Histopathological diagnoses of adnexal masses: which parameters are relevant in preoperative assessment?

Histopathological diagnoses of adnexal masses:

which parameters are relevant in preoperative assessment?

Histopatologiczne diagnozy jajnika: które parametry są istotne w ocenie przedoperacyjnej?

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1 Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia

2 Department of Obstetrics and Gynecology, Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia

3 Department of Cellular Pathology, Path Links Pathology Services, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK

4 Center for anesthesiology and resuscitation, Clinical Centre of Serbia, Pasterova 2, Belgrade, Serbia

5 Occupational Health Department, General Health Centre “Savski Venac”, Pasterova 1, Belgrade, Serbia

Abstract

Objective: The aim of the study was to assess which clinical, laboratory and ultrasound characteristics of adnexal masses might predict the histopathological nature of the disease.

Materials and Methods: The study involved all women treated at the Clinic of Gynecology and Obstetrics Cli- nical Centre of Serbia for adnexal tumors between July 1, 2010 and December 31, 2011. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan performed and RMI was calculated for all patients. Data were related to histopathological findings and statistically analyzed.

Results: The study included 540 women out of which 85 had malignant (seven diagnoses), 435 benign (seven diagnoses) and 20 borderline tumors. All types of malignant and borderline tumors were more frequent in postme- nopausal women (p=0.000). Only papillary adenocarcinoma significantly more often produced early metastases (p=0.000). Ascites is a common finding in Krukenberg tumors, granulose cell tumors and papillary adenocarci- nomas. There were significant differences between tumor diagnoses regarding the levels of Ca 125 and CEA, erythrocyte sedimentation rate (ESR) and risk of malignancy index (RMI) (p<0.05). No significant differences were found within the group of malignant tumor types regarding the levels of all examined tumor markers, ESR as well as RMI (p>0.05).

Conclusions: In the light of our results, patient age, menopausal status, blood levels of Ca 125, CEA and ESR, as well as calculated RMI, can predict the nature of adnexal masses. Unfortunately, none of the examined parameters can accurately determine the exact histopathological diagnosis of the adnexal tumor.

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Otrzymano: 15.07.2012 Corresponding author:

Milan M. Terzic

Clinic of Ob/Gyn, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade Dr Koste Todorovica 26, 11000 Belgrade, Serbia

Tel: +381 11 361 5592, Fax: +381 11 361 5603

Introduction

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Streszczenie

Cel: Celem pracy była ocena, które cechy kliniczne, laboratoryjne i ultrasonograficzne guzów jajnika mogą pomóc przewidzieć histopatologiczny charakter choroby.

Materiał i metoda: Badaniem objęto wszystkie kobiety leczone w Klinice Ginekologii i Położnictwa w Centrum Klinicznym w Serbii z powodu guzów przydatków pomiędzy 1 lipca 2010 a 31 grudnia 2011. Przy przyjęciu uzyskano szczegółowe dane anamnestyczne i laboratoryjne, wykonano USG i obliczono RMI (indeks ryzyka złośliwości) dla wszystkich pacjentek. Uzyskane dane były powiązane z wynikami histopatologicznymi nowotworów i poddane analizie statystycznej.

Wyniki: Badaniem objęto 540 kobiet, z których 85 miało złośliwy nowotwór, 435 łagodny i 20 graniczny. Wszystkie rodzaje guzów złośliwych i granicznych były częstsze u kobiet po menopauzie (p=0,000). Tylko gruczolakorak brodawkowaty znacznie częściej dawał wczesne przerzuty (p=0,000). Wodobrzusze jest powszechnym zjawiskiem w nowotworach Krukenberga , guzach typu granulose-cell i w gruczolakoraku brodawkowatym. Nie było istotnych różnic w grupie nowotworów złośliwych dotyczących poziomu CA125 o CEA, szybkości sedymentacji erytrocytów (ESR) i indeksie ryzyka nowotworu złośliwego RMI (p>0,05).

Wnioski: Według naszych wyników, wiek chorych, status menopauzalny, poziom we krwi CA125, CEA i ESR a także obliczone RMI może pomóc przewidzieć charakter guza jajnika. Niestety, ani jeden z badanych parametrów nie może dokładnie określić rozpoznania histopatologicznego guza przydatków.

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Ta b l e I . Distribution of histopathological diagnoses in pre- and postmenopausal patients with adnexal masses.

Diagnosis

1XPEHU Menopausal status

Absolute Relative Pre-

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Benign

Simple ovarian cyst 141 41 101 40

Endometriotic cyst 110  86 24

Hemorrhagic cyst 28 644 20 8

Teratoma 61 1402 47 14

Benign ovarian cystadenoma 58 1 44 14

2varian ¿Erothecoma 29 667 19 10

Other diagnoses 8 182 8 0

Borderline 20 100 7 13

Malignant

Serous adenocarcinoma 23 2706 4 19

0ucinous adenocarcinoma 8 941 2 6

Granulose cell tumor 6 706 0 6

Endometriotic carcinoma 12 1412 6 6

3apillary adenocarcinoma 18 2118 5 13

Krukenberg tumors 7 824 3 4

Other malignant diagnoses 11 1294 4 7

Ta b l e I I . Symptoms in patients with adnexal masses.

