Serous carcinoma of the ovary
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| Serous carcinoma of the ovary | |
|---|---|
| Diagnosis in short | |
| IHC | WT-1 +ve, CK7 +ve |
| Gross | solid and cystic, serous fluid |
| Site | ovary |
|
| |
| Signs | adnexal mass |
| Blood work | CA-125 elevated |
| Radiology | complex mass with solid and cystic area, often large |
| Prognosis | poor for high-grade |
| Treatment | surgery, chemotherapy |
Serous carcinoma of the ovary, also ovarian serous carcinoma, is relatively common malignant ovarian tumour.
General
- Most common malignant ovarian tumour in the eldery.
- Poor prognosis.
- May be associated with a BRCA1 gene or BRACA2 gene mutation.[1]
Precursors lesions:
- Serous borderline tumours for low-grade serious carcinoma.
- Serous tubal intraepithelial carcinoma (STIC)[2] for high-grade serous carcinoma.
Gross
- Ovarian mass.
- Typically solid with multiple cystic areas.
- Often >10 cm.
Note:
- Lesions <10 cm and unilocular are usually benign.[3]
Microscopic
Features:
- Nuclear pleomorphism:
- Variation in size - often marked.
- Variation in staining.
- Variation in shape.
- +/-Macronucleolus - key feature.
- Eccentric nucleus.
- Architecture:
- Solid.
- Papillary - classic.
- Glandular - uncommon.
- +/-Psammoma bodies - uncommon.
- +/-Necrosis - often extensive.
DDx:
- Clear cell carcinoma of the ovary - less nuclear size variation.
- Endometrioid carcinoma of the ovary - usu. lower grade.
- Primary peritoneal serous carcinoma - bulk of tumour in peritoneum, small ovarian tumour.
- Other non-ovarian serous carcinomas - see serous carcinoma.
- Ovarian serous borderline tumour - mild to moderate nuclear atypia, no invasion, few mitoses.
Grading
Serous carcinoma is subdivided into:[4][5]
| Grade | Nuclear atypia (most important) | Mitotic rate |
|---|---|---|
| Low-grade (Type I) | mild/moderate atypia: round/oval nuclei, evenly distributed chromatin, +/-conspicuous nucleoli |
<=12 mitoses/10 HPFs † |
| High-grade (Type II) | severe atypia: >=3:1 size variation, irregular chromatin, +/-macronucleoli |
>12 mitoses/10 HPFs † |
Notes:
- † Definition suffers from HPFitis.
- In fairness, the paper[5] notes that the Olympus BH2 microscope was used. The 40x objective on this microscope has a field diameter of 0.5 mm, according to a manual found online.[6] Assuming this is so, the field area is 0.19635 mm2. Thus, in standard units, the cut-point would be 6.1115 mitoses/1 mm2 and the sample area 1.9635 mm2.
- Tumours very rarely transform from low-grade to high-grade.[7]
Images
Serous carcinoma - cytology. (WC)
www:
IHC
Others:
- HNF-1beta -ve.[11][12]
- Usually +ve in clear cell carcinoma of the ovary.
See also
References
- ↑ Demsky, R.; McCuaig, J.; Maganti, M.; Murphy, KJ.; Rosen, B.; Armel, SR. (Aug 2013). "Keeping it simple: genetics referrals for all invasive serous ovarian cancers.". Gynecol Oncol 130 (2): 329-33. doi:10.1016/j.ygyno.2013.05.003. PMID 23707676.
- ↑ Vang, R.; Shih, IeM.; Kurman, RJ. (Jan 2013). "Fallopian tube precursors of ovarian low- and high-grade serous neoplasms.". Histopathology 62 (1): 44-58. doi:10.1111/his.12046. PMID 23240669.
- ↑ Bailey, CL.; Ueland, FR.; Land, GL.; DePriest, PD.; Gallion, HH.; Kryscio, RJ.; van Nagell, JR. (Apr 1998). "The malignant potential of small cystic ovarian tumors in women over 50 years of age.". Gynecol Oncol 69 (1): 3-7. doi:10.1006/gyno.1998.4965. PMID 9570990.
- ↑ Vang, R.; Shih, IeM.; Kurman, RJ. (Sep 2009). "Ovarian low-grade and high-grade serous carcinoma: pathogenesis, clinicopathologic and molecular biologic features, and diagnostic problems.". Adv Anat Pathol 16 (5): 267-82. doi:10.1097/PAP.0b013e3181b4fffa. PMID 19700937.
- ↑ 5.0 5.1 Malpica, A.; Deavers, MT.; Lu, K.; Bodurka, DC.; Atkinson, EN.; Gershenson, DM.; Silva, EG. (Apr 2004). "Grading ovarian serous carcinoma using a two-tier system.". Am J Surg Pathol 28 (4): 496-504. PMID 15087669.
- ↑ URL: [www.alanwood.net/downloads/olympus-bh-2-bht-manual.pdf www.alanwood.net/downloads/olympus-bh-2-bht-manual.pdf]. Accessed on: 1 January 2014.
- ↑ Garg, K.; Park, KJ.; Soslow, RA. (Sep 2012). "Low-grade serous neoplasms of the ovary with transformation to high-grade carcinomas: a report of 3 cases.". Int J Gynecol Pathol 31 (5): 423-8. doi:10.1097/PGP.0b013e31824ae6f2. PMID 22833081.
- ↑ Ayhan, A.; Kurman, RJ.; Yemelyanova, A.; Vang, R.; Logani, S.; Seidman, JD.; Shih, IeM. (Aug 2009). "Defining the cut point between low-grade and high-grade ovarian serous carcinomas: a clinicopathologic and molecular genetic analysis.". Am J Surg Pathol 33 (8): 1220-4. doi:10.1097/PAS.0b013e3181a24354. PMC 2716424. PMID 19461510. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716424/.
- ↑ Köbel, M.; Kalloger, SE.; Carrick, J.; Huntsman, D.; Asad, H.; Oliva, E.; Ewanowich, CA.; Soslow, RA. et al. (Jan 2009). "A limited panel of immunomarkers can reliably distinguish between clear cell and high-grade serous carcinoma of the ovary.". Am J Surg Pathol 33 (1): 14-21. doi:10.1097/PAS.0b013e3181788546. PMID 18830127.
- ↑ DeLair, D.; Oliva, E.; Köbel, M.; Macias, A.; Gilks, CB.; Soslow, RA. (Jan 2011). "Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases.". Am J Surg Pathol 35 (1): 36-44. doi:10.1097/PAS.0b013e3181ff400e. PMID 21164285.
- ↑ Tsuchiya, A.; Sakamoto, M.; Yasuda, J.; Chuma, M.; Ohta, T.; Ohki, M.; Yasugi, T.; Taketani, Y. et al. (Dec 2003). "Expression profiling in ovarian clear cell carcinoma: identification of hepatocyte nuclear factor-1 beta as a molecular marker and a possible molecular target for therapy of ovarian clear cell carcinoma.". Am J Pathol 163 (6): 2503-12. PMID 14633622. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892387/?tool=pubmed.
- ↑ Online 'Mendelian Inheritance in Man' (OMIM) 189907