Malignant Ovarian Tumours Histopathological Analysis Biology Essay
Back-to-back patient admitted with the diagnosing of Gynaecological malignances confirmed on ultrasound and all underwent laparotomies during the some admittance. Assorted parametric quantities were analyzed including age, para, carbon monoxide morbid, catamenial history, household history of malignant neoplastic disease and old surgeries. Statistical analyses were carried out utilizing SPSS 10.0 for Windowss.
Consequence: During the 18 month study 70 patients were diagnosed to hold gynecological malignance. Among them 16 patients ( 22.85 % ) had malignant ovarian tumours and their histopathology studies showed that bulk of instances 10 patients ( 62.5 % ) had tumours of epithelial beginning, 2 ( 10.5 % ) belong to sex cord tumours, 1 ( 6.25 % ) was of source cell beginning and 1 patients had metastatic ovarian tumours.
Decision: I was concluded from our survey that ovarian tumour rate is rather high and seen more in immature female and bulk of instances had tumour of epithelial beginning. The symptoms of the ovarian tumours are frequently non-specific and vague, which makes it different to name. Prognosis is hapless if non handle in early disease.
INTRODUTION: Ovary is the 3rd most common site for primary malignant in the female venereal piece of land 1. Ovarian malignant neoplastic disease is the 5th taking cause of malignant neoplastic disease decease in adult females, the taking cause of decease from gynaecological malignance[ 2 ]. It is sometimes called a ‘Silent Killer ‘ because symptoms appear until the disease has progress already. More than two two tierce of instances are at advanced at the clip of diagnosing, i.e. phase III and phase IV3.
Therefore the forecast is hapless in most of the instances.
Diagnosis is confirmed by histology of the tissue obtained at laparotomy. Epithelial ovarian malignant neoplastic disease is the most common type. These history for about 85 % of ovarian malignant neoplastic diseases 4.
Different Ovarian tumours show different malignant potency. Depending upon their histopathology, they could be of boundary line or extremely malignant type. On its footing, the nature and behaviour of the tumour is identified which is of import and assist no merely in modifying the class of intervention for e.g. 2nd expression surgery or demand of chemotherapy and its dose etc. , but besides act upon the forecast and five twelvemonth endurance rate.
The intent of this survey was to observe the happening rate of malignant ovarian tumours in our patients and to analyze their different histopathological form in our patients as it has an impact on intervention and survival rate.
MATERIAL AND METHODS:
It was a prospective survey carried out at section of gynae/obs in J.P.M.C was diagnosed to hold gynecological malignances. Among them 16 ( 22.5 % ) patients had malignant ovarian tumours and their histopathology studies showed that bulk of instances 10 patients ( 62.5 % ) had tumour of epithelial beginning.
A elaborate history was taken sing age, para and presenting ailments, catamenial history, household history of malignant neoplastic disease were besides recorded. After elaborate scrutiny, with accent on abdominal and two-handed pelvic scrutiny was done, probe included were CBC, serum CA 125 degrees, PAP vilification, Ultrasound, C-T scan and MRI.
Interpretation of consequences was done on the footing of biopsy studies ( histopathology ) .
Who were showing with diagnostic ovarian mass more than 5 centimeter. All had surgical intervention for the tumour.
Patients presented with symptomless, simple and unilocular cyst less than 5 centimeters were non included in this survey.
This 18 month survey comprised of 70 patients diagnosed to hold gynecological malignances during this period time.Among these ovarian malignant neoplastic disease ranked 2nd with 16 patients i.e. , ( 22.85 % ) after cervical malignant neoplastic disease 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 old ages to 40 old ages. While staying 5 patients ( 31.25 % ) were of age more than 40 old ages. None of the patients presented before 15 old ages of age ( Table II ) .
Parity of the patients showed 6 multiparable ( i.e. 37.5 % ) , 4 patients were single ( 25.0 % ) and 2 patients were married with no issue ( Table III ) .
On histopatholoy, epithelial tumours were the most common type found in 11 patients i.e. ( 68.75 % ) . Histologic sub typing of these Epithelial tumours showed predomination of mucinous assortment ( 5 patients i.e. 31.25 % ) followed by serous
Cyst glandular cancer ( 2 patients i.e. 12.50 % ) . Papillary adeno carcinoma was presented in 2 patients i.e. ( 12.50 % ) severally.
Two patients ( 12.50 % ) presented with farinaceous cell tumours, while one patient ( 6.25 % ) had germ cell tumour. krukenberg tumour ( metastatic ) was seen in one patient ( Table IV ) .
Most of the patients received chemotherapy and had regular followups in our out patients clinics.
Table NO. 1
January 2001 to June 2002
Gynecological Malignancies: –
Endometrial Carcinoma and Sarcomas
Age Distribution: –
Age distribution of ovarian tumour patients.
Age groups ( Old ages )
PARITY OF PATIENTS
& gt ; 5 kids
Types of tumor
Papillary adeno Ca
Clear Cell Adeno Ca
Clear Cell Adeno Ca
2.Sex cord stromal tumours:
Sertoli Leydig Cell
3.Germ Cell Tumour:
Assorted source Cell
Ovarian malignant neoplastic disease is the most deadly of all gynaecologic malignant neoplastic diseases. Over the last 50 old ages, the incidence and mortality from this disease has been increasing steadily. It will impact about 1 % of American adult females during their life clip and contributes to more than 14,000 deceases yearly 5.
