Ovarian lesions encompass a spectrum of Benign conditions, including infectious, non infectious inflammatory, non-neoplastic and vascular entities. Infectious lesions arise from various sources, such as Bacterial (Actinomycosis, Tuberculosis, Leprosy, Syphilis), Viral (cytomegalovirus), Parasitic (Schistosomiasis, Enterobius vermicularis), and fungal. Non-infectious inflammatory lesions are typically granulomatous like Foreign body granuloma, necrobiotic granuloma and granulomas secondary to systemic diseases. Non neoplastic lesions of the follicular and stromal elements include Solitary follicle cysts and corpus luteum cysts, Ovarian Hyperstimulation Syndrome, Polycystic Ovarian Syndrome, Stromal Hyperplasia and Stromal Hyperthecosis, Leydig cell Hyperplasia. Vascular lesions encompass a range of abnormalities like Ovarian Vein Thrombophlebitis, Ovarian Hemorrhage, Ovarian Torsion and Infarction¹.

Cystic follicles are very common in the ovary. Functional cysts differ from neoplastic cysts in being usually of size 6-8 cm, asymptomatic, regress spontaneously and are unilocular containing clear fluid. These are frequently seen in young females in their 2nd decades due to failure of ovulation. Ovarian cysts are usually present with pain or discomfort in the lower abdomen. Cyst rupture may lead to peritoneal signs, abdominal distention. Polycystic ovarian syndrome also known as Stein Leventhal syndrome, affects 6% to 10% of reproductive age group women worldwide. Association with obesity, type 2 diabetes and premature atherosclerosis is there.²

Ovarian tumors that present in the reproductive age group are mostly benign while about 30% in the postmenopausal age group are malignant³. Ovarian cancer comprises up to 8.7% of cancers in different parts of India.^4-5 Ovarian cancer accounts for 3% of all cancers in females in the United States. Ovarian cancer is the fifth most common malignancy among women and second most common gynecologic malignancy. It is the most common cause of death due to malignancy of female genital tract. Ovarian malignancies constitute about 4% of the total cancers in females and 25% of malignant tumors of the female genital tract. In India, the ovary is next in importance to cervix as the seat of cancer of female genital system⁶.

The purpose of the study was to analyse the spectrum of ovarian lesions in a tertiary care center and to categorise histomorphological patterns as inflammatory, non neoplastic and neoplastic (benign, borderline and malignant).

AIMS AND OBJECTIVES

To analyse the spectrum of ovarian lesions and to categorize them on the basis of histopathological patterns, and the frequency of non malignant (benign) and malignant neoplasms, examining their age distribution and comparing findings with similar studies.

MATERIALS AND METHODS

This prospective cross-sectional study was conducted at the Department of Pathology, JLN Medical College, Ajmer from January 2024 to December 2024, analyzing 200 resected ovarian specimens and hysterectomy with adnexa specimens received for histopathological examination. Specimens were excluded if they were small biopsies (insufficient for diagnosis) or not well fixed in formalin (compromising tissue integrity).

Data were systematically recorded, including patient age, gender, registration number, histopathology number, type of surgery (ovarian resection or hysterectomy with adnexectomy) and gross features of the resected specimen (size, shape, color, consistency, and any notable abnormalities). All surgical pathology specimens underwent routine processing: tissues were fixed, embedded in paraffin blocks and serially sectioned at 3–5 micron thickness using a rotary microtome. Slides were stained with conventional Haematoxylin and Eosin (H&E) for microscopic evaluation, and special stains were applied selectively when required. The stained slides were then mounted with DPX (Di-styrene Plasticizer Xylene) and reviewed under a microscope to determine the histopathological diagnosis, ensuring accurate categorization of ovarian lesions.

Descriptive and Inferential statistical analysis has been carried out in the present study using computer software (IBM SPSS version 23). The qualitative data were expressed in number and percentages and the quantitative data expressed as mean and standard deviations. Association were analyzed by using chi-square test. Significance level for tests was determined as 95% (P< 0.05).

RESULTS

TABLE 1 : Age distribution and Complaints

TABLE 2 : Ovarian Lesions

TABLE 3 :   Microscopic Diagnosis (Non-Neoplastic)

TABLE 4 : Microscopic Diagnosis (Neoplastic)

DISCUSSION

The age-wise distribution of ovarian lesions in the present study aligns with existing literature, highlighting a predominant occurrence in the 41–60 years age group (52%), consistent with Mohan S et al. (2019)⁷, who reported a similar peak (51.32%). In contrast, Yasmeen QS et al. (2023)² reported a younger cohort, with 52.28% cases under 20 years, possibly reflecting regional or genetic variations, as this age group is typically associated with functional cysts rather than neoplasms. Ahmad N et al. (2019)⁸ observed a peak in the 21–40 years group (55.50%), indicating variability in age patterns across studies, which may correlate with differing etiological factors

