European Journal of Cardiovascular Medicine

Ovarian neoplasms are one of the most serious health issues that affect women globally. Ovarian cancer ranks as the third gynecological cancer following cervical and uterine cancers. It has the least favorable prognosis and the highest death rate. The high death rate of ovarian carcinoma is attributed to the silent course of disease, delayed presentation, lack of screening programs which lead to its diagnosis during late stage, there by naming it the silent killer ⁽³⁾⁽⁴⁾.

Ovarian cancer has a wide age of distribution and affects women of all ages but mostly diagnosed between 55 and 64 ⁽²⁾. Familial genetic syndromes have shown to be the strongest risk factors influencing ovarian cancer, accounting for 10-12% of all cases⁽²⁾

Other risk factors include ⁽⁵⁾

1. Age
2. Nulliparous or low parity
3. Late menopause
4. Obesity
5. Multiple cycles of ovulation induction

A wide spectrum of ovarian tumors with different histologies could emerge from the ovaries according to the cell of origin, such as⁽⁵⁾

1. Epithelial tumors
2. Sex cord stromal tumors
3. Germ cell tumors

Ovarian tumors cannot be confirmed alone on the basis of clinical, radiological and gross findings. Hence, a precise histopathological diagnosis is required for starting definitive treatment.

AIMS AND OBJECTIVES:

The aim of this study is to determine the histological patterns of ovarian neoplasm, their clinical presentation and age distribution in patients attending GGH, Kakinada.

Type of study: Retrospective study

Study period: From November 2022- October 2024

Duration: 2 years

Sample size: 200 cases

METHOD OF COLLECTION:

All ovarian specimens that are obtained following laparoscopy/laparotomy with or with out hysterectomy are included. History regarding age, parity, presenting complaints like lower abdominal pain, mass per abdomen, menstrual irregularities, postmenopausal bleeding and duration of symptoms are taken. We have planned the type of surgery depending on IOTA classification on USG, tumour markers and CECT abdomen and pelvis/ MRI pelvis.

INLCUSION CRITERIA:

All the histologically proven cases of ovarian tumors were included during given period.

EXCLUSION CRITERIA:

All functional cyst like

1. Follicular cyst
2. Hemorrhagic cyst
3. Inclusion cyst
4. Endometriotic cyst
5. Corpus luteal cyst

All the obtained specimen are grossly examined and sent for histological examination. Data from histopathology reports included specimen source, type of tumor (neoplastic/non- neoplastic) are collected. If found to be neoplastic, data regarding Stage, type, subtype of neoplasm is collected.

A total of 200 cases of ovarian tumors were studied. The clinical presentation, symptoms and ovarian parameters in USG were recorded. After the surgery and excision of ovarian tumour and later by seeing the HPE report, data was analysed and following results were obtained. Out of 200 cases of ovarian tumors, 177 cases were benign, 14 were borderline, 9 were malignant.

According to age group distribution of ovarian tumors:

Most of the patients are from 40-59 years, 74 to be precise followed by 72 cases between 20-39 cases.

Table 1: Distribution of ovarian tumors according to age

Table 2: Distribution of ovarian tumors according to gross appearance:

Clinical presentation of ovarian tumors:

In the present study, most of them were asymptomatic and it is an incidental finding on USG. Abdominal pain was the second most common presenting complaint followed by mass per abdomen.

Table 3: Distribution according to clinical presentation

Types of biopsies received in present study:

Ovarian tissues were received in the form of oophorectomy, staging laparotomy, unilateral or bilateral salpingo-oopherectomy with or without total abdominal hysterectomy.

Table 4: Distribution according to type of biopsy

Table 5: Distribution of the cases according to WHO classification:

The peak incidence of the ovarian tumors in the present study was in the fifth decade (41.5%) which was very much similar to the observations of Valson et al in their study in the year 2017 reported 30.85% cases in 5^th decade ⁽¹⁾. In the present study most patients were asymptomatic(37%) followed by abdominal pain (28%) . It is similar with studies done by Mankar et al in 2015 (33.48%) and Kanthikar et al (53.33%) where pain in abdomen was the commonest symptom ⁽¹⁾. The majority of epithelial tumors were serous tumors accounting 51% then followed by mucinous tumors, accounting for 40.5% of cases. The results were similar to studies done by Abdullah and Bondagji in Saudi and Sawant and Mahajan in India ⁽²⁾ in 2016. Serous cystadenocarcinoma was the most common malignant surface epithelium tumor which was in concordance with the results of Ahmad et al ⁽¹⁾ in 2016. When compared with other studies done by Pilli et al in 2002, Jha et al in 2004 and Mankar et al in 2015, the incidence of malignant tumors in our study was low. In present study germ cell tumor were 13(6.5%) in which benign cystic teratoma comprised maximum number of cases 10(5%). Akakpo et al in 2017 reported similar incidence of mature cystic teratoma (93.5%) cases in their study ^(1).

• Ovarian tumor is usually presented as asymptomatic followed by pain abdomen, mass per abdomen and menstrual abnormalities in females of 3rd to 5th decade of age group.
• The study conducted at Gynecology OPD GGH, Kakinada and the results concluded that most of the ovarian tumors are benign tumors followed by borderline and then malignant tumors.
• Surface epithelial tumors were found to be the most common variety followed by germ cell tumors and then sex cord stromal tumors in present study(6).
• Among subtypes of ovarian tumors, serous cystadenoma is the most common subtype followed by mucinous cystadenoma and then mature cystic teratoma.
• So, from this study by histopathology we can differentiate benign from malignant and improving 5 year survival rate
• Differentiation of benign tumor from malignant one is important for determining better management and prognosis (1).

1. Histopathological study of ovarian tumours in a tertiary healthcare centre of southern Rajasthan Pranshu Sharma, Pranveer Singh Rao*, Narendra Mogra, Khushbu Talreja
2. The Histopathological Patterns of Ovarian Neoplasms in Different Age Groups: A Retrospective study in Tertiary Care Center Nouran H Farag, Zahraa H Alsaggaf, Noha O Bamardouf, Dhuha M Khesfaty, Morouj M Fatani, Maha K Alghamdi, Samah N Saharti
3. Histopathological insights into ovarian tumors: A case series perspective Archi Arun Chawla, Priyanka Nimbalkar Jadhav, Shilpi Sahu, Apeksha Suresh Savale
4. Histopathological Evaluation of Ovarian Lesions: A Retrospective Analysis from a Tertiary Care Centre Vidhi Patel, Khushbu Patel, Neepa Patej
5. SHAW’S textbook of Gynaecology Howkins and Bourne
6. Histopathological features of Ovarian mass among patients attending a tertiary care hospital in South India Radhika Kasiraj, B.M. Logeswari, P. Bhanupriya, C. Amritha, R. Veena
7. Clinico-histopathological spectrum of ovarian tumors in tertiary care center rajahmundry. Shaik M, Divya S, Kadukuntla S, Annapoorna Y. Indian J Obstet Gynecol Res.
8. Frequency of ovarian tumors according to WHO histological classification and their association to age at diagnosis. Khan MA, Afzal S, Saeed H, et al. Ann King Edw Med Univ. 2017;10:23. 
9. Study of morphological patterns of ovarian neoplasms. Tejeswini V, Reddy S, Premalatha P, Vahini G. IOSR J Dent Med Sciences.
10. Histopathological evaluation of ovarian tumors. Singh S, Saxena V, Khatri SL, Gupta S, Garewal J, Dubey K. 
11. A retrospective study of ovarian tumours and tumour-like lesions. Zaman S, Majid S, Hussain M, Chughtai O, Mahboob J, Chughtai S.