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Download Download HISTOPATHOLOGICAL TYPES OF OVARIAN NEOPLASMS IN UNIVERSITY COLLEGE HOSPITAL, IBADAN BETWEEN JANUARY 1991 AND JUNE 2013 BY DR. MUSTAPHA AKANJI AJANI, MBBS (OGBOMOSO) DEPARTMENT OF PATHOLOGY, UNIVERSITY COLLEGE HOSPITAL, IBADAN [email protected] /08039125255 A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE FELLOWSHIP OF THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA (FMCPath) OCTOBER 2014 i DECLARATION This is to certify that this study titled HISTOPATHOLOGICAL TYPES OF OVARIAN NEOPLASMS IN UNIVERSITY COLLEGE HOSPITAL, IBADAN BETWEEN JANUARY 1991 AND JUNE 2013 was performed by me in the Department of Pathology, University College Hospital, Ibadan. This project has not been submitted to any other College for consideration ----------------------------------- AJANI, MUSTAPHA AKANJI MBBS (OGBOMOSO) ii ATTESTATION This is to certify that we supervised Dr M. A. Ajani in the conduct of the study entitled HISTOPATHOLOGICAL TYPES OF OVARIAN NEOPLASMS IN UNIVERSITY COLLEGE HOSPITAL, IBADAN BETWEEN JANUARY 1991 AND JUNE 2013. ---------------------------------------------- PROFESSOR E. E. U. AKANG MBBS (Ib), FWACP, FMCPath ----------------------------------- DR. C. A. OKOLO MBBS, FMCPath iii DEDICATION This project is dedicated to: the Almighty God, my present help; my late cheerful and kind - hearted mother, Mrs Amudat Ajani (Nee Lasisi). You sold all you had so that I could be educated. You taught me to be diligent in all that I do. Even in death, you will always be loved. iv ACKNOWLEDGEMENT Who am I without Him? My foremost and deepest appreciation goes to Almighty God-my greatest inspiration, who has made this work a possibility. I acknowledge the efforts of my supervisors, Prof EEU Akang and Dr CA Okolo, for their guidance and dedication to this work. My gratitude also goes to my other teachers in the Department of Pathology: Prof JO Ogunbiyi, Dr AO Oluwasola, Dr GO Ogun, Dr AO Adeoye, Dr UO Eze and Dr A Salami for imparting my life. I wish to thank Mr S Ajagboye and Mr SP Otegbade of the Department of Pathology for the technical assistance they rendered with the slides used for this study. I also wish to acknowledge my fellow resident doctors for their support and encouragement. My gratitude goes to my lovely wife, Dr TA Ajani for her support throughout all these years and also to my lovely children; Esther Ajani and Daniel Ajani for their encouragement. v TABLE OF CONTENTS Page TITLE PAGE i DECLARATION ii ATTESTATION iii DEDICATION iv ACKNOWLEDGEMENT v TABLE OF CONTENTS vi–vii LIST OF FIGURES viii–ix LIST OF TABLES x LIST OF APPENDICES xi SUMMARY xii–xiii CHAPTER ONE Introduction 1– 2 Justification 3 Aim and Objectives 4 vi CHAPTER TWO Literature Review 5– 21 CHAPTER THREE Materials and Methods 22– 23 CHAPTER FOUR Results 4.1 General Findings 24–25 4.2 Age 25–26 4.3 Location 26–28 4.4 Specific Ovarian Neoplasms 28 –32 4.5 Childhood Ovarian Neoplasms 33 List of Figures and Tables 34 –63 CHAPTER FIVE Discussion 64–73 Conclusion 74 REFERENCES 75-80 APPENDICES 81- 83 vii LIST OF FIGURES Page Figure 1- Age distribution of Ovarian Neoplasms 34 Figure 2 – Photomicrograph of a case of Mucinous Cystadenoma (X 400) 35 Figure 3 – Photomicrograph of a case of Benign Brenner Tumour (X 400) 36 Figure 4 – Photomicrograph of a case of Borderline Serous Tumour (X 100) 37 Figure 5 – Photomicrograph of a case of Papillary Serous Cystadenocarcinoma showing predominant papillary pattern (X 400) 38 Figure 6- Photomicrograph of a case of Papillary Serous Cystadenocarcinoma showing psammoma bodies (X 400) 39 Figure 7 – Photomicrograph of a case of Mucinous Cystadenocarcinoma (X100) 40 Figure 8 – Photomicrograph of a case of Malignant Brenner Tumour (X400) 41 Figure 9 – Photomicrograph of a case of Mature Cystic Teratoma (X 100) 42 Figure 10 – Photomicrograph of a case of Struma Ovarii (X 100) 43 Figure 11 – Photomicrograph of a case of Choriocarcinoma (X 100) 44 Figure 12 – Photomicrograph of a case of Dysgerminoma (X100) 45 Figure 13 – Photomicrograph of a case of Yolk sac tumour (X 100) 46 Figure 14 – Photomicrograph of a case of Granulosa Cell Tumour (X 400) 47 viii Figure 15 – Photomicrograph of a case of Metastatic Adenocarcinoma (X 400) 48 Figure 16 – Photomicrograph of a case of Burkitt Lymphoma (X400) 49 ix LIST OF TABLES Page Table 1 – Age distribution of 822 patients with primary ovarian neoplasms 50 Table 2 – Age distribution of 46 patients with secondary ovarian neoplasms 51 Table 3 – Age distribution of 516 patients with benign/borderline ovarian neoplasms 52 Table 4 – Age distribution of 352 patients with malignant ovarian neoplasms 53 Table 5 – Correlation between location of ovarian neoplasms and age 54 Table 6 – Frequency of Surface epithelial tumours 55 Table 7 – Frequency of Germ cell tumours 56 Table 8 – Frequency of Sex cord Stromal tumours 57 Table 9 – Frequency of Primary and Secondary ovarian neoplasms 58 Table 10 – Age distribution of Childhood ovarian neoplasms 59 Table 11 – Comparison of distribution of benign, borderline