Ovarian Carcinoma: Current Diagnostic Principles

Czech version

Authors: P. Dundr
Authors‘ workplace: Ústav patologie 1. LF UK a VFN, Praha
Published in: Čes.-slov. Patol., 46, 2010, No. 3, p. 53-61
Category: Reviews Article

Overview

Ovarian cancer is the most common cause of death from a gynecologic cancer. The most common types of ovarian cancer are carcinomas of surface epithelial-stromal origin. Ovarian carcinomas are a heterogeneous group of neoplasms. Based on proposed different pathways of tumorigenesis, these tumors are divided into two broad subgroups (type I and II) with different biologic behaviour, prognosis and response to therapy. Type I tumors include low-grade serous adenocarcinoma, low-grade endometrioid adenocarcinoma, mucinous adenocarcinoma, malignant Brenner tumor and some clear cell carcinomas. These tumors are low-grade neoplasms evolving from a defined precursor lesion. Type II tumors are high-grade neoplasms including undifferentiated carcinoma, high-grade serous adenocarcinoma, high-grade endometrioid adenocarcinoma, malignant mixed Müllerian tumor and probably some clear cell carcinomas. At present, the histological type of ovarian carcinoma has only limited impact on the management of these tumors. However, with progress towards the type-specific treatment of ovarian carcinoma, accurate histopathological diagnosis of ovarian carcinoma becomes increasingly important. In this review we summarize recent advances in the histopathological diagnosis of ovarian carcinoma. Moreover, we mention genetic changes in different types of ovarian carcinoma.

Key words:
ovarian carcinoma – classification – immunohistochemistry – genetics

Sources

1. Ayhan, A., Kurman, R.J., Yemelyanova, A. et al.: Defining the cut point between low-grade and high-grade ovarian serous carcinomas: a clinicopathologic and molecular genetic analysis. Am. J. Surg. Pathol., 2009, 33: 1220–1224.

2. Bowen, N.J., Walker, L.D., Matyunina, L.V. et al.: Gene expression profiling supports the hypothesis that human ovarian surface epithelia are multipotent and capable of serving as ovarian cancer initiating cells. BMC Med. Genomics, 2009, 2: 71.

3. Bristow, R.E., Tomacruz, R.S., Armstrong, D.K., Trimble, E.L., Montz, F.J.: Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J. Clin. Oncol., 2002, 20: 1248–1259.

4. Burks, R.T., Sherman, M.E., Kurman, R.J.: Micropapillary serous carcinoma of the ovary. A distinctive low-grade carcinoma related to serous borderline tumors. Am. J. Surg. Pathol., 1996, 20: 1319–1330.

5. Cantrell, L.A., Van Le, L.: Carcinosarcoma of the ovary: a review. Obstet. Gynecol. Surv., 2009, 64: 673–680.

6. Cho, K.R.: Ovarian cancer update: lessons from morphology, molecules, and mice. Arch. Pathol. Lab. Med., 2009, 133: 1775–1781.

7. Cuatrecasas, M., Catasus, L., Palacios, J., Prat, J.: Transitional cell tumors of the ovary: a comparative clinicopathologic, immunohistochemical, and molecular genetic analysis of Brenner tumors and transitional cell carcinomas. Am. J. Surg. Pathol., 2009, 33: 556–567.

8. Dubé, V., Roy, M., Plante, M., Renaud, M.C., Tźtu, B.: Mucinous ovarian tumors of Mullerian-type: an analysis of 17 cases including borderline tumors and intraepithelial, microinvasive, and invasive carcinomas. Int J Gynecol. Pathol., 2005, 24: 138–146.

9. Euscher, E.D., Malpica, A., Deavers, M.T., Silva, E.G.: Differential expression of WT-1 in serous carcinomas in the peritoneum with or without associated serous carcinoma in endometrial polyps. Am. J. Surg. Pathol., 2005, 29: 1074–1078.

10. Folkins, A.K., Jarboe, E.A., Saleemuddin, A. et al.: A candidate precursor to pelvic serous cancer (p53 signature) and its prevalence in ovaries and fallopian tubes from women with BRCA mutations. Gynecol. Oncol., 2008, 109: 168–173.

11. Hart, W.R.: Mucinous tumors of the ovary: a review. Int. J. Gynecol. Pathol., 2005, 24: 4-25.

12. Kikkawa, F., Kawai, M., Tamakoshi, K. et al.: Mucinous carcinoma of the ovary. Clinicopathologic analysis. Oncology, 1996, 53: 303–307.

