Ovarian cancer pathophysiology: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(26 intermediate revisions by 6 users not shown)
Line 1: Line 1:
{{ovarian cancer}}
{{ovarian cancer}}
{{CMG}}
{{CMG}}; {{AE}} {{Hudakarman}}


==Overview==
==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.
[[Ovarian cancer]] is usually [[Diagnosis|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==
==Pathophysiology==
<div align="left">
===Clear Cell Tumor===
<gallery heights="175" widths="175">
* Clear cell [[tumor]]s are part of the [[surface epithelial-stromal tumor]] group of [[ovarian cancer]]s, accounting for 6% of all neoplastic cases. Clear cell tumors are also associated with the [[pancreas]] and [[salivary glands]].
Image:Ovserca3.jpg|Photomicrograph is from the solid / papillary right ovarian tumor. As shown in this photo, much of the tumor had a papillary pattern with exuberant epithelial proliferation but no obvious stromal invasion. Other areas, such as the one depicted in the second photo, show extensive stromal invasion, the criterion upon which rests the diagnosis of frank malignancy.
* [[Benign]] and borderline variants of this [[neoplasm]] are rare, and most cases are [[malignant]].
Image:Ovserca2.jpg|Extensive stromal invasion, the criterion upon which rests the diagnosis of frank malignancy
* Typically, they are [[cystic]] [[neoplasms]] with polypoid [[masses]] that protrude into the [[cyst]].
Image:ovserca.jpg|In this TAH-BSO specimen, the right ovary (on the left of the image) has been replaced by a solid serous carcinoma. The contralateral ovarian tumor is grossly cystic and could be termed a "cystadenocarcinoma." The patient had omental metastases and positive peritoneal fluid cytology. This cancer, which was discovered at exploratory laparotomy, apparently developed very rapidly; the patient had a normal pelvic ultrasound exam only 2 months before. (Courtesy of Ed Uthman, MD)
===Endometrioid Tumor===
Image:Mucinous cystadenocarcinoma.jpg|Ovary: Mucinous cystadenocarcinoma: Gross, an excellent image of uterus is in picture and thus illustrates the very large size of the ovarian tumor. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology</small>]
[[Endometrioid tumor|Endometrioid tumors]] are part of the [[surface epithelial-stromal tumor|surface epithelial]] [[tumor]] group of [[Ovarian cancer|ovarian neoplasm]]s (10-20% of which are the [[Endometrium|endometrioid]] type). [[Benign]] and borderline variants are rare, as the majority are [[malignant]]. There is an association with [[endometriosis]] and concurrent primary [[endometrial carcinoma]] ([[endometrial cancer]]).
</gallery>
===Gross Patholgy===
</div>
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
 
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|''' Ovarian Carcinomas Subtype'''}}
 
==Gross Patholgy==
{| {{table}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|''' Vulvar Carcinomas Subtype'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Features on Gross Pathology'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Features on Gross Pathology'''}}
|-
|-
| ovarian serous cystadenocarcinoma||
|[[Ovarian]] [[serous]] cystadenocarcinoma||
* Ovarian mass.
*[[Ovarian mass]].
Typically solid with multiple cystic areas.
 
Often >10 cm.
* Typically solid with multiple cystic areas.
* Often >10 cm.


|-
|-
|ovarian mucinous cystadenocarcinoma||
|[[Ovarian]] [[mucinous cystadenocarcinoma]]||
*Multiloculated.
*Multiloculated.
* Sticky, gelatinous fluid (glycoprotein).
* Sticky, gelatinous fluid (glycoprotein).
* +/-Necrosis.
* +/- [[Necrosis]].
* Typically unilateral.
* Typically unilateral.
 
