Introduction
Ovarian lesions have a broad spectrum of presentation in clinical practice. Therefore, it is important to know there histological diagnosis for management. Also, on clinical examination, most of the non neoplastic lesions forming pelvic mass mimic ovarian neoplasm. The purpose of the study was to analyze the spectrum of ovarian lesions in a tertiary care centre and to categorize histomorphological pattern as non neoplastic, benign, borderline and malignant.
The ovaries are paired organs located on the sides of the uterus close to the lateral pelvic wall, behind the broad ligament and anterior to the rectum.1 Most commonly lesions encountered in the ovary are functional or benign cysts and tumors. Oophoritis are uncommon and in rare occasion autoimmune pathology can arise in ovary.
Non-neoplastic and functional cysts include follicle cyst, luteal cyst, polycystic ovaries and stromal hyperthecosis. Cystic follicles are very common in the ovary. Functional cysts differ from neoplastic cysts in being usually of size 6-8cm, asymptomatic, regress spontaneously and are unilocular containing clear fluid.2 These are frequently seen in young female in their 2 decade due to failure of ovulation. Ovarian cysts usually present with pain or discomfort in lower abdomen. Cyst rupture may lead to peritoneal signs, abdominal distention.3, 4 Polycystic ovarian syndrome also known as Stein Leventhal syndrome, affects 6% to 10% of reproductive age group women worldwide. Association with obesity, type 2 diabetes and premature atherosclerosis is there.
In ovary neoplastic lesions can be grouped according to their origin from each of the three main types; mullerian epithelium, germ cells and sex cord stromal cells.5 Ovarian tumors are of numerous types. About 80% are benign. Occurs mostly in between 20 and 45 years of age. Borderline tumors occurs at slightly older ages. Malignant tumors are more common in women between 45 and 65 years of age. Ovarian tumors are called as silent killers as they are difficult to detect until they are advanced in size or stage.6 Also ovaries are inaccessible therefore easy screening methods are not available.7 Ovarian cancer comprises up to 8.7% of cancers in different parts of India.8, 9 Ovarian cancer accounts for 3% of all cancers in females in the United states. Epithelial ovarian tumors are classified into benign, borderline and malignant. Majority of the malignant epithelial tumors are high grade serous carcinoma. They have poor prognosis as are detected after they have spread beyond the ovary and fallopian tube.
Materials and Methods
This was a observational, cross-sectional study done between January to December 2022 in department of Pathology of JIIU’s IIMSR, Warudi, in Jalna district of Maharashtra. Approval of Institutional ethical committee was obtained for this study. The histopathological specimen of the patients who underwent ovarian resection and total abdominal hysterectomy with bilateral salphingo-oophorectomy were included in the study. Total 132 samples were received in our department. Specimens were fixed in 10% formalin. Relevant clinical details were obtained from the medical records. Detailed gross finding were noted and representative section submitted. The tissue was processed in fully automated processing unit, blocks prepared, 3-5 microns tissue sections were cut by Leica microtome and the sections were stained with Haematoxylin and Eosin stain. Slides were reported by atleast two pathologists and histopathological diagnosis was finalized. The details of the patients and data were kept confidential. The data was analysed using MS Excel worksheet.
Results
A total of 132 cases of ovarian lesions were included in this study. The patients were in the age range of 20 to 72 years of age.
Table 1
Age wise distribution of cases for ovarian masses
Upto 29 years benign neoplastic lesions were the commonest. After 30 years majority of the lesions were non neoplastic.(Table 1)
The non neoplastic lesions constituted 54% (71 out of 132) of the total cases.
Follicular cysts were the commonest amongst the non neoplastic lesions (48 out of 71 cases).
Mucinous cyst adenoma were the commonest amongst the neoplastic lesions (20 out 61 cases) followed by serous cyst adenoma (18 out of 61 cases).
Table 2
Distribution of ovarian lesions according to laterality
Majority of ovarian lesions presented as unilateral lesions - 87.87% (116 out of 132 cases).
Figure 4
Gross photograph of mucinous cystadenoma showing cyst wall with thick mucinous contents in it
Figure 5
Gross photograph of case of low grade serous cyst adenocarcinoma showing papillary excrescences
Figure 6
Photograph showing fibrovascular cyst wall lined by mostly single layer of columnar epithelium with basal layer and apical mucin vacuoles showing focal complex architecture and focal nuclear atypia. (H and E, x10)
Discussion
In our study 132 cases of ovarian lesions were included. Most of the cases presented in 3rd and 4th decade of life. Study done by Purti Agrawal et al10 had peak incidence of ovarian tumor in 3rd and 5th decade of life. In our study majority of the ovarian lesions were unilateral (116/132 cases) 87.87%. Bilateral ovarian lesions were 12.12% which was in concordance with studies done by Maitry D Charel et al,11 Couto et al. 12
Non neoplastic lesions were 71/132 cases (53.78%) and neoplastic lesions were 61/132 cases (46.22%). Similar findings were seen in studies done by Nehal Ahmad et al13 non neoplastic 55.8% and neoplastic 44.2%. The most common non neoplastic lesion was follicular cyst (48/71 cases) followed by haemorrhagic luteal cyst. Studies done by Amod Sawant et al,14 Thakkar et al15 had similar findings. Ashraf et al16 had corpus luteal cyst as the commonest non neoplastic lesion.
Commonest neoplastic lesion encountered in present study was mucinous cyst adenoma (32.78%) which was in concordance with study done by Purti Agrawal et al.10 Mondal et al. had serous cystadenoma (32.57%) as the most commonest histiologic type followed by mucinous cyst adenoma (15.71%).
In borderline cases, two cases were of mucinous cyst adenoma borderline and one case of serous cyst adenoma borderline. In studies done by Agrawal et al and Bhagyalaxmi et al17 most common borderline ovarian tumor was borderline mucinous tumor 55.5%. Two cases turned out to be malignant both being serous cyst adenocarcinoma. Amongst the malignant epithelial tumors, serous cyst adenocarcinoma was the commonest in study done by Maheshwari et al.18
Ovarian lesions contribute major proportion of the cases of abdominal and pelvic swellings in female population. The prevalence of various ovarian pathologies varies according to age. Radiological investigations like transvaginal ultrasonography and CT scan helps in accessing size, spread and probable diagnosis of ovarian lesions. Many studies concluded that grossly most of non neoplastic and neoplastic ovarian lesions present as cystic swellings; while malignant and borderline lesions are partly solid and partly cystic. However, HPE confirmation always remains the gold standard for the diagnosis. It also helps in clinical staging and appropriate management of the patients.
Conclusion
Ovarian lesions are common in younger age group. Most of the cystic lesions of ovary are asymptomatic. In present study, follicular cyst was most common diagnosis amongst the non neoplastic lesions of ovary. Borderline mucinous cystadenoma was the commonest in borderline cases and in malignant cases serous cystadenocarcinoma was the commonest. Hence histopathological examination of ovarian lesions is important for exact diagnosis and proper management.
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