Clinical Characteristics Of Patients With Clear Cell Ovarian Cancer And Mixed Malignant Epithelial Ovarian Tumors

For the first time on a large clinical material, the results of the study of clinical and morphological features and prognostic factors of clear cell ovarian cancer and mixed malignant neoplasms of the ovaries with a mandatory clear cell component are presented. Based on a comparative analysis of pure and mixed forms of clear cell neoplasms of the ovaries, their morphological signs and features of the clinical course of the disease were established. The factors of prognosis of malignant clear-cell neoplasms of the ovaries were revealed: the stage of the disease, the volume of surgery, the degree of tumor differentiation and the degree of cellular anaplasia.


INTRODUCTION
According to various authors, the prevalence of clear cell adenocarcinoma is 2-6% of all ovarian neoplasms and 5-6% of all malignant epithelial ovarian tumors [2,4,5]. in most cases, chemotherapy was carried out (various regimens with/without the inclusion of platinum drugs), much less often radiation therapy was used to the pelvic and/or abdominal cavity.
The volume of surgical intervention was assessed as optimal, suboptimal (residual tumor less than 2 cm) and non-radical or cytoreductive (residual tumor more than 2 cm), depending on the volume of tumor removal, as well as in relation to the adequate volume of surgical interventions for ovarian malignant neoplasms.

RESULTS AND DISCUSSION
We analyzed the clinical and morphological characteristics and course of the disease in 96 patients with clear cell ovarian cancer aged 21 to 75 years.
After revision of histological preparations according to the above diagnostic criteria, all patients were divided into two groups.    However, in the blood relatives of the II group, in the same number of observations, both genital tract cancer (4.2%) and breast cancer (4.2%) were diagnosed (Table 4).

Obstetric and gynecological history
When analyzing the distribution of patients depending on the age of the onset of menarche, it turned out that among patients with pure forms of clear cell ovarian cancer, patients in whom the age of onset of menarche was 11-14 years (66.2%) prevailed. However, no fundamental differences were found in the age of menarche onset among patients with mixed malignant neoplasms of the ovaries (Table 5).
When assessing sexual function, it should be noted that only 3 (4.2%) patients in the group of clear cell ovarian cancer and 2 (8%) in the group of mixed tumors were Virgo. Menstrual dysfunction occurred significantly more often in patients with mixed forms of ovarian cancer than among patients with clear cell cancer (20% and 2.8%, respectively) ( Table  6).  Hormonal drugs for various gynecological diseases were taken by 6 (8.5%) patients in group I and 4 (16%) in group II.
It is assumed that endometriosis plays an important role in the pathogenesis of malignant clear cell neoplasms of the ovaries. This hypothesis is based on the frequent (up to 54% of cases) finding of concomitant endometriosis in patients with clear cell ovarian adenocarcinoma [3].
In our study, endometriosis in patients with pure forms of clear cell ovarian cancer was detected as often as in mixed tumors (30.9% and 36%, respectively), which exceeds the frequency of this pathology in other histological types of ovarian malignant neoplasms (Table 8). Inflammation of the parovarium occurred with the same frequency both in the 1st and in the IIth group -52.1% and 48%, respectively (Table  9).  (Table 10).
An interesting fact is that with mixed malignant ovarian tumors in 9 (36%) patients, pathological processes in the uterus were revealed, while in clear cell ovarian cancer this figure was 12 (16.9%) patients (Table 11).  Adenomyosis was detected in 5 (7.04%) patients in group I and in 3 (12%) patients in group II.
The high incidence of endometrial and uterine pathology in malignant clear-cell neoplasms of the ovaries testifies in favor of the theory of the hormone-dependent nature of the origin of this type of neoplasm.
Breast diseases were also more common in the group of mixed tumors -in 9 (36%) patients versus 7 (9.9%) patients with pure forms of clear cell ovarian adenocarcinoma.
Diseases of the thyroid gland were 4 times more common in history in patients with mixed Most often, patients with cervical erosion underwent electrocoagulation of the cervix -13 (18.3%) patients in group I and 6 (24%) patients in group II.

CONCLUSION
The average age of patients in the first group was 52.8 + 1.2 years, in the second group -54.4 + 1.8 years, which does not contradict the data of world literature.
When analyzing the age composition of patients with clear cell ovarian cancer and mixed forms of malignant ovarian tumors, it turned out that most often these diseases