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

Clear cell tumors are part of the surface epithelial-stromal tumor group of ovarian cancers, 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.
Typically, they are cystic neoplasms with polypoid masses that protrude into the cyst.

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	Ovarian mass. 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	Nuclear pleomorphism: Variation in size – often marked Variation in staining Variation in shape +/-Macronucleolus – key feature Eccentric nucleus Architecture: Solid Papillary – classic Glandular – uncommon +/-Psammoma bodies – uncommon +/-Necrosis – often extensive
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)
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.

References

↑ Hoffman, Barbara (2012). Williams gynecology. New York: McGraw-Hill Medical. ISBN 9780071716727.
↑ Malignant melanoma. Libre pathology. http://librepathology.org/wiki/index.php/Malignant_melanoma. URL Accessed on September 30, 2015
↑ Basal cell carcinoma . Libre pathology. http://librepathology.org/wiki/index.php/Basal_cell_carcinoma. URL Accessed on September 30, 2015
↑ Squamous cell carcinoma. Libre pathology. http://librepathology.org/wiki/index.php/Squamous_cell_carcinoma. URL Accessed on September 30, 2015

Template:WikiDoc Sources

[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

[1]

[2]

[3]

[4]