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

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

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


Basal cell carcinoma of vulva
  • Multiloculated.
  • Sticky, gelatinous fluid (glycoprotein).
  • +/-Necrosis.
  • Typically unilateral.
Vulvar melanoma
  • Superficial spreading is the most common type
  • Brown/black color, but may include reddish brown or white
  • Hyperkeratotic, diffused borders with no distinct demarcation
  • Irregular and elevated

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
Squamous cell carcinoma of vulva
  • Eosinophilia
  • Extra large nuclei/bizarre nuclei
  • Inflammation (lymphocytes, plasma cells)
  • Long rete ridges
  • Numerous beeds/blobs of epithelial cells that seem unlikely to be rete ridges
Squamous cell carcinoma of vulva
Basal cell carcinoma of vulva
  • Basaloid cells - similar in appearance to basal cells
  • Moderate blue/grey cytoplasm.
  • Dark ovoid/ellipsoid nucleus with uniform chromatin
  • Palisading of cells at the edge of the cell nests
  • Artefactual separation of cells (forming the nests) from the underlying stroma - key feature
  • Surrounded by blue (myxoid) stroma - key feature
Basal cell carcinoma of vulva
Vulvar melanoma
  • Presence of intraepidermal lateral spread (most characteristic feature)
  • Dermal invasion
  • Desmoplasia
  • Epidermal hyperplasia
  • Appearance of epithelioid cells with occasional spindle cells
Vulvar melanoma

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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