RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE
AND ADDRESS / : / Dr.ANUBHA ADITYA.
PG IN PATHOLOGY ,
DEPARTMENT OF PATHOLOGY,
MYSOREMEDICALCOLLEGE
AND RESEARCH INSTITUTE
MYSORE – 570001
2. / NAME OF THE INSTITUTION / : / MYSOREMEDICALCOLLEGE
AND RESEARCH INSTITUTE, MYSORE
3. / COURSE OF STUDY AND SUBJECT / : / M. D. PATHOLOGY.
4. / DATE OF ADMISSION TO COURSE / : / 31.05. 2011
5. / TITLE OF THE TOPIC / : / CLINICOPATHOLOGICAL STUDY OF OVARIAN NEOPLASMS –A PROSPECTIVE STUDY.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY

Cancer of the ovary represents about 30% of all the cancers of the female genital organs.1It is the fifth leading cause of death among cancer deaths in females.4

Ovarian tumors behave in diverse way and generally escape detection, which is related to the ovaries’ position within the peritoneal cavity, resulting in minimal local irritation or interference with the vital structures. Although presentation is often vague and non specific, symptoms are definitely present.3Abdominal pain and distension, urinary and gastrointestinal symptoms due to tumor invasion and vaginal bleeding are the most common presentation.4

No age group is safe from these tumors; different tumors tending to involve different age groups preferentially like benign tumors occur more commonly in younger women and malignant tumors are more common in older women.4

Early diagnosis of ovarian cancer is a challenge and crucial in decreasing morbidity and mortality. Ultimately it is the histological examination of biopsy material that determines the diagnosis, prognosis and behavior of the neoplasm. The WHO classification of ovarian tumors is proposed which reveals the morphology and reflects the embryogenesis of this complex organ.1

This study is intended to be carried out with the aim to determine various histological and morphological variants of ovarian tumor, their age distribution and clinical presentation.

6.2 REVIEW OF LITERATURE

Ovarian neoplasms have become increasingly important not only because of the large variety of neoplastic entities but more because they have gradually increased the mortality rate due to female genital cancers.2

Although some of the specific tumors have distinctive features and are hormonally active, most are nonfunctional and tend to produce relatively mild symptoms until they reach a large size.4The study in Lahore by Wasim et al showed that abdominal enlargement and abdominal mass were significantly more in malignant tumors than benign but constitutional symptoms like loss of appetite and weight loss were only present in malignant group.3Bhattacharya et al found that ascites was present in about 50% of all malignant neoplasms and one sixth of benign tumors.5

Determination of various histological patterns is very important in the diagnosis as well as prognosis of ovarian tumors as studied by Yasmin et al.6 Studies have shown surface epithelial tumors are the commonest ovarian tumors followed by germ cell tumors, sex cord-stromal tumors and metastatic tumors.2,6Swamy et al found that most common benign tumor was serous cystadenoma followed by mature cystic teratoma.2 The histological subdivision of surface epithelial tumors into benign, borderline and carcinomatous forms is clinically most important because it correlates well with prognosis.7

Jagannath et al in their study found that germ cell tumors mainly affect young women, so surgery should be conservative even in the presence of extra-ovarian disease as these tumors are often curable with chemotherapy.8Among mixed germ cell tumors all components and their approximate proportions should be mentioned in the diagnosis as therapeutic regimens should be based on the most malignant elements of the tumor.1

Sex cord-stromal tumors present with overt endocrine manifestations that may be either feminizing or masculinizing. In sertoli leydig cell tumor presence of hetrogenous mesenchymal elements is associated with poor survival of 12.5%7.Histipathological evidence of number of mitotic figures and nuclear atypia differentiates a fibroma from fibrosarcoma and also suggests increased risk of metastasis in lutenized thecoma.1

Krukenberg tumors refer to metastatic mucinous/signet ring cell adenocarcinoma of ovary which typically originate from primary tumors of gastrointestinal tract & occurs in approximately 30% of women dying of cancer. They often represent late disseminated stage, prognosis is, therefore poor.1

6.3OBJECTIVE OF THE STUDY

  1. To study the various histomorphological pattern of ovarian tumors.
  2. To study the age distributions.
  3. To study the various modes of clinical presentations.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA:

Surgically resected ovarian neoplasms sent for histopathological examination to the Department of Pathology, from Cheluvamba Hospital attached to Mysore Medical College and Research Institute.

