Clinical management of incidental findings on pelvic adnexal masses / Manejo clínico dos achados incidentais de massas pélvicas anexiais

Summary Due to widespread use of pelvic and transvaginal ultrasound in routine gynecological evaluation, the incidental finding of adnexal masses has led to discussions about management in asymptomatic patients regarding the risk of ovarian cancer. Transvaginal ultrasonography remains the modality of choice in the evaluation of suspicious characteristics. The combined analysis of ultrasound morphological parameters with Doppler study, serum carcinona antigen 125 and investigation of a symptom index may improve diagnosis. Surgical approach should be considered whenever there are suspicious images, rapid growth of cysts, changes in the appearance compared to the initial evaluation or when the patient has symptoms. Future studies on genetic and molecular mechanisms may help explain the pathophysiology of ovarian cancer, improving early diagnosis and treatment.

Resumo Em virtude da ampla utilização da ultrassonografia pélvica e transvaginal na avaliação ginecológica de rotina, o achado incidental de massas anexiais tem ocasionado discussões sobre a conduta em pacientes assintomáticas frente ao risco de desenvolvimento do câncer de ovário. A ultrassonografia transvaginal continua a ser a modalidade de primeira escolha na avaliação de características suspeitas. A análise conjunta de parâmetros morfológicos ultrassonográficos com o estudo Doppler, a pesquisa de CA-125 e a investigação de índice de sintomas pode incrementar as taxas de diagnóstico. Abordagem cirúrgica deve ser considerada sempre que houver alterações em exames de imagem, quando houver crescimento rápido do cisto, mudanças em seu aspecto em relação à avaliação inicial ou quando a paciente apresentar sintomatologia. Uma compreensão melhor de mecanismos genéticos e moleculares pode auxiliar na elucidação da fisiopatologia do câncer ovariano, aprimorando seu diagnóstico e tratamento precoces.

FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum: abridged republication / 부인종양

No abstract available.

Histopathological Study of Ovarian Tumors.

The ovarian tumors show wide variation in the clinical and morphological features. The incidence also varies in different parts of the world. This is a histopathological study of 100 ovarian tumors over a period of 5 years in our institute. The ovarian tumors were classified according to WHO Classification. The aim of this work was to study the incidence and gross and microscopic features of different benign and malignant ovarian tumors. Benign tumors were more common than malignant tumors. Among benign tumors serous cystadenoma (41.89%) was the most common followed by mucinous cystadenoma (29.72%) and mature cystic teratoma (16.21%). Among malignant ovarian tumors, the most common type was serous cystadenocarcinoma (38.46%) followed by dysgerminoma (11.53%) and clear cell carcinoma (11.53%). Majority of the ovarian tumors were surface epithelial tumors (77%) followed by germ cell tumors (16%) and sex cord stromal tumors (6%).

Human telomerase reverse transcriptase expression in ovarian tumors.

Background : Ovarian cancer is the 6 th most common cancer among women. In ovarian tumors, the borderline category is not well defined due to the difficulty in assessing stromal invasion. The World Health Organization (WHO) defined it as tumor that lacks obvious invasion of the stroma with mitotic activity and nuclear abnormalities intermediate between clearly benign and unquestionably malignant. Telomerase is expressed in many human cancers and is hence a potential biomarker for cancer. Immunohistochemical study of anti-human telomerase enzyme reverse transcriptase (hTERT) antibody allows direct visualization of its expression. The aim of this study was to determine the expression of hTERT and serum CA-125 level in ovarian epithelial tumors, and their ability to distinguish borderline tumor from malignancy. Materials and Methods : This was a retrospective study on 68 ovarian epithelial tumors, comprising of 41 cystadenocarcinoma, 22 borderline tumor and five cystadenoma. By immunohistochemistry, hTERT expression was graded as negative (0-10%), focal (11-25%), regional (26-75%) and diffuse (>75%) positivity. Results : hTERT protein expression in ovarian cystadenocarcinoma, borderline tumor and cystadenoma were 71.4%, 59.1% and 0%, respectively. hTERT and CA-125 had a linear relationship with tumor grade and stage. hTERT protein is detected as large granules/speckled in the cytoplasm and nuclei of ovarian tumors. Conclusions : hTERT protein was highly expression in ovarian epithelial carcinoma. However, the difference between carcinoma and borderline tumor was not statistically significant (P-value = 0.51). It is not an independent biomarker to differentiate borderline tumor from malignant tumor. We suggest using the combination of hTERT immunohistochemistry and serum CA-125 to evaluate difficult situations where histological evaluation fails to distinguish malignant from borderline ovarian tumor.

