Histopathological study of Non-neoplastic & Neoplastic ovarian lesions in a tertiary care hospital in Gujarat, India

Aims & Objectives: (1) To know about various histopathological types of ovarian lesions presented and diagnosed at our institute. (2) To study the incidence of ovarian lesions with respect to patient’s age. (3) To study the frequency of ovarian lesions in terms of non-neoplastic or neoplastic, benign or malignant, unilateral or bilateral, etc. Materials & Methods: The present study was performed at the Department of Pathology, GMERS Medical College & Hospital-Junagadh (Gujarat, India) from January 2015 to December 2018 and includes 100 cases of ovarian lesions diagnosed on both clinical & histopathological basis. We have received ovarian specimens and performed routine grossing and H& E staining procedure. We have included parameters like Age wise incidence, Nature of Lesion, Frequency & Laterality in this present study. Results: Out of100 cases, 89% are unilateral and 11% are bilateral. 52% lesions are Benign Neoplasms, 44% lesions are Non-neoplastic Cysts and 4% lesions are Borderline & Malignant Neoplasms. Majority of cases (58%) belong to age group of 20-39 years. Among Non-neoplastic Lesions, Follicular Cyst is common & frequently bilateral while among Benign Neoplasms, Serous Cystadenoma is common & frequently bilateral. Conclusion: Ovarian Lesions both non-neoplastic and neoplastic include a variety of morphological features and show a particular age wise incidence. Role of histopathological evaluation remains always important in both diagnosis & management of such cases, particularly in cases of Malignant Lesions in order to save the patient’s life.


Introduction
Ovarian enlargements (lesions), cystic or solid, may occur at any age [1]. These enlargements may be Nonneoplastic or Neoplastic in nature. Non-Neoplastic Enlargements include Simple Follicular Cysts, Corpus Leuteal Cysts, Chocolate Cysts due to Endometriosis, Twisted Hemorrhagic Cysts, Polycystic Ovarian Disease (PCOD), Various Inflammatory Lesions, etc. To define a functional non-neoplastic cyst, its size or diameter must be at least 3 cm, but not more than 7 cm [1]. Non-Neoplastic Enlargements develop almost exclusively during the childbearing years.
They may be asymptomatic or produce local discomfort, menstrual disturbances, infertility, or in rare cases cause acute symptoms due to complications like haemorrhage, rupture or torsion [1]. Neoplastic disorders or lesionsof Ovary can arise from (1) Mullerian epithelium, (2) Germ cells or (3)  Stromal cells [2]. Classification of Ovarian Neoplasms given by WHO is completely based upon the tissue of origin. It includes a variety of entities like Surface Epithelial Tumors, Sex cord Stromal Tumors, Pure or Mixed Germ Cell Tumors, Gonadoblastoma, Soft Tissue Tumors, Metastatic Tumors, Unclassified Tumors, etc. Surface Epithelial Tumors are further categorized into benign, borderline and malignant [1,3]. Ovarian neoplasms behave in diverse way and generally escape the detection until they attain a larger size. This is primarily due to the reason that either the symptoms are vague or most of these are asymptomatic therefore they manifest over a time period due to no definite screening program. Therefore, diagnosis of various histological patterns of ovarian tumors is very important in the treatment and prognosis. [2] Aims & Objectives  To know about various histopathological types of ovarian lesions presented and diagnosed at our institute.
 To study the incidence ofovarian lesions with respect to patient's age  To study the frequency of ovarian lesions in terms of non-neoplastic or neoplastic, benign or malignant, unilateral or bilateral, etc.

Material & Method
The present retrospective studywas performed at the Department of Pathology, GMERS Medical College& Hospital-Junagadh (Gujarat, India) from January 2015 to December 2018 for a period of 4 years. It includes a total number of 100 random cases of ovarian lesions diagnosed initially on the basis of clinical findings and finally on the basis of histopathological examination.       [14] has reported 24% cases of Serous Cystadenoma followed by 18% cases of Mature Cystic Teratoma. Sowe can say that outcome of all these similar studies are comparable with that of our present study.

Discussion
In our study, majority of the patients (58%) belong to age group of 20-39 years followed by age group of 40-59 years (32%) and 60 years or more (10%). In our study we have not included patients who are below 20 years of age.
Comparison of this age distribution with that of other similar studies is mentioned below in table no. 3.

Conclusion
Ovarian Lesions or Enlargements, both non-neoplastic and neoplastic include a variety of morphological features and show a particular age wise incidence. Among non-neoplastic lesions, simple follicular cyst is common while among benign tumors, serous cystadenoma is common. Both are frequently bilateral. Malignant Neoplasms of Ovary are rare as compared to Benign Neoplasms and Non-neoplastic Lesions, but require a specific attention during diagnosis on both clinical and pathological basis in order to save the patient's life.
Role of histopathological evaluation remains always important in diagnosis and management of such cases along with clinical and radiological evaluations. Histopathological study is useful to predict nature and course of ovarian lesions so that future worse outcome can be prevented with early intervention and marker study.