Ovarian cancer classification

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

Overview

Ovarian cancer is classified according to the histology of the tumor, obtained in a pathology report.

Classification

Histology dictates many aspects of clinical treatment, management, and prognosis.

• Surface epithelial-stromal tumour, including serous and mucinous cystadenocarcinoma, is the most common type of ovarian cancer.
• Sex cord-stromal tumor, including estrogen-producing granulosa cell tumor and virilizing Sertoli-Leydig cell tumor or arrhenoblastoma, accounts for 8% of ovarian cancers.
• Germ cell tumor accounts for approximately 5% of ovarian cancers. It tends to occur in young women and girls, and has a better prognosis than other ovarian tumors.
• mixed tumors, containing elements of more than one tumor histology

Ovarian cancer often is primary, but can also be secondary, the result of metastasis from a primary cancer elsewhere in the body. For example, from breast cancer, or from gastrointestinal cancer (in which case the ovarian cancer is a Krukenberg cancer). Surface epithelial-stromal tumor can originate in the lining of the abdominal cavity, in which case the ovarian cancer is secondary to primary peritoneal cancer, but treatment is basically the same as for primary ovarian cancer of this type.

Cellular Classification of Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer

The following is a list of ovarian epithelial, fallopian tube, and primary peritoneal cancer histologic classifications.

• Serous cystomas:
• Serous benign cystadenomas.
• Serous cystadenomas with proliferating activity of the epithelial cells and nuclear abnormalities but with no infiltrative destructive growth (low malignant potential or borderline malignancy).
• Serous cystadenocarcinomas.
• Mucinous cystomas:
• Mucinous benign cystadenomas.
• Mucinous cystadenomas with proliferating activity of the epithelial cells and nuclear abnormalities but with no infiltrative destructive growth (low malignant potential or borderline malignancy).
• Mucinous cystadenocarcinomas.
• Endometrioid tumors (similar to adenocarcinomas in the endometrium):
• Endometrioid benign cysts.
• Endometrioid tumors with proliferating activity of the epithelial cells and nuclear abnormalities but with no infiltrative destructive growth (low malignant potential or borderline malignancy).
• Endometrioid adenocarcinomas.
• Clear cell (mesonephroid) tumors:
• Benign clear cell tumors.
• Clear cell tumors with proliferating activity of the epithelial cells and nuclear abnormalities but with no infiltrative destructive growth (low malignant potential or borderline malignancy).
• Clear cell cystadenocarcinomas.
• Unclassified tumors that cannot be allotted to one of the above groups.
• No histology.
• Other malignant tumors (malignant tumors other than those of the common epithelial types are not to be included with the categories listed above).

Primary ovarian tumor

• 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 11

• 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

• Germ cell ovarian tumor (~20%)

• ovarian teratoma: commonest primary benign tumour of ovary

• mature ovarian (cystic) teratoma
• immature ovarian teratoma
• specialised teratomas of the ovary
• struma ovarii tumour
• ovarian carcinoid tumor

• ovarian dysgerminoma
• ovarian yolk sac tumour: endodermal sinus tumour
• ovarian embryonal carcinoma
• ovarian choriocarcinoma: <1% of ovarian tumor
• pure primary ovarian choriocarcinoma: extremely rare 2
• malignant mixed germ cell tumour of the ovary

• Sex cord / stromal ovarian tumor (8-10%)

• ovarian fibrothecoma: ~5% of ovarian tumor
• ovarian fibroma: ~4% of ovarian tumor
• ovarian thecoma: ~1% of ovarian tumor
• sclerosing stromal tumour of the ovary: rare 9
• ovarian Sertoli-Leydig cell tumour - ovarian androblastoma: ~0.5% of ovarian tumor
• granulosa cell tumour of ovary: commonest malignant sex cord tumour
• juvenile granulosa cell tumour of ovary
• adult granulosa cell tumour of ovary
• Mixed

• These are uncommon:

• collision tumor of the ovary
• ovarian carcinosarcoma <1%
• Other

• ovarian lymphoma
• primary ovarian lymphoma
• secondary involvement of the ovary with lymphoma

• metastases to the ovary

• Krukenburg tumour
• other metastatic lesions to ovary

References

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