Clinicopathological Analysis of 358 Ovarian Tumors from a Sub-Saharan African Country

Abstract

Introduction: Ovarian tumors are classified into 4 main groups: epithelial tumors, germ cell tumors (GCT), sex cord-stromal tumors (SCST) and metastatic tumors. Their clinicopathological features and biological behavior vary largely across age groups and World regions. Methods: We retrospectively collected 358 cases of ovarian tumors diagnosed at our Pathology service in a tertiary care hospital (February 2020 – March 2024). We performed statistical comparison between clinical and histopathological groups (Student’s t -test, Fisher exact and chi-square tests). We also performed logistic regression analysis to identify clinicopathological factors associated with malignancy in ovarian tumors (using odds ratio (OR) and 95% confidence interval (CI)). Results: The mean age was 37.1 years ± 15.9 (range of 4– 81 years), with 38 cases (10.7%) from pediatric patients. Epithelial tumors and GCT were the most frequent tumors representing 52% and 34.6%, respectively. The majority of ovarian tumors were benign (283 cases, 79.1%) with 72 ovarian cancers (20.1%), representing 41.1% of all gynecological tract malignancies diagnosed at our department. Patients with adnexal torsions were younger than those without torsion and had larger cystic, left-sided tumors ( p < 0.05), irrespective of biological behavior ( p ˃0.05). Ovarian cancer was often found in older and post-menopausal women (mean ages of 48.35± 16.56 years versus 34.2± 14.40 years; 58.8% versus 15.7%; p < 0.001). Ovarian malignant tumors were more often larger and heterogenous with mixed macroscopic aspect (mean size of 17.73± 11.46 versus 13.40± 8.71 cm; p =0.006; 56.9% versus 9.9%; p < 0.001). The epithelial histological differentiation (OR = 5.08, 95% CI = 2.12– 12.17, p < 0.001) and the solid/mixed gross feature (OR = 36.93, 95% CI =14.91– 91.47, p < 0.001) were significantly associated with tumor malignancy. Conclusion: We found that the clinicopathological features of ovarian tumors vary widely according to age groups, macroscopic aspects and histological differentiation. Ovarian cancer is often found in post-menopausal women with larger and heterogenous tumors compared to patients with benign tumors. Keywords: ovarian tumors, histopathology, Niger, sub-Saharan Africa