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ORIGINAL ARTICLE
Year : 2015  |  Volume : 6  |  Issue : 2  |  Page : 107-111

Histopathological profile of ovarian tumours: A twelve year institutional experience


Department of Pathology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India

Date of Web Publication13-Jul-2015

Correspondence Address:
Dr. Deepti Vijay Mankar
Department of Pathology, 2nd Floor, Krishna Institute of Medical Sciences, Malkapur, Karad - 415 110, District - Satara, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-9727.160675

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  Abstract 

Context: Ovarian tumours represent about 30% of all cancers of the female genital system. They manifest in a wide spectrum of clinical, morphological and histological features. Aim: To study the frequency of incidence of different histopathological types of ovarian tumours in our institute. Materials and Methods: This retrospective study included 257 cases of histopathologically proven ovarian tumours, reported in the Department of Pathology of a rural tertiary care referral hospital, over a 12 year period (January 2000 to December 2011). These were classified according to the WHO classification of ovarian tumours (2003). Clinical presentation of the patients was analysed from archived case records. Results: Of the 257 tumours studied, 162 (63.04%) were benign, 15 (5.84%) were borderline and 80 (31.12%) were malignant. Surface epithelial tumours were the most common (68.48%) followed by germ cell tumours (15.95%). Mucinous cystadenomas (32.69%) were the most common benign tumours, while serous cystadenocarcinomas (31.13%) were the most common malignant tumours. Most ovarian neoplasms (43.19%) occurred in the 21-40 years age-group. Dull abdominal pain was the most common clinical presentation. Conclusions: Benign ovarian tumours were more common than malignant ones across all age groups. Surface epithelial tumours were the most common histopathological type of ovarian tumour. Due to vague symptoms, patients present late. Development of methods for early diagnosis of ovarian neoplasia is therefore, a pressing need today. The relative frequency of incidence of different ovarian tumours shows regional variations, highlighting the need to identify region-specific risk factors.

Keywords: Incidence, ovarian tumours, regional variation


How to cite this article:
Mankar DV, Jain GK. Histopathological profile of ovarian tumours: A twelve year institutional experience. Muller J Med Sci Res 2015;6:107-11

How to cite this URL:
Mankar DV, Jain GK. Histopathological profile of ovarian tumours: A twelve year institutional experience. Muller J Med Sci Res [serial online] 2015 [cited 2019 Nov 22];6:107-11. Available from: http://www.mjmsr.net/text.asp?2015/6/2/107/160675


  Introduction Top


Ovarian tumours represent about 30% of all cancers of the female genital system. [1] Indian trend analysis reveal a steady increase in the age-standardized incidence rate of ovarian cancer, ranging from 0.26% to 2.44% per year in different area registries. [2] Conversely, incidence and mortality rates due to ovarian cancer have shown a slight decline over the last few decades in countries like Denmark. [3] Recent improvement in patient survival in developed countries is attributed to an earlier stage at diagnosis. [4] Ovarian tumours are often difficult to detect until they are advanced in stage or size, as symptoms are vague and insidious. Identification of various histologic patterns of ovarian tumours is important for diagnosis as well as prognosis. This study was conducted with the aim of finding out the frequency of incidence of different histologic types of ovarian tumours reported by the Department of Pathology of a rural tertiary care referral hospital.


  Materials and Methods Top


This retrospective study included 257 consecutive cases of histopathologically proven ovarian tumours, reported by the Department of Pathology of our institute, over a 12 year period (January 2000 to December 2011). All non-neoplastic or tumour-like lesions of the ovary were excluded.

Paraffin blocks of the ovarian tumours were retrieved, 3-5 micron thick sections prepared, stained with H&E and studied subsequently. The WHO classification of ovarian tumours (2003) was used for classifying the tumours. [5] The clinical presentation of the patients was analysed from their archived case records. All required data was retrieved from the archived records of the hospital.


  Results Top


From January 2000 to December 2011, a total of 257 neoplastic ovarian specimens were received in the Department of Pathology of our institute. These specimens were removed from 227 patients, 30 (11.67%) of whom had synchronous bilateral ovarian malignancies.