In Pakistan its incidence has been increased well. Out of 5906 instances reported in Northern Pakistan 4.83 % were ovarian malignances 6. While Southern Pakistan its frequence is 4.31 % 7.
In our survey, it is 2nd most common malignant neoplastic disease accounting for 22.85 % of all malignance. Jafarey SN etal 8 ( 1995 ) besides report Ovarian 2nd most common gynaecologic malignant neoplastic disease in Pakistan, which is being increasing encountered. At some centres it is the commonest 1. In another survey of gynaecologic malignant neoplastic diseases in Faisalabad ( Pakistan ) , Ovarian malignant neoplastic diseases was the most often found gynaecologic malignant neoplastic disease 9.
Two important consequences were noted in this survey. The most common hazard factors for Ovarian malignant neoplastic disease is increasing age and it is rare in generative age 10. But in contrast to this, the average age of patients studied was 46.5 old ages with a scope of 15 old ages to 78 old ages. Majority of the instances occurred before the age of 40 old ages. Peak incidence was noted between 21 to 30 old ages of age and merely 4 patients ( i.e. 25.0 % ) were perimenopausal or postmenopausal. These are different from western literature which quotes higher average age. Frederic etal 11. ( 1993 ) reported that average age of their patients was 61.5 old ages ( run 17 to 85 old ages ) . Rubin etal 12 found average age of 59 old ages with a scope of 33-81 old ages in their survey.
In our survey, most of our patients ( 10 patients i.e. 62.5 % ) were multiparous which is once more different from other surveies which shows nulliparity as a major hazard factor associated with this disease. Crawford etal 13 showed 48 % nulliparous patients patients in their survey. Ovarian multitudes were cystic in 43.75 % of instances, solid in 31.25 % of instances and assorted type in 25.0 instances on operative findings. Majority type of tumour were more than 10 centimeter in size ( i.e. 56.25 % ) of instances. Ascites present in 37.5 % instances.
Histopathologic distribution of Ovarian carcinoma in our survey showed the predomination of Epithelial Ovarian carcinoma accounting for 68.75 % of all instances, comparable to other surveies. Parker SL, Tong T ( 1996 ) described Epithelial Ovarian malignant neoplastic disease as the figure one slayer of U.S. adult females among all malignant neoplastic diseases of female venereal tract14. In our survey, among the epithelial malignant neoplastic diseases, mucinous Ovarian malignant neoplastic diseases were the most common assortment representing 31.25 % followed by serous cystadeno carcinoma and Papillary adeno carcinoma with 12.50 % instances each. This predomination of mucinous carcinoma is different from other surveies ; Costa MJ 15 besides described Serous carcinoma as the most preponderantly happening in their survey ( i.e. 65.4 % ) .
Serous carcinoma are besides described as most normally happening Epithelial carcinomas in literature representing about 75 % of Epithelial Ovarian malignant neoplastic diseases, followed by Mucinous malignant neoplastic diseases i.e. 20 % . Mucinous malignant neoplastic diseases occur in center grownup life and therefore rare before pubescence and after climacteric. Mucinous carcinoma histories for merely 10 % of all Ovarian cancers16.
Brenner tumours are uncommon assortment. One patient in our survey ( 6.25 % ) in our survey had Brenner tumour.
Two patients i.e. ( 12.50 % ) had granulose cell tumours, which has a low class malignance. Assorted source cell tumours was found in two patients i.e. ( 12.50 % ) . Germ cell tumours constitute about 15-20 % of all Ovarian tumors17. Most are benign cystic teratomas but some tumours which are found chiefly in immature grownups have incidence of malignance behaviour.
Sing metastatic Ovarian malignant neoplastic diseases, one patient was diagnosed to hold Krukenberg ‘s tumour can account for 30-40 % of metastatic malignant neoplastic diseases to the ovaries18. The primary site is often located in the GI piece of land.
PROGNOSIS AND SURVIVAL: –
Despite new techniques of diagnosing and intervention, the overall 5 old ages survival rate of patients with Ovarian malignant neoplastic disease is about 30 % .
Of the I6 instances reviewed, two patients ( 12.5 % ) were lost to follow up. One patient was expired prior to chemotherapy. Of the staying 13 patients 10 ( 62.5 % ) survived. Most of these patients were presented with early phase disease. 3 out of 5 patients who presented with FIGO phase III and IV were died due to this deadly disease.
In our survey Ovarian Carcinoma stands for the 2nd most common malignance of female venereal piece of land. In contrast to western surveies, the peak incidence of disease occurred at younger age. Epithetial malignant neoplastic diseases remained the most common Ovarian malignant neoplastic disease among which Mucinous malignant neoplastic diseases are the prevailing discrepancies. The overall forecast is hapless, but depends on the extent of disease at the clip of diagnosing, histological type, tumour class and the thoroughness of surgical remotion of the tumour tissue. Largely patients present late with advanced phase of disease. Prognosis is straight related to the phase of disease at presentation. All the patients should be decently counselled and follow up.