The aim of this study is a retrospective analysis of the spectrum of ovarian tumors: statistics, epidemiology and pathological features, based on one-year experience in our hospital. Materials and method. We analyzed 58 cases registered in the Pathology Department as oophorectomy or hysterectomy specimens diagnosed with ovarian tumors, including benign, borderline and malignant tumors of various histological types.
Based on their tumoral behavior, we had: three cases of benign tumors, all of them associated with a different histological tumor type and grade in the contralateral ovary, 12 cases of borderline tumors and 46 cases of malignant tumors 39 cases of primary and 7 cases of secondary tumors. The most benign cancer of uterus histologic type was represented by high-grade serous carcinoma Rare primary ovarian tumors were represented by: adult granulosa cell tumor, clear cell carcinoma, mixed serous-mucinous carcinoma and undifferentiated pleomorphic sarcoma 1.
The earliest age of all patients with ovarian tumors was 31 years old for the mixed serous-mucinous carcinoma. Mean age distribution was 52 years old for benign tumors, 51 years old for borderline and benign cancer of uterus years old for malignant tumors. Primary malignant tumors are the most frequent type of ovarian tumors and their age incidence ranges from the third to the eighth decade.
The majority of secondary ovarian tumors are of endometrial origin. Keywords ovarian tumors, benign, borderline, malignant Rezumat Obiectiv.
A clinical-pathological study of ovarian tumors - one-year center experience
Scopul acestui studiu este analiza retrospectivă a spectrului de tumori ovariene, din punct de vedere statistic, epidemiologic şi al caracteristicilor histopatologice, reprezentând experienţa de un an în spitalul nostru Materiale şi metodă.
Am analizat 58 de cazuri, din Departamentul de Anatomie Patologică, înregistrate ca piese de ooforectomie sau histerectomie diagnosticate cu tumori ovariene, cuprinzând diferite tipuri histologice de tumori ovariene benigne, borderline şi maligne. În funţie de caracterul tumoral, am identificat: trei cazuri de tumori benigne, toate asociate cu un alt tip histologic tumoral în ovarul contralateral, 12 cazuri de tumori borderline şi 46 de cazuri de tumori maligne dintre care 39 de cazuri de tumori primare şi 7 cazuri reprezentând tumori secundare.
Vârsta minimă în rândul tuturor pacientelor cu tumori ovariene a fost 31 de ani. Benign cancer of uterus medie pe categorii a fost 52 de ani pentru tumori benigne, 51 de ani pentru tumori borderline şi 60 de ani pentru tumori maligne. Tumorile maligne primare reprezintă cel mai frecvent tip de tumori ovariene, cu o incidenţă de vârstă cuprinsă între decadele a treia şi a opta de viaţă.
Majoritatea tumorilor ovariene secundare sunt de origine endometrială. The relative frequency of ovarian tumor is different for western and Asian countries. Two third of ovarian tumors occur in women of reproductive age group 1.
Borderline tumors occur benign cancer of uterus slightly older ages and malignant tumors are more common in women between 45 and 65 years old 2. Ovarian cancer represents the fifth cause of cancer and the fifth cause of death due to cancer in females in the European Union 3. There are three major histologic subtypes of surface epithelial tumors: serous, mucinous and endometrioid. Serous carcinomas are divided in: high-grade serous carcinoma and low-grade serous carcinoma.
These tumors are associated with KRAS mutation mainly, and smoking is a risk factor, not associated with serous tumors. Mucinos tumors are composed of gastrointestinal type cell containing intracytoplasmic mucin and therefore, malignant benign cancer of uterus should always be carefully examined for excluding metastatic tumors with similar morphology 2,5.
Endometrioid tumors of the ovary are similar to endometrioid tumors of the endometrium. Other rare epithelial tumors include: clear cell tumors, Brenner tumors, mixed serous-mucinous or mixed epithelial-mesenchymal tumors. The benign cancer of uterus includes: teratomas mature, immature and monodermal or highly specializeddysgerminoma, Yolk-sac tumor, non-gestational chorio-carcinoma, embryonal carcinoma and mixed tumors.
In this group, only mature teratomas and monodermal teratoma - benign struma ovarii are benign tumors. Sex-cord stromal tumors include neoplasms that contain granulosa cells, theca cells, fibloblasts, Sertoli cells and Leydig cells, which are derived from ovarian stroma, that is formed from sex cords under the influences of coelomic and mesonephric epithelium. This type of tumor has clinical importance because of its potential to elaborate large amounts of estrogens and because it has malignant potential.
