Surface Epithelial Tumors Research Articles

Double Pathology: Malignant Epithelial Ovarian Tumor and Germ Cell Tumor (Choriocarcinoma), a Rare Coexistence

Surface epithelial stromal tumors account for approximately 60% of all ovarian tumors and approximately 90% of all ovarian malignancies. Sex cord stromal tumors account for 7% of all malignant ovarian tumors. Germ cell tumors make up only 3-7% of malignant ovarian tumors. A combination of serous carcinoma of the ovary and choriocarcinoma is rare. Until today such combination has been documented only in six cases in the English literature. Here, we describe a case of ovarian serous carcinoma, where histopathology revealed a combination of serous carcinoma with adjacent choriocarcinoma component in the extraovarian peritoneal deposits. A 64-year-old post-menopausal female was diagnosed to have stage IV ovarian cancer. She received six cycles chemotherapy. Subsequently she underwent optimal cytoreductive surgery. Microscopically, monomorphic histology (serous carcinoma) was noted in both the ovaries and dimorphic histologies (serous carcinoma and choriocarcinoma) in the sigmoid mesocolon nodule, omentum and left subdiaphragmatic nodules. Metronomic chemotherapy continued and patient is on regular follow-up for the past 1 year with stable disease. Recognition of choriocarcinomatous components in ovarian carcinomas is important because of its association with aggressive behavior. In spite of the aggressive histology, the patient is surviving for the past 1 year. Different chemotherapeutic regimens have been used in cases of mixed choriocarcinoma and carcinoma, but established chemotherapeutic regimens have not been described. Chemotherapeutic regimens that target both components have been advocated and used. The absence of choriocarcinoma in ovarian primary and its presence in the extraovarian peritoneal deposits have not been described in the English literature so far. This case is being presented for its rarity.

Epithelial ovarian tumors: Clinicopathological correlation and immunohistochemical study.

Background:Ovarian cancer is the third leading site of cancer among women, trailing behind cervix and breast cancer.Aim:This study was undertaken to analyze the immunohistochemical (IHC) profile of estrogen receptors (ER), progesterone receptors (PR), Ki-67, and p53 in various ovarian epithelial tumors and attempt correlation with clinical and histopathological findings.Materials and Methods:The present study was conducted over a period of 4 years. A technique of manual tissue array was employed for cases subjected for IHC. The primary antibodies used were ER, PR, p53, and Ki-67. A correlation was attempted between histopathological and IHC findings. Results were subjected to statistical analysis. Software program “the primer of biostatistics 5.0” was used for calculation of interrelationships between the analyzed ER, PR, p53, and Ki-67 expression and histological factors by Pearson's Chi-square test. The results were considered to be significant when the P < 0.05.Results:There were 110 cases of surface epithelial ovarian tumors (SEOT) encountered over the period of 4 years. The expression of ER was more in malignant tumors (13/16, 81.25%) than borderline (9/12, 75%) and benign (20/82, 24.39%). As compared to ER, the expression of PR was more in benign (51/82, 62.19%) than borderline (8/12, 66.67%) and malignant tumors (9/16, 56.25%). The expression of PR was more in benign tumors than borderline and malignant tumors. However, this was not statistically significant (Chi-square = 0.335 with 2 degrees of freedom; P = 0.846). The expression of p53 was less in benign (5/82, 6.1%) than borderline (9/12, 75%) and malignant tumors (13/16, 81.25%). The expression of Ki-67 was more in malignant (4/82, 4.88%) than borderline (10/12, 83.33%) and benign tumors (15/16, 93.75%). In all the above cases, the difference was statistically significant (P < 0.05). There was statistically significant difference in the expression of ER, PR, p53, and Ki-67 in the patients with age <40 years and above 40 years (P = 0.912). A positive correlation was observed in p53 expression and tumor grade. Similar correlation was seen in Ki-67 and tumor grade. It was also noted that mean Ki-67 labeling index (Li) had also increased with tumor grade. In the case of serous tumors, ER was expressed in all high- and low-grade tumors. The expression of PR was more in low-grade tumors than high-grade ones. P53 expression was seen in all high-grade tumors and 33.34% of low-grade tumor. The Ki-67 Li was more in high-grade tumors than low-grade tumors. Expression of ER, p53, and Ki-67 was higher in tumor showing metastasis. The mean Ki-67 Li was also higher in metastasizing tumors. However, PR expression was less in metastasizing tumors than nonmetastasizing tumors.Conclusion:IHC marker report of ER, PR status, and Ki-67 if included in each pathology report will pave the way for better understanding of biological behavior and modify treatment strategies.