|-
| Vulvar melanoma||
|[[Endometrial cancer|Endometrioid]] [[carcinoma]] of the [[ovary]]||
* Superficial spreading is the most common type
* Usually solid and [[Cyst|cystic]], bilateral
* Brown/black color, but may include reddish brown or white
* Hyperkeratotic, diffused borders with no distinct demarcation
* Irregular and elevated


|-
|-
Line 44: Line 38:
==Microscopic Pathology==
==Microscopic Pathology==


Histologic subtypes of epithelial ovarian tumor
[[Histologic]] subtypes of [[epithelial ovarian tumor]] include:<ref>{{cite book | last = Hoffman | first = Barbara | title = Williams gynecology | publisher = McGraw-Hill Medical | location = New York | year = 2012 | isbn = 9780071716727 }}</ref><ref>Malignant melanoma. Libre pathology. http://librepathology.org/wiki/index.php/Malignant_melanoma. URL Accessed on September 30, 2015</ref><ref>Basal cell carcinoma
include:<ref>{{cite book | last = Hoffman | first = Barbara | title = Williams gynecology | publisher = McGraw-Hill Medical | location = New York | year = 2012 | isbn = 9780071716727 }}</ref><ref> Malignant melanoma. Libre pathology. http://librepathology.org/wiki/index.php/Malignant_melanoma. URL Accessed on September 30, 2015</ref><ref> Basal cell carcinoma
. Libre pathology. http://librepathology.org/wiki/index.php/Basal_cell_carcinoma. URL Accessed on September 30, 2015</ref><ref>Squamous cell carcinoma. Libre pathology. http://librepathology.org/wiki/index.php/Squamous_cell_carcinoma. URL Accessed on September 30, 2015</ref>
. Libre pathology. http://librepathology.org/wiki/index.php/Basal_cell_carcinoma. URL Accessed on September 30, 2015</ref><ref> Squamous cell carcinoma. Libre pathology. http://librepathology.org/wiki/index.php/Squamous_cell_carcinoma. URL Accessed on September 30, 2015</ref>
* '''Surface epithelial stromal ovarian tumor''' (60-70%)
* '''Surface epithelial stromal ovarian tumor''' (60-70%)
:* ovarian serous tumor
 
::* ovarian serous cystadenoma: ~60% of serous tumor
:*'''Ovarian serous tumor'''
::* ovarian borderline serous cystadenoma: ~15% of serous tumor
::* Ovarian serous cystadenoma: ~60% of serous tumor
::* ovarian serous cystadenocarcinoma: ~25% of serous tumor; commonest malignant ovarian tumour
::* Ovarian borderline serous cystadenoma: ~15% of serous tumor
:* ovarian mucinous tumor: ~20% of all ovarian tumor  
::* Ovarian serous cystadenocarcinoma: ~25% of serous tumor. Commonest malignant ovarian tumor
::* ovarian mucinous cystadenoma: ~80% of mucinous tumor
:*'''Ovarian mucinous tumor''': ~20% of all ovarian tumor
::* ovarian bordeline mucinous cystadenoma: 10-15% of mucinous tumor
::* Ovarian mucinous cystadenoma: ~80% of mucinous tumor
::* ovarian mucinous cystadenocarcinoma: 5-10% of mucinous tumor
::* Ovarian bordeline mucinous cystadenoma: 10-15% of mucinous tumor
:* ovarian endometrioid tumour: 8-15% of all ovarian tumor
::* Ovarian mucinous cystadenocarcinoma: 5-10% of mucinous tumor
:* clear cell ovarian carcinoma: ~5% of ovarian cancer
:*'''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
:* Brenner tumour: ~2.5% of ovarian epithelial neoplasms
:* squamous cell carcinoma of the ovary
:* Squamous cell carcinoma of the ovary
:* ovarian cystadenofibroma / ovarian adenofibroma: can be serous, mucinous, endometrioid, clear cell or mixed
:* Ovarian cystadenofibroma / ovarian adenofibroma: can be serous, mucinous, endometrioid, clear cell or mixed
:* ovarian cystadenocarcinofibroma: extremely rare
:* Ovarian cystadenocarcinofibroma: extremely rare
:* undifferentiated carcinoma of the ovary: ~4% of all ovarian tumor
:* Undifferentiated carcinoma of the ovary: ~4% of all ovarian tumor
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|''' Vulvar Carcinomas Subtype'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|''' Vulvar Carcinomas Subtype'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Features on Histopathological Microscopic Analysis'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Features on Histopathological Microscopic Analysis'''}}
Line 70: Line 64:
|-
|-
| Ovarian serous cystadenocarcinoma||
| Ovarian serous cystadenocarcinoma||
* Nuclear pleomorphism:
*[[Nuclear]] [[pleomorphism]]:
:* Variation in size - often marked
:* Variation in size - often marked
:* Variation in staining
:* Variation in staining
Line 79: Line 73:
:* Solid
:* Solid
:* Papillary - classic
:* Papillary - classic
* Glandular - uncommon
*[[Glandular]] - uncommon
* +/-Psammoma bodies - uncommon
* +/-Psammoma bodies - uncommon
* +/-Necrosis - often extensive
* +/-[[Necrosis]] - often extensive


