Authors : Dr. Vismaya J; Dr. Amrutha Ramachandran; Dr. Jayasree S

Volume/Issue : Volume 8 - 2023, Issue 12 - December

Google Scholar : http://tinyurl.com/43pdvfs4

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DOI : https://doi.org/10.5281/zenodo.10409482

Abstract : Introduction: Ovarian cancer is an important cause of morbidity and mortality among women. About 15–20% of all gynecological cancers are ovarian cancer. According to the Age Specific Incidence Rate (ASIR) for ovarian cancer, the incidence of disease increases starting at age of 35 and peaks between ages 55 and 64. Ovarian tumors frequently go undetected until they are large or in an advanced stage because their symptoms are vague and subtle. Mortality and recurrence depend on the stage of disease, tumor histology, initial treatment and any residual disease after surgery. Women with epithelial malignancies, advanced-stage disease and those who hadresidual tumors after cytoreductive surgery are more likely to experience recurrence and die. Health care professionals must be aware of the clinicopathology, epidemiology and histological type of ovarian cancer in order to do screening, early identification and management. There is a relative paucity of studies on ovarian tumors in younger age as compared to those in older age group. There is a need for further studies to define the clinicopathological criteria underlying ovarian tumors in the younger age.Objectives: To analyze the clinicopathological pattern of ovarian neoplasms, diagnosed and operated in women 15 years to 40 years of age at government medical college Kozhikode from 1st April 2021 to 1st April 2022. To analyze the surgical and treatment outcomes of these patients over a period of 6 months.Materials and Methods: A Prospective cohort study conducted among 60 consecutive patients, aged 15 years to 40 years diagnosed with ovarian neoplasms who underwent surgery, either laparoscopy or laparotomy at government medical college Kozhikode. The study period was from 1st APRIL 2021 to 1st APRIL 2022 and they were followed up for 6 months after treatment. Statistical tests of association using SPSS (version 25.0) wereemployed at the level of significance of 5%. A proforma designed with history, examination, investigations, ultrasonography, serum tumor markers, CECT and details of surgery were recorded for these patients. Patients were followed up to 6 months after the surgery. Histopathological findings collected. Details of further treatment and recurrence was obtained. Tumor markers andUSG were done 6 months after surgery. Data collected were analyzed.Results Out of 60 cases, 22% were between 15-20 years, 38% were between 20-30 years and 40% were >30 years. 31.7% patients underwent staging laparotomy and hysterectomy. 5% patients underwent interval cytoreduction surgery and hysterectomy. Ovariancystectomy done for 18.3% and ovariotomy done for 38.4% patients. Para ovarian cystectomy and laparoscopic cystectomy done for 5% and 1.7% patients respectively. 43 cases (71.67%) were benign,5 cases (8.3%) were borderline and 12 cases (20%) were malignant. Among them 39 were surface epithelial tumors (65%), germ cell tumors 17(28%), sex cord stromal tumors 3(5%) and metastasis 1(2%). Among benign ovarian tumors 37.2% were serous cystadenoma,35% were mature cystic teratoma, 23.2% mucinous cystadenoma and fibroma 4.6% respectively. Among the malignant tumors 72% were epithelial,14% germ cell tumors and sex cord stromal tumors and metastasis 7%. Among the epithelial cancers 51% were serous tumors, 37% endometroid cancers and 12% mucinous tumors. 10 patients required chemotherapy and 2 patients had recurrence-1 mucinous carcinoma & 1 case of high-grade serous carcinoma.Conclusion In this study on ovarian neoplasms among women 15 to 40 years of age, most common presenting symptoms was abdominal pain/abdominal distension. IOTA simplerule has sensitivity of 91.67% and specificity of 93.9% in predicting malignant tumorsfrom benign tumors. Tumor markers has no predictive ability in diagnosing malignantovarian neoplasm in this study. Staging laparotomy with hysterectomy and interval cytoreduction with hysterectomy done in 36.7% cases. Fertility preserving surgeries were done in 63.33% cases and they were benign. Surface epithelial tumors is the most common type of tumor, followed by germ cell tumors. Benign tumors (71.67%) are more common than malignant tumors (20%). Most common tumor was serous cystadenoma. Most common malignant tumor was serous epithelial tumors. On followup 2 patients had recurrence within 6 months and they were having stage 3 disease.

Keywords : Ovarian Tumors, Clinicopathological Patterns, Surgical Outcomes.