13. Köbel, M., Kalloger, S.E., Carrick, J. et al.: A limited panel of immunomarkers can reliably distinguish between clear cell and high-grade serous carcinoma of the ovary. Am. J. Surg. Pathol., 2009, 33: 14–21.

14. Köbel, M., Kalloger, S.E., Santos, J.L., Huntsman, D.G., Gilks, C.B., Swenerton, K.D.: Tumor type and substage predict survival in stage I and II ovarian carcinoma: insights and implications. Gynecol. Oncol., 2010, 116: 50–56.

15. Kuo, K.T., Mao, T.L., Jones, S. et al.: Frequent activating mutations of PIK3CA in ovarian clear cell carcinoma. Am. J. Pathol., 2009, 174: 1597-1601.

16. Kurman, R.J., Shih, I.M.: The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am. J. Surg. Pathol., 2010, 34: 433–443.

17. Lee, K.R., Young, R.H.: The distinction between primary and metastatic mucinous carcinomas of the ovary: gross and histologic findings in 50 cases. Am. J. Surg. Pathol., 2003, 27: 281–292.

18. Levanon, K., Crum, C., Drapkin, R.: New insights into the pathogenesis of serous ovarian cancer and its clinical impact. J. Clin. Oncol., 2008, 26: 5284–5293.

19. Logani, S., Oliva, E., Amin, M.B., Folpe, A.L., Cohen, C., Young, R.H.: Immunoprofile of ovarian tumors with putative transitional cell (urothelial) differentiation using novel urothelial markers: histogenetic and diagnostic implications. Am. J. Surg. Pathol., 2003, 27:1434–1441.

20. Madore, J., Ren, F., Filali-Mouhim, A. et al.: Characterization of the molecular differences between ovarian endometrioid carcinoma and ovarian serous carcinoma. J. Pathol., 2010, 220: 392–400.

21. Malpica, A., Deavers, M.T., Lu, K. et al.: Grading ovarian serous carcinoma using a two-tier system. Am. J. Surg. Pathol., 2004, 28: 496–504.

22. McAlpine, J.N., Wiegand, K.C., Vang, R. et al.: HER2 overexpression and amplification is present in a subset of ovarian mucinous carcinomas and can be targeted with trastuzumab therapy. BMC Cancer, 2009, 9: 433.

23. McCluggage, W.G., Young, R.H.: Primary ovarian mucinous tumors with signet ring cells: report of 3 cases with discussion of so-called primary Krukenberg tumor. Am. J. Surg. Pathol., 2008, 32: 1373–1379.

24. Nonaka, D., Chiriboga, L., Soslow, R.A.: Expression of pax8 as a useful marker in distinguishing ovarian carcinomas from mammary carcinomas. Am. J. Surg. Pathol., 2008, 32: 1566–1571.

25. O’Neill, C.J., Deavers, M.T., Malpica, A., Foster, H., McCluggage, W.G.: An immunohistochemical comparison between low-grade and high-grade ovarian serous carcinomas: significantly higher expression of p53, MIB1, BCL2, HER-2/neu, and C-KIT in high-grade neoplasms. Am. J. Surg. Pathol., 2005, 29: 1034–1041.

26. O’Neill, C.J., McBride, H.A., Connolly, L.E., Deavers, M.T., Malpica, A., McCluggage, W.G.: High-grade ovarian serous carcinoma exhibits significantly higher p16 expression than low-grade serous carcinoma and serous borderline tumour. Histopathology, 2007, 50: 773–779.

27. Phillips, V., Kelly, P., McCluggage, W.G.: Increased p16 expression in high-grade serous and undifferentiated carcinoma compared with other morphologic types of ovarian carcinoma. Int. J. Gynecol. Pathol., 2009, 28: 179–186.

28. Provenza, C., Young, R.H., Prat, J.: Anaplastic carcinoma in mucinous ovarian tumors: a clinicopathologic study of 34 cases emphasizing the crucial impact of stage on prognosis, their histologic spectrum, and overlap with sarcomalike mural nodules. Am. J. Surg. Pathol., 2008, 32: 383–389.

29. Sarrió, D., Moreno-Bueno, G., Sánchez-Estévez, C. et al.: Expression of cadherins and catenins correlates with distinct histologic types of ovarian carcinomas. Hum. Pathol., 2006, 37: 1042–1049.

