Clinico pathological study of ovarian neoplasms

Abstract

Background: Ovarian tumors are common form of neoplasm in women and account for 30% of female genital tract cancers. Ovarian cancer is the sixth most common cancer in women and the leading cause of death in women with gynaecological malignancy. Due to inefficient diagnosis/prognosis strategies mainly due to the lack of specific symptoms at the initial stage of the disease about 70% cases diagnose at advanced stage when the metastatic tumor has acquired drug resistant phenotype.Methods: Prospective study of two years duration with sample of 108 cases of simple oophorectomy and hysterectomy with unilateral or bilateral salpingo oophorectomy specimens are included in this study.Results: Maximum cases were in the age group of 21 to 45 years. Mean age of presentation was 42.84 years (benign tumors), 46.66years (Borderline tumors) and 32.6 years (malignant tumors). Epithelial ovarian tumors are the commonest and constituted 78.7% of all ovarian tumors. In present study 40.74% were benign, 2.78% were borderline and 56.48% were malignant ovarian tumors.Conclusions: Most of the ovarian neoplasms presented in the reproductive age group but ovarian malignancy can occur at all age group and abdominal symptoms are the only clue for the diagnosis of the disease. There is no definite universal screening protocol yet, for malignant ovarian tumors however abdominal symptoms supported by tumor markers like serum CA-125 and ultrasound of abdomen and pelvis with Doppler may be yardstick for early diagnosis of malignant ovarian tumor.

Do women with benign versus malignant ovarian masses demonstrate variable clinical presentation?

“…Baru et al report distension in 43.18% benign and 70.49% women with malignant tumors. 13 We found that women with cancers had a higher probability of having distension in abdomen as compared to those with benign lesions (OR=5, 95% CI 1.03-24.17, p=0.01) comparable to Goff et al (odds ratio=7.4, 95% confidence interval [CI], 3.8-14.2) ( Table 3). 16 The size of the tumor did not correlate with presence of cancer in this study (likelihood ratio χ2=7.55, p=0.255) ( Table 4).…”

“…Presence of lump in abdomen as a complaint has been reported from 43% to 78% in various studies. 12,13,15,16 We found that the odds of reporting a mass in abdomen were significantly greater in women with cancers compared to those with benign tumors (OR= 4.9, 95% CI 1.07-24.06, p=0.01). Ebell et al in a systematic review reported the likelihood ratio of 30 for presence of an abdominal mass and 16 for distension of abdomen.…”

“…The commonest symptom was pain. It was seen in 69.23% women with malignancies and 83.78% women with benign lesions compared to 79.55% and 77.05% in a study by Baru et al 13 Radhamani et al also reported pain in 83% women with adnexal masses. 14 Kuladeepa et al report abdominal pain as a symptom in 63.4 % women with benign tumors and 68.2% with malignancies.…”

Clinico-radiological and histopathological study of ovarian masses at a tertiary care centre

“…22 Pain in the abdominal region was reported by 77.05% of patients, swelling by 70.49%, the presence of ascites by 57.38%, the presence of a mass in the abdominal region by 44.90%, and other constitutional symptoms such as "gastrointestinal distress, weakness, menstrual disorders, and urinary symptoms" by 29.5%, 16.4%, 3.28%, and 3.282%, respectively in Baru et al's study. 23 At a cut off of 35, 37.50% had <35 U/ml CA-I25 and 62.50% had >35 U/ml CA-I25. Among the patients analysed by Kamath et al, 62% had CA-125 levels over 100 U/l, 16% had levels between 35 and 100 U/l, and 22% had levels below 35 U/l.…”

“…21 Similar distribution was seen in In the research by Baru et al, only 22.22 percent of patients with ovarian tumours were nulliparous, while the remaining 77.78 percent were multiparous. 23 With regards to clinical presentation, 57.50% presented with pain abdomen, 40% with menstrual irregularities, 75% with mass per abdomen, 32.5% with abdominal distension, 27.5% with white discharge and 32.5% with bladder disturbances. Laul et al reported 44.3% had pain abdomen, 35.1 mass per abdomen, 8.2% with menstrual complaints, 12.4% with infertility, 25.8% had pressure symptoms in their study.…”