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A CLINICO-PATHOLOGICAL STUDY OF OVARIAN MASSES IN MATERNITY TEACHING HOSPITAL, ERBIL CITY Dr.Ahang Ali, Assistant.Prof. Shahla Alalaf Hawler medical university,College of medicine, Department of Obstetrics and Gynaecology

Background and Objectives Results and Discussion Conclusions

References

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2-Davies AP, Jacobs I, Woolas R.The adnexal mass benign or

malignant.Evauation of arisk of malignancy index.Br J Obstet

Gynecol. 1993 ;100:927-31.3-Sundar S, Reynolds K. Benign and malignant ovarian masses in :LuesleyDM,BakerPN.editors.Obestetric and Gynecology an evidence based text for MRCOG.Britain.Arnod,2010.pp;8111-820.4-The Encyclopedia of medical imaging volume IV.

15-Reynaud MC, Plante M, Roy M. Ovarian thecoma associated with a

large quantity of ascites and elevated serum CA 125 and CA 15-3. J

Obste Gynaecol Can. Dec 2002; 24(12):963-5.

6- Curran D, Ashton JL. "Benign Lesions of the Ovaries." eMedicine.Eds.Trupin SR. 19

Aug. 2007. Medscape. 28 Jul. 2009 .Available from:

http://emedicine.medscape.com/article/265548-overview.

7-Crandall C. Ovarian Cysts.[Online] Last Editorial Review:

9/24/2010.Availablefrom:http://emedicine.medscape.com/article/255865-overview.8 -Smith WW, Peipert JF, et al. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol. 2005; 105:1098-1103.…

-An ovarian mass may be neoplastic or physiological and most adnexal masses are benign.-Most ovarian masses are cystic, but the presence of solid areas makes a malignancy possible.-Approximately 40% of ovarian masses in postmenopausal women are malignant, but less than 10% are malignant in the premenopausal female population -It can occur in women of any age group, most often in childbearing years.-Rupture or bleeding of the cysts can cause pain.-The incidence of malignant ovarian masses is increasing all over the world.-It is the sixth most common cancer in women and the fourth leading cause of cancer deaths in women.-50% of all deaths from cancers of female genital tract.-Surface epithelial tumours are the commonest tumours while germ cell tumours are the commonest in female < 20y and one third of them are malignant.-Ovarian masses occur in 30% of female with regular menses,50% with irregular menses, 6% of post menopausal female -Worldwide, 7% of women have an ovarian cyst at some point in their lives.-Ovarian masses may be discovered by abdominal palpation or during bimanual pelvic examination.-Transvaginal ultrasonography remains the standard for evaluation of adnexal masses( ths size, characteristics, complexity) , and presence of pelvic or abdominal ascitis or blood.

Objectives:(1) To evaluate the types of ovarian masses operated on it in Maternity teaching hospital.(2)To determine the types of surgical operations used for their removal.(3)To determine the probable risk factors for ovarian masses

1)Benign ovarian masses were common in all age groups whereas malignant ovarian masses were common in old age groups. 2)Nulli parity and multiparous women with small family sizes have a significant risk factors for ovarian tumour. 3) The commonest pathology under lying the ovarian masses in the current studty was non-neoplastic cysts followed by benign neoplasia .4)surface epithelial tumor of which serous type was the most common benign tumors5) Germ cell tumour of which mature teratoma was the commonest malignant tumour and was more common in young age group women.

Patients and Methods

-Across sectional simple review study 85 cases that operated on as cases of ovarian masses .

Maternity teaching hospital, Erbil city, North of Iraq, Kurdistan region 1st May-1st December 2010.-Exclusion:uterine fibroid,PID ovarian ectopic-Patients attained the hospital directly as emergency cases, refereed from health centers or private clinics.-A specially designed questionnaire -History :age, parity, LMP, marital state ,menarche ,induction of ovulation,smoking, family history of ovarian tum-ours,clinical presentation.-Abdominal pain, PMB ,dysparaunea, Frequency of micturition, difficulty in defecation,Abdominal distention, Ascitis, Asymptomatic.-Diagnosis confirmed: Ultrasound vaginal or abdominal ,Tumor marker Ca 125 .-Laparatomy was done for all cases,removal of the mass alone or hysterectomyThe fluid inside the masses were aspirated and send for cytological exam.Ethical approval:-Verbal informed consent was taken from each patient -All informed about the purpose of the study-Confidentiality was approved.-The study was approved by scientific committee in college of medicineStatistical analysis:SPSS version 15 was used for data entry and analysis.-Chi square test uses to compare proportions-Contingency coefficient used for normal variables-P value < 0.05 regarded scientifically significant.