30. Schipf, A., Mayr, D., Kirchner, T., Diebold, J.: Molecular genetic aberrations of ovarian and uterine carcinosarcomas – a CGH and FISH study. Virchows Arch., 2008, 452: 259–268.

31. Shaw, P.A., McLaughlin, J.R., Zweemer, R.P. et al.: Histopathologic features of genetically determined ovarian cancer. Int. J. Gynecol. Pathol., 2002, 21: 407–411.

32. Shaw, P.A., Rouzbahman, M., Pizer, E.S., Pintilie, M., Begley, H.: Candidate serous cancer precursors in fallopian tube epithelium of BRCA1/2 mutation carriers. Mod. Pathol., 2009, 22: 1133–1138.

33. Shih, I.M., Kurman, R.J.: Ovarian tumorigenesis: a proposed model based on morphological and molecular genetic analysis. Am. J. Pathol., 2004, 164: 1511–1518.

34. Shimizu, Y., Kamoi, S., Amada, S., Akiyama, F., Silverberg, S.G.: Toward the development of a universal grading system for ovarian epithelial carcinoma: testing of a proposed system in a series of 461 patients with uniform treatment and follow-up. Cancer, 1998, 82: 893–901.

35. Singer, G., Oldt, R. 3rd, Cohen, Y. et al.: Mutations in BRAF and KRAS characterize the development of low-grade ovarian serous carcinoma. J. Natl. Cancer Inst., 2003, 95: 484–486.

36. Tabrizi, A.D., Kalloger, S.E., Köbel, M. et al.: Primary ovarian mucinous carcinoma of intestinal type: significance of pattern of invasion and immunohistochemical expression profile in a series of 31 cases. Int. J. Gynecol. Pathol., 2010, 29: 99–107.

37. Tavassoli, F.A., Devilee, P (Eds.): WHO Classification of Tumours: Tumours of the Breast and Female Genital Organs. 2003, IARC Press, Lyon.

38. Vang, R., Gown, A.M., Barry, T.S., Wheeler, D.T., Ronnett, B.M.: Immunohistochemistry for estrogen and progesterone receptors in the distinction of primary and metastatic mucinous tumors in the ovary: an analysis of 124 cases. Mod. Pathol., 2006, 19: 97–105.

39. Vang, R., Gown, A.M., Barry, T.S. et al.: Cytokeratins 7 and 20 in primary and secondary mucinous tumors of the ovary: analysis of coordinate immunohistochemical expression profiles and staining distribution in 179 cases. Am. J. Surg. Pathol., 2006, 30: 1130–1139.

40. Vang, R., Gown, A.M., Farinola, M. et al.: p16 expression in primary ovarian mucinous and endometrioid tumors and metastatic adenocarcinomas in the ovary: utility for identification of metastatic HPV-related endocervical adenocarcinomas. Am. J. Surg. Pathol., 2007, 31: 653–663.

41. Vang, R., Shih, I.M., Kurman, R.J.: Ovarian low-grade and high-grade serous carcinoma: pathogenesis, clinicopathologic and molecular biologic features, and diagnostic problems. Adv. Anat. Pathol., 2009, 16: 267–282.

42. Wong, K.K., Lu, K.H., Malpica, A. et al.: Significantly greater expression of ER, PR, and ECAD in advanced-stage low-grade ovarian serous carcinoma as revealed by immunohistochemical analysis. Int. J. Gynecol. Pathol., 2007, 26: 404–409.

43. Yamamoto, S., Tsuda, H., Aida, S., Shimazaki, H., Tamai, S., Matsubara, O.: Immunohistochemical detection of hepatocyte nuclear factor 1beta in ovarian and endometrial clear-cell adenocarcinomas and nonneoplastic endometrium. Hum. Pathol., 2007, 38: 1074–1080.

Labels

Anatomical pathology Forensic medical examiner Toxicology

False Negative PAP test? Cytopathologist as a Member of Expert Group in Case of Late Diagnosis of Cervical Cancer

Autoimmune Pancreatitis with Biliary Tree and Liver Involvement as a Part of IgG4-related Autoimmune Sclerosing Disease. Case Report

Autosomal Dominant Polycystic Kidney Disease in the Fetus with Seemingly Negative Family History. A Case Report

Nerve Sheath Myxoma with Bidirectional Schwannomatous and Perineural Differentiation

Article was published in

Czecho-Slovak Pathology

2010 Issue 3