Out of these, 63.04% (162/257) were benign, 5.84% (15/257) were borderline and 31.12% (80/257) were malignant. Surface epithelial tumours were the most common (68.48%), followed by germ cell tumours (15.95%).

Surface epithelial tumours comprised 69.75% (113/162) of all benign tumours, 60.00% (48/80) of all malignant tumours. They were the most common benign and borderline tumours across all age groups, while germ cell tumours were the most common malignant tumours up to 20 years of age. The youngest patient in this series was a 14 year old girl with a malignant teratoma. Most germ cell tumours, both benign and malignant, were seen in women younger than 40 years. Most sex-cord stromal tumours (83.34%) occurred in women above 40 years of age. Our oldest patient was a 76 year old lady, diagnosed with a benign thecoma. Malignant tumours were most common between 41-60 years [Table 1].
Table 1: Age-wise incidence of various histological types of ovarian tumours

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The most common clinical presentation (33.48%) was a complaint of vague pain in abdomen, which was often of the dull or dragging type. Occasional tumours, commonly of the benign type, presented with severe, acute onset abdominal pain, consequent to twisting of the ovarian pedicle. Most women reported symptoms for a period over 6-12 months, which often progressed gradually. A significant proportion of cases (14.98%) were asymptomatic at presentation and were only incidentally diagnosed [Table 2].
Table 2: Clinical presentation of patients with ovarian tumours

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Among benign surface epithelial tumours, mucinous cystadenomas [Figure 1] were the most common, while both mucinous and serous borderline tumours had nearly equal incidence. Among malignant surface epithelial tumours, serous cystadenocarcinomas [Figure 2], [Figure 3] outnumbered all others.
Figure 1: Mucinous cystadenoma - Microphotograph. (400x, H&E)

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Figure 2: Serous cystadenocarcinoma - gross specimen

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Figure 3: Serous cystadenocarcinoma - microphotograph. (400x, H&E)

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Germ cell tumours were the second (41/257) most common tumours observed in this study, a majority i.e. 80.49% (33/41) of which were benign mature cystic teratomas [Figure 4], [Figure 5].
Figure 4: Mature cystic teratoma - gross specimen

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Figure 5: Mature cystic teratoma - microphotograph. (100x, H&E)

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Sex cord stromal tumours comprised 9.34% (24/257), the third most common category observed. Fibromas [Figure 6] were the most common benign sex cord stromal tumours, granulosa cell tumours [Figure 7] being the most common malignant type.
Figure 6: Left ovarian Fibroma - gross specimen

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Figure 7: Granulosa cell tumour - microphotograph. (400x, H&E)

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Metastatic ovarian neoplasms were seen in 10 patients, 6 of whom had bilateral metastasis, yielding a total of 16 out of 257 specimens. Two of these were cases of Krukenberg tumour [Figure 8] metastatic from gastric adenocarcinomas; while, colonic adenocarcinoma (6), endometrial carcinoma (1) and renal cell carcinoma [Figure 9] (1) were the primary malignancies in the rest.
Figure 8: Krukenberg tumour - gross specimen

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Figure 9: Metastatic clear cell carcinoma - microphotograph. (400x, H&E)

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  Discussion Top


In the present study, 63.04% tumours were benign, 5.84% were borderline and 31.12% were malignant. Compared to studies in western countries, where 75-80% of tumours were benign, [1] this study shows a relative decrease in the percentage of benign tumours and a consequent increase in the percentage of malignant tumours, which agreed with the findings of Ahmad et al., who reported an incidence of 59.18%, 0.2% and 40.81% for benign, borderline and malignant tumours respectively. [6] Pilli et al., [7] and Gupta et al., [8] however, reported figures of 75.2%, 2.8%, 21.9% and 72.9%, 4.10%, 22.9% for benign, borderline and malignant ovarian tumours respectively.

