Title: Histopathological Profile of Uterine Adnexal Masses and Correlation with Serum CA 125 of Benign & Malignant Adnexal Masses

Authors: Jinia Das, Tushar Kanti Das, R.P. Ganguly

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i9.56

Abstract

The detection of uterine adnexal mass with associated raised serum CA 125 level is highly suspicious for ovarian cancer, but there are various other benign and malignant adnexal pathologies that mimic the above findings, especially in premenopausal women in our country as seen in our case study. The aims and objectives of this study were to study the histopathological spectrum of uterine adnexal mass and correlation of serum CA125 with benign & malignant masses, determine the incidence rate, age distribution and histopathological pattern of  adnexal mass in operated specimens, to study the frequency of benign and malignant neoplasms of ovary in this region and also to study the cut off values of Serum CA-125 in Benign and Malignant ovarian lesions. The present study had revealed various facets of epithelial ovarian tumours keeping comparable results with different studies. Among all cases 64.71% of the cases were benign, 5.88% borderline and 29.41% malignant. Benign tumours clustered a decade earlier than malignant tumours. The epithelial tumours are the most common tumours. Unless better methods of prevention, early diagnosis and/or curative treatment are introduced, a gradual rise in the mortality rate from uterine adnexal cancer, especially ovarian cancer is expected in this country.