Mucinous Adenocarcinoma Involving the Ovary: Comparative Evaluation of the Classification Algorithms using Tumor Size and Laterality

For intraoperative consultation of mucinous adenocarcinoma involving the ovary, it would be useful to have approaching methods in addition to the traditional limited microscopic findings in order to determine the nature of the tumors. Mucinous adenocarcinomas involving the ovaries were evaluated in 91 cases of metastatic mucinous adenocarcinomas and 19 cases of primary mucinous adenocarcinomas using both an original algorithm (unilateral > or =10 cm tumors were considered primary and unilateral or =15 cm were primary, respectively. The diagnostic algorithm using size and laterality, in addition to clinical history, preoperative image findings, and operative findings, is a useful adjunct tool for differentiation of metastatic mucinous adenocarcinomas from primary mucinous adenocarcinomas of the ovary.

[ prevalence and classification of ovarian tumours in maternity hospital at Damascus university]

This study is retrospective descriptive study organized to find out the prevalence of ovarian cancer in Maternity Hospital at Damascus University, and to clarify the classification of types of this caner in our community. Maternity Hospital at Faculty of Medicine in Damascus University from 1, May, 1996 to 1, May, 2006. 768 patients who met the criteria in that period of time. Any patient admitted to department of oncology in Maternity Hospital at Damascus University with the diagnosis of adnexal mass and then confirmed to have had ovarian tumours histopathologically. Ovarian cancer is the second gynecologic tumour affecting women after cervical cancer in our hospital. 570 [74.22%] patients had benign ovarian tumours. 189 [24.61%] patients had malignant ovarian tumours. 9 [1.17%] patients had borderline ovarian tumours. 613 [79.8%] patients had epithelial ovarian tumours. 120 [15.6%] patients had germinal-cell ovarian tumours. 26 [3.4%] patients had sex cell ovarian tumours. 9 [1.17%] patients had metastases of other cancers to the ovaries

Cararcterização fenotípica dos tumores mucinosos do ovário / Phenotype characterization of the mucinous ovarian tumors

Os tumores mucinosos primários de ovário são classificados como benignos, borderline e malignos, com diferentes fenótipos, recentemente designados como gastrointestinal e seromucinoso. O propósito desse estudo retrospectivo foi analisar os diferentes padrões morfológicos de apresentação dos tumores mucinosos ovarianos e sua associação com o potencial de malignidade e perfil imunoistoquímico. Marcação imunoistoquímica para produtos de gene de mucina (MUC1, MUC2, MUC5AC e MUC6), RE, RP, CK7, CK20, CA19.9 e CA125 foram realizados em tissue microarrays. Os resultados sugerem que os fenótipos pilórico e intestinal puros são diferentes em relação ao potencial de malignidade e perfil imunoistoquímico. Provavelmente os tumores borderline de padrão intestinal, mesmo aqueles sem pseudomixoma peritoneal associado, devem ser considerados como tumores secundários, muitos destes com origem em apêndice cecal...

Primary mucinous ovarian tumors are classified as benign, borderline and malignant, with different phenotypes, recently called as gastrointestinal and seromucinous. The purpose of this retrospective study was to analyze the different morphological patterns of presentation of mucinous ovarian tumors and their association with malignant potential and immunohistochemical profile. Immunohistochemical staining for mucin gene product (MUC1, MUC2, MUC5AC and MUC6), ER, PR, CK7, CK20, CA19.9 and CA125 were performed in tissue microarrays. The results suggest that the pure pyloric and intestinal phenotypes differ regarding malignant potential and immunoprofile. Probably most intestinal borderline tumors, even those without pseudomixoma peritonei, should be considered as secondary tumor, most of them with appendiceal oring...