| [[File: Serous_carcinoma_-_omentum_3_--_very_high_mag.jpg|thumb|none|300px|Micrograph showing serous carcinoma in the omentum, presumed to have arisen from the ovary (ovarian serous carcinoma)]]
|


|-
|-
|ovarian mucinous cystadenocarcinoma||
|Ovarian mucinous cystadenocarcinoma||
* Mucinous differentiation
* Mucinous differentiation
:* Tall columnar cells in glands with apical mucin
:* Tall columnar cells in glands with apical mucin
Line 99: Line 93:
:* No cilia
:* No cilia


| [[File:256px-Mucinous_lmp_ovarian_tumour_intermed_mag.jpg|thumb|none|300px| micrograph of a low malignant potential (LMP) mucinous ovarian tumor]]
|


|-
|-
  | Vulvar melanoma||
  | Endometrioid carcinoma of the ovary||
* Tubular glands
* Tubular glands
* Cribriform pattern common
* Cribriform pattern common
* May see mucinous secretion
* May see mucinous secretion
* May have squamous differentiation/squamous metaplasia
* May have squamous differentiation/squamous metaplasia
 
* Resemblance to endometrial carcinoma, and over a third of cases have focal squamous differentiation
| [[File:Melanoma.JPG |thumb|none|300px| Vulvar melanoma]]
|-
|-
|}
|}
===Clear cell tumor===
[[Clear cell tumor|Clear cell tumors]] can be either clear cell adenocarcinomas or clear cell sarcomas.On [[microscope|microscopic]] [[pathology|pathological]] examination, they are composed of cells with clear [[cytoplasm]] (that contains [[glycogen]]) and ''hob nail'' cells (from which the glycogen has been secreted).The pattern may be glandular, papillary or solid.


Shown below is an image of Overian clear cell adenocarcinoma.(H&E stain,very high mag)
<div align="left">
<gallery heights="175" widths="175">
Image:ovserca.jpg|In this TAH-BSO specimen, the right ovary (on the left of the image) has been replaced by a solid serous carcinoma. The contralateral ovarian tumor is grossly cystic and could be termed a "cystadenocarcinoma." The patient had omental metastases and positive peritoneal fluid cytology. This cancer, which was discovered at exploratory laparotomy, apparently developed very rapidly; the patient had a normal pelvic ultrasound exam only 2 months before. (Courtesy of Ed Uthman, MD)
Image:Mucinous cystadenocarcinoma.jpg|Ovary: Mucinous cystadenocarcinoma: Gross, an excellent image of uterus is in picture and thus illustrates the very large size of the ovarian tumor. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology</small>]
</gallery>
</div>
==Video==
Shown below is a video of clear cell adenocarcinoma of the vagina.
{{#ev:youtube|qO2w8VLf690}}
==References==
==References==
{{reflist|2}}
{{reflist|2}}
Line 123: Line 130:
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Gynecology]]
[[Category:Surgery]]

