Difference between revisions of "Serous carcinoma of the ovary"

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Serous carcinoma of the ovary (view source)

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Serous carcinoma - omentum 3 -- very high mag.jpg
| Width      =
| Caption    = Serous carcinoma. [[H&E stain]].
| Synonyms  =
| Micro      =
| Subtypes  =
| LMDDx      = [[serous carcinoma]] from other sites (e.g. [[serous carcinoma of the fallopian tube]]), [[clear cell carcinoma of the ovary]], poorly differentiated [[endometrioid carcinoma of the ovary]], [[ovarian serous borderline tumour]] for low-grade tumours
| Stains    =
| IHC        = WT-1 +ve, CK7 +ve, ER +ve, [[HNF-1beta]] -ve
| EM        =
| Molecular  = +/-BRCA1 mutation, +/-BRCA2 mutation
| IF        =
| Gross      = solid and cystic, serous fluid
| Grossing  =
| Site      = [[ovary]] - see ''[[ovarian tumours]]''
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = adnexal mass
| Symptoms  =
| Prevalence =
| Bloodwork  = CA-125 elevated
| Rads      = complex mass with solid and cystic area, often large
| Endoscopy  =
| Prognosis  = poor for high-grade
| Other      =
| ClinDDx    =
| Tx        = surgery, chemotherapy
}}
'''Serous carcinoma of the ovary''', also '''ovarian serous carcinoma''', is relatively common malignant [[ovarian tumour]].
'''Serous carcinoma of the ovary''', also '''ovarian serous carcinoma''', is relatively common malignant [[ovarian tumour]].


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*Most common malignant ovarian tumour in the eldery.
*Most common malignant ovarian tumour in the eldery.
*Poor prognosis.
*Poor prognosis.
*Thought to arise from [[serous tubal intraepithelial carcinoma]] (STIC).<ref name=pmid23240669>{{Cite journal  | last1 = Vang | first1 = R. | last2 = Shih | first2 = IeM. | last3 = Kurman | first3 = RJ. | title = Fallopian tube precursors of ovarian low- and high-grade serous neoplasms. | journal = Histopathology | volume = 62 | issue = 1 | pages = 44-58 | month = Jan | year = 2013 | doi = 10.1111/his.12046 | PMID = 23240669 }}</ref>
*May be associated with a ''[[BRCA1]] gene'' or ''[[BRCA2]] gene'' mutation.<ref name=pmid23707676>{{Cite journal  | last1 = Demsky | first1 = R. | last2 = McCuaig | first2 = J. | last3 = Maganti | first3 = M. | last4 = Murphy | first4 = KJ. | last5 = Rosen | first5 = B. | last6 = Armel | first6 = SR. | title = Keeping it simple: genetics referrals for all invasive serous ovarian cancers. | journal = Gynecol Oncol | volume = 130 | issue = 2 | pages = 329-33 | month = Aug | year = 2013 | doi = 10.1016/j.ygyno.2013.05.003 | PMID = 23707676 }}</ref>
**Approximately 20% of high-grade serous carcinoma are associated with BRCA1 or BRCA2.<ref name=pmid22776961>{{Cite journal  | last1 = Schrader | first1 = KA. | last2 = Hurlburt | first2 = J. | last3 = Kalloger | first3 = SE. | last4 = Hansford | first4 = S. | last5 = Young | first5 = S. | last6 = Huntsman | first6 = DG. | last7 = Gilks | first7 = CB. | last8 = McAlpine | first8 = JN. | title = Germline BRCA1 and BRCA2 mutations in ovarian cancer: utility of a histology-based referral strategy. | journal = Obstet Gynecol | volume = 120 | issue = 2 Pt 1 | pages = 235-40 | month = Aug | year = 2012 | doi = 10.1097/AOG.0b013e31825f3576 | PMID = 22776961 }}</ref>
 
Precursors lesions:
*[[Serous borderline tumour]]s for low-grade serious carcinoma.
**Generally do not progress to high-grade serous carcinoma.{{fact}}
*[[Serous tubal intraepithelial carcinoma]] (STIC)<ref name=pmid23240669>{{Cite journal  | last1 = Vang | first1 = R. | last2 = Shih | first2 = IeM. | last3 = Kurman | first3 = RJ. | title = Fallopian tube precursors of ovarian low- and high-grade serous neoplasms. | journal = Histopathology | volume = 62 | issue = 1 | pages = 44-58 | month = Jan | year = 2013 | doi = 10.1111/his.12046 | PMID = 23240669 }}</ref> for high-grade serous carcinoma.
 
