Bereks - Ovarian Cancer

• Cell tumors


  The most common type of malignant ovarian sex cord-stromal tumors
• Premenopausal women


  Cell tumors can be treated conservatively
• Adjuvant chemotherapy is of unproven value for cell tumors
• Metastatic tumors to the ovaries

  Most frequently from the breast and gastrointestinal tract
• Epithelial serous fallopian tube carcinomas and peritoneal cancers are the same as ovarian cancer and are treated in the same way
• The distinction between high-grade serous ovarian, fallopian tube, and peritoneum cancers is an anachronism because most high-grade serous cancers arise from the fimbriae of the fallopian tube
• Ovarian cancer


  • It is the second most common gynecologic cancer in the United States
  • It accounts for the majority of deaths from these cancers
  • Epithelial cancers are the most common ovarian/fallopian malignancy
  • At initial diagnosis, over two-thirds of patients have advanced disease
• Ovarian cancer


  • It represents a major surgical challenge as the aim is to resect all visible disease
  • Optimal therapy includes maximal attempt at surgical cytoreduction to no gross disease, or at least optimal debulking (to <1 cm of residual disease), followed by platinum-based combination chemotherapy
  • It has the highest fatality-to-case ratio of all the gynecologic malignancies
• There are nearly 22,280 new cases of ovarian cancer annually in the United States, and 14,240 women can be expected to succumb to their illness
• Ovarian cancer is the seventh most common cancer in women in the United States, accounting for 3% of all malignancies, 6% of deaths from cancer in women, and almost one-third of invasive malignancies of the female genital organs
• The lifetime risk of being diagnosed with ovarian cancer is 1% to 1.5% and of dying from ovarian cancer is almost 0.5%
• Most serous carcinomas originate from the fallopian tube, while other subtypes (clear cell, endometrioid) are derived from endometriosis
• Epithelial Ovarian Tumors


  • Serous
  • Mucinous
  • Endometrioid
  • Clear-cell
  • Brenner
  • Mixed epithelial
  • Undifferentiated
  • Unclassified
• Serous tumors


  • They resemble tubal secretory cells
  • Psammoma bodies are frequently found in these neoplasms
• Serous borderline tumors


  • They tend to remain confined to the ovary for long periods
  • They occur predominantly in premenopausal women
  • They are associated with a very good prognosis
• Serous borderline tumors with micropapillary features


  • They are more frequently bilateral, exophytic, and high stage than the usual serous borderline tumor
• Up to 10% of women with ovarian serous borderline tumors and extraovarian implants may have invasive implants (i.e., low-grade serous carcinoma), and these can behave more aggressively
• The 5-year overall survival for women with invasive implants (low-grade serous carcinoma) is about 50% if stringent criteria are applied
• Most implants are noninvasive
• Borderline serous tumors may harbor foci of stromal microinvasion, which is associated with lymphovascular space invasion in the primary ovarian tumor but is not associated with an aggressive clinical course
• Low-grade serous adenocarcinomas


  • Papillary and glandular structures predominate
• High-grade serous adenocarcinomas


  • Characterized by solid sheets of cells, nuclear pleomorphism, and high mitotic activity
• Serous psammocarcinoma


  A rare variant of serous carcinoma characterized by massive psammoma body formation and low-grade cytologic features
• Patients with serous psammocarcinoma have a protracted clinical course and a relatively favorable prognosis
• Mucinous tumors


  • They may reach enormous size, filling the entire abdominal cavity
• It is important to take multiple sections from many areas in the mucinous tumor to identify the most malignant alteration
• Bilateral mucinous tumors occur in 8% to 10% of cases
• Mucinous lesions are confined to the ovary in 95% to 98% of cases
• Most ovarian mucinous carcinomas contain enteric-type cells, so they cannot be distinguished from metastatic carcinoma of the gastrointestinal tract on the basis of histology alone
• Pseudomyxoma peritonei


  A clinical term used to describe the finding of abundant mucoid or gelatinous material in the pelvis and abdominal cavity surrounded by fibrous tissue
• Pseudomyxoma peritonei is most commonly secondary to a well-differentiated appendiceal mucinous neoplasm or other gastrointestinal primary
• Endometrioid lesions constitute 6% to 8% of epithelial ovarian tumors
• The malignant potential of endometriosis is very low, although a transition from benign to malignant epithelium may be demonstrated
• Rarely, mucinous tumors arising in an ovarian mature teratoma are associated with pseudomyxoma peritonei
• Endometrioid lesions


  Constitute 6% to 8% of epithelial tumors
• Endometrioid neoplasia includes all the benign demonstrations of endometriosis
• In 1925, Sampson suggested that certain cases of adenocarcinoma of the ovary probably arose in areas of endometriosis
• The adenocarcinomas are similar to those seen in the uterine corpus
• Borderline endometrioid tumors


  Have a wide morphologic spectrum, may resemble an endometrial polyp or complex endometrial hyperplasia with glandular crowding
• Well-differentiated endometrioid carcinoma


  Has back-to-back, architecturally complex glands with no intervening stroma