Brenner tumor with serous cystadenoma-an unusual combination: a case report

Surface epithelial tumors are most common, which comprise 58% of all ovarian tumors. Serous and mucinous cystadenoma are the most common epithelial tumors which accounts for about 35% of ovarian tumors. Different combinations of epithelial tumors can occur in ovary most common among them is Mucinous cystadenoma and Brenner tumor. We report a case of an ovarian tumor with rare combination Brenner tumor with serous cyst adenoma of ovary in 56 year old female patient. Only a few cases with this combination are very rarely reported in the literature.

Napsin A is a specific marker for ovarian clear cell adenocarcinoma

Ovarian clear cell adenocarcinoma has a relatively poor prognosis among the ovarian cancer subtypes because of its high chemoresistance. Differential diagnosis of clear cell adenocarcinoma from other ovarian surface epithelial tumors is important for its treatment. Napsin A is a known diagnostic marker for lung adenocarcinoma, and expression of napsin A is reported in a certain portion of thyroid and renal carcinomas. However, napsin A expression in ovarian surface epithelial tumors has not previously been examined. In this study, immunohistochemical analysis revealed that in 71 of 86 ovarian clear cell adenocarcinoma patients (83%) and all of the 13 patients with ovarian clear cell adenofibroma, positive napsin A staining was evident. No expression was observed in 30 serous adenocarcinomas, 11 serous adenomas or borderline tumors, 19 endometrioid adenocarcinomas, 22 mucinous adenomas or borderline tumors, 10 mucinous adenocarcinomas, or 3 yolk sac tumors of the ovary. Furthermore, expression of napsin A was not observed in the normal surface epithelium of the ovary, epithelia of the fallopian tubes, squamous epithelium, endocervical epithelium, or the endometrium of the uterus. Therefore, we propose that napsin A is another sensitive and specific marker for distinguishing ovarian clear cell tumors (especially adenocarcinomas) from other ovarian tumors.

Ovarian leiomyoma with cystic degeneration - a case report

Primary leiomyoma of the ovary is a rare benign tumour and accounts for 0.5-1% of all benign ovarian neoplasms. As their uterine counterparts, ovarian leiomyomas also exhibit the same varied histological spectrum. Cystic degeneration accounts for 4% in leiomyomas. We herein report a case of ovarian leiomyoma with cystic degeneration. The predominant cystic and myxoid nature of the lesion in our case mimicked a primary surface epithelial neoplasm on gross examination. Extensive degeneration in ovarian leiomyoma is unusual and one should consider this rare possibility when dealing with a cystic ovarian mass.