==Gross==
*Ovarian mass.
**Typically solid with multiple cystic areas.
**Often >10 cm.
 
Note:
*Lesions <10 cm and unilocular are usually benign.<ref name=pmid9570990>{{Cite journal  | last1 = Bailey | first1 = CL. | last2 = Ueland | first2 = FR. | last3 = Land | first3 = GL. | last4 = DePriest | first4 = PD. | last5 = Gallion | first5 = HH. | last6 = Kryscio | first6 = RJ. | last7 = van Nagell | first7 = JR. | title = The malignant potential of small cystic ovarian tumors in women over 50 years of age. | journal = Gynecol Oncol | volume = 69 | issue = 1 | pages = 3-7 | month = Apr | year = 1998 | doi = 10.1006/gyno.1998.4965 | PMID = 9570990 }}</ref>


==Microscopic==
==Microscopic==
Features:
Features:
*Marked nuclear pleomorphism:
*Nuclear pleomorphism:
**Variation in size - usually marked.
**Variation in size - often marked.
**Variation in staining.
**Variation in staining.
**Variation in shape.
**Variation in shape.
*Prominent nucleolus - '''key feature'''.
*+/-[[Macronucleolus]] - '''key feature'''.
*Eccentric nucleus.
*Eccentric nucleus.
*Architecture:
*Architecture:
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**Papillary - classic.
**Papillary - classic.
**Glandular - uncommon.
**Glandular - uncommon.
*+/-Psammoma bodies - uncommon.
*+/-[[Psammoma bodies]] - uncommon.
*+/-Necrosis - often extensive.
*+/-Necrosis - often extensive.


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{| class="wikitable sortable"  
{| class="wikitable sortable"  
! Grade
! Grade
! Nuclei (most important)
! Nuclear atypia (most important)
! Mitotic rate
! Mitotic rate  
|-
|-
| Low-grade (Type I)
| Low-grade (Type I)
| mild/moderate atypia: round/oval nuclei, evenly distributed <br>chromatin, +/-conspicuous nucleoli
| mild/moderate atypia: round/oval nuclei, evenly distributed <br>chromatin, +/-conspicuous nucleoli
| <=12 mitoses/HPF †
| <=12 mitoses/10 HPFs †
|-
|-
| High-grade (Type II)
| High-grade (Type II)
| severe atypia: >=3:1 size variation, irregular <br>chromatin, +/-[[macronucleoli]]
| severe atypia: >=3:1 size variation, irregular <br>chromatin, +/-[[macronucleoli]]
| >12 mitoses/HPF †
| >12 mitoses/10 HPFs †
|}
|}


Notes:
Notes:
* † Definition suffers from [[HPFitis]].
* † Definition suffers from [[HPFitis]].
*Tumours very rarely transform from ''low-grade'' to ''high-grade''.<ref name=pmid22833081/>
** In fairness, the paper<ref name=pmid15087669/> notes that the ''Olympus BH2'' microscope was used.  The 40x objective on this microscope has a field diameter of 0.5 mm, according to a manual found online.<ref>URL: [www.alanwood.net/downloads/olympus-bh-2-bht-manual.pdf‎ www.alanwood.net/downloads/olympus-bh-2-bht-manual.pdf‎]. Accessed on: 1 January 2014.</ref> Assuming this is so, the field area is 0.19635 mm<sup>2</sup>. Thus, in standard units, the cut-point would be 6.1115 mitoses/1 mm<sup>2</sup> and the sample area 1.9635 mm<sup>2</sup>.
*Tumours very rarely transform from ''low-grade'' to ''high-grade''.<ref name=pmid22833081>{{Cite journal  | last1 = Garg | first1 = K. | last2 = Park | first2 = KJ. | last3 = Soslow | first3 = RA. | title = Low-grade serous neoplasms of the ovary with transformation to high-grade carcinomas: a report of 3 cases. | journal = Int J Gynecol Pathol | volume = 31 | issue = 5 | pages = 423-8 | month = Sep | year = 2012 | doi = 10.1097/PGP.0b013e31824ae6f2 | PMID = 22833081 }}</ref>


