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Retrospective and prospective histopathological study of tumors and tumor-like lesions of female genital tract.

Introduction

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. [1]

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. [2] 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. [1]

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.

Result

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.

Discussion

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. [7]

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., [8] it was shown that about one-fourth of the ovarian tumors were malignant and the remaining benign. Another study [9] 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. [10] in Iran. Incidence of germ cell tumor was relatively higher in study done by Jha and Karki. [11]

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, [12] it was 4 cases (1.42%) of the total 281 cases. The results in the study by Naik et al. [13] 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 [14] and by Molitor, [12] which were 0.7% and 36%, respectively. High incidence was noted in the studies carried out by Lal and Gupta [15] and by Allahbadia et al., [16] which was 8.57% and 3%, respectively.

Conclusion

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.

References

[1.] National Cancer Registry Program. Consolidated Report of Hospital Based Cancer Registries 2001-3. New Delhi, India: Indian Council of Medical Research, 2007.

[2.] Stewart BW, Kleihues P (Eds.). Cancers of the female reproductive tract. In: World Cancer Report. Lyon, France: IARC Press, 2003.

[3.] Gershenson DM, Luna TG, Malpica A, Baker VV, Whittaker L, Johnson E, et al. Ovarian intraepithelial neoplasia and ovarian cancer. Obstet Gynecol Clin North Am 1996; 23(2):475-543.

[4.] Cramer D. Epidemiologic aspects of gynaecologic oncology unit "A" basic science aspect. In: Gynaecologic Oncology, Chapter 8, Knapp RC, Berkowitz R (Eds.). New York, NY: McGraw-Hill, 1993. pp. 139-50.

[5.] Rajshree, Rushed, Mahantappa S, Pattankar VA. A clinicopathologic study of ovarian tumors. Indian J Pathol Micribiol 1997; 11(2):239.

[6.] Bhattacharya MM, Shinde SD, Purandare VN. A clinicopathological analysis of 270 ovarian tumors. J Postgrad Med 1980; 26(2):103-7.

[7.] Nasreen F. Pattern of gynaecological malignancies in tertiary hospital. J Post Grad Med Inst 2002; 16(2): 215-20.

[8.] Wasim T, Majrroh A, Siddiq S. Comparison of clinical presentation of benign and malignant ovarian tumours. J Pak Med Assoc 2009; 59(1):18-21.

[9.] Sultana A, Hasan S, Siddiqui QA. Ovarian tumors: A five years retrospective study at Abbasi Shaheed Hospital, Karachi. Pak J Surg 2005; 21 (1): 37-40.

[10.] Gilani MM, Behnamfar F, Zamani F, Zamani N. Frequency of different types of ovarian cancer in Valli-e-Asr hospital (Tehran university of medical Sciences) 2001-2003. Pak J Biol Sci 2007; 10(7):3026-8.

[11.] Jha R, Karki S. Histological pattern of ovarian tumors and their age distribution. Nepal Med Coll J 2008; 10(2): 81-5.

[12.] Molitor JJ. Adenomyosis: A clinical and pathological appraisal. Am J Obstet Gynecol 1971;110(2):275-84.

[13.] Naik VS, Rege JD, Jashani KD. Pathology of genital tract in postmenopausal bleeding. Bombay Hosp J 2005; 47(3):10-4.

[14.] Watt WF, Kimbrough RA Jr. Hysterectomy: Analysis of 1000 consecutive operations. Obstet Gynecol 1956; 7(5): 483-93.

[15.] Lal K, Gupta YV. Adenomyosis--A clinical and pathological appraisal. J Obstet Gynecol India 1981; 31:173-6.

[16.] Allahbadia G, Ambiye V, Vaidya P. Study of the vaginal hysterectomy in cases other than done for prolapsed. J Obstet Gynecol Ind 1991; 41(4):543-6.

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: atulshri@ymail.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., [5] Karnataka      67.30        23.71
2       Bhattacharya et al., [6] Bombay     61.60        24.08
3       Gilani et al., [10] Iran            67.10        17.10
4       Jha et al., [11] 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 [12]                 4/281          1.42
2        Naik et al., [13]            10/108         9.61
3        Watt and Kimbrough [14]     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 [12]                  1/281          0.36
2        Watt and Kimbrough, [14]      7/1000         0.7
3        Lal and Gupta [15]             3/35          8.57
4        Allahbadia et al., [16]       3/100          3
5        Our study                     21/565         3.71
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Article Details
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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
Article Type:Report
Date:Nov 1, 2015
Words:1720
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