Clinico-pathological Evaluation of Residual Ovary Syndrome: A Cross Sectional Study.

The residual ovary syndrome (ROS) occurs in patients where one or both ovaries are conserved at the time of hysterectomy. It occurs mostly within 10 years of hysterectomy. Residual ovary syndrome usually requires surgery and histology varies from some physiological cysts to benign or even malignant neoplasms. The objectives of the study were to analyze the etiopathology of re-operation for ROS and to find out their clinical presentations. This cross-sectional observational study was conducted in the department of Obstetrics and Gynaecology, BSMMU during a period of 5 years from January 2014 to December 2018. All consecutive patients admitted with residual ovary syndrome (ROS) at the department of Obstetrics and Gynaecology and also in Gynae-oncology department at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. Total 40 cases were enrolled according to selection criteria and sampling technique was purposive. The mean age of the study populations was 42.20±7.13 years. All of the study populations were parous except one who was nulliparous. The mean age of hysterectomy was 37.25±6.44 years. The indication of primary surgery by hysterectomy was fibroid in 50% of cases; others were abnormal uterine bleeding, pelvic inflammatory disease etc. After primary surgery majority (77.5%) of the study populations presented with chronic pain with or without dyspareunia and 20% presented with lump in abdomen either symptomatic or asymptomatic. Around half (57.5%) of the patients were presented within 5 years and 82.5% within 10 years of hysterectomy. Per-operative findings of secondary surgery for ROS were mainly extensive peri-ovarian and peritoneal adhesions involving surrounding structures. Among them majority (77.5%) of the cases were presented with various types of cystic and complex masses in the ovaries. Histopathological reports of residual ovary were functional cysts 35.0% (n=14), Corpus luteal cyst 12.5% (n=5), endometriotic cyst 12.5% (n=5), benign ovarian tumours 37.5% (n=15) and malignant ovarian tumour 2.5% (n=1). ROS, usually requires surgery which in most of the cases becomes troublesome due to presence of extensive adhesions with surrounding structures. So, decision is crucial whether to remove or conserve apparently healthy ovaries found at hysterectomy in pre-menopausal women. Moreover decision of hysterectomy in premenopausal women should be taken very judiciously as several medicines are available for conservative management. Usually indications of hysterectomy are benign.

Preoperative Analysis of CA-I25 and its Relation with Histopathological Study in Ovarian Tumours.

Ovarian cancer (OC) is the seventh most common cancer among women in the world. Epithelial OC is the most predominant pathological subtype, with five major histotype. All five subtypes that differ in origination, pathogenesis, molecular alterations, risk factors and prognosis. The clinical presentations of ovarian tumors are variable and not specific. Most of the malignant ovarian tumor seeks medical advice at advanced stage of the disease. At that stage no effective treatment could be possible. There are several researches are going on developing a screening test for ovarian cancer. But there hasn't been much success yet. Clinical examination such as complete pelvic examination together with two investigations is used most often to screen the ovarian cancer. These investigations are transvaginal ultrasound (TVUS) and the blood test CA-125. The measurement of CA-125 level usually in combination with other modalities like bimanual pelvic examination, transvaginal ultrasonography is the proposed modality of early detection of ovarian cancer. The most promising application of this tumor marker is the screening. Therefore this cross sectional and observational study was conducted to observe the relationship of histopathological diagnosis and clinical features with serum CA-125 levels. Study conducted from January 2017 to December 2017 at Sir Salimullah Medical College& Mitford Hospital, Dhaka, Bangladesh. All admitted Gynecological patients having ovarian tumors during study period were included purposively for this study. Sample size was 50. Clinical features and preoperative findings of CA-125 level of these 50 patients were collected. Finally histopathological reports were accumulated after operative treatment. Gastrointestinal & constitutional complain, gynecologic mass and pain in abdomen were the selected symptoms. CA-125 levels were evaluated in relation with histopathological findings. The different findings were correlated with those of studies done at home and abroad. Mean age of the study population was (Mean±SD) 34.25±14.65. Histological findings among the study population showed that benign tumors were 72% (n=36) and malignant tumors were 28% (n=14). In case of benign ovarian tumors among 36 women, 94.4% (n=34) of them showed CA 125 level <35U/ml, other 5.6% (n=2) showed more than normal (>35U/ml) but range was 35-65U/ml. While 14 of the study population having histopathologically proven malignant ovarian tumor, showed the tumor marker level >35U/ml among 71.4% (n=10) and 28.6% (n=4) showed tumor marker <35U/ml. This finding was statistically significant (p=0.001). Histopathological findings revealed that there were significant increases in CA-125 levels in women with malignant serous histotype of serous cyst adenocarcinoma where range of CA-125 level were 2018.88 to 4249.63U/ml. Constitutional symptoms such as weight loss, loss of appetite, symptoms of mass effect such as urinary retention and rapidly progressing tumor were the symptoms of malignant ovarian tumors. Preoperative elevated level of CA-125 is the differentiating points of malignant serous histotype from benign ovarian tumors. This study will put forward some clues about the clinical diagnosis of ovarian tumor which may be utilized for making investigation and management plan. Also it will help for making prompt decision during pre-operative and per-operative procedures.