The purpose of this paper is to quantify the incidence of different histological types of ovarian tumors and to demonstrate the clinical importance of an effective screening program, considering the paucisymptomatic nature of this pathology.
The incidence of ovarian epithelial tumors varied across age groups, our study group including women aged between 34 and 64 years old. Knowing the age distribution plays an important role in the implementation of screening programs.
All cases presented with similar symptomatology: pelvic pain, abdominal distension and ascites. The gross appearance of these tumors was overlapping in different histological subtypes, showing variable cystic and solid components. The histological subtypes included in our study were: serous carcinoma, low grade and high grade, mucinous carcinoma, endometrioid carcinoma and clear cell carcinoma. A positive correct diagnosis of the histological subtype is essential for therapy and follow-up, and immunohistochemial studies should be performed in difficult cases.
There is a large series of antibodies used for the ovarian cancer histology diagnosis of ovarian carcinoma, so the pathologist should know what algorithm to use in approaching a diagnosis in order to obtain a correct result. Scopul acestei lucrări este de a cuantifica incidența diferitelor tipuri histologice de tumori ovariene și de a demonstra importanța clinică a unui program eficient de screening, având în vedere natura ovarian cancer histology a acestei patologii.
Incidența tumorilor epiteliale ovariene a variat în funcție de grupurile de vârstă, grupul nostru de studiu incluzând femei cu vârsta cuprinsă între 34 și 64 de ani. Cunoașterea distribuției pe vârste joacă un rol important în implementarea programelor de screening. Toate cazurile au prezentat simptomatologie similară: durere pelviană, distensie abdominală și ascită. Aspectul macroscopic al acestor tumori se suprapune în diferite subtipuri histologice, prezentând componente variabile chistice și solide.
Subtipurile histologice incluse în studiul nostru au fost carcinomul seros, de grad scăzut sau crescut, carcinomul mucinos, carcinomul endometrioid pastile pentru ovarian cancer histology carcinomul cu celule clare.
Un diagnostic corect pozitiv al subtipului histologic este esențial pentru terapie și follow-up, iar studiile imunohistochimice trebuie efectuate în cazuri dificile. Există o ovarian cancer histology mare de anticorpi folosiți pentru diagnosticul pozitiv al carcinomului ovarian, astfel încât anatomopatologul ar trebui să știe ce algoritm să utilizeze în abordarea unui diagnostic pentru a obține un rezultat corect.
Cuvinte cheie epiteliu carcinom ovar imunohistochimie Introduction Ovarian ovarian cancer histology is a public health problem that affects women of reproductive age and is a major cause of morbidity and mortality.
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Early diagnosis is the primary method of ameliorating complications and long-term prognosis, but this is hampered by reduced symptomatology, with most patients presenting in advanced stages. From tothe incidence rate and the mortality rate decreased by 0.
The most important factor in determining the prognosis of the patient is the tumor stage. For epithelial ovarian cancer, ovarian cancer histology screening methods ultrasound and tumor markers have not been as effective as in cervical or breast tumors. Ovarian epithelial tumors represent a heterogeneous class of neoplasia, classified by cell type in serous, mucinous, endometrioid and clear cell. Because there are no benign equivalent tissues in the ovary, the mechanism of carcinogenesis was attributed initially to the ovarian epithelium mesotheliumbut recent studies have proposed that serous tumors are secondary tumors, derived from lesions of the fallopian tube fimbria, while endometrioid tumor or clear cells tumors are secondary to ovarian endometriosis 4.
Ovarian epithelial tumors are classified according to the degree of nuclear atypia, tumor proliferation and the presence or absence of stromal invasion, in benign, borderline and malignant conditions. The borderline tumors are called this way because they present cytological ovarian cancer histology histological aspects that are intermediate between benign and malignant.
Materials and method The purpose of this paper ovarian cancer histology to quantify the incidence of different histological types of ovarian tumors and to demonstrate the clinical importance of an effective screening program, considering the paucisymptomatic nature of this pathology.
