Post-Hysterectomy Vaginal Cuff Lesions: A Clinico-Pathologic Study, Emphasizing Diagnostic Challenges and Outcome
M Cascio, JT Rabban. UCSF, San Francisco, CA
Background: Vaginal cuff nodules arise in a minority of patients following hysterectomy for either benign or malignant gynecologic disease. While polypoid granulation tissue is often the pathologic finding, atypical fibroblasts, atypical endometriosis or recurrent tumor may pose diagnostic challenges. The pathology of post-hysterectomy vaginal cuff lesions is not well-described, particularly with respect to significance of atypical findings and clinical outcome of recurrent tumor; this is the aim of this study.
Design: We identified 97 post-hysterectomy patients with a vaginal cuff nodule/polyp on speculum examination which was surgically excised. Clinical and pathologic features were evaluated, emphasizing morphologic features, atypical fibroblasts, atypical endometriosis and recurrent tumor morphology. Outcome data was obtained from our institutional cancer registry.
Results: Hysterectomy was via transabdominal approach in 82 while the remainder were laparoscopic. Among 13 patients with vaginal cuff lesions after hysterectomy for benign disease, the diagnosis was granulation tissue(3), scar (5), fibroepithelial polyp (1), endometriosis (1), or adenocarcinoma of colonic (1), breast (1) or Mullerian origin (1). Among 84 patients with vaginal cuff lesions after hysterectomy for malignant disease (Table 1), 36 (43%) represented recurrence of tumor, most of which were uterine or ovarian in origin. Benign polypoid granulation tissue composed 16/84 (19%); the remainder showed scar tissue, fibrosis, inflammation or fibroepithelial polyp. Atypical fibroblasts were noted in 1/84. Follow up of all vaginal cuff lesions diagnosed as benign revealed that 2 patients later presented with primary tumor recurrence at the vaginal cuff; 2 in the peritoneum and 6 had distant spread. Average survival after vaginal cuff recurrence was 23 months.
|Hysterectomy Indication||Granulation Tissue||Scar/Non-specific Changes||Recurrent Tumor|
|Metastatic Colon Cancer||0||1||0|