Book Review: Advances in Diagnosis and Management of Ovarian Cancer

2014 Ovarian cancer remains a feared disease as the non-specific symptoms result in delayed diagnosis and presentation with late-stage disease. Samir A Fargaly, the editor, Consultant Obstetrician and Gynecologist at Weill Cornell Medical College, New York, acknowledges in the preface that a woman’s lifetime risk of getting ovarian cancer is approximately 1 in 72. It is not a common cancer, ranking ninth in order of frequency, but it is the fifth commonest cause of cancer deaths in women. It is difficult for the specialist in active practice to appreciate just how many advances in the management of ovarian cancer have occurred over the last 10 years or so. This text book addresses improvements in approaches to screening, detection, surgical and nonsurgical management of the disease, which, as the editor acknowledges in his preface, have enhanced survival of women with ovarian cancer. There is still scope for further improvement and this book underlines some of the challenges. The recognition of the multidisciplinary approach to the treatment of this disease is implied rather than explicitly stated in this book. The international list of authors range from diagnostic physicians to surgical and nonsurgical oncologists as well psychologists. The breadth of subject matter is ambitious and the chapters are necessarily short. The concise chapters, relevant to the undergraduate and specialist alike, have been written by recognised experts who bring the wealth of their experience to the text. The chapters are well referenced with current literature. The absence of evidence, where relevant, is declared. The illustrations are clear and appropriate. For example, the chapters on Surface Epithelial Tumors of the Ovary and Pathology of Non-epithelial Malignancies of the Ovary have excellent microscopic photographs that clarify the pathology for the nonspecialist. The difficulty with making a diagnosis of ovarian cancer makes screening an attractive option. An ideal screening program would be inexpensive, convenient and reproducible, and would detect the disease in its precancerous state where treatment would prevent progression to cancer. None of the current screening trials for the prevention of ovarian cancer has managed to achieve this. The trials for ovarian cancer have explored combinations of tumor markers and ultrasound. The chapter on screening highlights all the important screening trials and their limitations, which include the low prevalence of the disease and deficiencies in our understanding of the early natural history of ovarian cancer. Advances in diagnosis and management of ovarian cancer

Diagnosis, surgical treatment, and management of borderline ovarian surface epithelial neoplasms: Report of 2 cases and review of literature

Abstract Ovarian borderline surface epithelial neoplasms occur infrequently in the pediatric population. Preoperative diagnostic criteria include ultrasound and serum tumor markers with definitive diagnosis made on pathologic examinations intraoperatively. Treatment typically involves resection of the tumor with an emphasis on preserving fertility. Patients diagnosed with borderline tumors generally have a good prognosis; however the possibility of recurrence remains. Two cases of 15 year-old females with borderline ovarian tumors are presented that add to the current literature by highlighting the diagnosis, clinical management, and follow-up postoperatively.

Primary pure large cell neuroendocrine carcinoma of the ovary

Neuroendocrine tumors are more common in the female genital tract than in the male genital tract, and most are uterine small cell carcinomas or ovarian carcinoid tumors. Most ovarian tumors are associated with surface epithelial tumors, SertolieLeydig cell tumors, teratoma, small cell carcinoma, pulmonary-type and undifferentiated carcinoma, and nonsmall cell lung cancer [1]. Large cell neuroendocrine carcinoma (LCNEC) of the ovary is unusual and defined as an extremely malignant tumor with an aggressive lethal outcome. For this original and updated review, we searched the databases of PubMed Clinical Queries, MEDLINE, Cochrane Library and UpToDate. We also hand-searched relevant journals and reference lists of identified articles. The keywords used were “ovary”, “pure LCNEC”, and “immunohistochemistry”. We found that only 37 cases of ovarian tumor involving LCNEC associated with surface epithelial stromal tumors and/or teratoma have been reported to date [2e5]. In addition, seven cases of primary LCNEC of the ovary without any associated component have been described [2,3,6e8]. Herein, we present the case of a patient with stage IV primary pure LCNEC of the ovary with liver metastasis and carcinomatosis. A 50-year-old married, Taiwanese female, G3P3, was referred by a clinical oncologist for the evaluation of a pelvic mass. She denied specific systemic disease, a gynecological history, and undergoing major operations previously. She also denied any significant symptoms, such as compression sensation, lower abdominal pain, or abnormal vaginal bleeding. Because of an increased abdominal circumference and a palpable 20-cmmass in the abdomen that had been present for 2 weeks, she was referred by a clinical oncologist and underwent a suboptimal debulking operation with total abdominal hysterectomy, bilateral salpingo-oophorectomy, partial

