Cervical cancer screening before hysterectomy in pelvic organ prolapse patients: Is it essential? A case series

HIGHLIGHTS Higher result of cervical pre-cancer histopathology compared with cervical smear is found in POP patients undergoing vaginal hysterectomy. Preoperative biopsy or ultrasound among POP patients undergoing vaginal hysterectomy cannot be a routine procedure. ABSTRACT Objective: Pelvic organ prolapse (POP) is caused by a weakening of pelvic floor muscles. The prevalence of unanticipated premalignant and malignant pathologies after hysterectomy is varied from 0.2 to 0.8%. This report to present a case series of POP’s patients undergoing vaginal hysterectomy (VH) with preoperative evaluation of abnormal cervical smear ending with higher result of histopathology. Case Series: Case 1: A-55-year-old woman, P3A0 was diagnosed as third grade both in uterine prolapse and cystocele. The result of Pap smear revealed atypical glandular cells of undetermined significance (AGUS). Histopathological result after VH was vaginitis and metaplastic chronic cervicitis with atypia to mild dysplasia of endocervical epithelial cell/ low grade squamous intraepithelial lesion (LSIL). Case 2: A-62-year-old woman, P5A0, was diagnosed as third grade of uterine prolapse. The result of Pap smear showed atypical squamous cells of undetermined significance (ASCH). Histopathological result after VH was high grade squamous intraepithelial lesion (HSIL) up to in situ carcinoma with involvement of microinvasive gland and focus. Conclusion: Since cervical cancer still become the second most common cause of mortality in Indonesia, it is recommended to screen preoperatively for pre-cancerous gynecological lesion and cancer.