Retrospective and prospective histopathological study of tumors and tumor-like lesions of female genital tract.
Cancer is one of the major public health issues with the incidence of more than 800,000 new cases every year in India. The estimation reveals that of the 2.5 million cases reported in the country, approximately 400,000 deaths are caused by cancer. Indian women reveal greater prevalence of female genital tract and breast cancers. 
The female genital tract includes the ovaries, fallopian tubes, uterus (body/corpus and cervix), vagina, and vulva. Cervical cancer is one of the leading cancers in women worldwide, second only to breast cancer; 80% of new cases occur in developing countries.  In India, the data obtained from the population-based registries under the National Cancer Registry Program show that the four organs, namely, cervix uteri, breast, corpus uteri, and ovaries, are the most affected organs (about 50%-60%), of all types of cancers among women. 
Several studies were done in the previous years for the incidence and prevalence of various types of tumors in the female genital tract. [3-6] We also undertook this study to better understand the problem burden in our region.
Materials and Methods
This study was carried out in the Department of Pathology of CU Shah Medical College Hospital of Saurashtra region. The specimens were received from both Obstetrics and Gynecology and Surgery Departments of the college; some specimens were received from private hospitals, various talukas, and nearby district referral hospitals of this region.
The study period included 3 years (January 2010 to December 2013). A total of 565 specimens were received during the study period. All the available records of this period in the Department of Pathology were studied. The various types of specimen included were from procedures such as panhysterectomy, hysterectomy, oophorectomy, cystectomy, endometrial biopsy, and dilation and curettage (D&C) and cervical biopsy materials. These specimens were fixed by immersing in 10% formalin. After that, a gross examination was done, and sections from representative areas were taken for histopathological diagnosis. The sections were processed by serial alcohol dehydration. Paraffin blocks were prepared; sections were taken on slides, stained with hematoxylin and eosin, and mounted using a mixture of distyrene, a plasticizer, and xylene (DPX). Lesions were classified according to the WHO classification for tumor and tumor-like lesions of the female genital tract.
Prior approval for this study was taken from our institutional ethical committee. The statistical analysis was done by using SPSS software, version 8.
During the study period, a total of 565 specimens were received from the Obstetrics and Gynecology and Surgery Departments. Our observations are mentioned in Tables 1-6.
Table 1 shows the age-wise distribution of patients, which ranged from 16 to 80 years. The maximum number of patients [210 (37.17%)] was in the age group of 41 to 50 years.
In this study, of the total 565 specimens, the maximum number of cases were benign [355 (62.83%)], followed by 126 (22.31%) tumor-like lesions, 79 (13.98%) malignant cases, and 5 (0.88%) cases with borderline malignant potential [Table 2]. Age distribution of lesions according to their nature (benign and malignant) is given in Table 3.
Tables 4-6 show the comparison of findings of various studies with our study. Observations were discussed to fulfill the aims and objectives of this work done.
Tumors of the female genital tract along with other surgical specimens from gynecological operation theatres create the biggest burden of biopsy reporting at the Department of Pathology. The female genital tract comprises a complex structure with respect to embryology, histology, and the potential for malignancy. Majority of the tumors (>90%) are benign, but the malignant tumors are on the rise with the passage of time. 
The reported incidence of different types of tumor varies widely. The comparisons of various studies on female genital tract tumor conducted by several authors in India and abroad are presented in Tables 4-6.
According to a recent study by Wasim et al.,  it was shown that about one-fourth of the ovarian tumors were malignant and the remaining benign. Another study  showed that, of the total ovarian lesion, only one-fifth were malignant. Table 4 showed that surface epithelial tumors were the highest, followed by germ cell tumor, sex cord stromal tumor, and metastatic tumors. Incidence of metastatic tumor of the ovary was relatively higher in this study and in the study carried out by Gilani et al.  in Iran. Incidence of germ cell tumor was relatively higher in study done by Jha and Karki. 
In this study, Table 5 shows that the incidence of carcinoma of endometrium was 0.88% (5 cases of the total 565 cases). In the study by Molitor,  it was 4 cases (1.42%) of the total 281 cases. The results in the study by Naik et al.  showed 10 cases (9.61%) of the total 108 cases.
The incidence of carcinoma of cervix in this study was 3.71 % [Table 6]. Low incidence was noted in the studies carried out by Watt and Kimbrough  and by Molitor,  which were 0.7% and 36%, respectively. High incidence was noted in the studies carried out by Lal and Gupta  and by Allahbadia et al.,  which was 8.57% and 3%, respectively.
Benign tumors are the most common tumor of the female genital tract, and malignant tumors are on the rise with age. Most of the tumors occur in the age group of 31-50 years. This burden can be reduced by implementing screening method of female genital tract such as Papanicolaou (Pap) smear study at timely interval in case of cervical cancer.
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Source of Support: Nil, Conflict of Interest: None declared.
(1) Department of Pathology, CU Shah Medical College, Surendranagar, Gujarat, India.
Correspondence to: Atul Shrivastav, E-mail: email@example.com
Received February 27, 2015. Accepted July 16, 2015.
Table 1: Distribution according to age in study group S no. Age in years No. of cases Percentage 1 10-20 10 1.77 2 21-30 77 13.63 3 31-40 195 34.51 4 41-50 210 37.17 5 51-60 60 10.62 6 61-70 6 1.06 7 [greater than or equal to]]71 7 1.24 Total 565 100 Table 2: Histopathological typing of tumors female genital tract S. no. Tumor type No. of cases Percentage 1 Benign 355 62.83 2 Borderline 5 0.88 3 Malignant 79 13.98 4 Tumor-like lesions 126 22.31 Total 565 100 Table 3: Distribution of benign, malignant, and tumor-like lesions in various age group S. no. Age in years Benign Malignant Tumor-like lesions 1 10-20 3 1 6 2 21-30 53 7 17 3 31-40 112 32 51 4 41-50 141 27 37 5 51-60 40 10 10 6 61-70 3 2 1 7 [greater than 3 -- 4 or equal to]71 Table 4: Comparison of different pathology of ovary by various authors S no. Study Surface Germ cell epithelial tumor (%) tumor (%) 1 Rajshree et al.,  Karnataka 67.30 23.71 2 Bhattacharya et al.,  Bombay 61.60 24.08 3 Gilani et al.,  Iran 67.10 17.10 4 Jha et al.,  Nepal 52.20 42.20 5 Our study 50.98 31.37 S no. Sex-cord Metastatic stromal tumor tumors (%) (%) 1 8.33 0.64 2 6.8 -- 3 9.20 6.60 4 3.10 2.50 5 11.76 5.89 Table 5: Comparison of percentage distribution of endometrial carcinoma in other studies with this study S. no. Study No. of cases Percentage 1 Molitor  4/281 1.42 2 Naik et al.,  10/108 9.61 3 Watt and Kimbrough  3/1,000 0.30 4 Our study 5/565 0.88 Table 6: Comparison of percentage distribution of carcinoma of cervix in other studies with this study S. no. Study No. of cases Percentage 1 Molitor  1/281 0.36 2 Watt and Kimbrough,  7/1000 0.7 3 Lal and Gupta  3/35 8.57 4 Allahbadia et al.,  3/100 3 5 Our study 21/565 3.71
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|Title Annotation:||Research Article|
|Author:||Dalsaniya, Miral; Choksi, Tejas S.; Shrivastav, Atul; Agnihotri, Ashok S.|
|Publication:||International Journal of Medical Science and Public Health|
|Date:||Nov 1, 2015|
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