Histopathological Findings in Symptomatizing Patients After Supracervical Hysterectomy: A Cross Sectional Study

Background: Supra-cervical hysterectomy (SCH) is widely common and has many complications either immediate or delayed, including bleeding, infection, and chronic pelvic pain. Clinical studies evaluating histopathological findings in these patients are few.

Objective: To study the underlying pathological changes in the cervical stump after supracervical hysterectomy in symptomatizing patients.

Patients and Methods: This cross-section study was conducted at Tanta University. All patients (n=132) underwent cervical stump biopsy for histopathological examinations. Immunohistochemical expression of P16 was also performed in all patients with cervical pathological abnormalities as a recommended biomarker for cervical lesions.

Results: Vaginal bleeding was the most common presentation of enrolled patients (54/132). Endometriosis was the commonest pathological lesion detected in patients with cervical stump bleeding (27/54). After Hematoxylin and eosin staining was applied; 52 cases showed normal cervical tissue, chronic non-specific cervicitis in 11 cases, endometriosis in 27 cases, squamous metaplasia with no atypia in 6 cases, cervical intraepithelial neoplasia in 32 cases, squamous cell carcinoma in 3 cases and adenocarcinoma in only one case. P16 immuno-staining showed negative expression in chronic cervicitis and squamous metaplasia with no atypia, ambiguous p16 expression was observed in 50%, 63.2% and 80% cases of CIN I, CIN II, and III respectively, while 100% of cervical cancer cases showed block positive expression.

Conclusion: Pathological lesions of cervical stump following SCH could be screened by p16 immuno-staining as a complementary test for early detection of cervical cancer. Ambiguous expression of p16 should not be neglected as the lesion may have a low possibility of harboring high-risk human papilloma.

Keywords: Cervical stump; Histopathology; p16 expression; Supracervical hysterectomy

Abbreviations: BMI: Body Mass Index; CIN: Cervical Intraepithelial Neoplasia; H&E: Hematoxylin and Eosin; HSIL: High-grade Squamous Intraepithelial Lesions; HPV: Human Papilloma Virus; IHC: Immunohistochemistry; SCH: Supracervical Hysterectomy.