===Images===
===Images===
<gallery>
Image: Serous carcinoma - omentum -- high mag.jpg | Serous ca - high mag.
Image: Serous carcinoma - omentum -- very high mag.jpg | Serous ca - very high mag.
Image: Serous carcinoma - omentum 3 -- very high mag.jpg | Serous ca - very high mag.
</gallery>
<gallery>
<gallery>
Image:Serous_carcinoma_cytology.jpg | Serous carcinoma - cytology. (WC)
Image:Serous_carcinoma_cytology.jpg | Serous carcinoma - cytology. (WC)
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==IHC==
==IHC==
*WT-1 +ve - '''key immunostain'''.<ref name=pmid18830127>{{Cite journal  | last1 = Köbel | first1 = M. | last2 = Kalloger | first2 = SE. | last3 = Carrick | first3 = J. | last4 = Huntsman | first4 = D. | last5 = Asad | first5 = H. | last6 = Oliva | first6 = E. | last7 = Ewanowich | first7 = CA. | last8 = Soslow | first8 = RA. | last9 = Gilks | first9 = CB. | title = A limited panel of immunomarkers can reliably distinguish between clear cell and high-grade serous carcinoma of the ovary. | journal = Am J Surg Pathol | volume = 33 | issue = 1 | pages = 14-21 | month = Jan | year = 2009 | doi = 10.1097/PAS.0b013e3181788546 | PMID = 18830127 }}</ref>
*[[WT-1]] +ve - '''key immunostain'''.<ref name=pmid18830127>{{Cite journal  | last1 = Köbel | first1 = M. | last2 = Kalloger | first2 = SE. | last3 = Carrick | first3 = J. | last4 = Huntsman | first4 = D. | last5 = Asad | first5 = H. | last6 = Oliva | first6 = E. | last7 = Ewanowich | first7 = CA. | last8 = Soslow | first8 = RA. | last9 = Gilks | first9 = CB. | title = A limited panel of immunomarkers can reliably distinguish between clear cell and high-grade serous carcinoma of the ovary. | journal = Am J Surg Pathol | volume = 33 | issue = 1 | pages = 14-21 | month = Jan | year = 2009 | doi = 10.1097/PAS.0b013e3181788546 | PMID = 18830127 }}</ref>
*CK7 +ve.
*[[CK7]] +ve.
*CA-125 +ve.
*CA-125 +ve.
*ER +ve.<ref name=pmid21164285>{{Cite journal  | last1 = DeLair | first1 = D. | last2 = Oliva | first2 = E. | last3 = Köbel | first3 = M. | last4 = Macias | first4 = A. | last5 = Gilks | first5 = CB. | last6 = Soslow | first6 = RA. | title = Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases. | journal = Am J Surg Pathol | volume = 35 | issue = 1 | pages = 36-44 | month = Jan | year = 2011 | doi = 10.1097/PAS.0b013e3181ff400e | PMID = 21164285 }}</ref>  
*ER +ve.<ref name=pmid21164285>{{Cite journal  | last1 = DeLair | first1 = D. | last2 = Oliva | first2 = E. | last3 = Köbel | first3 = M. | last4 = Macias | first4 = A. | last5 = Gilks | first5 = CB. | last6 = Soslow | first6 = RA. | title = Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases. | journal = Am J Surg Pathol | volume = 35 | issue = 1 | pages = 36-44 | month = Jan | year = 2011 | doi = 10.1097/PAS.0b013e3181ff400e | PMID = 21164285 }}</ref>  
*p53 +ve.
*p53 +ve/-ve.
**p16 -ve/+ve.