OPTIONALLOGO HERE

OPTIONALLOGO HERE

Investigation Characteristic Frequency in no. and %

Ultrasound finding

Size

<5 cm5-10 cm>1T0 cm

11 (12.6%)54 (62.1%)22 (25.3%)

Total 87 (100%)

Location

UnilateralBilateral

83 (97.6%)2 (2.4%)

Total 85 (100%)

Side

Right sideLeft side

59 (67.8%)28 (32.2%)

Total 87 (100%)

Ascitis 2 (2.3%)

Report

Negative Normal Raised

51 (69%)15 (20%) 8 (11%)

Total 74 (99.9%)

Report

Negative for atypical cells Positive for atypical cells Total

36 (94.7%)

2(5.3%)

3(100%)

Demographic data Patients in no. and%

Age group

< 20 years20-29 years30-39 years≥ 40 years

6 (7%)31 (36.5%)24 (28.2%)24 (28.2%)

Age of menarche

≤ 12 >12

63 (76%)20(24%)

Marital status

Married(not pregnant)Married (pregnant)Un married

65 (76.5%)4 (4.70%)16 (18.80%)

Parity

Nulliparous (p=0)Multiparous (p=1-4)Grant multipara(≥5)

20(23.5%) 59 (69.4%) 6 (7.1 %)

Table 1:Distribution of demographic data among sample size.

Table 2: Distribution of cases according to the result of investigations

Non-neoplastic cysts No. ( %)Functional follicular cysts 13(15%)Functional luteal cysts 16(18.3%)Chocolate cysts 4(4.6%)Total 33(37.9%)

Benign (epithelial masses )

Serous cyst adenoma 16(18.3%)Papillary serous adenofibroma 3(3.4%)Mucinous cyst 5(6%)Total 24(27.7%)Benign germ cell

Mature teratoma 20(23 %)Stroma ovarii 1(1.1%)Total 21(24.1%)Sex cord tumors

Fibroma 2(2.3%)

Fibrothecoma 1(1.1%)Total 3(3.4%)Malignant epithelial masses

Serous cyst carcinoma 2(2.3%)Mucinous cyst carcinoma 1(1.1%)

Endometrioid tumor 1(1.1%)Total 4(4.5%)Malignant germ cell

Immature teratoma 1(1.14%)Yolk sac tumor 1(1.14%)

Total 2(2.28%)

Table 3: The result of histopathological examination in the ovarian mass.

Histopathological type of ovarian masses

Age groups

Functional cyst

Chocolatecyst

Epitheial ovarian masses

Germ cell tumors

Sex cordOvarian masses

< 20 years 0(0%) 1(16.6%) 2(33.3%) 3(50%) 0(0%)20-29 years 15(46.8%) 2(6.2%) 7(21.8%) 8(25%) 0(0%)

30-39 years 12(48%) 0 4(16%) 8(32%) 1(4%)

≥ 40 years 2(8.3%) 1(4.1%) 15(62.5%) 4(16.6%) 2(8.3%)

Total 29(33.3%) 4(4.6%) 28(32.2%) 23(26.4) 3(3.4%)

Table- 4:Frequency of different type of ovarian masses according to age groups

-The number of women with ovarian masses underwent laparatomy atMaternity teaching hospital within the period of the study was 85 cases-93% of cases were benign while 7% were malignant.* A study done by Jamal et al at institute of Nuclear medicine and oncology in Lahore Pakistan-The age range was 7-60y , 60% of patients their menarche was <= 12y.*Despand and Badjatiya revealed ovarian tumour in adolescent group was 4.2% .-The center for Adult Disease in Japan reported germ cell tumours more frequent at younger age groups. 65% of germ cell tumor in the current study were in age group < 35.-Family history of ovarian tumours is a recognized risk factors for ovarian tumors, although it was not in the current study , may be because small sample size.-4.7% of cases associated with pregnancy, 75% were complicated ovarian cysts operated on them as emergency cases, while one case diagnosed during Caesarean delivery as a routine visualization of the ovaries.

-The most common non neoplastic ovarian masses was physiological cysts (33.3%) of cases,Wasim et al and Gupta N also found that the histopathological result of the benign tumours in their study was functional cysts in about 32% of the cases.-In our locality early pregnancy after marriage is always suspected and any woman failed to get pregnant after few months of marriage, will heisted in seeking gynaecological advise which most commonly use induction of ovulation even when they are not in need of that.-32% of neoplastic cysts were epithelial tumour, followed by germ cell tumour in 26.4% of cases, this was in comparison to another study done a broad.-Tumour size is not an important criterion in predicting malignancy in a mass, as 50% of malignant tumours and 26.5% of benign cysts > 10cm

Age ofMenarche

Benign tumors

Malignant tumors

Total no. P value

≤ 12 year 60 (92.3 %) 5 (7.7%) 65(100%) 0.2

> 12 year 20 (100 %) 20(100%)

Total no. 80 (94.1%) 5(5.9%) 85(100%)

Table 5: Relation between type of ovarian masses (benign and malignant) according to age of menarche.

Gestational age

Type of ovarian massesTotal P value

Functionalcyst

Epithelial tumor

5 wks 1(100%) 0 1 0.2

12 wks 0 1(100%) 1

17 wks 0 *1(100%) 1

38 wks 0 1(100%) 1

Total 1(25%) 3(75%) 4(100%)

Table 6: Association between types of ovarian masses and pregnancy.

Ca125Value

Benign tumors Malignant tumors Total

No. Functional

Epithelial Germ cell Sex cord

Chocolate

Epithelial

normal 1(6.7%) 5(33.3%) 8(53.3%) 1(6.7%)

15(100%)

*high 1(12.5%) 3(37.5%)

*4 (50%) 8(100%)

Total 1(4.35%) 6(26.1%) 8(34.8%) 1(4.35%)

3(13.0%)

4(17.4%) 23(100%)

Table 7: Relation between types of ovarian masses (benign and malignant) with level of tumour marker CA125.

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