Review of Clinico-pathological Presentation, Management and Outcomes of Patients With Sex Cord-stromal Tumours of the Ovary Managed at KNH From 2010 to 2020. A Descriptive Retrospective Cross Sectional Study.

Abstract

Background: Sex cord-stromal tumours (SCST) represent a heterogenous group of tumour histological subtypes that develop from primitive sex cords, stromal cells or mesenchyme. They are indolent however most patients present in early stage because of symptoms caused by hormones produced by these tumours. Surgery is the mainstay of treatment. These tumours predominantly affect reproductive age women therefore fertility sparing surgery is a good option. There is paucity of data regarding SCSTs in our setup. The objective was to review the clinico-pathological presentation, management and outcome of these patients. Methods and Materials: This was a descriptive cross sectional study where 55 study participants with SCSTs managed at Kenyatta National Hospital (KNH) between January 2010 and December 2020 were recruited. Data on clinico-pathological presentation, management and management outcome was reviewed from their medical records, captured on questionnaires, entered into SPSS software and analysed. Results: Of the 1296 patients with ovarian tumours identified 55 had confirmed SCSTs representing 4.2%. Patients presented at a wide age range from 7-81 years but majority were young, most in their reproductive years and most were married. The median age was 46 years (IQR 33-59 years). Granulosa cell tumours (GCT) accounted for 80% (44/55), of which adult granulosa cell tumour (AGCT) was 39% (17/44) but 52% (23/44) of GCT were not sub- classified on reporting. Most patients presented at early stage. Abdominal pain (85%, 47/55) and abdominal distension (78%, 43/55) were the most common symptoms. Vaginal bleeding was found in 40% (22/55). A pelvic mass was palpable in 55% (30/55) of the patients. All underwent surgery out of which 32% (17/55) were fertility sparing (FSS). Information on tumor staging and grading was poorly documented, with only 9 reports indicating histological grade. BEP was the most used adjuvant chemotherapy regime. Fourty (73%) of the documented study participants were alive at 2 years and 15 (55.6%) at 5 years. Some records could not be traced and others lacked critical details. Conclusion: Sex cord stromal tumours are rare at KNH, have a range of age at diagnosis and clinic-pathological presentation. Treatment outcomes were good but accurate diagnosis and management requires good knowledge and a high index of suspicion.. Recommendations: Patients who desire fertility retention may be offered fertility sparing treatment. Improvement need to be made in medical records and patient follow-up.