and malignant ovarian neoplasms seen in the present study with other studies 60 Table 12 – Comparison of Histological types seen in the present study with other studies 61 Table13 – Relative frequencies of the eight commonest benign ovarian tumours in the present study compared with other studies 62 Table 14 – Relative frequencies of the eight commonest malignant ovarian tumours in the present study compared with other studies 63 x LIST OF APPENDICES Page Appendix 1 2003 WHO Histological Classification of Tumours of the Ovary 81- 82 Appendix 2 Ethical Approval 83 xi SUMMARY Design- This was a retrospective study carried out at the Department of Pathology, University College Hospital, Ibadan. Aim- The aim of this study was to determine the histopathological pattern of ovarian neoplasms seen at the University College Hospital, Ibadan, Nigeria. Methods- Histologically confirmed cases of ovarian neoplasms diagnosed at the University College Hospital (UCH), Ibadan between January 1991 and June 2013 were used for the study. Cases with inadequate clinical or pathology data and those whose blocks and or slides could notbe retrieved were excluded from the study. Data were obtained from the records of the Department of Pathology. The cases were histologically classified using the 2003 WHO histological classification of tumours of the ovary. The data obtained were subjected to statistical analysis using the Statistical Package for Social Sciences version 20. Results- A total of 868 cases of ovarian neoplasm were included in this study. Five hundred and ten (58.8%) were benign, 351 (40.6%) were malignant and 6 (0.7%) were borderline tumours. Three hundred and sixty-two (41.7%) cases were right sided, 297 (34.2%) were left sided and 209 (24.1%) were bilateral. Eight hundred and twenty-two (94.7%) cases were primary ovarian tumours and 46 (5.3%) constituted the secondary ovarian neoplasms. The age range was from 4 to 92 years with the mean age of 39.2 (S. D = 15.8 years). The peak age of occurrence of ovarian neoplasms was in the fourth decade. Surface epithelial tumours were the most common histological type of ovarian neoplasms constituting 359 (41.4%) closely followed by Germ cell tumours 313 (36.1%). Mature cystic teratoma was the commonest benign ovarian tumour accounting for 279 (32.1%) cases. It showed a wide range of occurrence with peak occurrence xii between 20 and 29 years. Serous cystadenocarcinoma was the commonest malignant ovarian tumour accounting for 117 (13.5%) of all ovarian neoplasms with peak age of occurrence between 50 and 59 years. Conclusion- Surface epithelial tumours were the most common ovarian neoplasm followed by germ cell tumours. This pattern is observed in most parts of Nigeria, some African and Asian countries, and in the Western world. Keywords: Histopathological pattern, ovarian neoplasms, Ibadan, Nigeria xiii CHAPTER ONE 1.1 INTRODUCTION Ovarian tumours are common forms of neoplasms in women. There are many types of ovarian tumours, both benign and malignant. About 80% of ovarian neoplasms are benign, and these occur mostly in young women between the ages of 20 and 45 years. The malignant tumours are more common in older women between the ages of 40 and 65 years.1 Malignant ovarian tumours account for about 30% of female genital cancers. Ovarian carcinoma is the fourth most common female cancer and the fourth leading cause of cancer related deaths in females.2, 3, 4, 5 Ovarian tumours are generally difficult to detect until they are of advanced stage or are large in size. This is primarily due to the fact that symptoms are vague and most cases are asymptomatic and therefore they manifest when advanced. Another reason is the fact that no definite screening program exists.6 The proposed causal relationship between ovarian stimulation and neoplasia is based on three main hypotheses proposed by Fathalla. The first hypothesis suggests that epithelial ovarian carcinoma results from repeated ovulations, where the cumulative effects of each minor trauma on the ovarian epithelium can lead to malignant transformation. This proposes that the risk of ovarian cancer is directly proportional to the number of ovulatory cycles between the menarche and the menopause. The second hypothesis suggests that persistent exposure of the ovary to endogenous or exogenous gonadotrophins or in conjunction with secondarily elevated oestradiol concentrations may be directly carcinogenic. The third hypothesis relates to the production of chemical carcinogens within the local ovarian environment after stimulation with gonadotrophins and oestrogens.6 1 Determination of various histological patterns of ovarian tumours is very important in diagnosis, treatment as well as prognostication of ovarian tumours. Prognosis of the tumours can also be predicted from the degree of differentiation of the tumours. The stage and laterality of the tumour also indicates their nature; for example, tumours in the sex cord stromal category are almost always confined to a single ovary.
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