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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109
Volume 15, Issue 3, July 2015 pp 631-637
Gynaecological pelvic masses: A clinicopathological study
Lavanya Anuranjani1, Alka Patil2
1Sr. Resident, 2Professor and HOD, Department of Obstetrics and Gynecology, ACPM Medical College, Dhule, Maharashtra, INDIA.
Introduction: Mass arising from female genital tract includes anatomical lesions of the Uterine Corpus and Cervix, Ovaries, Fallopian Tubes, Vagina and Vulva. Amongst them the Adnexal region is composed of Ovary, Fallopian Tube, Broad Ligament and its associated blood and nerve supply. The kaleidoscopic diagnosis of pelvic lump is also contributed by the various non-gynaecological sources like those arising from Bladder, Ureter, Rectum, Colon and their blood vessels and nerves in the pelvis which make the diagnosis of pelvic lump operose. Aims and Objective: To study the clinic-pathological spectrum of gynaecological pelvic masses and correlating them with final histopathological diagnosis. Materials and Method: The present study was conducted at department of Obstetrics and Gynaecology of ACPM medical college, Dhule during the period of June 2013 to October 2014. Total 100 cases of fulfilling the inclusion criteria were enrolled in the present study. A detailed history of presenting complaints and associated symptoms were noted along with menstrual history. A thorough general and systemic examination was performed. Examination assessed the presence or absence of mass (upon P/A, P/Sp or P/V). During bimanual examination the position, size, shape, mobility and tenderness of uterus and uterine appendages was noted. Rectal examination was performed in patients suspected with malignancy. A clinical diagnosis was put forth based on the symptomatology, Per abdomen, Per speculum and Per vaginum findings for the presenting condition. After surgical treatment all specimens were submitted for detailed Histopathological examination. The final diagnosis was concluded based on Histopathological Diagnosis. The comparison of various pelvic lumps was done with Histopathological Diagnosis which was taken as Gold Standard. Finally, the clinical diagnosis was analyzed as regards to their true positivity, false positivity and false negativity by correlating them with final histopathological diagnosis. Results: It was observed that out of the 100 cases, clinical examination suggested 76% masses were of uterine origin. While 24% were adnexal masses. Among them 48% were fibroid, 19% adenomyosis, 16% tubo-ovarian mass, 5% polyp, 3% Pyometra and 1% carcinoma cervix. Histopathological diagnosis was taken as final diagnosis. HPE reports found that the most common mass was fibroid (53%). Other masses were Adenomyosis (11%), Chocolate cyst 3%, Polyp (13%) out of which endometrial polyps were 9%, cervical were 4%. Pyometra was 3%, Hydrosalpinx 3%, Benign ovarian tumors were 15%, Cancer Cervix was 2%, Malignant ovarian mass was 1% and Endosalpingiosis was 1%. Clinical diagnostic sensitivity was high for cases of fibroid (73.5%), pyometra (100%) but was low in cases of adenomyosis (54.55%), ovarian lesions (43.75%) and polyp (38.46%). Conclusion: Uterine leiomyoma was the most common gynaecological pelvic mass encountered in the present study. Overall clinical diagnostic accuracy was found to be 62%. The sensitivity of clinical diagnosis was more for uterine lesion as compared to adenexal and ovarian lesion.