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Difference between revisions of "Serous carcinoma of the ovary"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = Serous carcinoma - omentum 3 -- very high mag.jpg | ||
| Width = | | Width = | ||
| Caption = | | Caption = Serous carcinoma. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = | ||
| Micro = | | Micro = | ||
| Line 11: | Line 11: | ||
| IHC = WT-1 +ve, CK7 +ve, ER +ve, HNF-1beta -ve | | IHC = WT-1 +ve, CK7 +ve, ER +ve, HNF-1beta -ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = +/-BRCA1 mutation, +/-BRCA2 mutation | ||
| IF = | | IF = | ||
| Gross = solid and cystic, serous fluid | | Gross = solid and cystic, serous fluid | ||
| Line 35: | Line 35: | ||
*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 '' | *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: | Precursors lesions: | ||
*[[Serous borderline tumour]]s for low-grade serious carcinoma. | *[[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. | *[[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. | ||
| Line 93: | Line 95: | ||
===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 100: | 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== | ||