What do the findings during a hysterectomy indicate about the condition of the uterus and surrounding organs?

Pathology Report Interpretation: Hysterectomy Findings

Overall Assessment

Your pathology report describes multiple uterine fibroids (leiomyomas) with associated findings that are common and generally benign, though the specimen shows several abnormalities requiring microscopic confirmation. The most significant findings are the multiple fibroids, hemorrhagic changes around the largest fibroid, ovarian adhesions, and ovarian cysts that need histologic evaluation to rule out malignancy 1.

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Detailed Organ-by-Organ Analysis

Uterus (119 grams, 8.6 x 7 x 5 cm)

Normal vs. Abnormal:

• Weight: Your uterus at 119g is above normal (normal non-pregnant uterus: 50-80g) 2
• Size: The dimensions are enlarged (normal uterus: approximately 7.5 x 5 x 2.5 cm) 2
• Endometrial thickness: <0.1 cm is normal for postmenopausal state or inactive endometrium 1
• Myometrial thickness: 1.2-4.4 cm shows asymmetric thickening (normal: 1-2 cm) 2

Key Findings:

• Multiple fibroids (0.7-4.6 cm): These are benign smooth muscle tumors, the most common indication for hysterectomy 3. The white, whorled appearance is classic for leiomyomas 2
• Hemorrhagic myometrium around largest fibroid: This suggests red degeneration or recent hemorrhage, which can occur with larger fibroids and requires microscopic confirmation to exclude rare sarcomatous change 1, 2
• Intraoperative defect (1.2 cm): This is a surgical artifact from the hysterectomy procedure itself 4
• Serosal adhesions (0.6 cm): These are abnormal fibrous bands, likely from prior inflammation, endometriosis, or previous surgery 4

Cervix (3.2 cm long x 3 cm diameter)

Normal vs. Abnormal:

• Size: Within normal range (normal cervix: 2.5-3.5 cm long) 1
• Appearance: Grossly unremarkable is normal 5
• Patent os: Normal finding 1

Right Ovary (3.3 grams, 3.6 x 1.6 x 1 cm)

Normal vs. Abnormal:

• Weight and size: Normal for postmenopausal state (postmenopausal ovary: typically 2-4 cm, 2-5g) 1
• Cerebriform surface with adhesions: Abnormal - suggests prior inflammation or endometriosis 1
• Variegated cut surface: Requires microscopic evaluation to exclude malignancy 1
• Paratubal cysts (up to 0.4 cm): These are normal incidental findings (benign paratubal cysts are common) 1

Left Ovary (disrupted, 3.2 x 2.7 x 2 cm)

Normal vs. Abnormal:

• Size: Slightly enlarged compared to typical postmenopausal ovary 1
• Multiple cysts (0.8-2.2 cm) with smooth walls and serous contents: Likely benign functional cysts, but microscopic examination is essential to exclude cystadenoma or borderline/malignant tumors 1
• Absence of papillary excrescences: This is reassuring as papillary projections raise concern for malignancy 1
• Extensive adhesions (up to 1.2 cm): Abnormal - suggests endometriosis, prior infection, or inflammatory process 1
• 2 cm cauterized defect: This is a surgical artifact from the oophorectomy 4

Fallopian Tubes

Normal vs. Abnormal:

• Right tube (3.2 x 0.7 x 0.6 cm): Normal size and appearance 1
• Left tube (4.4 x 0.6 x 0.4 cm): Normal size and appearance 1
• Fimbriated ends present bilaterally: Normal finding 1

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Clinical Significance and Next Steps

What This Means:

1. The fibroids are the primary pathology explaining why hysterectomy was performed - they are the most common indication for this surgery 3, 1

2. The hemorrhagic changes around the largest fibroid require microscopic evaluation to definitively exclude leiomyosarcoma, though this is rare (occurring in <1% of cases) 1, 2

3. The ovarian cysts and variegated appearance necessitate histologic examination to rule out ovarian neoplasia, particularly given the adhesions and disrupted architecture 1

4. The extensive adhesions suggest prior pelvic inflammatory disease, endometriosis, or previous surgery 1, 4

Critical Caveats:

• Gross examination alone cannot definitively exclude malignancy - microscopic evaluation of all submitted tissue sections (A1-A6) is mandatory 1
• Postmenopausal patients with growing fibroids or persistent bleeding have increased suspicion for malignancy and require thorough pathologic evaluation 1
• The final pathology report with microscopic findings will provide definitive diagnosis and determine if any additional treatment or surveillance is needed 1

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Summary of Abnormalities Requiring Microscopic Confirmation:

• Multiple uterine leiomyomas (fibroids) with hemorrhagic changes 2, 1
• Bilateral ovarian adhesions and architectural distortion 1
• Left ovarian cysts requiring exclusion of cystadenoma or malignancy 1
• Pelvic adhesions suggesting prior inflammatory process 4

The microscopic pathology report will be essential to confirm these are benign processes and exclude any unexpected malignancy 1.