Ovarian cancer pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Ovarian cancer is often diagnosed late resulting in a poor overall outcome for the patient. Pathological findings, therefore, often only occur in advanced symptomatic onset and tend to present more as severe pathologic outcomes.

Pathophysiology


Gross Patholgy

Ovarian Carcinomas Subtype Features on Gross Pathology
ovarian serous cystadenocarcinoma
  • Ovarian mass.

Typically solid with multiple cystic areas. Often >10 cm.

ovarian mucinous cystadenocarcinoma
  • Multiloculated.
  • Sticky, gelatinous fluid (glycoprotein).
  • +/-Necrosis.
  • Typically unilateral.
Endometrioid carcinoma of the ovary
  • Usually solid and cystic.

Microscopic Pathology

Histologic subtypes of epithelial ovarian tumor

include:[1][2][3][4]
  • Surface epithelial stromal ovarian tumor (60-70%)
  • ovarian serous tumor
  • ovarian serous cystadenoma: ~60% of serous tumor
  • ovarian borderline serous cystadenoma: ~15% of serous tumor
  • ovarian serous cystadenocarcinoma: ~25% of serous tumor; commonest malignant ovarian tumour
  • ovarian mucinous tumor: ~20% of all ovarian tumor
  • ovarian mucinous cystadenoma: ~80% of mucinous tumor
  • ovarian bordeline mucinous cystadenoma: 10-15% of mucinous tumor
  • ovarian mucinous cystadenocarcinoma: 5-10% of mucinous tumor
  • ovarian endometrioid tumour: 8-15% of all ovarian tumor
  • clear cell ovarian carcinoma: ~5% of ovarian cancer
  • Brenner tumour: ~2.5% of ovarian epithelial neoplasms
  • squamous cell carcinoma of the ovary
  • ovarian cystadenofibroma / ovarian adenofibroma: can be serous, mucinous, endometrioid, clear cell or mixed
  • ovarian cystadenocarcinofibroma: extremely rare
  • undifferentiated carcinoma of the ovary: ~4% of all ovarian tumor
Vulvar Carcinomas Subtype Features on Histopathological Microscopic Analysis Image
Ovarian serous cystadenocarcinoma
  • 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
Micrograph showing serous carcinoma in the omentum, presumed to have arisen from the ovary (ovarian serous carcinoma)
ovarian mucinous cystadenocarcinoma
  • Mucinous differentiation
  • Tall columnar cells in glands with apical mucin
  • May have an endocervical-like or intestinal-like appearance - see subtypes
  • Invasive morphology - one of the following:
  • Back-to-back glands/confluent growth pattern
  • Desmoplastic stromal response
  • Cribriforming of glands
  • Malignant characteristics:
  • +/-Nuclear atypia
  • +/-Necrosis
  • No cilia
micrograph of a low malignant potential (LMP) mucinous ovarian tumor
Endometrioid carcinoma of the ovary
  • Tubular glands
  • Cribriform pattern common
  • May see mucinous secretion
  • May have squamous differentiation/squamous metaplasia


References

  1. Hoffman, Barbara (2012). Williams gynecology. New York: McGraw-Hill Medical. ISBN 9780071716727. 
  2. Malignant melanoma. Libre pathology. http://librepathology.org/wiki/index.php/Malignant_melanoma. URL Accessed on September 30, 2015
  3. Basal cell carcinoma . Libre pathology. http://librepathology.org/wiki/index.php/Basal_cell_carcinoma. URL Accessed on September 30, 2015
  4. Squamous cell carcinoma. Libre pathology. http://librepathology.org/wiki/index.php/Squamous_cell_carcinoma. URL Accessed on September 30, 2015

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