|Year : 2023 | Volume
| Issue : 1 | Page : 11-15
ClinicoPathological Overview of Ovarian Tumors and Diagnostic Utility of Imprint Cytology
Nirali Patel, Rupali Bavikar, Yaminy Pradeep Ingale, Yesha Parimalbhai Lad, Arpana Dharwadkar, Vidya Viswanathan
Departments of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
|Date of Submission||04-Oct-2022|
|Date of Acceptance||13-Dec-2022|
|Date of Web Publication||31-Mar-2023|
Yaminy Pradeep Ingale
Department of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune - 411 018, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: For intra-operative diagnosis of ovarian tumors, imprint cytology is the method which gives result within 20 min. It does not affect the quality and utility of the specimen for histopathology. Despite advances in genetics and imaging, histopathological analysis remains the mainstay of ovarian tumor diagnosis. Aim: To describe incidence, age distribution, histological characteristics and whenever feasible, correlate the histopathological diagnosis of ovarian tumors with the imprint cytology technique. Materials and Methods: A total of 200 patients with ovarian tumors were included in this ambispective study from January 2017 to April 2022 at the Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri. Results: One hundred and forty-eight (74%) of the 200 cases were benign, while 52 (26%) were malignant. The peak age incidence of benign tumors was in the second to fourth decades and malignant ovarian tumors was in fourth to sixth decades. Ovarian tumors involved the left ovary (n = 104, 52%) more than the right ovary (n = 90, 45%). Out of 200 cases, 130 cases (65%) were surface epithelial ovarian tumors, followed by 50 cases (25%) were germ cell tumors, followed by 14 cases (7%) were sex cord stromal tumors followed by 3 cases (3%) were secondary/metastatic tumors of ovary. Imprint cytology technique done on 148 cases (74%) showed 100% correlation with the histopathological diagnosis. Conclusion: Imprint cytology diagnosis correlated with the histopathological diagnosis of ovarian tumors.
Keywords: Histopathology, imprint cytology, intraoperative diagnosis, ovarian tumors
|How to cite this article:|
Patel N, Bavikar R, Ingale YP, Lad YP, Dharwadkar A, Viswanathan V. ClinicoPathological Overview of Ovarian Tumors and Diagnostic Utility of Imprint Cytology. Asian J Pharm Res Health Care 2023;15:11-5
|How to cite this URL:|
Patel N, Bavikar R, Ingale YP, Lad YP, Dharwadkar A, Viswanathan V. ClinicoPathological Overview of Ovarian Tumors and Diagnostic Utility of Imprint Cytology. Asian J Pharm Res Health Care [serial online] 2023 [cited 2023 Jun 8];15:11-5. Available from: http://www.ajprhc.com/text.asp?2023/15/1/11/373376
Nirali Patel & Rupali Bavikar are the first primary authors and contributed equally.
| Introduction|| |
A diverse category of neoplasms, ovarian tumors are generally divided into subgroups based on their type and degree of differentiation. Although it is increasingly clear that each major histological variety has distinctive genetic abnormalities that down regulate particular signalling pathways in the tumor cells, current therapeutic therapy of ovarian cancer generally ignores this heterogeneity.
One of the top five locations where cancer occurs and kills women from wealthy industrialized nations is the ovary. Following the advent of oral contraceptives, which – along with parity – are the most widely acknowledged preventive factors for the illness, the incidence and fatality rates have been dropping over the past several decades. Although it is yet unknown how hormone replacement therapy would affect menopause and fertility therapies, late menopause and irregular menstrual cycles may also lower the risk.
Surface epithelial tumors, which make up the majority of ovarian tumors (>90%), develop from the ovary's surface epithelium. Additional forms develop from the egg cells (germ cell tumours). Of all ovarian tumors, surface epithelial tumors make up 65.7%. They display varied levels of aggression and have neutral histological patterns., Serous are the most prevalent among them, followed by mucinous, endometrioid, and other types. The most prevalent ovarian neoplasms in the younger age range are germ cell tumors (16 and 20 years). Various molecular genetic processes may have led to the various histological subtypes of epithelial ovarian tumors. Loss of heterozygosity for the regions of chromosome 17 is a frequent occurrence, as demonstrated by molecular genetic investigations in epithelial ovarian tumors, which likely reflects the inactivation of one or more tumor-suppressor genes present on this chromosome.
Imprint cytology is a technique that can diagnose ovarian tumors during surgery within 20 min. It is especially beneficial for young people who require conservative surgery to protect their fertility. Imprint cytology is an affordable, straightforward, and rapid method of diagnosis that is trustworthy in terms of accuracy, sensitivity, specificity, and positive predictive value. The specimen's quality and usefulness for histology are unaffected. Despite advances in genetics and imaging, histological analysis remains the mainstay of ovarian tumor diagnosis.
The goal of the current study is to analyze in depth both past and future ovarian tumor cases for clinicopathological evaluation.
| Materials and Methods|| |
A total of 200 patients with ovarian tumors were included in this ambispective study conducted by the Pathology Department at Pad. Dr. D. Y. Patil Medical College and Hospital and Research Centre, Pimpri, Pune, from January 2017 to April 2019 (retrospectively) and from May 2019 to April 2022 (prospectively).
The Institutional Ethics Committee provided ethical approval (IEC No. 938).
The descriptive statistics were used to analyze the collected data.
Cystectomy, oophorectomy, salphingo-oophorectomy, and total abdominal hysterectomy with bilateral or unilateral salphingo-oophorectomy specimens were included in the study.
Nonneoplastic ovarian lesions.
Most of the specimens were received in formalin solution. Few specimens were received in normal saline on which imprint cytology technique was done. Then they were thoroughly studied considering gross features such as size, weight, solid, cystic, solid/cystic, and right/left ovary involved and were noted. For imprint cytology technique, firstly touch imprints were done on the surgically fresh specimen sent in normal saline to pathology department. This touch imprint method was applied to the cut-open specimen, which was then gently distributed across another slide using the clean edge of a glass slide. After that, smears were promptly fixed in 95% ethyl alcohol and stained with H and E stain. The samples were subsequently preserved in 10% buffered formalin solution for 24–48 h for histopathological analysis. The samples were opened to reveal the contents of the cystic tumour (serous fluid, mucinous fluid, and sebaceous material) and the solid tumor was sliced serially at a thickness of 1 cm for fixation.
| Results|| |
A total of 200 cases were studied retrospectively and prospectively. Age distribution in our study showed 104 cases (52%) in 21–40 years of age group, followed by 64 cases (32%) in 41–60 years of age group, out of total 200 cases. The youngest case in our study was 8-year-old who had immature teratoma and the oldest cases were of 65 years of age.
The patients in our current study displayed a variety of signs and symptoms, including abdominal mass, abdominal discomfort, ascites, and irregular menstruation alone and in combination. The abdominal mass (90 cases) and abdominal pain (64 cases) were the two most frequent symptoms. One hundred and four cases showed involvement of the left ovary, while 90 cases showed involvement of the right ovary, and in 6 cases both ovaries were involved. One hundred and ninety-four cases out of total 200 cases studied were primary ovarian tumors and remaining 6 cases were secondary tumor in our present study [Table 1].
|Table 1: Incidence of Primary and Secondary Ovarian tumours in the cases of present study|
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Our study showed 148 cases of benign ovarian tumors and 52 cases of malignant ovarian tumors, out of 200 cases studied [Table 2]. Age incidences studied in the benign ovarian tumors showed 86 cases (58.10%) in 21–40 years of age group out of 148 cases. Age incidence studied in malignant ovarian tumors showed 24 cases (46.15%) in 41–60 years of age group out of 52 malignant cases.
In study, out of 200 cases, 144 cases (72%) were cystic, 38 cases (19%) were solid, and 18 cases (9%) were mixed (cystic/solid) including of both benign and malignant ovarian tumors. Maximum of 134 cases (67%) out of 200 cases were of cystic benign ovarian tumors and 28 cases (14%) were of solid malignant ovarian tumors.
Out of 200 cases, 130 cases (65%) were surface epithelial ovarian tumors, followed by 50 cases (25%) of germ cell tumors of the ovary, while 14 cases (7%) were of sex cord stromal tumors of the ovary. Remaining 6 cases (3%) were secondary/metastatic tumors of ovary [Table 3].
|Table 3: Histomorphological types of ovarian tumours of cases in present study|
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In this study, most common ovarian tumors were serous tumors in 62 cases (31%) followed by mucinous tumors in 50 cases (25%). Mature teratomas were seen in 36 cases (18%) out of 200 cases. Least common ovarian tumors seen were endometrioid tumors, mixed malignant mullerian tumors, strumaovarii, 4 cases (2%) each [Table 3].
In our study, 148 cases (74%) were selected on which imprint cytology was done. These 148 cases were of mucinous cystadenoma [Figure 1]a, benign cystic teratoma [Figure 1]b, serous carcinoma, and endometrioid carcinoma. On imprint cytology, microscopic features of mucinous cystadenoma showed tall columnar epithelium with basally located nuclei, vacuolated mucin filled cytoplasm, cells arranged in honeycomb pattern and “picket fence” appearance. Benign cystic teratoma showed benign squamous epithelial cells, cyst macrophages, glandular epithelial cells, and fat. Serous carcinoma showed papillary pattern, cuboidal epithelial cells with severe cellular atypia, and psammoma bodies. Endometrioid carcinoma showed clusters of highly cellular cells with marked cellular atypia and squamous metaplasia against necrotic background.
|Figure 1: (a) Imprint of ovarian cyst showing honeycomb pattern of mucinous epithelial cells. The lining of peg cells can be appreciated with basally located nuclei and mucinous cytoplasm (H and E, ×400), (b) Imprints of teratoma showing clumps of mature squamous epithelial cells (H and E, ×400), (c) Granulosa cell tumor - Photomicrograph showing tumor cells arranged in nests (H and E, ×100), (d) Krukenbergs tumor - Photomicrograph showing signet ring cells (H and E, ×400)|
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| Discussion|| |
The fifth most frequent cancer among women is an ovarian tumor. It accounts for more than half of all fatalities from gynecologic malignancies and is the second most prevalent and deadliest gynecologic cancer.
In our study, 200 cases of ovarian tumors with histological diagnoses were examined clinicopathologically. In our analysis, abdominal mass (45 cases) and pain were the two most frequent symptoms (32 cases). The study done by Vora and Bhargava in 1969. observed mass in the abdomen was the most common ailment in their study followed by pain in the abdomen which showed concordance with our study.
In the present study, the most common side of involvement was left ovary, 104 cases out of 200 cases which showed concordance with the study done by Tyagi et al. 194 cases were unilateral ovarian tumors and remaining 6 cases were bilateral tumor in our study. Comparative analysis was done with two studies. Prabhakar and Maingi in 1989 studied 636 cases, out of which 578 (90.88%) were unilateral cases and 58 (9.11%) were bilateral cases. The incidences of unilateral and bilateral involvement of ovarian tumors in our study showed concordance with the mentioned study.
In our study, 194 cases (97%) were primary ovarian tumors and remaining 6 (3%) cases were secondary tumors.
The incidence of primary [Figure 1]c and secondary ovarian tumors [Figure 1]d in our study showed similar findings with the above-mentioned studies [Table 4].
|Table 4 : Comparison of primary and secondary ovarian tumours with other studies|
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Our study's incidence of benign and malignant ovarian tumors was consistent with the results of the research described above [Table 5].
|Table 5: Comparison of incidence of benign and malignant ovarian tumours with other studies|
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In study, the age incidence in benign ovarian tumors comprised of 21–40 years of age group having 86 cases (58.10% cases) out of total 148 benign cases which were studied. This correlated with the study of Pilli et al. in 2002, which showed 62.70% cases in 21–40 years of age group.
In study, the age incidence in malignant tumors comprised of 41–60 years of age group having 24 cases (46.15% cases) out of 52 malignant cases which showed concordance with the studies of Ramachandran et al. in 1972 which showed 44.80% cases in 40–50 years of age group and Gupta et al. in 1986 showed 40% cases in 35–50 years of age group.
Out of 200 patients, 144 cases had cystic ovarian tumors, 38 cases had solid ovarian tumors, and 18 cases had mixed (cystic/solid) ovarian tumors, which included both benign and malignant tumors. Total 134 out of 200 cases were benign cystic ovarian tumors, while 28 were solid malignant ovarian tumors. The study done by Bhuvanesh and Logambal in 1978 showed 44 cases of cystic benign ovarian tumors and 10 cases of solid malignant ovarian tumors which showed concordance.
In our present study, 65% cases were of surface epithelial tumors followed by 25% cases of germ cell tumors. In 1972, study done by Ramachandran et al. showed 65% cases of surface epithelial tumors, 7% cases of sex cord stromal tumors, 25% cases of germ cell tumors which showed much similar findings with our study.
Serous tumors were the most common (31%) tumor in our study which showed concordance with study by Prabhakar and Maingi (32.7%) and Kar et al. (30%). Mucinous tumors comprised of 25% cases and are the second most common of all tumors. Similar findings were reported by Prabhakar and Maingi in 1989 and Gupta et al. in 1989 (25% cases). Teratoma comprised 23% cases and is the third most common group in our study. Similar incidences were reported by Prabhakar and Maingi in 1989 (22.41% cases) and Patil et al. in 1964 (20.4%).
On the basis of their clinical or gross features alone, the majority of ovarian tumors cannot be clearly separated from one another. Therefore, ovarian neoplasm cytological interpretation is both fascinating and difficult. Imprint cytology can be utilized for flow cytometry, cytogenetic research, postoperative follow-up, recurrence detection, staging, and other purposes. Although it has many applications, its use in the diagnosis of ovarian tumors has not received widespread recognition, and there are only a few studies on the identification of ovarian tumors by imprint cytology.
In our study, 148 cases (74%) were selected on which imprint cytology was done. These 148 cases were prospective cases which included mucinous cystadenoma, benign cystic teratoma, serous carcinoma, and endometrioid carcinoma. Gross pathologic features and the relevant clinical data helped analyze the cytology slides. Based on cell preservation, cellularity, pattern, and cell morphology, imprint cytology diagnoses on smears were determined, and the total correlation was then evaluated with histopathology. The study done by Kar et al. in 2005 showed 100% diagnostic accuracy in cases of mucinous cystadenoma and benign cystic teratoma. Our study also showed similar findings.
| Conclusion|| |
In our study, benign ovarian tumors exceeded malignant ovarian tumors in frequency. The majority of the other histomorphological categories of ovarian tumors were surface epithelial tumors. Serous tumors were the most frequent type of individual tumor, followed by mucinous tumors and teratomas. The patients with ovarian tumors ranged in age from 20 to 60 years old. The age group of women who generally had benign tumors was that of fertility, while the age group of women who typically had malignant tumors was that of postmenopausal women. The lump per abdomen was the most typical clinical symptom. Compared to the right ovarian, the left ovary was more involved. Malignant tumors tended to be solid, whereas benign tumors were typically cystic.
Imprint cytology diagnosis for ovarian tumors correlates with histological diagnosis. Thus, our study showed correlation between clinical, gross, and histopathological findings in the respective cases.
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| References|| |
Cho KR, Shih IeM. Ovarian cancer. Annu Rev Pathol 2009;4:287-313.
La Vecchia C. Epidemiology of ovarian cancer: A summary review. Eur J Cancer Prev 2001;10:125-9.
Auersperg N, Wong AS, Choi KC, Kang SK, Leung PC. Ovarian surface epithelium: Biology, endocrinology, and pathology. Endocr Rev 2001;22:255-88.
Maheshwari V, Tyagi SP, Saxena K, Tyagi N, Sharma R, Aziz M, et al.
Surface epithelial tumours of the ovary. Indian J Pathol Microbiol 1994;37:75-85.
Pieretti M, Powell DE, Gallion HH, Case EA, Conway PS, Turker MS. Genetic alterations on chromosome 17 distinguish different types of epithelial ovarian tumors. Hum Pathol 1995;26:393-7.
You W, Dainty LA, Rose GS, Krivak T, McHale MT, Olsen CH, et al.
Gynecologic malignancies in women aged less than 25 years. Obstet Gynecol 2005;105:1405-9.
Goff BA, Mandel L, Muntz HG, Melancon CH. Ovarian carcinoma diagnosis. Cancer 2000;89:2068-75.
Kar T, Kar A, Mohapatra PC. Intra-operative cytology of ovarian carcinoma. J Obstet Gynecol India 2005;55:345-9.
Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer statistics, 2003. CA Cancer J Clin 2003;53:5-26.
Vora S, Bhargava VL. Clinicopathological study of ovarian neoplasms. J Obstet Gynecol India 1969;19:358.
Tyagi SP, Madan A, Mohsin S, Hameed F, Saxena K. Epithelial tumours of the ovary. Indian J Pathol Microbiol 1978;21:281-9.
Prabhakar BR, Maingi K. Ovarian tumours – Prevalence in Punjab. Indian J Pathol Microbiol 1989;32:276-81.
Ramachandran G, Harilal KR, Chinnamma KK, Thanga H. Ovarian neoplasms – A study of 903 cases. J Obstet Gynecol 1972;22:309-15.
Bhattacharya M, Shinde SD, Purandare VN. A clinicopathological analysis of 270 ovarian tumours. J Postgrad Med 1980;26:103-7.
] [Full text]
Bhuvanesh U, Logambal A. A study of ovarian tumors. J Obstet Gynecol India 1978;28:271.
Hassan E, Creatsas G, Deligeorolgou E, Michalas S. Ovarian tumors during childhood and adolescence. A clinicopathological study. Eur J Gynaecol Oncol 1999;20:124-6.
Pilli GS, Suneeta KP, Dhaded AV, Yenni VV. Ovarian tumours: A study of 282 cases. J Indian Med Assoc 2002;100:420, 423-4, 447.
Gupta SC, Singh PA, Mehrotra TN, Agarwal R. A clinico-pathological study of ovarian tumours. Indian J Pathol Microbiol 1986;29:354-62.
Patil PN, Jhala CI, Mathur BB. Pathological study of ovarian tumors. Indian J Cancer 1964;1:36-41.
Bonfiglio TA, Yener SE. Gynecologic Cytology. Philadelphia: Lippincott-Raven; 1997. p. 157-64.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]