Características clínicas e histopatológicas de tumores de ovario en ginecología HEODRA en el período de agosto 2003-diciembre 2005 / Clinical characteristics and histopatológicas of ovary tumors in gynecology HEODRA in the period of August 2003-December 2005

El presente trabajo sobre, características clínicas e histopatológicas de tumores de ovario en ginecología del Hospital "Oscar Danilo Rosales Argüello", León en el período de agosto 2003-diciembre 2005 es un trabajo de tipo descriptivo de serie de casos, donde se tomó como universo 68 pacientes, que ingresaron al servicio de Ginecología con diagnóstico de tumor de ovario, donde de acuerdo a los grupos étareos el más afectado fue de 40-49 años representando el 33.82 porciento, en los cuales se encontro inicio de vida sexual activa en menores de 19 años 89.69 porciento e irregularidades menstruales en el 64.70 porciento. Los signos y síntomas fueron dolor en fosa ilíaca 58.82 porciento, irregularidad menstrual 64.70 porciento, dispareunia 61.76 porciento y menos frecuencia dismenorrea y presencia de masas. Las característricas clínicas de tumores de ovario al examen pélvico más frecuentemente encontradas fueron unilaterales de consistencia quística 83.82 porciento, móviles 69.11 porciento y con un tamaño menor de 5cm, en un 54.41 porciento. El principal método de diagnóstico fue ultrasonido pélvico, seguido de radiografía simple de abdomen y CA 125, con un menor porcentaje de exámenes complementarios como Pielograma intravenoso y Rectosigmoidocospia. Según los hallazgos histopalógicos de total de paciente con tumores de ovario funcionales, predominaron los quistes foliculares para el 69.81 porciento, Cistoadenoma seroso 24.55 porciento de predominio unilateral y tumores benignos bilaterales como quiste foliculares 46.66 porciento y teratoma madural 20 porciento.

Ovarian germ cell tumors in childhood and adolescents: Review 20 years of Pathology Center of Imam Reza Hospital of Mashhad

The aim of this study is evaluation of clinical and histopathologic characteristics of patients with orarian germ cell tumors. In this descriptive retrospective study we analysed 40 records of patients [<20 years] with ovarian germ cell tumor. The patients admitted and operated upon in Imam Reza Hospital Mashhad from March 1981 to March 2001 [20 year period] Archival slides of all tumors were reviewed and tumors were classified according to the WHO system. All of our patients were under 20 years with median age of 15.3 years, and the youngest was 13 month old. The prevalence of germ cell tumors [GCT] was 50.2% [40/79] of all ovarian neoplasms. From 40 patients with GCT, 26 cases [65%] were benign and 14 [35%] were malignant. Mature cystic teratoma was the commonest neoplasm [26 patients]. Of 14 children with malignant GCT 9 [22.5%] had pure dysgerminoma, 3 [7.5%] had endodermal sinus tumor, and two [5%] had mixd malignant G.C.T. Unilateral involvment was seen in 38 cases [51.7% in right and 41.3% in left] and bilateral in-two. Weight range of neoplastic ovarian lesion, were 15 [in endodermal sinus tumor] to 4200 gram [in mature treatoma]. Tumoral torsion accounted for 2.5% [1 case] of our patients. Germ cell tumors are the most common ovarian neoplasms seen in the pediatric and adolescent age groups. Mature cystic teratoma and dysgerminoma are respectivly the most common benign and malignant G.C.T. Most patients with malignant ovarian germ cell tumor are in their reproductive years and wish to preserve fertility

Clinical manifestations of benign ovarian tumours

To examine the cases of Benign Ovarian Tumours and their clinical manifestations. Prospective study of consecutive cases of Ovarian tumours, identified using gynaecological case records. Tertiary care teaching hospital affiliated with Fatima Jinnah Medical College Lahore, managing more than 1500 gynaecological cases annually. 50 cases of Ovarian tumours managed in Department of Gynaecology and Obstetrics Sir Ganga Ram Hospital, Lahore between 1st May 2004 to 1st May 2005. The most common presenting complaints were abdominal pain or discomfort and palpable tumour causing abdominal distension. Abdominal pain was present in 70% of benign ovarian tumours. 20% of the patients had pain due to torsion of ovarian cyst. The complaint of a palpable tumour was found in 4 7% of cases. Vague abdominal and bowel complaints were present in 2 2.5% of cases. 6[15%] patients were asymptomatic. Of these 2 were diagnosed by ultrasound and 3 at the time of emergency Cesarean section and one on routine pelvic examination. Menstrual irregularity and urinary complaints were present in a small number of patients. None of the patient complaint of weight loss or post menopausal bleeding. Benign Ovarian Tumours are most common cause of ovarian enlargement and a very common cause of hospital admission. Symptoms and signs are non specific and presentation is a late stage