References

  1. ACOG Practice Bulletin. Evaluation and Management of adnexal masses. Obstet Gynecol. 2016 Nov. 128(5):e210-226.
  2. Drake J. Diagnosis and management of the adnexal mass. Am Fam Physician. 1998 May 15. 57(10):2471-6, 2479-80.
  3. Gallup DG, Talledo E. Management of the adnexal mass in the 1990s. South Med J. 1997 Oct. 90(10):972-81.
  4. Sayasneh A, Ekechi C, Ferrara L, et al. The characteristic ultrasound features of specific types of ovarian pathology (Review). Int J Oncol. 2015 Feb. 46(2):445-58.
  5. Hricak H, Chen M, Coakley FV, et al. Complex adnexal masses: detection and characterization with MR imaging--multivariate analysis. Radiology. 2000 Jan. 214(1):39-46.
  6. Alcazar JL, Ruiz-Perez ML, Errasti T. Transvaginal color Doppler sonography in adnexal masses: which parameter performs best?. Ultrasound Obstet Gynecol. 1996 Aug. 8(2):114-9.
  7. Castillo G, Alcázar JL, Jurado M. Natural history of sonographically detected simple unilocular adnexal cysts in asymptomatic postmenopausal women. Gynecol Oncol. 2004 Mar. 92(3):965-9.
  8. Modesitt SC, Pavlik EJ, Ueland FR, DePriest PD, Kryscio RJ, van Nagell JR Jr. Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter. Obstet Gynecol. 2003 Sep. 102(3):594-9.
  9. Zalel Y, Piura B, Elchalal U, Czernobilsky B, Antebi S, Dgani R. Diagnosis and management of malignant germ cell ovarian tumors in young females. Int J Gynaecol Obstet. 1996 Oct. 55(1):1-10. [Medline].
  10. Barber HR, Graber EA. Gynecological tumors in childhood and adolescence. Obstet Gynecol Surv. 1973 May.28(5):suppl:357-81.
  11. Pfeifer SM, Gosman GG. Evaluation of adnexal masses in adolescents. Pediatr Clin North Am. 1999 Jun. 46(3):573-92.
  12. Slap GB, Forke CM, Cnaan A, et al. Recognition of tubo-ovarian abscess in adolescents with pelvic inflammatory disease. J Adolesc Health. 1996 Jun. 18(6):397-403.
  13. Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H. Indeterminate ovarian mass at US: incremental value of second imaging test for characterization--meta-analysis and Bayesian analysis. Radiology. 2005 Jul. 236(1):85-94.
  14. Russo A, Calò V, Bruno L, Rizzo S, Bazan V, Di Fede G. Hereditary ovarian cancer. Crit Rev Oncol Hematol. 2008 Jul 23.
  15. Lancaster JM, Powell CB, Chen LM, Richardson DL, SGO Clinical Practice Committee. Society of Gynecologic Oncology statement on risk assessment for inherited gynecologic cancer predispos-itions. Gynecol Oncol. 2015 Jan. 136 (1):3-7.
  16. Plon SE, Cooper HP, Parks B, Dhar SU, Kelly PA, Weinberg AD, et al. Genetic testing and cancer risk management recom-mendations by physicians for at-risk relatives. Genet Med. 2011 Feb. 13 (2):148-54.
  17. Genetic/Familial High-Risk Assessment: Breast and Ovarian. NCCN Clinical Practice Guidelines in Oncology. Version 2.2015. NCCN; 2015.
  18. Risch HA, McLaughlin JR, Cole DE, Rosen B, Bradley L, Kwan E. Prevalence and penetrance of germline BRCA1 and BRCA2 mutations in a population series of 649 women with ovarian cancer. Am J Hum Genet. 2001 Mar. 68(3):700-10.
  19. Pal T, Permuth-Wey J, Betts JA, Krischer JP, Fiorica J, Arango H. BRCA1 and BRCA2 mutations account for a large proportion of ovarian carcinoma cases. Cancer. 2005 Dec 15. 104(12):2807-16.
  20. Press JZ, De Luca A, Boyd N, Young S, Troussard A, Ridge Y. Ovarian carcinomas with genetic and epigenetic BRCA1 loss have distinct molecular abnormalities. BMC Cancer. 2008. 8:17.
  21. The Million Women Study: design and characteristics of the stud population. The Million Women Study Collaborative Group.Breast Cancer Res 1999;1(1):73-80.
  22. Hays J, Hunt JR, Hubbell FA, Anderson GL, Limacher M, Allen C, et al. The Women's Health Initiative recruitment methods and results. Ann Epidemiol 2003; 13(9 Suppl):S18-77.
  23. ROBERT V. KREJCIE University of Minnesota, Duluth DARYLE W. MORGAN Texas A. & M. University https://home.kku.ac.th/sompong/guest_speaker/KrejcieandMorgan.
  24. Lefebvre R, Chenoweth PJ, Drost M, et al. Characterization of the oviductal sperm reservoir in cattle. Biol Reprod. 1995 Nov. 53(5):1066-74.
  25. Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA. 2004;291(22) :2705-2712.
  26. Rubin SC, Finstad CL, Federici MG, Lioyd KO, Hoskins WJ. Prevalence and Significance of HER-2/neu Expression in Early Epithelial Ovarian Cancer. Cancer 1994;73:1456
  27. Gong TT, Wu QJ, Vogtmann E, Lin B, Wang YL. Age at menarche and risk of ovarian cancer: a meta-analysis of epidemiological studies. Int J Cancer 2013 Jun 15;132(12):2894-900
  28. Wagner BJ, Buck JL, Seidman JD, McCabe KM. Ovarian epithelial neopl-asms: radiologicpathologic correlation. Radio Graphics 1994;14:1351–1374
  29. Maxim AR, Coadă CA, Badea RI. Ovarian cancer experience from a Romanian regional center: preliminary results. HVM Bioflux 2013;5
  30. Mccluggage WG. Morphological subtypes of ovarian carcinoma: a review with emphasis on new developments and pathogenesis. Pathology August 2011;43(5):420–432 3):109-113
  31. Phukan JP, Sinha A, Sardar R, Guha P. Clinicopathological analysis of ovarian tumors in perimenopausal women: A study in a rural teaching hospital of eastern India. Bangladesh Journal of Medical Science 2013 July;12(03):263-268
  32. WHO Classification of Tumours of Female Genital Tract, 2014.

Corresponding Author

Jinia Das

91/C/ 27 , Motilal Gupta Road, Pramod Nagar,P.O. Haridevpur, Kolkata 700082

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Phone no. 8777294506