Clinicopathological spectrum of ovarian neoplasms in pre and post menopausal Indian women

Abstract

Ovarian cancers are the third most common cancers in women trailing behind cervical and breast cancer. Various molecular insults are seen in hereditary cancer syndromes that results in different morphological types of ovarian cancer.Accurate histological typing suggests screening of the first degree relatives and also targeted therapy for the same. Age specific incidence rate showed that ovarian cancer increases from 35 years of age and peaks between 55 to 64 years of age. Present study was conducted to know the clinical and histopathological spectrum of ovarian neoplasms. To correlate the histopathological subtype with the pre and post menopausal age group. This is a retrospective observational study of 196 cases found over 2.5 years during January 2018 to June 2020. Surface epithelial tumors(SET) are commonest in our study (benign 50%, borderline 6% and malignant 17%) followed by germ cell tumors (12%), sex cord stromal tumors (9%), secondary tumors (5%) and mixed epithelial and mesenchymal tumor (0.5%). Benign SET and germ cell tumors are significantly associated with premenopausal age whereas malignant SET has significant association with post menopausal age. However sex cord stromal tumors did not show any significant association with both the groups. Bilateral involvement was commonest with secondary tumors followed by malignant SET. Mean age of presentation was 41 years with maximum cases presenting in 4 and 5 decade. Various histomorphological parameters were evaluated in detail along with immunohistochemistry(IHC). Inhibin negativity helped to differentiate sertoliform variant of endometrial carcinoma from sertoli cell tumor. WT1 positivity in serous carcinoma ruled out poorly differentiated endometrioid carcinoma in two cases. Thirteen cases show extraovarian spread. Synchronous neoplasms of female genital tract (fibroma with uterine endometrial carcinoma and Brenner with basaloid carcinoma cervix ) were found. Collision tumors (sex cord stromal tumors with germ cell tumors) were also found in present study. Using WHO classification, ovarian tumors can be precisely subcategorized into different morphological subtypes. However overlapping features may need IHC to pinpoint the correct diagnosis. Age specific occurrence of different morphological subtypes may suggest other ancillary investigations and different treatment modalities