Immunohistochemical Expression of ERα, ERβ, and TFF1 in Type I and II Ovarian Tumors

Surface epithelial tumors of the ovary are no longer considered as a single disease but are divided into types I and II on the basis of their molecular features, cell of origin, and their behavior. A possible direct action of gonadal steroids on ovarian carcinogenesis has been suggested. The current information about the possible role of TFF1 in ovarian tumors,, together with its relationship to the estrogen receptor (ER) status, is insufficient. The aim of this study was to investigate ERα, ERβ, and TFF1 expression in type I and II ovarian tumors and their correlation with clinicopathologic parameters of each type. The present study was carried out on 97 ovarian tumors [20 benign, 15 borderline, and 62 malignant (36 type I and 26 type II tumors)]. ERα expression was significantly in favor of type II tumors (P=0.04), whereas high TFF1 expression was significantly in favor of type I tumors (P=0.02). ERα and ERβ showed a significant positive correlation in benign cases (P=0.004) and in type I tumors (P=0.006), but not in type II tumors. In type I tumors, the expression of ERα was correlated with serous carcinoma (P=0.002) and bilaterality (P=0.05), whereas TFF1 was correlated with mucinous carcinoma (P=0.02), unilaterality (P=0.04), early FIGO staging (P=0.01), and a low mitotic count (P=0.03). A high ERβ:ERα H score ratio was associated with advanced FIGO staging in both type I (P=0.05) and type II tumors (P=0.009). The difference in the expression of ERα and TFF1 between type I and II tumors may be indicative of the difference in their origin and molecular pathway. The ERβ:ERα ratio is more important in determining the net result of ER effects than the evaluation of each receptor separately, and the high ratio may promote progression to advanced stage in type I and II ovarian tumors. High TFF1 expression in ovarian mucinous carcinoma may indicate that their mucinous differentiation is toward an intestinal type rather than an endocervical type. TFF1 expression in ovarian tumors seems to occur independent of the status of the ER.

Gonadoblastoma and hepatoid and endometrioid-like yolk sac tumor: an update.

Dr Robert E. Scully greatly advanced our understanding of germ cell neoplasia to the extent that it is difficult to narrow the discussion of his contributions to this topic so that it can be covered in a brief article. This article accordingly focuses on some of the recent developments concerning 2 of his major contributions in this area-the gonadoblastoma (GB) and variant morphologies of yolk sac tumor. GB was defined by Dr Scully in 1953 and its features elaborated in detail by him in 1970. This neoplasm occurred in young patients who often displayed phenotypic sex ambiguities and frequently presented with primary amenorrhea. It was bilateral in 40%, and consisted of circumscribed nests of small sex cord cells and germinoma-like cells admixed with round deposits of eosinophilic, hyaline, often calcified material. These nests were set in a spindle cell gonadal stroma with Leydig-like or lutein-like cells. Because of his work we now understand that this precursor to invasive germ cell tumors occurs in patients with a specific form of disorder of sex development, namely gonadal dysgenesis, and only in those who have a particular portion of the Y chromosome, the GB locus/TSPY gene, within the gonadal tissue. An essential element to the development of GB appears to be a defect in the genetic pathway that leads to the development of Sertoli cells. Improperly formed Sertoli cells predispose to "delayed maturation" of the gonocytes of the gonad and predispose them to undergo malignant transformation. "Undifferentiated gonadal tissue" has been proposed as the precursor to the development of GB and consists of an unorganized mixture of apparently non-neoplastic germ cells, germ cells with delayed maturation, and neoplastic germ cells with sex cord cells and gonadal stroma. Two variant morphologies of yolk sac tumor were also recognized by Dr Scully. In the hepatoid variant features similar to hepatocellular carcinoma occurred, although primitive glandular foci and lack of liver involvement permitted its distinction in most cases. More recently this variant has been found to occasionally produce bile in canalicular-like structures and to stain strongly for both SALL4 and glypican 3, 2 recently described markers of yolk sac tumor. Recognition of hepatoid yolk sac tumor was followed by the description of a potential mimic, primary ovarian hepatoid carcinoma, which, however, occurred in a significantly older patient population and was occasionally associated with surface epithelial neoplasia. The endometrioid-like variant of yolk sac tumor simulated primary endometrioid adenocarcinoma. It can be suspected on routine stains because of primitive appearing nuclei, frequent subnuclear vacuoles, and in some cases association with more usual yolk sac tumor. Its recognition is now facilitated by a panel of immunohistochemical stains that are often expressed differentially in these 2 neoplasms--endometrioid-like yolk sac tumor: positive for SALL4, glypican 3, and α-fetoprotein; endometrioid adenocarcinoma: positive for cytokeratin 7 and epithelial membrane antigen. Finally, Dr Scully contributed one of the first cases in the literature of yet another nuance in the complicated world of yolk sac neoplasia, namely the development of some tumors on the background of a surface epithelial neoplasm. This is analogous to the more common development of choriocarcinoma from carcinoma and, in the case of yolk sac tumor, diagnosis is aided clinically by the usual older age of the patient and nature of the associated neoplasia.