Clinicopathological analysis of ovarian tumours

To study the relative frequency and histological pattern of ovarian tumours in various age groups. The study was carried out in the Histopathology department, AFIP Rawalpindi from Jan 2002 to Jun 2003 One hundred and ninety four specimens of ovarian tumours were received in Histopathology department, AFIP Rawalpindi. All the surgical specimens were fixed in 10% formalin and routinely processed. The sections were then cut and stained with Haematoxylin and Eosin. The histological typing of ovarian tumours was done according to WHO classification of 2003. The main bulk comprised surface epithelial tumours [73%]. Among them, 107 [75.33%] were benign neoplasms and 35 [24.09%] were malignant. There were 40 [21%] germ cell tumours, 10 [5%] sex cord stromal tumours and 2 [1%] metastatic tumours. The benign category comprised 88 cases of serous cystadenoma, 34 cases of mature cystic teratomas and 19 mucinous cystadenomas. In the malignant group, there were 15 serous cystadenocarcinomas, 10 endometrioid carcinomas, 7 mucinous cystadenocarcinomas, 2 yolk sac tumours and 2 cases of granulosa cell tumour. Benign tumours were mostly diagnosed in 3rd and 4th decades of life, whereas malignant tumours were seen after 40 years, with exception of malignant germ cell tumours, which were mostly found in younger age groups. There were minor differences from local studies. The overall frequency of various tumour groups was very similar to that in the west with some difference in tumour types

Eficácia do tratamento quimioterápico para tumores de células germinativas de ovário com preservação da fertilidade. Relato de um caso e revisão de literatura / The efficacy of chemotherapy in the treatment of germ cell tumors of the ovary with preservation of fertility. Case report and literature's review

As neoplasias malignas de ovário representam a principal causa de mortalidade por câncer no sexo feminino. Asneoplasias de células germinativas constituem 15 a 20 das neoplasias de ovário, dos quais o disgerminoma é oprincipal representante. O objetivo do presente estudo foi relatar um caso de disgerminoma em uma mulher jovemcom infertilidade e revisar a literatura sobre a eficácia da quimioterapia como método de tratamento de tumores decélulas germinativas de ovário possibilitando a preservação da fertilidade. RELATO DO CASO: Paciente de 27 anos com infertilidade há 4 anos. Procurou uma clínica de Reprodução Humana em Curitiba. Negava antecedentes mórbidos pregressos. Menarca aos 14 anos, ciclos menstruais irregulares, com duração de 4 a 5 dias em quantidade II ( 3 a 5 absorventes por dia ). GIAI, curetagem em 28/07/2000. Não apresentava nenhuma alteração ao exame ginecológico. A ecografia pélvica evidenciou um cisto de retenção ovariano. Foi encaminhada à videolaparoscopia e à ooforectomia unilateral. O AP evidenciou um disgerminoma. A paciente foi submetida a 3 ciclos de quimioterapia com bleomicina, etoposide, cisplatina. Cinco meses depois apresentou BHCG+. Concluiu-se que a quimioterapia é uma opção eficaz no tratamento dos tumores de células germinativas, contudo, maiores estudos são necessários para a escolha de um esquema cada vez mais seguro, com menos efeitos colaterais e preservação da fertilidade

Fine needle aspiration biopsy of ovarian neoplasm.

Twenty cases of ovarian neoplasm (12 non-coelomic and 8 coelomic and 8 epithelial tumors) have been subjected to fine needle aspiration biopsy (FNAB). FNAB yielded adequate material in all those cases and it was possible to accurately classify the tumors in 16 cases (80%). In eight cases of non coelomic epithelial neoplasms preoperative cytological diagnosis helped in conservative surgery. Cytological features of different groups of ovarian tumors are to some extent characteristic. FNAB is a relatively safe and reliable diagnostic procedure.

Neoplasias malignas del ovario diagnósticados en el departamento de patología en el período de enero 1996 a diciembre 1999

El presente estudio es descriptivo, retrospectivo, de corte transversal, serie de casos en el que revisaron los Tumores Malignos del Ovario diagnosticados en el Departamento de patología del Hospital Escuela Oscar Danilo Rosales Argüello (HEODRA) en el período enero 1996 a diciembre 1999. Se encontraron 25 casos de Neoplasias malignas de Ovario y el mayor número estaba en los grupos de 31-45, 46-60 y mayores de 60 años con 24 porciento respectivamente, el grupo de 15 años o menos tuvo el menor número con 12 porciento. En relación a la sintomatología el dolor abdominal, mas abdominal o pélvica y sensación de peso en bajo vientre fueron los más comunes con 76 , 68 y 48 porciento respectivamente. El dolor lumbar, las dismenorrea y dispareunia se presentó sólo en el 4 porciento de los casos. Los antecedentes gineco-obstétrico reflejan que el 60 porciento de pacientes tienen cuatro partos o más y sólo el 20 porciento refirió haber usado gestágenos orales. Los procedimientos quirúrgicos efectuados fueron en orden descentes de frecuencia, Panhistectomía y biopsia de correderas parietocólicas 24 porciento, Histerectomía y Salpingoforectomía y cuña de ovario contralateral 20 porciento. La salpingooforectomía unilateral y muestra peritoneal sólo se efectuó en un 4 porciento. La clasificación histopatológica de las neoplasias malignas de ovario fue la siguiente: tumores derivados del epitelio de superficie con 40 porciento, tumores de células germinales 28 porciento, tumores del estroma y cordones sexuales 20 porciento tumores metastásicos 12 porciento. Los tumores mas comunes fueron los carcinomas serosos 22 porciento con 55 años tumores de células granulosas 23 porciento con 53 años y teratoma maligno 13.5 porciento con 24 años, los más raros fueron Tumor de Brenner, carcinoma indiferenciado y carcinoma mucinoso con 4.5 porciento. Los únicos casos diagnosticados en menores de 15 años con tumores de células germinales. Los estadíos clínicos de las neoplasias malignas primarias reflejan que el 64 porciento de casos estaban entre los estadíos II-IV al momento de la cirugía de esta un 18 porciento ya se encontraba en estadío IV

Borderline epithelial tumours of the ovary--a retrospective analysis of 31 cases.

Thirty one cases of epithelial borderline tumours of the ovary recorded over a period of six years were reviewed. The incidence of borderline tumours was 6% in relation to ovarian epithelial malignancies, with serous and mucinous types comprising three fourth of the lesions. The serous tumours were bilateral in 39%, revealed surface growth in 17% and had peritoneal implants in 11% of cases. The mucinous tumours were bilateral in 11% and had associated pseudomyxoma peritonei in 22% of cases. Nuclear grade appeared to correlate with extraovarian spread and surface growth in the serous borderline tumours, but not in the mucinous borderline tumours. The endometrioid borderline tumours and mixed epithelial borderline tumours were rare lesions. Twenty one patients (68%) presented in Stage-la. Surface growth correlated with recurrences. The prognosis remained good in serous borderline tumours even in the presence of implants as these were non-invasive. The mean disease free survival was 43.03 months. There was no statistical difference in disease free survival of patients with and without implants.

Cáncer epitelial del ovario / Ephitelial carcinoma of the ovary

Son cuatro los factores de riesgo más importantes para el cáncer de ovario: antecedentes de infertilidad, menor cantidad de hijos, ingesta alta de grasas de origen animal y la transmisión hereditaria. Es bien conocido que en los últimos 30 años se han logrado avances muy pobres en la supervivencia de pacientes con cáncer de ovario y se debe principalmente a que no existe un buen método de pesquisa y, por ende, se diagnóstica en etapas avanzadas. En el caso de un tumor anexial, para decidir si se efectúa la cirugía se deben tomar en cuenta los siguientes factores: edad y paridad, pre o posmenopáusica, tamaño del tumor, bilateralidad y ascitis, presencia o no de síntomas, características del ultrasonido y cuantificación del antígeno Ca125. La cirugía juega un papel muy importante, tanto desde el punto de vista diagnóstico como terapéutico; es así que a esta cirugía se le conoce como laparotomía etapificadora y citorreductora y el resultado de ésta sigue siendo el factor pronóstico más importante hasta la fecha. La segunda laparotomía ha quedado confinada únicamente a protocolos de investigación

Utilización de un índice clínico-ecográfico para la clasificación de los tumores de ovario

Diseñar un método que seleccione con cierta confiabilidad entre tumores benignos y malignos, de estos últimos poder seleccionar cuales verdaderamente requieren otros exámenes complementarios o de extensión