Malignant Ovarian Tumours Histopathological Analysis Biology Essay

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Consecutive patient admitted with the diagnosis of Gynaecological malignancies confirmed on ultrasound and all underwent laparotomies during the some admission. Various parameters were analyzed including age, parity, co morbid, menstrual history, family history of cancer and previous surgeries. Statistical analyses were carried out utilizing SPSS 10.0 for windows.

RESULT: During the eighteen month study 70 patients were diagnosed to have gynaecological malignancy. Among them 16 patients (22.85%) had malignant ovarian tumors and their histopathology reports showed that majority of cases 10 patients (62.5%) had tumors of epithelial origin, 2 (10.5%) belong to sex cord tumors, 1 (6.25%) was of germ cell origin and 1 patients had metastatic ovarian tumors.

CONCLUSION: I was concluded from our study that ovarian tumor rate is quite high and seen more in young female and majority of cases had tumor of epithelial origin. The symptoms of the ovarian tumors are often non-specific and vague, which makes it different to diagnose. Prognosis is poor if not treat in early disease.

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INTRODUTION: Ovary is the third most common site for primary malignant in the female genital tract 1. Ovarian cancer is the fifth leading cause of cancer death in women, the leading cause of death from gynecological malignancy [2] . It is sometimes called a 'Silent Killer' because symptoms appear until the disease has advance already. More than two two third of cases are at advanced at the time of diagnosis, i.e. stage III and stage IV3.

Thus the prognosis is poor in most of the cases.

Diagnosis is confirmed by histology of the tissue obtained at laparotomy. Epithelial ovarian cancer is the most common type. These account for approximately 85% of ovarian cancers 4.

Different Ovarian tumors show different malignant potential. Depending upon their histopathology, they could be of borderline or highly malignant type. On its basis, the nature and behavior of the tumor is identified which is important and help no only in modifying the course of treatment for e.g. second look surgery or need of chemotherapy and its dosage etc., but also influence the prognosis and five year survival rate.

The purpose of this study was to note the occurrence rate of malignant ovarian tumors in our patients and to study their different histopathological pattern in our patients as it has an impact on treatment and survival rate.

MATERIAL AND METHODS:

It was a prospective study carried out at department of gynae/obs in J.P.M.C was diagnosed to have gynaecological malignancies. Among them 16 (22.5%) patients had malignant ovarian tumors and their histopathology reports showed that majority of cases 10 patients (62.5%) had tumor of epithelial origin.

A detailed history was taken regarding age, parity and presenting complaints, menstrual history, family history of cancer were also recorded. After detailed examination, with emphasis on abdominal and bimanual pelvic examination was done, investigation included were CBC, serum CA 125 levels, PAP smear, Ultrasound, C-T scan and MRI.

Interpretation of results was done on the basis of biopsy reports ( histopathology).

INCLUSION CRITERIA:

Who were presenting with symptomatic ovarian mass more than 5 cm. All had surgical treatment for the tumor.

EXCLUSION CRITERIA:

Patients presented with asymptomatic, simple and unilocular cyst less than 5 cms were not included in this study.

RESULT:

This eighteen month study comprised of 70 patients diagnosed to have gynaecological malignancies during this period time.Among these ovarian cancer ranked second with 16 patients i.e., (22.85%) after cervical cancer which is found in 38 patients (i.e., 54.28%) Table 1.

Most of our patients (11 out of 16 patients) presented in age group from 15 years to 40 years. While remaining 5 patients (31.25%) were of age more than 40 years. None of the patients presented before 15 years of age (Table II).

Parity of the patients showed 6 multiparable (i.e. 37.5%), 4 patients were unmarried (25.0%) and 2 patients were married with no issue (Table III).

On histopatholoy, epithelial tumors were the most common type found in 11 patients i.e. (68.75%). Histologic sub typing of these Epithelial tumors showed predominance of mucinous variety (5 patients i.e. 31.25%) followed by serous

Cyst adenocarcinoma (2 patients i.e. 12.50%). Papillary adeno carcinoma was presented in 2 patients i.e. (12.50%) respectively.

Two patients (12.50%) presented with granulose cell tumors, while one patient (6.25%) had germ cell tumor. krukenberg tumor (metastatic) was seen in one patient (Table IV).

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Most of the patients received chemotherapy and had regular follow-ups in our out patients clinics.

TABLE NO. 1

January 2001 to June 2002

Gynaecological Malignancies:-

Number

Percentages

Cervical carcinoma

38

54.28

Ovarian Carcinoma

16

22.85

Endometrial Carcinoma and Sarcomas

09

12.85

Chorio Carcinoma

05

7.14

Vaginal Carcinoma

01

1.42

Vulvar carcinoma

01

1.42

Table II

Age Distribution:-

Age distribution of ovarian tumor patients.