Latest revision as of 15:12, 6 September 2019

Ovarian cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classifications

Pathophysiology

Causes of Ovarian cancer

Differentiating Ovarian cancer from other Diseases

Epidemiology & Demographics

Risk Factors

Screening

Natural History, Complications & Prognosis

Diagnosis

History & Symptoms

Physical Examination

Staging

Laboratory Findings

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Ovarian cancer pathophysiology On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Ovarian cancer pathophysiology

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Ovarian cancer pathophysiology

CDC on Ovarian cancer pathophysiology

Ovarian cancer pathophysiology in the news

Blogs on Ovarian cancer pathophysiology

Directions to Hospitals Treating Ovarian cancer

Risk calculators and risk factors for Ovarian cancer pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Huda A. Karman, M.D.

Overview

Ovarian cancer is usually 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

Clear Cell Tumor

Endometrioid Tumor

Endometrioid tumors are part of the surface epithelial tumor group of ovarian neoplasms (10-20% of which are the endometrioid type). Benign and borderline variants are rare, as the majority are malignant. There is an association with endometriosis and concurrent primary endometrial carcinoma (endometrial cancer).

Gross Patholgy

Ovarian Carcinomas Subtype Features on Gross Pathology
Ovarian serous cystadenocarcinoma
  • 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, bilateral

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 tumor
  • 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
  • Variation in size - often marked
  • Variation in staining
  • Variation in shape
  • +/-Macronucleolus - key feature
  • Eccentric nucleus
  • Architecture:
  • Solid
  • Papillary - classic
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
Endometrioid carcinoma of the ovary
  • Tubular glands
  • Cribriform pattern common
  • May see mucinous secretion
  • May have squamous differentiation/squamous metaplasia
  • Resemblance to endometrial carcinoma, and over a third of cases have focal squamous differentiation

Clear cell tumor

Clear cell tumors can be either clear cell adenocarcinomas or clear cell sarcomas.On microscopic pathological examination, they are composed of cells with clear cytoplasm (that contains glycogen) and hob nail cells (from which the glycogen has been secreted).The pattern may be glandular, papillary or solid.

Shown below is an image of Overian clear cell adenocarcinoma.(H&E stain,very high mag)

  • In this TAH-BSO specimen, the right ovary (on the left of the image) has been replaced by a solid serous carcinoma. The contralateral ovarian tumor is grossly cystic and could be termed a "cystadenocarcinoma." The patient had omental metastases and positive peritoneal fluid cytology. This cancer, which was discovered at exploratory laparotomy, apparently developed very rapidly; the patient had a normal pelvic ultrasound exam only 2 months before. (Courtesy of Ed Uthman, MD)

    In this TAH-BSO specimen, the right ovary (on the left of the image) has been replaced by a solid serous carcinoma. The contralateral ovarian tumor is grossly cystic and could be termed a "cystadenocarcinoma." The patient had omental metastases and positive peritoneal fluid cytology. This cancer, which was discovered at exploratory laparotomy, apparently developed very rapidly; the patient had a normal pelvic ultrasound exam only 2 months before. (Courtesy of Ed Uthman, MD)

  • Ovary: Mucinous cystadenocarcinoma: Gross, an excellent image of uterus is in picture and thus illustrates the very large size of the ovarian tumor. Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

    Ovary: Mucinous cystadenocarcinoma: Gross, an excellent image of uterus is in picture and thus illustrates the very large size of the ovarian tumor.
    Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Video

Shown below is a video of clear cell adenocarcinoma of the vagina.

{{#ev:youtube|qO2w8VLf690}}

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


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Ovarian_cancer_pathophysiology&oldid=1581270"