Others:
Others:
*HNF-1beta -ve.<ref>{{Cite journal  | last1 = Tsuchiya | first1 = A. | last2 = Sakamoto | first2 = M. | last3 = Yasuda | first3 = J. | last4 = Chuma | first4 = M. | last5 = Ohta | first5 = T. | last6 = Ohki | first6 = M. | last7 = Yasugi | first7 = T. | last8 = Taketani | first8 = Y. | last9 = Hirohashi | first9 = S. | title = Expression profiling in ovarian clear cell carcinoma: identification of hepatocyte nuclear factor-1 beta as a molecular marker and a possible molecular target for therapy of ovarian clear cell carcinoma. | journal = Am J Pathol | volume = 163 | issue = 6 | pages = 2503-12 | month = Dec | year = 2003 | doi =  | PMID = 14633622 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892387/?tool=pubmed }}</ref><ref name=omim189907>{{OMIM|189907}}</ref>
*HNF-1beta -ve.<ref>{{Cite journal  | last1 = Tsuchiya | first1 = A. | last2 = Sakamoto | first2 = M. | last3 = Yasuda | first3 = J. | last4 = Chuma | first4 = M. | last5 = Ohta | first5 = T. | last6 = Ohki | first6 = M. | last7 = Yasugi | first7 = T. | last8 = Taketani | first8 = Y. | last9 = Hirohashi | first9 = S. | title = Expression profiling in ovarian clear cell carcinoma: identification of hepatocyte nuclear factor-1 beta as a molecular marker and a possible molecular target for therapy of ovarian clear cell carcinoma. | journal = Am J Pathol | volume = 163 | issue = 6 | pages = 2503-12 | month = Dec | year = 2003 | doi =  | PMID = 14633622 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892387/?tool=pubmed }}</ref><ref name=omim189907>{{OMIM|189907}}</ref>
**Usually +ve in [[clear cell carcinoma of the ovary]].
**Usually +ve in [[clear cell carcinoma of the ovary]].
*PAX2 +ve.
**Usually -ve in [[malignant mesothelioma]].<ref name=pmid22498671>{{Cite journal  | last1 = Gao | first1 = FF. | last2 = Krasinskas | first2 = AM. | last3 = Chivukula | first3 = M. | title = Is PAX2 a reliable marker in differentiating diffuse malignant mesotheliomas of peritoneum from serous carcinomas of müllerian origin? | journal = Appl Immunohistochem Mol Morphol | volume = 20 | issue = 3 | pages = 272-6 | month = May | year = 2012 | doi = 10.1097/PAI.0b013e3182366531 | PMID = 22498671 }}</ref>
==Sign out==
<pre>
A. RIGHT OVARY, BIOPSY:
- SEROUS CARCINOMA, HIGH-GRADE.
- PSAMMOMATOUS CALCIFICATIONS.
B. OMENTUM, BIOPSY:
- SEROUS CARCINOMA, HIGH-GRADE.
- PSAMMOMATOUS CALCIFICATIONS.
COMMENT:
The morphology is compatible with a serous carcinoma (prominent
nucleoli, large nuclear size variation, psammomatous calcifications).
The immunostaining is that of a serous carcinoma:
POSITIVE: CK7, ER, PR (focal), CA-125, WT-1.
NEGATIVE: CK20, p53.
The ovary has multiple small tumour nodules.  The status of the opposite
ovary is unknown. The bulk of the tumour in the specimen provided is in
the omentum.
Clinical and radiologic correlation is suggested for the determination of
the primary site of this serous carcinoma.
High-grade serous carcinoma of ovary/fallopian tube/periteonum is associated
with BRCA1/2 mutation in approximately 20% of patients. Referral to genetic
counseling is recommended.
</pre>


==See also==
==See also==
*[[Ovary]].
*[[Ovary]].
*[[Ovarian tumours]].
*[[Ovarian tumours]].
*[[Serous carcinoma of the fallopian tube]].


==References==
==References==
Michael
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