Seromucinous borderline tumor-associated high-grade ovarian cancers

Abstract

We present 6 high grade ovarian carcinomas that were associated with seromucinous borderline tumors. Patients ranged in age from 26 to 66 years. All cancers appeared as solid regions within otherwise paucicystic tumors that measured from 4.2 cm to 14.0 cm in greatest dimension. Five of the 6 tumors were bilateral, and endometriosis was seen in 4 of the tumors. Clinical data, with follow up periods ranging from 0 to 40 months, was available for all patients. Four patients died of their disease and two had recurrent disease at the time of this review. All tumors exhibited a low-grade carcinoma component, which is consistent with ovarian cancers developing in a progressive adenoma to carcinoma sequence (so-called type I ovarian cancers). Two of the associated low-grade/borderline tumors had focal serous characteristics with WT1+ epithelial cell clustering. High-grade tumors exhibited an array of cell types expressing endometrioid, undifferentiated, serous, clear cell, and mucinous features that were at times mixed within the same tumor. Five cancers were focally WT1+; two showed admixed lowgrade serous features and one showed a high-grade serous adenocarcinoma with transitional features. Two cancers had mucinous features (one with focal CK20 and CDX2 immunohistochemical staining and one only with focal CDX2 immunohistochemical staining). All the high-grade tumors showed a mutated-pattern of p53 nuclear staining with >75% 2-3+ staining. We conclude that seromucinous borderline tumors need to be extensively sampled. Cyst wall membrane rolls are important to evaluate since they may reveal persisting endometriosis and solid regions most likely harbor a high-grade tumor. Identifying high-grade cancer within a seromucinous borderline tumor is important because, although seromucinous borderline tumors and their oftassociated low-grade endometrioid cancers have favorable outcomes, tumors harboring a high-grade component are aggressive and may eventuate in patient death.