Diagnosis

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Present Absent

Benign

Simple ovarian cyst 61 80

Endometriotic cyst 52 58

Hemorrhagic cyst 8 20

Teratoma 32 29

Benign ovarian cystadenoma 32 26

Ovarian ¿brothecoma 14 15

Other diagnoses 5 3

Borderline 12 8

Malignant

Serous adenocarcinoma 9 14

0ucinous adenocarcinoma 5 3

Granulose cell tumor 1 5

Endometriotic carcinoma 7 5

3apillary adenocarcinoma 13 5

Krukenberg tumors 6 1

Other malignant diagnoses 9 2

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Ta b l e I I I . Adnexal masses: diameter, metastases and ascites in various histopathological findings.

Diagnosis

Metastases Ascites 7XPRUGLDPHWHUV

Yes No Yes No FP FP !FP

Benign

Simple ovarian cyst 0 141 14 127 28 84 29

Endometriotic cyst 0 110 10 100 27 68 15

Hemorrhagic cyst 0 28 1 27 7 16 5

Teratoma 0 61 1 60 18 34 9

Benign ovarian cystadenoma 0 58 5 53 15 31 12

Ovarian ¿brothecoma 0 29 5 24 2 22 5

Other diagnoses 0 8 0 8 1 7 0

Borderline 0 20 8 12 2 10 8

Malignant

Serous adenocarcinoma 9 14 14 9 4 15 4

0ucinous adenocarcinoma 3 5 3 5 0 3 5

Granulose cell tumor 2 4 5 1 2 4 0

Endometrioid

carcinoma 5 7 8 4 2 2 8

3apillary adenocarcinoma 10 8 15 3 3 8 7

Krukenberg tumors 7 0 7 0 2 5 0

Other malignant diagnoses 5 6 8 3 1 5 5

Ta b l e I V. Adnexal masses: sonographic characterization.

Diagnosis

Multilocularity Bilaterality

Yes No Yes No

Benign

Simple ovarian cyst 103 38 55 86

Endometriotic cyst 70 40 41 69

Hemorrhagic cyst 18 10 10 18

Teratoma 41 20 23 38

Benign ovarian cystadenoma 40 18 30 28

Ovarian ¿brothecoma 21 8 13 16

Other diagnoses 7 1 3 5

Borderline 16 4 6 14

Malignant

Serous adenocarcinoma 15 8 14 9

0ucinous adenocarcinoma 7 1 1 7

Granulose cell tumor 3 3 1 5

Endometrioid carcinoma 9 3 5 7

3apillary adenocarcinoma 15 3 9 9

Krukenberg tumors 7 0 5 2

Other malignant diagnoses 6 5 3 8

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Discussion

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Ta b l e V. Mean levels of tumor markers, ESR and RMI in various histopathological findings of adnexal masses.

Diagnosis Ca

125 Ca 19.9 CEA Ca 15.3 ESR RMI

Benign

Simple ovarian cyst 6332 2159 196 1940 2106 18257

Endometriotic cyst 7996 2801 172 1956 1759 18522

Hemorrhagic cyst 4197 1754 150 1508 2229 14545

Teratoma 3764 2757 224 2119 1807 11103

Benign ovarian cystadenoma 5347 1856 133 2325 2137 21011

Ovarian ¿brothecoma 3695 3063 164 1633 2555 8548

Other benign diagnoses 6240 711 147 000 900 15812

Borderline 28106 2511 228 1183 2650 170839

Malignant

Serous adenocarcinoma 125553 1066 138 15612 4778 466793

0ucinous adenocarcinoma 5585 37667 1327 1563 3113 37225

Granulose cell tumor 14570 300 020 1200 2983 124268

Endometrioid carcinoma 48773 2401 354 54842 5333 115495

3apillary adenocarcinoma 123493 1560 216 5530 3300 643336

Krukenberg tumors 18543 3646 834 11487 2843 121500

Other malignant diagnoses 210347 2150 1053 9325 4127 929921

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Ta b l e V I . Relationship between discriminating variables and standardized canonical discriminant functions (variables ordered by absolute size of correlation within function).

Discriminant analysis function 1

Examined parameters

Ascites 0.764(*)

Metastases 0.631(*)

Ca19.9 0.009

RMI 0.271

Bilaterality 0.074

US dimensions 0.010

Ca15.3 0.153

Ca125 0.179

Solid parts 0.171

CEA 0.162

Symptoms -0.191

Multilocularity -0.014

Menopause 0.136

ESR 0.212

Functions at group centroids

Serous Adenocarcinoma 2.101 Mucinous Adenocarcinoma 0.670

Endometrioid Ca 2.223

Other malignant diagnoses 3.340

Krukenberg tumors 2.979

Granulose cell tumors 0.604 Papillary adenocarcinoma 1.902 Other benign diagnoses -0.678

Simple ovarian cyst -1.384

Endometriotic cyst -1.035

Hemorrhagic cyst -1.475

Teratoma -1.497

Benign ovarian

cystadenoma -1.336

-1.767

* Largest absolute correlation between each variable and any discriminant function

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