The 61–80 years age group accounted for 6% of cases in the present study, comparable to Yasmeen QS et al. (2023)² (6.06%) but higher than Ahmad N et al. (2019)⁸ (3.50%), underscoring the risk of malignancy in elderly women While the present study mirrors trends from Mohan S et al. (2019)⁷, differences with Yasmeen QS et al. (2023)² suggest geographic or demographic influences on ovarian pathology, warranting larger multicentric analyses to establish regional patterns and optimize early detection protocols. (Table 1)

The present study found that benign ovarian tumors were most common (70.71%), followed by malignant (23.23%) and borderline (6.06%) tumors, consistent with the trend observed in other studies. Mohan S et al. (2019)⁷ Patel PK et al. (2020)⁹, and Gaikwad SL et al. (2020)¹⁰ reported higher benign rates (82.29%, 85.72%, and 88.10%, respectively), However, the present study’s lower benign proportion (70.71%) and higher malignant rate (23.23%) align more closely with Shringi P et al. (2023)¹¹ (19.51% malignant), indicating possible variations in referral bias, genetic factors, or late presentation in symptomatic cases.

The malignant proportion in the present study (23.23%) is higher than most studies (Mohan S et al.: 12.50%, Gaikwad SL et al.¹⁰: 9.50%) but lower than Hathila R et al. (2020)¹² (33.30%), highlighting heterogeneity in study populations or diagnostic settings (tertiary care vs. community). The borderline tumors were relatively low across studies (2.4–6.06%), including the present study (6.06%), reflecting their rarity but clinical importance, as they require close follow-up due to malignant potential. (Table 2)

Microscopic Diagnosis (Non-Neoplastic Lesions)

The present study found serous cystadenoma as the most common benign neoplastic lesion (26.26%), followed by mature cystic teratoma (18.18%), mucinous cystadenoma (14.14%), fibroma (4.04%), and borderline mucinous tumor (2.02%), aligning with trends from other studies. Mohan S et al. (2019)⁷ and Gaikwad SL et al¹⁰. (2020) also reported serous cystadenoma as predominant (43.75% and 35.70%, respectively), reflecting its frequent occurrence, likely due to its association with surface epithelial origin and hormonal influences. Mature cystic teratoma (18.18%) was the second most common in the present study, consistent with Patel PA et al. (2020)⁹ (33.92%) and Parmar RA et al. (2021) (19.00%)¹³, highlighting its prevalence in reproductive-age women. The distribution of mucinous cystadenoma (14.14%) was comparable across studies (14.28–29.68%), indicating its common benign nature. Fibroma (4.04%) and borderline mucinous tumor (2.02%) were less frequent, consistent with their rarity. Variations between studies may stem from genetic, geographic, or age-related factors, as ovarian neoplasms show regional heterogeneity.               (Table 3)

Microscopic Diagnosis (Neoplastic Lesions)

The present study observed simple serous cyst as the most common non-neoplastic ovarian lesion (12.96%), followed by follicular cyst (5.32%), haemorrhagic cyst (3.99%), endometriosis (3.32%), and corpus luteum cyst (1.66%), indicating a predominance of functional cysts. This pattern contrasts with Ahmad N et al. (2019)⁸, where corpus luteum cyst (24.50%) and endometriosis (19.80%) were more prevalent, and Patel PA et al. (2020)⁹, who reported a higher incidence of simple serous cyst (38.88%) and endometriosis (27.77%). The low incidence of corpus luteum cyst (1.66%) and endometriosis (3.32%) in the present study compared to others suggests possible underreporting or differences in diagnostic thresholds. Follicular cysts (5.32%) were consistent across studies (5.55–5.60%), indicating their common occurrence as transient, self-limiting lesions. (Table 4)

CONCLUSION:

This study underscores the diverse spectrum of ovarian lesions, highlighting a notable predominance of non-neoplastic lesions over neoplastic ones. Most cases occurred in the middle reproductive age group, with pain and menstrual irregularities being key presenting symptoms. Benign tumors, particularly serous cystadenoma and mature cystic teratoma, were the most common neoplastic findings, while functional cystic changes dominated the non-neoplastic category. The majority of neoplastic lesions were benign, emphasizing the importance of histopathological evaluation to differentiate these from potentially malignant tumors, especially in symptomatic women. Further research is warranted to explore regional variations and risk factors influencing ovarian pathology, ultimately guiding early detection and tailored management strategies. Histopathological examination remains the gold standard for accurate diagnosis and prognostication of ovarian tumors, enabling effective management and improved patient outcomes particularly in high-risk age groups.

ACKNOWLEDGEMENT

The authors wish to acknowledge the Department of Pathology, JLN Medical College Ajmer for its support and opportunity. The authors also wish to acknowledge Dr. Shailendra Vashistha (Assistant Professor, Transplant Immunology – HLA Lab, Department of IHTM, GMC, Kota) and the VAssist Research team (www.thevassist.com) for their contribution in journal selection and manuscript submission process.

Conflict of interest: None

Source of funding: Nil

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