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Symptoms suggestive for this pathology were noted to demonstrate the silent clinical appearance of ovarian neoplasia. Ovarian cancer histology were obtained from limited tumor excision, but also from oophorectomy and hysterectomy with bilateral anexectomy, formalin fixed and paraffin embedded, then stained with Hematoxylin-Eosin. In some cases, additional immunohistochemical stains were needed to clarify the diagnosis. Results This study included data from a batch of 23 ovarian carcinomas, selected from ovarian pathology patients.
The incidence of ovarian epithelial tumors varies across age groups, our study group including women aged between 34 and 64 years old.
Knowing the age distribution plays an ovarian cancer histology role in the implementation of screening neuroendocrine cancer fatigue. All cases presented with similar symptomatology: pelvic pain, abdominal distension and ascites in two cases. In the category of malignant serous tumors, we included 9 patients, 6 low-grade and 3 high-grade.
The low-grade serous carcinoma was non-invasive and showed a papillary-type development, with small nuclei, rare mitoses and a hyalinized stroma with occasional psamoma bodies. Immunohistochemical assays showed positivity to CK7 and ER. Figure 1. The immunohistochemical un medicament parazitar pentru copii pentru prevenire showed, by contrast to the previous low-grade serous cases, a mutated expression of p53 and ovarian cancer histology Ki67 index.
The pattern of p53 immunosay is very important and the result should refer to the presence or absence of a mutation. A strong and diffuse immunoexpression of p53, as well as a completely negative immunostaining should be interpreted as an indicator of a TP53 gene mutation. In our cases, all high grade showed mutated status of TP53 gene. Hormone receptor testing showed no difference from the low-grade cases and is not useful in the differential diagnosis.
Also, all cases of both low-grade and high-grade serous carcinoma exhibited diffuse nuclear positivity with WT1.
Figure 2. High-grade serous carcinoma of the ovary, HE, 40x, and p53 mutated, 40x The cases of carcinomas with glandular architecture, atypical cells and foci of squamous metaplasia were classified as endometroid carcinomas due ovarian cancer ovarian cancer histology their resemblance to the endometrium 5 cases. The immunohistochemical profile of endometriod carcinomas is similar to that of benign endometrial tumors, presenting a positive reaction for cytokeratins and both estrogenic and progesterone receptors and different values of Ki67, depending on the aggresive character of the tumor.
In one case, the initial intraoperative diagnosis was endometriod cyst, while extensive grossing for the final diagnosis revealed the presence of a small area of endometrioid carcinoma Figure 3.
Figure 3. Endometrioid ovarian carcinoma and associated endometrioid cyst, HE, 40x A third histopathological category of ovarian epithelial tumors were the mucinous tumors, which represented 2.
On gross examination, two cases showed cystic appearance and the rest were solid with dimensions between 6 and 14 cm.
MANAGEMENT OF BORDERLINE OVARIAN TUMORS
In one case, the mucinous adenocarcinoma has shown an expansive pattern of development, without any ovarian cancer histology invasion and complex architecture, while the rest were infiltrative. Figure 4. The year-old patient who was diagnosed with this tumor had epiploic metastasis at admission.
Because all bilateral or large mucinous ovarian tumors should be considered secondary dissemination until proven otherwise, immunohistochemical tests are compulsory. In our cases, three tumors turned out to be primary tumors, two were metastasis from a colorectal adenocarcinoma and one of them was a Krukenberg tumor metastasis from a gastric carcinoma. Figure 5. Primary mucinous ovarian adenocarcinoma, HE, 40x, and CK7 positive The Krukenberg tumor showed a specific pattern, with signet ring infiltrating tumoral cells, Ck20, CDx2 and CEA positive, but the diagnosis cannot be relied solely on histological and immunohistochemical pattern and it had to be confirmed by the clinical context.
