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Difference between revisions of "Serous carcinoma of the ovary"
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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, [[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. | ||
* | *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== | ||
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Notes: | Notes: | ||
* † Definition suffers from [[HPFitis]]. | * † Definition suffers from [[HPFitis]]. | ||
** 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>. | ** 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> | *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) | ||
| Line 57: | Line 107: | ||
==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== | ||