Ovarian mass - Large Biopsy 3-6 cm

Biopsy

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Histopathology of ovarian lesions.

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Ovarian Mass - Large Biopsy 3-6 cm

Why is it done?
- To obtain tissue samples from ovarian masses measuring 3-6 cm for histopathological diagnosis and differentiation between benign and malignant lesions
- To determine the specific type and grade of ovarian tumors when imaging findings are inconclusive or suspicious for malignancy
- To guide treatment planning and prognosis in patients with known or suspected ovarian neoplasms
- To evaluate for recurrent ovarian disease or metastatic lesions in patients with history of ovarian cancer
- Typically performed when transvaginal or transabdominal ultrasound, CT, or MRI shows a suspicious or indeterminate ovarian mass in the 3-6 cm size range
- Often performed when tumor markers (CA-125, HE4) are elevated or clinical presentation suggests malignancy
Normal Range
- Normal (Benign) Results: Histology consistent with benign ovarian pathology such as cystadenoma, mature cystic teratoma (dermoid cyst), fibroma, thecoma, or simple cyst with no atypical or malignant features
- Abnormal (Malignant) Results: Histology demonstrating epithelial ovarian cancer (serous, mucinous, endometrioid, clear cell, or high-grade serous carcinoma), germ cell tumors, sex cord-stromal tumors with malignant features, or metastatic disease
- Borderline/Atypical Results: Borderline ovarian tumors (BOT) or ovarian tumors of low malignant potential (LMP) showing atypical cellular features but limited stromal invasion
- Reporting Parameters: Diagnosis (histological type), grade if applicable, presence/absence of invasion, mitotic rate, and recommendations for staging or additional treatment
Interpretation
- Benign Diagnoses: Confirmation of benign pathology allows reassurance to patient, potential observation without chemotherapy, and normal follow-up imaging intervals. Cystadenomas and fibromas typically do not require further treatment.
- Early-Stage Epithelial Ovarian Cancer (EOC): Diagnosis of malignancy necessitates complete surgical staging (total abdominal hysterectomy, bilateral salpingo-oophorectomy, lymph node dissection, omentectomy) followed by platinum-based chemotherapy. Prognosis depends on histologic grade, stage, and tumor biology.
- High-Grade Serous Carcinoma (HGSC): Most aggressive epithelial ovarian cancer requiring immediate surgical cytoreduction and platinum-taxane chemotherapy. Genetic testing (BRCA1/2) recommended for treatment planning and prognostication.
- Low-Grade Serous/Mucinous Carcinoma: Generally more indolent course but still requires surgical staging and may benefit from chemotherapy depending on stage and patient factors.
- Borderline Ovarian Tumors: May be managed conservatively with surgery alone if completely excised and confined to ovary (Stage Ia). Chemotherapy decisions require consideration of age, stage, grade, and patient preference.
- Germ Cell Tumors: Dysgerminomas and yolk sac tumors typically respond well to BEP chemotherapy (bleomycin, etoposide, cisplatin) with excellent cure rates, particularly in young women. Fertility-sparing surgery often possible.
- Sex Cord-Stromal Tumors: Granulosa cell tumors may present with hormonal symptoms and generally have favorable prognosis if completely resected; adjuvant chemotherapy considered for advanced or recurrent disease.
- Factors Affecting Interpretation: Adequacy of tissue sample, specimen fixation, presence of associated findings (ascites, peritoneal involvement), pathologist expertise in gynecologic oncology, and immunohistochemical studies when needed
Associated Organs
- Primary Organ: Ovaries (female gonads located in pelvis, responsible for oogenesis and hormone production)
- Associated Organ Systems: Fallopian tubes, uterus, bladder, rectum, peritoneum, and retroperitoneal lymph nodes (sites of potential metastatic spread)
- Common Benign Conditions: Functional ovarian cysts, cystadenomas (serous or mucinous), mature cystic teratomas (dermoid cysts), fibromas, thecomas, Brenner tumors, and endometriomas
