically collected and analyzed.

Materials and Methods: Specimens underwent gross examination and histopathological analysis to determine the type, location, and morphological characteristics of leiomyomas. Inclusion criteria were based on confirmed cases of leiomyomas in complete hysterectomy specimens, while cases with laparoscopically resected fibroids or incomplete specimens were excluded. Microscopic examination focused on cellularity, nuclear features, and mitotic activity to classify conventional leiomyomas and rarer variants.

Results: The study found that conventional leiomyomas were the most prevalent type (83.12%), followed by cellular leiomyomas (15.88%). Rare variants, including leiomyomas with bizarre nuclei, lymphocytic-rich leiomyomas, and mitotically active leiomyomas, constituted only 0.25% each. Most leiomyomas were intramural, and smaller tumors (<5 cm) were more common. Abdominal pain was the most frequently reported symptom, followed by abnormal uterine bleeding. Variants such as mitotically active leiomyomas and leiomyomas with bizarre nuclei presented histopathological challenges, highlighting the importance of accurate diagnosis to prevent overtreatment.

Discussion: The findings emphasize the impact of leiomyomas on women’s health and underscore the need for detailed histopathological analysis to differentiate benign from potentially malignant variants. The age distribution, with a peak incidence in the 41-50 age range, aligns with hormonal influences on leiomyoma development. Understanding these variants informs treatment planning, allowing for tailored approaches that improve patient outcomes.

Conclusion: This study underscores the prevalence of conventional leiomyomas while highlighting the clinical significance of rare variants. Histopathological examination remains essential in distinguishing benign from malignant-like leiomyomas, guiding appropriate management. Further research into minimally invasive therapies and molecular insights could offer new diagnostic and treatment pathways for leiomyomas.