Age groups (Years)

Number

Percentage

15-20

2

12.50%

21-30

7

43.75%

31-40

2

12.50%

41-50

2

12.50%

51-60

2

12.50%

61-70

Nil

--

71-80

1

6.25%

TABLE III

PARITY OF PATIENTS

PARITY

NUMBER

PERCENTAGE

NULLI PAROUS

6

37.50%

1-5 Children

7

43.75%

> 5 children

3

18.75%

HISTOPATHOLOGICAL FINDINGS:

Types of tumours

No

%

1.Epithelial tumours:

Mucinous

5

31.25%

Serous

2

12.50%

Papillary adeno Ca

1

12.50%

Clear Cell Adeno Ca

1

6.25%

Clear Cell Adeno Ca

--

--

Brenner

1

6.25%

2.Sex cord stromal tumors:

Granulosa Cell

2

12.50%

Sertoli Leydig Cell

--

--

3.Germ Cell Tumour:

Mixed germ Cell

2

12.50%

4.Metastatic Tumours:

Kruenbug

1

6.25%

DISCUSSION

Ovarian cancer is the most lethal of all gynaecologic cancers. Over the last 50 years, the incidence and mortality from this disease has been increasing steadily. It will affect approximately 1% of American women during their life time and contributes to more than 14,000 deaths annually 5.

In Pakistan its incidence has been increased considerably. Out of 5906 cases reported in Northern Pakistan 4.83% were ovarian malignancies 6. While Southern Pakistan its frequency is 4.31% 7.

In our study, it is second most common cancer accounting for 22.85% of all malignancy. Jafarey SN etal 8(1995) also report Ovarian second most common gynaecologic cancer in Pakistan, which is being increasing encountered. At some centers it is the commonest one. In another study of gynaecologic cancers in Faisalabad (Pakistan), Ovarian cancers was the most frequently found gynaecologic cancer 9.

Two significant results were noted in this study. The most common risk factors for Ovarian cancer is increasing age and it is rare in reproductive age 10. But in contrast to this, the mean age of patients studied was 46.5 years with a range of 15 years to 78 years. Majority of the cases occurred before the age of 40 years. Peak incidence was noted between 21 to 30 years of age and only 4 patients (i.e. 25.0%) were perimenopausal or postmenopausal. These are different from western literature which quotes higher mean age. Frederic etal 11. (1993) reported that median age of their patients was 61.5 years (range 17 to 85 years). Rubin etal 12 found mean age of 59 years with a range of 33-81 years in their study.

In our study, most of our patients (10 patients i.e. 62.5%) were multiparous which is again different from other studies which shows nulliparity as a major risk factor associated with this disease. Crawford etal 13 showed 48% nulliparous patients patients in their study. Ovarian masses were cystic in 43.75% of cases, solid in 31.25% of cases and mixed type in 25.0 cases on operative findings. Majority type of tumor were more than 10 cm in size (i.e. 56.25%) of cases. Ascites present in 37.5% cases.

Histopathologic distribution of Ovarian carcinoma in our study showed the predominance of Epithelial Ovarian carcinoma accounting for 68.75% of all cases, comparable to other studies. Parker SL, Tong T (1996) described Epithelial Ovarian cancer as the number one killer of U.S. women among all cancers of female genital tract14. In our study, among the epithelial cancers, mucinous Ovarian cancers were the most common variety constituting 31.25% followed by serous cystadeno carcinoma and Papillary adeno carcinoma with 12.50% cases each. This predominance of mucinous carcinoma is different from other studies; Costa MJ 15 also described Serous carcinoma as the most predominantly occurring in their study (i.e. 65.4%).

Serous carcinoma are also described as most commonly occurring Epithelial carcinomas in literature constituting about 75% of Epithelial Ovarian cancers, followed by Mucinous cancers i.e. 20%. Mucinous cancers occur in middle adult life and thus rare before puberty and after menopause. Mucinous carcinoma accounts for only 10% of all Ovarian cancers16.

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Brenner tumors are uncommon variety. One patient in our study (6.25%) in our study had Brenner tumor.

Two patients i.e. (12.50%) had granulose cell tumors, which has a low grade malignancy. Mixed germ cell tumors was found in two patients i.e. (12.50%). Germ cell tumors constitute about 15-20% of all Ovarian tumors17. Most are benign cystic teratomas but some tumors which are found principally in young adults have incidence of malignancy behavior.

Regarding metastatic Ovarian cancers, one patient was diagnosed to have Krukenberg's tumor can account for 30-40% of metastatic cancers to the ovaries18. The primary site is frequently located in the gastrointestinal tract.

PROGNOSIS AND SURVIVAL:-

Despite new techniques of diagnosis and treatment, the overall 5 years survival rate of patients with Ovarian cancer is approximately 30%.

Of the I6 cases reviewed, two patients (12.5%) were lost to follow up. One patient was expired prior to chemotherapy. Of the remaining 13 patients 10 (62.5%) survived. Most of these patients were presented with early stage disease. 3 out of 5 patients who presented with FIGO stage III and IV were died due to this lethal disease.

CONCLUSION:-

In our study Ovarian Carcinoma stands for the second most common malignancy of female genital tract. In contrast to western studies, the peak incidence of disease occurred at younger age. Epithetial cancers remained the most common Ovarian cancer among which Mucinous cancers are the predominant variants. The overall prognosis is poor, but depends on the extent of disease at the time of diagnosis, histological type, tumor grade and the thoroughness of surgical removal of the tumor tissue. Mostly patients present late with advanced stage of disease. Prognosis is directly related to the stage of disease at presentation. All the patients should be properly counselled and follow up.