7.2METHOD OF COLLECTION OF DATA

All the ovarian specimens received in the Department of Pathology for histopathological examination over a period of 18 months will be taken up along with clinical details. An approximate of 80 samples will be studied. Received specimen will be studied thoroughly first on gross examination. Then the representative and surrounding areas will be processed for microscopic study. The tissue sections obtained from the paraffin blocks will be stained with Haematoxylin and Eosin stain and then examined. Special stains like PAS, Von Gieson, Gomori’s reticulin stain will be done whenever required.

Inclusion Criteria:

Ovarian lesions including both benign and malignant neoplasm will be included in the study.

Exclusion Criteria:

Inflammatory, non-neoplastic, gestational-related and developmental disorders of ovary are excluded.

7.3Does the study required any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

No

7.4Has ethical clearance been obtained from your institution in case of 7.3?

Yes (Copy Enclosed)

7.5 Duration of study:18 months (30thNovember 2011 to 31st May 2013)

8. LIST OF REFERENCES

  1. Tavassoli FA, Deville P. World Health Organisation classification of tumors. pathology and genetics of tumors of breast and female genital organs. Lyon: IARC Press; 2003.pp 113-202.
  2. Swamy GG, Satyanarayana N. Clinicopathological analysis of ovarian tumors-A study on five years samples. Nepal Med Coll J 2010;12(4):221-3.
  3. Wasim T, Majrroah A, Siddiq S. Comparison of benign and malignant ovarian tumors. J Pak Med Assoc 2009;59(1):18-21.
  4. Crum CP, Female Genital tract.In:Robins and Cotran Pathologic Basis of Disease.Kumar V, Abbas AK, Fausto N, Aster JC, Eds.8th ed. In:. Philadelphia: Elsevier; 2010.pp 1005-63.
  5. Bhattacharya MM, Shinde SD, Purandare VN. A clinicopathological analysis of 270 ovarian tumors. J Postgrad Med 1980;26(2):103-7.
  6. Yasmin S,Yasmin A, Mohammad A. Clinicohistological pattern of ovarian tumors in Peshwar region. J Ayub Med Coll Abottabad 2008;20(4):11-13.
  7. Jaime Prat. Pathology of the Ovary: Philadelphia. Saunders;2004.pp 83-84.
  8. Jagannath JB, Ashok SM. Ovarian germ cell tumor: a 3 years study. J Obstet Gynecol India 2005;55(1):61-63.

9. / Signatureofthe candidate / : / (Dr. ANUBHA ADITYA)
10. / Remarks of the guide / :
11. / Name and designation of
11.1 Guide / : / Dr. K. SHILPA.M.D.
ASSOCIATE PROFESSOR
DEPARTMENT OF PATHOLOGY,
MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, MYSORE.
11.2 Signature of the Guide / :
11.3 Head of the Department / : / DR.A.L. HEMALATHA.M.D., D.C.P
PROFESSOR AND HEAD,
D DEPARTMENT OF PATHOLOGY,
MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, MYSORE.
/

11.4 Signature of the Head

of theDepartment

/ :
12. / REMARKS
/ 12.1 Remarks of the Dean
and Director / :
12.2 Signature / :

ETHICAL COMMITTEE CLEARANCE

1. / TITLE OF THE DISSERTATION / : / “CLINICOPATHOLOGICAL STUDY OF OVARIAN NEOPLASMS -A PROSPECTIVE STUDY.”
2. / NAME OF THE CANDIDATE / : / Dr. ANUBHA ADITYA
3. / SUBJECT / : / M. D. PATHOLOGY
4. / NAME OF THE GUIDE / : / Dr. K. SHILPA.M.D.,
ASSOCIATE PROFESSOR,
DEPARTMENT OF PATHOLOGY,
MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, MYSORE.
5. / APPROVED/NOTAPPROVED / :
MEDICAL SUPERINTENDENT
K.R.Hospital, MMC & RI,
Mysore. / MEDICAL SUPERINTENDENT
Cheluvamba Hospital, MMC & RI,
Mysore.
PROFESSOR AND HOD
Department of Medicine,
K.R.Hospital, MMC & RI,
Mysore. / PROFESSOR AND HOD
Department of Surgery,
K.R.Hospital, MMC & RI,
Mysore.
MEDICAL SUPERINTENDENT
PKTBHospital, MMC & RI,
Mysore. / LAW EXPERT

DEAN AND DIRECTOR

MysoreMedicalCollege and Research Institute, Mysore.

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