- Common Malignant Conditions: Epithelial ovarian cancer (serous, mucinous, endometrioid, clear cell, mixed histology), germ cell tumors (dysgerminoma, yolk sac tumor, embryonal carcinoma), sex cord-stromal tumors (granulosa cell tumor, Sertoli-Leydig cell tumor), and metastatic tumors from gastrointestinal tract, breast, or other primary sites
- Potential Complications of Abnormal Results: Cancer spread to peritoneum, omentum, and distant organs (liver, lungs, bone); ascites accumulation; bowel obstruction; peritoneal involvement; infertility; hormonal dysregulation; and systemic effects of advanced cancer
- Risk Factors: Age (peak incidence 55-65 years), family history of ovarian or breast cancer (BRCA1/2 mutations), reproductive history (nulliparity, infertility), hormone replacement therapy, endometriosis, and Lynch syndrome
Follow-up Tests
- If Benign Diagnosis: Follow-up pelvic ultrasound in 3-6 months if cyst present; no follow-up imaging if solid benign tumor is completely removed; reassurance and routine gynecologic care
- If Malignant Diagnosis: Comprehensive surgical staging (if not already performed), assessment of tumor grade and stage, genetic testing (BRCA1/2, panel testing if indicated), and multidisciplinary tumor board evaluation
- Tumor Markers: CA-125, CA-19-9, and HE4 (human epididymis protein 4) should be obtained if cancer is diagnosed; useful for baseline measurement and monitoring response to treatment
- Imaging Studies: CT chest, abdomen, pelvis with contrast; PET-CT may be considered for staging advanced disease; pelvic MRI for further characterization if needed
- Immunohistochemistry: Additional staining for hormone receptors, HER2/neu, MMR proteins, and other biomarkers to guide treatment decisions and determine prognosis
- Molecular Testing: Next-generation sequencing (NGS) to identify actionable mutations (BRCA1/2, TP53, PTEN, homologous recombination deficiency status) for targeted therapy options
- Monitoring During Treatment: Serum tumor markers (CA-125) measured monthly during chemotherapy; imaging (CT or ultrasound) every 2-3 cycles to assess treatment response; frequency adjusted based on clinical presentation
- Surveillance Post-Treatment: Clinical examination every 3-4 months for 2-3 years, then every 6 months; CA-125 and imaging (CT or ultrasound) every 6-12 months based on stage and risk of recurrence; annual surveillance for 5 years minimum
- Related Tests: Pelvic ultrasound, CT/MRI imaging, transvaginal biopsy for smaller lesions, fine needle aspiration (if transvaginal ultrasound-guided), and peritoneal washings/cytology at time of surgery
Fasting Required?
- Fasting Requirement: NO
- Pre-Procedure Preparation: Empty bladder and bowel before procedure for optimal imaging access and patient comfort; may eat and drink normally before the procedure
- Medications: Continue routine medications as prescribed; NSAIDs (ibuprofen, naproxen) should be stopped 3-7 days prior if possible to reduce bleeding risk; anticoagulants (warfarin, heparin, DOACs) may need temporary discontinuation based on physician discretion
- Anesthesia: Local anesthesia is typically used for transvaginal or transabdominal approaches; sedation or general anesthesia may be used for surgical approaches depending on facility and physician preference
- If Sedation Used: NPO (nothing by mouth) for 6-8 hours prior to procedure if moderate-to-deep sedation planned; clear liquids may be allowed up to 2 hours before in some settings
- Consent and Documentation: Informed consent must be obtained; patient history (bleeding disorders, allergies, previous procedures) and current medications should be reviewed before procedure
- Post-Procedure: If sedation used, patient requires monitoring in recovery area and cannot drive for 24 hours; arrange for driver; rest is recommended for remainder of day; possible mild vaginal spotting or cramping; contact physician if significant bleeding, fever, or severe pain occurs

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