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Krukenberg tumor, HE, x and CK20 positive, x Clear cell carcinomas are rare tumors and we only found two cases that showed very different histological pattern: one had hobnail cell that protruded into the lumina, while the other showed clear cytoplasm.
The arhitecture was heterogenous in both cases, with tubular-cystic, papillary cores with hyalinization and solid area. The immunohistochemical tests are useful mainly for the differential diagnosis with serous and mucinous carcinoma.
Also, Ki67 had a high value in both cases, as these types of tumors are rather aggressive Figure 8. Figure 8.
Histopathology Ovary--Serous cystadenoma
Clear cell carcinoma of the ovary - EMA positive, x, and Ki67 positive, x Discussions Malignant ovarian neoplasms are the seventh most common form of cancer diagnosed in the female population. Another important aspect of this pathology is the reduced symptomatology of the incipient stages.
The main symptoms are abdominal pain, palpable abdominal mass, or vaginal bleeding, which are predominantly found in borderline and malignant tumors 8. In some cases, the rapid increase in size leads to torsion of the ovary and important pain.
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The screening for this pathology consists in several methods, such as: transvaginal ultrasonography with or without contrast, BRCA mutation testing, or tumor marker dosing. An element of interest in this pathology is represented by risk factors still incompletely elucidated. The main process involved in pathogenic epithelial ovarian tumors is inflammation of the surface epithelium. The inflammatory changes occurring at the time of ovulation and hyaline body formation cause alterations of epithelial cell DNA A positive correct diagnosis of the histological subtype is essential for therapy and follow-up.
False negative results, that might come up intraoperatively, should be solved by extensive grossing of the surgical specimen. In our study, only one case showed false negative result. Most cases of ovarian carcinoma will need immunohistohemical confirmation, especially the mucinous subtypes. Ovarian mucinous tumors represent a wide range of neoplasms, from benign to malignant, and are distinct from other histological and molecular ovarian cancer histology epithelial tumor subtypes.
The assessment of ovarian mucosal tumors requires the correlation of clinical data, imaging aspects, contralateral ovary ovarian cancer histology, the presence or absence of intraperitoneal mucin and the macroscopic aspect of the appendix. Although in most cases a positive diagnosis of a benign lesion does not pose diagnostic problems, the differential diagnosis between a primary ovarian tumor and a metastasis is difficult to perform intraoperatively or in the classic histological examination.
The prognosis and therapeutic management are different for each histological entity, so positive diagnosis is essential.
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Malignant tumors of the ovary are characterized by positivity to CK7 and P53, and negative for CK20 Conclusions In conclusion, epithelial ovarian neoplasia affects an increased number of women, mainly of reproductive age. The most affected age categories are the third and fourth decades, with a maximum incidence in the fourth decade.
Thus, ovarian epithelial tumors also have socio-economic importance, in addition to public health, affecting the active occupational categories. Reducing the morbidity and mortality of this pathology through effective screening programs becomes a priority of the health system.
As therapy has progressed towards a more targeted approach, there have been changes and advances in the understanding of ovarian carcinoma. Also, the ovarian tumors of the epithelial type present a large histological variety, each exhibiting several developmental patterns and requiring additional immunohistochemical tests. Bibliografie 1. Gynecologic pathology: A volume in the series foundations in diagnostic pathology.
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Diagnostic Gynecologic and Obstetric Pathology. The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am J Surg Pathol ; Mutter G, Prat J.
Epidemiology of ovarian cancer: a review. Cancer Biol Med, ; 14 1 Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer, ; 2 Prediagnostic symptoms of ovarian carcinoma: A case-control study. Gynecologic oncology, ; 2 Value in Health, ; 20 4 Risk ovarian cancer histology for epithelial ovarian cancer by histologic subtype. Am J Epidemiol, ; 1 Kriplani D, Patel MM. Immunohistochemistry: A diagnostic aid in differentiating primary epithelial ovarian tumors and tumors metastatic to the ovary.
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