Spectrum of ovarian tumours-a five year study

Ovarian cancer is the most lethal gynecological malignancy and ranks overall seventh most common cause of cancer.1 Among women worldwide and in India it is comprising 8.7 % of cancer in different parts of country.1,2 The complex anatomy of ovary and its peculiar physiology with constant cyclic changes from puberty to menopause gives rise to a number of cell types.3 The histogenesis of ovarian tumours revolves around the four main components namely Surface epithelium, Germ cell, Sex cord and Specialized ovarian tumours.4 Ovarian tumours have a wide spectrum of clinical and morphological features. Ovary being an intra-abdominal organ, diagnosis of ovarian tumours is after late. Among all the ovarian neoplasm about 80 % are benign having cystic solid or mixed characteristics.5 The remaining 20 % of these tumours are malignant in nature leading to fatal prognosis.6 Women between 65 & 84 years of age have ovarian cancer incidence rates 2.3 times higher than younger women. Peak incidence of invasive epithelial ovarian cancer is 50–60 years 1183


INTRODUCTION
Ovarian cancer is the most lethal gynecological malignancy and ranks overall seventh most common cause of cancer. 1 Among women worldwide and in India it is comprising 8.7 % of cancer in different parts of country. 1,2The complex anatomy of ovary and its peculiar physiology with constant cyclic changes from puberty to menopause gives rise to a number of cell types. 3The histogenesis of ovarian tumours revolves around the four main components namely Surface epithelium, Germ cell, Sex cord and Specialized ovarian tumours.4 Ovarian tumours have a wide spectrum of clinical and morphological features.Ovary being an intra-abdominal organ, diagnosis of ovarian tumours is after late.Among all the ovarian neoplasm about 80 % are benign having cystic solid or mixed characteristics. 5The remaining 20 % of these tumours are malignant in nature leading to fatal prognosis. 6omen between 65 & 84 years of age have ovarian cancer incidence rates 2.3 times higher than younger women.Peak incidence of invasive epithelial ovarian cancer is 50-60 years of age.About 30% ovarian neoplasms in postmenopausal women are malignant.Whereas only about 7% of ovarian epithelium tumours in the premenopausal women are frankly malignant. 7Ovarian tumours are difficult to detect until they are advanced in stage or size, as symptoms are vague and insidious.Identification of various histological patterns of ovarian tumours is important for diagnosis as well as programs. 8The purpose of this study was to access the incidence morphological and clinicopathological correlation, gross, histological pattern and incidence of age distribution of ovarian tumours in Indore region.

MATERIALS AND METHODS
The present retrospective and prospective 5 years study was carried out in the department of pathology, Index medical college Hospital and research Centre, Indore, M.P., India.Permission from the Institutional Review Board was obtained.In the retrospective cases (Jan 2011 to Dec 2011) history and clinical features were collected from record section of the hospital.Gross finding were noted from histopathology records.All paraffin blocks were cut freshly and stained with routine H&E stain.In prospective cases (Jan 2012 to Dec 2015) specimen received were studied thoroughly to note the gross findings.Sections were taken from representative areas and subjected to routine processing.Paraffin blocks were prepared.Sections were cut 3 to 5 micron thickness and stained with H&E stain.Special stains like Periodic acid Schiff stain (PAS), Reticulin and immunohistochemistry (IHC) were carried cut whenever needed.All the data were analyzed using Microsoft Excel.

RESULTS
A Total 158 cases of ovarian tumours were studied at the department of Pathology, Index Medical College, Indore, from January 2011 to December 2015.In this study 99 cases (62.65%) were benign, 53 cases (33.55%) were malignant and 6 cases (3.79%) were borderline tumours.
Maximum cases of benign neoplasms were seen between the age group of 20-40 years, whereas malignant tumours were seen after the age of 50 years.The youngest patient was a 2 year old girl with sex cord stromal tumour and the oldest was 80 years old with serous cystadenocarcinoma and peak incidence of benign tumours was found between 21-30 years of age.
Benign tumours were mostly seen in the age group of 21-40 years, borderline 21-50 years and malignant more than 50 years.Peak incidence of benign tumours was found between 21-30 years.
In our study, the most common ovarian tumours were Surface epithelial tumours comprising 74.06%, followed by Germ cell tumours comprising 15.82% and Sex cord stromal tumours comprising 10.12%.Similar observations were made by Swami and Satyanarayana 9 , Gupta et al 10 and Pradhan A et al. 11 The most common epithelial tumour were Serous cystadenoma followed by Mucinous cystadenoma and most common Germ cell tumour was benign cystic teratoma seen in 15 cases.Similar results have been reported by Yasmin et al. 12 In our study the most common complaint of patients was lump in abdomen in 88 cases (85.7%) followed by pain in lower abdomen, about 70 cases (44.3%).These findings are in concordance with those of a study carried out by Pradhan A et al. 11 Majority of benign tumours occurred in the age group of 20-40 years in present study and malignant tumours were more common in older age.This is in agreement with the results of a study done by Jha and Karki et al 13 as well as Shah and Hishikar et al. 14 In our study 10 cases (6.3%) of bilateral ovarian tumours were seen.This incidence is lower DOI : 10.3126/jpn.v7i2.18002Spectrum of ovarian tumours than 13.04% and 8.3% reported by Jha and Karki et al 13 and Kanthikar et al. 15 The largest tumour found in the present study was Mucinous cystadenoma measuring 30x25x17 cm in size.Similar observation was noted by Zaman et al 16 who reported a case of mucinous cystadenoma of 27cm in diameter.Benign tumours were mostly cystic (56.96%) in consistency in our study, which was similar to the results of (44.78%)Kanthikar et al 15 and malignant tumours were solid in consistency.Similar observation has been reported by kanthikar et al. 15 Among the Surface epithelial tumours Serous tumours were the most common tumours accounting 62 cases (39.24%) which is comparable to 50% as reported by Kanthikar et al. 15 Mucinous tumours were seen in 25.32% cases of all ovarian tumours which is more than the observation of Jha and Karki et al 13 and Kanthikar et al 15 which were showing 16.8% and 10.10%.Five cases (3.16%) of Endometrioid carcinoma noted in our study which is similar to observation of Zaman et al 16 which was showing 6 cases,3.81%and lower than the observation of Ahmed et al 17 which was showing 7.73%.
In our study 6 cases (3.80%) of Granulosa cell tumours were seen which was comparable to the study (n=9; 5.80%) conducted by Zaman et al. 16 Fibroma were seen in 6.3% of cases in present study.This observation was similar to the observation of Kanthikar et al 15 who demonstrated fibromas in 4.28 percent.
Yolk sac tumours were seen in two cases between the age of 40-50 years, acounting for 1.27% of all ovarian tumours which is comparable to the result observed by and Zaman et al 16 and Ahmed et al 17 , who reported yolk sac tumour in 0.64% and 3.44% respectively.Teratoma was the most common Germ cell tumour found in our study contributing 18 cases (11.40%) of all ovarian tumours which is comparable to the results observed in studies carried out by Yasmin et al 12 and Zaman et al 16 which were showing 18% and 19.35%.However Jha and Karki 13 and Ahmed et al 17 found a higher percentage i.e 40.3% and 76.72% cases respectively.

CONCLUSION
It is concluded from this study that on morphological grounds, tumors originating from surface epithelium are the most common and their malignant counterparts are more frequent in the elderly age group.Therefore, it is suggested that such patients should be examined and treated promptly to reduce the associated morbidity and mortality.