Ovarian cancer pathophysiology: Difference between revisions

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{{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==
===Clear Cell Tumor===
===Clear Cell Tumor===
* 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.
* 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]].
* [[Benign]] and borderline variants of this neoplasm are rare, and most cases are [[malignant]].
* [[Benign]] and borderline variants of this [[neoplasm]] are rare, and most cases are [[malignant]].
* Typically, they are cystic neoplasms with polypoid masses that protrude into the cyst.
* Typically, they are [[cystic]] [[neoplasms]] with polypoid [[masses]] that protrude into the [[cyst]].
===Endometrioid Tumor===
===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 endometrioid type).
[[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]]).
[[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===
===Gross Patholgy===
{| {{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|''' Ovarian Carcinomas Subtype'''}}
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|''' Ovarian 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.
|-
|-
| Endometrioid carcinoma of the ovary||
|[[Endometrial cancer|Endometrioid]] [[carcinoma]] of the [[ovary]]||
* Usually solid and cystic, bilateral
* Usually solid and [[Cyst|cystic]], bilateral


|-
|-
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==Microscopic Pathology==
==Microscopic Pathology==


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
[[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
. 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'''}}
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|-
|-
| 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 73: 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
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:* 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]]
|


|-
|-
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* 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
 
|-
|-
|}
|}
===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.
[[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)
Shown below is an image of Overian clear cell adenocarcinoma.(H&E stain,very high mag)
<div align="left">
<div align="left">
<gallery heights="175" widths="175">
<gallery heights="175" widths="175">
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.
Image:Ovserca2.jpg|Extensive stromal invasion, the criterion upon which rests the diagnosis of frank malignancy
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: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>]
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>]
Image:800px-Ovarian_clear_cell_carcinoma_-_very_high_mag.jpg|Ovary: Clear cell carcinoma]
</gallery>
</gallery>
</div>
</div>
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Latest revision as of 15:12, 6 September 2019

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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


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