Histopathologically, surface epithelial tumours (68.48%) were the most common category of ovarian tumours encountered, followed by germ cell tumours. This agrees with the findings of Gupta et al. and others. [8],[9],[10] Surface epithelial tumours account for 50.0-55.0% of all ovarian tumours and their malignant forms for approximately 90.0% of all ovarian cancers in the western world. Corresponding figures for Japan are 46.0-50.0% and 70-75% respectively. [1] Malignant surface epithelial tumours account for only 60.00% of all ovarian malignancies in our series. This corresponds with the findings of Ahmed et al. and Jha et al., who reported incidences of 63.5% and 69.2% respectively for surface epithelial malignancies. [6],[11]

Among benign surface epithelial tumours, mucinous cystadenomas were the most common. Here, we differ from the findings of Shah et al. and Thanikasalam et al., each of whom reported that serous cystadenomas were the most common benign ovarian tumours. [9],[12]

Among borderline surface epithelial tumours, both mucinous and serous types had nearly equal incidence in our study. However, Li et al. noted an incidence of 38% and 51% for serous and mucinous borderline tumours respectively. [13] Also discordant, were the findings of Priya et al., who observed that serous borderline tumours were commoner than mucinous borderline tumours. [14]

Among the malignant tumours, serous cystadenocarcinomas (31/80-38.75%) outnumbered all others in our series. This agreed with the findings (46.2%) of Jha et al. [11] However, Swamy et al. having recorded granulosa cell tumours, and Yasmin et al. observing endometroid carcinomas as the most common ovarian malignancies respectively, differed. [15],[16]

Relative frequencies of incidence of different ovarian tumours are different for western and Asian countries. [5],[17],[18] The data available from this study can help in recognizing the pattern of ovarian tumours prevalent in this part of the world.

A majority of the tumours diagnosed in our study occurred in the 21-40 years age-group [Chart 1]. This agreed with the findings of studies by Pilli et al., Shah et al. and Jha et al. [7],[9],[11]



Most (52/80, 65%) malignant tumours were diagnosed in women above 40 years of age. Yet, a significant proportion (35%) of ovarian malignancies was found in women younger than 40 years [Chart 1]. This agreed with the findings of Jha et al., who found 26.90% of malignant neoplasms in women up to 40 years of age. [11]

The highest number of malignant tumours (40/80) was diagnosed in the 41-60 years age group [Chart 1]. Basic et al. found ovarian cancers occurred most frequently in a similar age group, but they reported no ovarian cancers below 40 years of age. [19] Shah et al. and Wasim et al. also found ovarian cancers unusual before age 40. [9],[20]

This study, as well as others from neighbouring countries, which are included here for comparison, have a relatively small sample size, whereas most of the data of the western world is the result of large population-based studies. This could be one cause of variation in results.

Alarmingly, we have observed an increased incidence of ovarian malignancy in our study, which calls for more research into region-specific risk factors. A more complete understanding of the epidemiologic and genetic determinants of ovarian cancer may lead to the development of better screening and detection methods for this disease.


  Conclusions Top


Benign ovarian tumours were more common than malignant ones across all age groups. On morphological grounds, tumours originating from surface epithelium were the most common variant. Though a majority of the tumours were benign, a higher incidence of malignancy was observed in our study as compared to those by other authors, which is an alarming finding. Vague, insidious-onset, dull pain in abdomen was the most common clinical presentation. As most of the malignant ovarian tumours present late, development of methods for early diagnosis is a pressing need today. The relative frequency of incidence of ovarian tumours is known to be different for western and Asian countries; we have additionally observed intra-regional variations in incidence rates within Asia. It is, therefore, suggested that further efforts must be made to identify region-specific risk factors for ovarian oncogenesis.