Pure fibromas are hormonally inactive; Sertoli and Leydig cell tumors are active and have masculinizing or de-feminization effects 5,7. Metastases derived from non-gynecological sites are eleven times more frequent than papillary urothelial tumor of low malignant potential derived from female genital organs, the gastrointestinal tract being benign cancer of uterus most common origin 7.
Tumors from the stomach, colon, and breast are the three most common neoplasms that metastasize to the ovary 8.
Materials and method We performed a retrospective analysis of ovarian tumor cases registered at the Pathology Department of the Bucharest Emergency University Hospital for a period of one year. The study included 58 cases of oophorectomy, salpingo-oophorectomy or hysterectomy specimens diagnosed with benign, borderline or malignant tumors of various histologic types. We classified them according to their morphologic features, we analyzed the age distribution for each category, the clinical manifestations, regional spread, lymph nodes status, peritoneal involvement or metastases in available cases; the follow-up was possible in a limited number of cases.
All data was obtained from medical records and from the Statistics Department of University Emergency Hospital in Bucharest. Results and discussions Based on their tumoral behavior, we had Figure 1 : three cases 4. In our study we found a smaller prevalence of benign tumors of only 4. Figure 1.
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The distribution of ovarian tumors over a period of one year The most frequent histologic type among all ovarian tumors was represented by high-grade serous benign cancer of uterus Mucinous carcinoma accounted for Studies of molecular alteration have suggested that this tumors do actually progress from endometriosis 4, We had one case of poorly differentiated carcinoma of unknown origin.
All the metastasis cases were large excision specimens and were integrated in the clinico-pathological context. The gynecological origin is usually less frequent than the gastrointestinal origin, which is the first cause of ovarian metastasis 7,8, Rare primary ovarian tumors were represented by: adult granulosa cell tumor Figure 2clear cell carcinoma, mixed serous-mucinous carcinoma, and undifferentiated pleomorphic sarcoma 1.
Figure 2. Intraoperative Amacroscopic B and microscopic C aspect of a voluminous left ovarian cyst in a patient of 60 years old; after the histopathological benign cancer of uterus the diagnose was adult granulosa cell tumor - note the micro-follicular pattern The earliest age of a patient with ovarian tumor was 31 years old for the mixed serous-mucinous carcinoma, a younger age than mean age for this type of tumor, but cases of patients within 16 to 79 years had been previously reported 13, Mean age distribution was: 52 years old for benign tumors, benign cancer of uterus a range of 45 to 67 years old; 51 years old for borderline tumors, with a range of 32 to 73 years old; 60 years old for malignant tumors, with a range of 31 to 83 years old Figure 3.
Mean age distribution in the category of malignant tumors is shown in Figure 4. We found a higher age range for benign tumors, but considering the fact that they were associated with borderline tumors, we found it acceptable 2,4. Figure 3. Age range distribution according to the type of tumor Figure 4. Mean age distribution among malignant ovarian tumors We had two cases of tumoral recurrence with multiple metastases of previous high-grade serous carcinoma in patients of 62 and 70 years old, respectively, and one deceased patient of 75 years old, with undifferentiated pleomorphic sarcoma.
They are highly aggressive tumors with poor prognosis, and can develop in younger patients as well. Kurtoglu et al.
The most encountered manifestations were: moderate to severe abdominal pain, distention, ascites and anorexia for malignant tumors and mild abdominal distension and menstrual disorders for borderline together with benign tumors. The symptoms are usually found in large tumors 16, The treatment of ovarian cancer with molecular targeting therapy, platinum and taxane containing chemotherapy and other specific drugs has improved the prognosis over time Currently, the benign cancer of uterus primary therapy for advanced disease involves a combination of maximal cytoreductive surgery and chemotherapy with carboplatin plus paclitaxel or with carboplatin alone.
Despite initial high response rates, a large proportion of patients relapse, resulting in a therapeutic challenge 19, Because these patients are not curable, the goal of therapy becomes the improvement in both quality and length of life. Single-agent paclitaxel, topotecan, or pegylated liposomal doxorubicin have demonstrated activity in benign cancer of uterus patient population and are reasonable treatment options cancer ulcere mamelon, Conclusions In our study, primary malignant tumors are the most frequent type of ovarian tumors and their age incidence ranges from the third to the eighth decade.
We found higher prevalence rates for high-grade serous carcinomas. The majority of secondary benign cancer of uterus tumors we studied were of endometrial origin, which may suggest that gynecological primary situs can be considered of greater potential of spreading to the ovaries than previously thought.
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