{'fraction_non_alphanumeric': 0.03328829382139786, 'fraction_numerical': 0.024567006510256725, 'mean_word_length': 4.964835164835165, 'pattern_counts': {'":': 0, '<': 1, '<?xml version=': 0, '>': 3, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 1, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Study of Ovarian Tumours in a Tertiary Care Hospital

1,2 Junior Resident, 3 Professor & HOD Department of Obstetrics & Gynaecology, Vinayaka Mission`s Research Foundation (DU), Karaikal, Puducherry. *Corresponding Author Dr. Alla Satyanarayana Reddy Professor and HOD, Department of Obstetrics & Gynaecology, Vinayaka Mission`s Medical College and Hospital, Karaikal, Puducherry. 609609, India Email: drallasreddy@yahoo.co.in Abstract Ovarian masses are a common gynaecological problem. Majority of them are non neoplasic or functional cysts, the others which are fewer in number are neoplastic, whether benign or malignant. This is a retrospective study done in the Department of Obstetrics and Gynaecology, Vinayaka Missions Medical College and Hospital, Karaikal, Union Territory of Puducherry in the calender year 2017. All the patients who attended gynaecology OPD and who were diagnosed to have Ovarian masses were included in the study. Out of 8564 patients who attended the Gynaecological OPD, 297 patients had ovarian masses, out of which 96 patients underwent surgery. Based on histopathology report, of the women with neoplastic tumours, 83.3% were benign and 16.7% were malignant.CA 125 is increased (>35 U/mL) in 38% of patients who were operated. The average CA-125 in benign Neoplastic lesions is 17U/mL and the average CA 125 in Neoplastic malignant lesions is 112 U/mL. Commonest malignancy was Serous Cyst adenocarcinoma (81.8%) followed by Mucinous Cyst adenocarcinoma (18%).


Introduction
Of all the Gynaecologic cancers, Ovarian Malignancies represent the greatest clinical challenge because they are relatively inaccessible and becoming symptomatic is late and they have a high mortality. The incidence of Ovarian tumours is increasing in developing countries (1,2) The ovary is complex in its Embryology, Histology, Steroidogenesis and has the potential to develop malignancy. Ovarian  of having ovarian cancer at some point in her life time is 1% to 1.5% and that of dying from ovarian cancer is almost 0.5% (3) The complex histology and the anatomical location of ovary are responsible for the late presentation and its management difficulties. Hence a high index of suspicion is needed. Tumour markers and radiological assistance helps in screening in suspected cases. More than 80% of epithelial ovarian cancers are found in Postmenopausal women. The peak incidence of Invasive epithelial ovarian cancer is at 56-60yrs of age (3,4,5). The age specific incidence of ovarian epithelial cancer rises precipitously from 40 years of age. (5) Ovarian cancer is associated with low parity and infertility (6) . Because parity is inversely related to risk of ovarian cancer, having atleast one child is protective for the disease, with the risk reduction of 0.3-0.4 (6). The performance of a prophylactic Salpingo-Oophorectomy significantly reduces but does not totally eliminate the risk of non uterine pelvic cancers. Peritoneal carcinomas can occur in 2% to 3%of women even after prophylactic bilateral Salpingo-Oophorectomy. (7) Before taking the decision of removing ovaries in premenopausal women undergoing hysterectomy for benign disease, the risks and benefits should be taken into consideration. The ovaries may provide protection from cardiovascular disease and osteoporosis, and longterm mortality may not be decreased by the performance of prophylactic Oophorectomy in women at population risk of ovarian cancer (8) Aim & Objective 1) To evaluate incidence of ovarian masses in the locality. 2) To know the incidence of benign and malignant ovarian tumours.

Material & Methods
The study was conducted in the department of Obstetrics and Gynaecology, Vinayaka Mission`s Medical College and Hospital, Karaikal, Union Territory, Puducherry, in the time period of January 2017 to December 2017. This is a retrospective study. All the women who were clinically diagnosed to have ovarian masses, who were identified to have ovarian masses at ultrasound examination, women who were referred with a diagnosis of ovarian masses, and the women diagnosed to have ovarian masses at laparotomy are the subjects of study. Information was extracted from the records of these women. Data of-history, clinical examination, routine investigations, Ultra sonography, CA 125, medical and surgical management, histopathology, follow up history for a minimum of three months and the results of the treatment were tabulated. The findings were analysed. Standard operating protocols of the OBG department for the management of ovarian masses were followed by every consultant uniformly.
In the women who underwent surgery, the indication for surgery, the type of surgery, the extent of surgery, the results of the surgery, surgical follow up and the histopathologic reports were analysed.

Results
During the one year study period, 8564 women attended the Gynaecology OPD. 297 were identified to have ovarian masses. Ovarian masses constituted 3.4% of the Gynaecological diseases.
Of the ovarian masses 219 were diagnosed as non neoplastic and 78 were diagnosed as neoplastic masses. So, of the ovarian masses, 73.7% were non neoplastic and 26.3% were neoplastic. All the women with non neoplastic ovarian masses were on conservative management. Some were given cyclical hormones. Ovulation induction drugs were discontinued in women who are on infertility management. Others were followed for three months for spontaneous remission of the masses. 24 women with non neoplastic ovarian masses, not responded to conservative methods were taken up for surgery.
All the women with neoplastic tumours were advised surgery. Two women refused surgery and the follow up records of four women were incomplete and so were not included in the analysis. The results of 72 women with operated neoplastic tumours were included in the analysis. The maximum number of patients with non neoplastic cysts belong to 20-29 years age group accounting for 4.1% and in the neoplastic group, maximum patients belong to 30-39 years age group. The percentage of women with neoplastic tumours was double (1.2%) in the >40 years group when compared with women < 40 years(0.6%). The least age of the subjects was 14 years and the maximum age was 88 years. Patients with ovarian pathology present with diverse symptoms. In our study, the most common presenting symptom was abdominal pain (70.3%) followed by pelvic heaviness (36%), abdominal lump (32.6%), GIT symptoms (30.9%), urinary symptoms (9.7%), and 19.5% were asymptomatic.   In our study 219 patients had non neoplastic ovarian pathology. Among them, functional cyst was most common (42.9%). Among the neoplastic lesions, 83.3% were benign and 16.67% were malignant. The most common benign neoplastic ovarian mass was serous cystadenoma (37.5%). In the malignant group, the most common type was serous cyst adenocarcinoma.  (10) In our study, 96 patients underwent surgery for ovarian pathology. Some of the patients with neoplastic ovarian mass were not willing for surgery (2 patients) or were lost to follow-up (4 patients) and so was not operated. The histopathology reports were compared and results were analysed. Out of the study population, 24 patients had ovarian cystic lesion during antenatal period and so was not included in the study. However they were followed up in the postnatal period and regression in the size of the cystic lesion was observed.16 of them was receiving infertility treatment. Four patients had post abortal cystic ovarian masses CA 125 is increased (>35 U/mL) in 38% of patients who were operated. The average CA-125 in benign neoplastic lesions is 17 U/mL and the average CA 125 in neoplastic malignant lesions is 112 U/mL .

Conclusion
Three fourths of the ovarian masses in the reproductive age group are non neoplastic, one fourth are neoplastic. In the neoplastic ovarian tumours one in six is malignant, five out of six are benign. Functional ovarian masses is more in the women with infertility or in women who are on infertility treatments. Cysts in the ovaries are not uncommon in the first trimester of pregnancy or in the postnatal or postabortal period.