 
  References Top

1.
Scully RE, Young RH, Clement PB. Atlas of Tumour Pathology. Tumours of the ovary, maldeveloped gonads, fallopian tube, and broad ligament. 3 rd series, Fascicle 23, Washington DC. Armed Force Institute of Pathology, 1999; 1-168.  Back to cited text no. 1
    
2.
Murthy NS, Shalini S, Suman G, Pruthvish S, Mathew A. Changing trends in incidence of ovarian cancer - the Indian scenario. Asian Pac J Cancer Prev 2009;10:1025-30.  Back to cited text no. 2
    
3.
Kjaerbye-Thygesen A, Huusom LD, Frederiksen K, Kjaer SK. Trends in the incidence and mortality of ovarian cancer in Denmark 1978-2002. Comparison with other Nordic countries. Acta Obstet Gynecol Scand 2005;84:1006-12.  Back to cited text no. 3
    
4.
Coleman MP, Esteve J, Damiecki P. Trends in Incidence and Mortality, Lyon, IARC, Scientific Publication No. 121, 1993; 1-806.  Back to cited text no. 4
    
5.
Tavassoli FA, Devilee P. WHO Classification of tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs. Lyon, IARC Press, 2003; p. 113-202.   Back to cited text no. 5
    
6.
Ahmad Z, Kayani N, Hasan SH, Muzaffar S, Gill MS. Histological pattern of ovarian neoplasm. J Pak Med Assoc 2000;50:416-9.  Back to cited text no. 6
    
7.
Pilli GS, Suneeta KP, Dhaded AV, Yenni VV. Ovarian tumours: A study of 282 cases. J Indian Med Assoc 2002;100:420, 423-24, 427.  Back to cited text no. 7
    
8.
Gupta N, Bisht D, Agarwal AK, Sharma VK. Retrospective and prospective study of ovarian tumours and tumour-like lesions. Indian J Pathol Microbiol 2007;50:525-7.  Back to cited text no. 8
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Shah S, Hishikar VA. Incidence and management of ovarian tumours. Bombay Hospital J 2008; 50:30-3.  Back to cited text no. 9
    
10.
Zaman S, Majid S, Hussain M, Chughtai O, Mahboob J, Chughtai S. A retrospective study of ovarian tumours and tumour-like lesions. J Ayub Med Coll Abbottabad 2010;22:104-8.  Back to cited text no. 10
    
11.
Jha R, Karki S. Histological pattern of ovarian tumors and their age distribution. Nepal Med Coll J 2008;10:81-5.  Back to cited text no. 11
    
12.
Thanikasalam K, Ho CM, Adeed N, Shahidan MN, Azizah WK. Pattern of ovarian tumours among Malaysian women at general hospital, Kuala Lumpur. Med J Malaysia 1992;47:139-46.  Back to cited text no. 12
    
13.
Li Y, Cui H, Shen DH, Zhao Y, Wei LH, Qian HN. Clinical and pathological features of borderline ovarian tumours. Zhonhua Fu Chan Ke Za Zhi 2003;38:81-4.  Back to cited text no. 13
    
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Priya C, Kumar S, Kumar L. Borderline ovarian tumours: An update. Indian J Med Paediatr Oncol 2008;29:19-27.  Back to cited text no. 14
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Swamy GG, Satyanarayana N. Clinicopathological analysis of ovarian tumors -- a study on five years samples. Nepal Med Coll J 2010;12:221-3.  Back to cited text no. 15
    
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Yasmin S, Yasmin A, Asif M. Clinicohistological pattern of ovarian tumours in Peshawar region. J Ayub Med Coll Abbottabad 2008;20:11-3.  Back to cited text no. 16
    
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La Vecchia C. Epidemiology of ovarian cancer: A summary review. Eur J Cancer Prev 2001;10:125-9.  Back to cited text no. 17
    
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Muir CS, Waterhouse JA, Mack T. Cancer incidence in Five Continents. Vol. 5. Lyon: IARC Scientific Publication No. 88, 1987; 1-186.  Back to cited text no. 18
    
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Basic E, Kozaric H, Kozaric M, Suko A. Ovarian-cancer incidence and surgical approach to treatment at clinic for Gynecology and Obstetrics of Clinical Center of University of Sarajevo in 2009. Mater Sociomed, 2010;22:101-4.  Back to cited text no. 19
    
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Wasim T, Majrroh A, Siddiq S. Comparison of clinical presentation of benign and malignant ovarian tumours. J Pak Med Assoc 2009;59:18-21.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
 
 
    Tables

  [Table 1], [Table 2]



 

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