English

BACKGROUND: Ovarian cancer is the fourth leading cause of death in females around the world and therefore an area of concern for health care professionals. The further distressing aspect of these tumors is that they do not manifest any symptoms till they are clinically advanced or have attained a considerable size. AIMS: To study the histological pattern of ovarian tumors and compare it with other studies. SETTINGS AND DESIGN: Retroprospective study. METHODS AND MATERIAL: A retro prospective study was done on 131 ovarian tumors received over a period of five years. Data including the age, clinical presentation, related history, involvement (whether unilateral or bilateral) were obtained from the histopathological requisition forms of the patients. Histopathology reports of all the cases were recorded from the data base. The histological categorization of ovarian tumors was done according to the WHO Classification of 2003. STATISTICAL ANALYSIS USED: None. RESULTS: Out of the 131 tumors studied, 87 (66.41%) were benign, 32 (24.42%) were malignant and 12 (9.16%) were borderline. Surface epithelial tumors (67.17%), including benign, borderline and malignant, contributed the bulk of the cases. Ovarian tumors were seen in younger age group and borderline tumors, both serous and mucinous, were reported more compared to other studies. Mucinous cystadenocarcinoma was the most common malignancy. CONCLUSIONS: Ovarian tumors once detected should be removed immediately without further delay. A very extensive sampling and careful histopathological examination should be the rule as the patient’s management and prognosis depends largely on the histologic type of tumor.

USG guided FNAC of ovarian mass lesions: A cyto-histopathological correlation, with emphasis on its role in pre-operative management guidelines.

Ultrasonography (USG)-guided fine-needle aspiration cytology (FNAC) of ovarian masses is an efficient diagnostic modality for accurately diagnosing ovarian tumours prior to surgery. The main aim of this study was to assess the sensitivity, specificity and accuracy of FNAC in diagnosing ovarian masses. Eighty-three patients with ovarian masses were recruited and correlation of USG-guided FNAC was made with histopathology in all but 6 cases, where surgery was not indicated. Cytological diagnosis was obtained in all 83 ovarian lesions: 56 cases were benign, 6 possibly benign, 3 suspicious of malignancy and 18 cases as malignant. Out of 77 cases where histology was available, the 12 non-neoplastic cysts were endometriotic cysts and follicular cysts. The majority of neoplastic lesions were surface epithelial tumours. Out of 12 non-neoplastic cysts and 43 benign tumours, all but two were diagnosed as benign or possibly benign on cytology; of the 22 histologically malignant or borderline tumours, 18 were malignant or suspicious of malignancy on cytology, while four were false negative (three of these were borderline tumours). