CLINICOPATHOLOGIC FEATURES OF PROBABLY MALIGNANT ADNEXAL MASSES WITHOUT SIGNS OF ASCITES AND CARCINOMATOSIS

Abstract

Objective: Our objective was to assess the patients who have probable early stage ovarian cancer. Materal and Method: Between 2010-2018, 208 patients with isolated adnexal masses who underwent surgery due to presumed malignancy were analyzed. We excluded patients with radiologic evidence of ascites and tumour implants. Results: According to the final pathology reports, 52 (25%) of 208 patients had benign tumours, 46 (22%) were borderline, and 110 (53%) patients’ tumours were malignant. The most unexpected benign tumours were serous cystadenofibroma. Of the malignant tumours, 3 were uterine sarcomas, 8 were metastatic ovarian tumours (all gastrointestinal origin), and 99 were primary ovarian cancers. Seventy-six of 99 primary ovarian cancers were epithelial and 23 were nonepithelial. The most common histologic types were respectively serous and endometrioid adenocarcinoma. Seventy-six percent of primary ovarian cancers were early stage (stage 1-2) and 24% were advanced stage (stage 3-4). Conclusion: Patients with a suspicious adnexal mass, even if ascites or carcinomatosis are not existing, have a high rate of malignancy and should be managed considering this risk.

Keywords

• Adnexal mass
• ovarian cancer
• malignancy

ASİT VE KARSİNOMATOZİS BULGUSU OLMAYAN YÜKSEK OLASILIKLA MALİGN ADNEKSİYEL KİTLELERİN KLİNİK VE PATOLOJİK ÖZELLİKLERİ

Abstract

Amaç: Amacımız muhtemelen malign adneksiyel kitlesi olan hastaları değerlendirmektir. Gereç ve Yöntem: 2010-2018 yılları arasında salt adneksiyal kitlesi olan ve malignite riski nedeniyle ameliyat yapılan 208 hastanın medikal verileri incelendi. Radyolojik olarak asit ve tümöral implant bulgusu olan hastalar çalışma dışı bırakıldı. Bulgular: Nihai patoloji raporlarına göre 208 hastanın 52'si (%25) benign, 46'sı (%22) borderline ve 110'u (%53) malign idi. En beklenmedik benign tümör seröz kistadenofibrom idi. Malign tümörlerin 3'ü uterin sarkom, 8'i metastatik over kanseri (tümü gastrointestinal kaynaklı), 99'u primer over kanseri idi. Doksan dokuz primer over kanserinin 76'sı epitelyal, 23'ü nonepitelyal idi. En sık görülen histolojik tipler sırasıyla, seröz ve endometrioid adenokarsinom idi. Primer over kanserlerinin %76'sı erken evrede (evre 1-2), %24'ü ileri evrede (evre 3-4) idi. Sonuç: Şüpheli adneksiyal kitlesi olan hastalarda, asit veya karsinomatosiz bulgusu olmasa bile, yüksek malignite riski mevcuttur ve bu risk göz önünde bulundurularak yönetilmelidir.

Keywords

• Adneksiyal kitle
• over kanseri
• malignite

References

1. 1. Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2015, National Cancer Institute.
2. 2. Van Calster B, Van Hoorde K, Valentin L, Testa AC, Fischerova D, Van Holsbeke C, Savelli L, Franchi D, Epstein E, Kaijser J, Van Belle V, Czekierdowski A, Guerriero S, Fruscio R, Lanzani C, Scala F, Bourne T, Timmerman D, International Ovarian Tumour Analysis Group Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ. 2014;349:g5920. [CrossRef]
3. 3. Bristow RE, Berek JS. Surgery for ovarian cancer: how to improve survival. Lancet 2006;367:1558–60. [CrossRef]
4. 4. Greving JP, Vernooij F, Heintz APM, van der Graaf Y, Buskens E. Is centralization of ovarian cancer care warranted? A cost‐effectiveness analysis Gynecol Oncol 2009;113:68–74. [CrossRef]
5. 5. Vergote I, De Brabanter J, Fyles A, Bertelsen K, Einhorn N, Sevelda P, et al. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet 2001;357:176–82. [CrossRef]
6. 6. Demir RH, Marchand GJ. Adnexal Masses Suspected to Be Benign Treated with Laparoscopy. JSLS. 2012;16(1):71–84. [CrossRef]
7. 7. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins— Gynecology. Gynecologists’ Committee on Practice, Practice Bulletin No. 174: evaluation and management of adnexal masses. Obstet Gynecol 2016;128:e210–26. [CrossRef]
8. 8. National Institutes of Health Consensus Development Conference Statement. Ovarian cancer: screening, treatment, and follow-up. Gynecol Oncol 1994; 55:S4. [CrossRef]

9. 9. McDonald JM, Doran S, DeSimone CP, Ueland FR, DePriest PD, Ware RA, Saunders BA, Pavlik EJ, Goodrich S, Kryscio RJ, van Nagell JR Jr. Predicting risk of malignancy in adnexal masses. Obstet Gynecol. 2010 Apr;115(4):687-94. [CrossRef]
10. 10. Heintz AP, Odicino F, Maisonneuve P, et al. Carcinoma of the fallopian tube. Int J Gynaecol Obstet 2006; 95:S145 [CrossRef]
11. 11. Dodge JE, Covens AL, Lacchetti C, et al. Management of a suspicious adnexal mass: a clinical practice guideline. Curr Oncol 2012;19:E244–57. [CrossRef]
12. 12. Engelen MJ, Kos HE, Willemse PH, Aalders JG, de Vries EG, Schaapveld M, et al. Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma. Cancer 2006;106:589-98. [CrossRef]
13. 13. U.S. Food and Drug Administration. OVA1 Next Generation. 510(k) substantial equivalence determination decision summary. Silver Spring (MD): FDA; 2016. Available at: http://www.accessdata.fda.gov/cdrh_ docs/reviews/ K150588.pdf. Retrieved June 24, 2016.
14. 14. U.S. Food and Drug Administration. ROMATM (HE4 EIA + Architect CA125 10TM). 510(k) summary. Silver Spring (MD): FDA; 2011. Available at: http:// www.accessdata.fda.gov/ cdrh_docs/pdf10/K103358.pdf. Retrieved June 24, 2016
15. 15. Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guideline No. 34. The Management of Ovarian Cysts in Postmenopausal Women. July 2016
16. 16. Kaijser J, Sayasneh A, Van Hoorde K, Ghaem-Maghami S, Bourne T, Timmerman D, et al. Presurgical diagnosis of adnexal tumours using mathematical models and scoring systems: a systematic review and meta-analysis. Hum Reprod Update 2014;20:449–62. [CrossRef]
17. 17. Malla VG, Tuteja A, Singh P. Rethinking the Role of Serum Cancer Antigen 125 and Risk of Malignancy Index in Indian Women with Ovarian Masses: Newer Perspectives and Review of Literature. Journal of SAFOG 2018;10(2):110-117. [CrossRef]
18. 18. Chilla B, Hauser N, Singer G, Trippel M, Froehlich JM, Kubik- Huch RA. Indeterminate adnexal masses at ultrasound: effect of MRI imaging findings on diagnostic thinking and therapeutic decisions. Eur Radiol. 2011;21(6):1301–10. [CrossRef]
19. 19. Iglesias DA, Ramirez PT. Role of minimally invasive surgery in staging of ovarian cancer. Curr Treat Options Oncol. 2011 Sep;12(3):217-29. [CrossRef]
20. 20. Schorge JO, Eisenhauer EE, Chi DS. Current surgical management of ovarian cancer. Hematol Oncol Clin North Am. 2012 Feb;26(1):93-109. [CrossRef]
21. 21. Morice P, Camatte S, Larregain-Fournier D, Thoury A, Duvillard P, Castaigne D. Port-site implantation after laparoscopic treatment of borderlineovarian tumours. Obstet Gynecol. 2004;104(5 Pt 2):1167-70. [CrossRef]
22. 22. Timmerman D, Testa AC, Bourne T, Ameye L, Jurkovic D, Van Holsbeke C, et al. Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol. 2008;31:681-90. [CrossRef]
23. 23. Timmerman D, Van Calster B, Testa A, Savelli L, Fischerova D, Froyman W, et al. Predicting the risk of malignancy in adnexal masses based on the simple rules from the international ovarian tumour analysis group. Am J Obstet Gynecol. 2016;214:424–37