Histomorphological Study of Ovarian Lesions with Emphasis on Rare Entities- A Descriptive Study

Introduction: The ovaries are bilateral organs on either side of the uterus. Non neoplastic and neoplastic lesions occur in all age groups and can present with similar clinical and radiological features. Histopathology remains the gold standard for diagnosing and categorising these lesions. Aim: To study the prevalence of ovarian lesions in relation to age and clinical findings. Neoplastic lesions will be histologically classified as per World Health Organisation guidelines. Findings in this study will be compared with that in other studies. Materials and Methods: This is an observational study of all ovarian lesions undertaken in the Department of pathology in NRI Institute of Medical Sciences, Sangivalasa, Vishakhapatnam, Andhra Pradesh, India, from June 2018 to November 2021. Specimens were received as ovarian masses alone, or in combination with hysterectomy with either unilateral or bilateral salpingo- oophorectomy. Relevant clinical information was obtained from the records. The tissues were processed by using an automatic tissue processor, paraffin blocks were made and sections cut were stained with Haematoxylin and Eosin(H&E) and examined under the microscope. The lesions were categorised as non neoplastic and neoplastic. The neoplastic lesions were classified according to the latest 2020 World Health Organisation (WHO) guidelines. Incidence of various lesions was expressed in percentage. Results: A total of 119 specimens were studied. Some of the specimens had bilateral ovaries and the second ovary had a different nonneoplastic lesion in 18 cases. 80 (60.60%) were nonneoplastic lesions and 52 (39.39%) were neoplastic lesions. 5 cases of torsion could not be classified into neoplastic or non-neoplastic due to lack of viable histological features. Non neoplastic lesions were more common in the 31-50 years age group. Benign neoplasms were common in 41-50 years age group. Malignant tumours were more common in the perimenopausal and postmenopausal age group. The most common non neoplastic lesion were 39 cases (48.75%) of follicular cyst followed by 26 cases (32.5%) of corpus luteal cyst, 13 cases (16.25%) of cystic follicles and 2 cases (2.5%) of endometriotic lesions. Of the neoplastic lesions, 47 cases (90.38%) were benign, 2 cases (3.84%) were borderline and 3 cases (5.76%) were malignant tumours. Surface epithelial tumours were 42 cases (80.76%), followed by 6 cases (11.53%) of germ cell tumours and 4 cases (7.69%) of sex cord stromal tumours. Conclusion: Non neoplastic lesions and neoplastic lesions present with similar clinical and radiologic picture and must be differentiated histopathologically. Non neoplastic lesions were more common in the present study. Among the neoplasms, benign tumours were more common and surface epithelial tumours were more common than any other category. Torsion ovary, Seromucinous cystadenoma, atypical endometrioid tumor and granulosa cell tumor were some rare entities that were encountered in the study. Classifying tumours helps in better patient management.