# Clinicopathological Analysis of Ovarian Neoplasms at a Tertiary Care Teaching Institute of North Malabar: A Four-Year Retrospective Study

## TL;DR

This study analyzed 455 ovarian tumor cases over four years, finding that most were benign, with serous cystadenomas being the most common, while malignant tumors like serous carcinoma were rare but serious.

## Contribution

The study provides a detailed clinicopathological analysis of ovarian neoplasms in the North Malabar region, highlighting local trends in tumor types and patient demographics.

## Key findings

- Serous cystadenomas were the most common benign ovarian tumors (45.7% of cases).
- Mature cystic teratomas were the second most common benign tumors (17.6% of cases).
- Serous carcinoma was the most frequent malignant tumor, but it occurred in only 3.3% of cases.

## Abstract

Background

Ovarian neoplasms represent a significant risk to women's health worldwide. Approximately 90% of ovarian neoplasms are of epithelial origin, representing the predominant category and comprising many subtypes, such as mucinous and serous. The incidence of ovarian cancer increases with age. Serous carcinoma, the predominant ovarian cancer observed in older individuals, is associated with a poor prognosis. A precise histopathological diagnosis is essential for successful management and therapy planning, as the histological subtype influences treatment modalities and prognostic outcomes.

Aim

This study aimed to determine the clinical symptomatology, age distribution, tumor laterality, gross appearance, and histopathological spectrum of ovarian tumors.

Materials and methods

This retrospective study was conducted at a tertiary care center in the Malabar region of North Kerala. All ovarian neoplasms received in the department of pathology as part of the diagnostic work-up from September 2019 to September 2023 were taken for analysis. Gross and microscopic features of resection specimens, along with relevant clinical data, were reviewed and analyzed from previous records. The ovarian neoplasms were categorized according to the latest WHO classification.

Results

The total sample size for ovarian neoplasms was 455. The age range was from 11 to 80 years. The predominant presenting complaint was abdominal pain (28%, n=128), followed by pelvic discomfort (16%, n=75). Surface epithelial ovarian tumors represented the predominant histological subtype with 329 (72%) cases, while the germ cell tumor category comprised 84 (19%) cases, followed by sex cord-stromal tumors with 24 (5%), mixed ovarian tumors with 11 (2%), and miscellaneous tumors with 7 (2%) cases. The majority of tumors in the surface epithelial (n=329) category were benign cystadenomas/cystadenofibromas, with 291 (88.4%) cases, while borderline and malignant epithelial tumors constituted 9 (2.8%) and 29 (8.8%) cases, respectively. The most common benign ovarian neoplasm was serous cystadenoma, with 208 (45.7%) cases, followed by mature cystic teratoma with 80 (17.6%) cases. The most common malignant tumor was serous carcinoma, with 15 (3.3%) cases. Metastasis of the ovary was seen in four cases, one of which was a bilateral ovarian metastasis from a uterine endometrial stromal sarcoma. We also encountered a rare case of small cell carcinoma of the ovary in a 26-year-old woman.

Conclusion

Ovarian tumors encompass a wide spectrum of neoplasms ranging from benign to highly malignant lesions, presenting significant diagnostic and management challenges. While benign tumors like serous cystadenomas often cause minimal morbidity and are readily treated surgically, malignant ovarian tumors, including high-grade serous carcinoma, are associated with a grave prognosis due to their often delayed diagnosis and aggressive nature. Early detection remains paramount to reducing the high morbidity and mortality associated with ovarian malignancies.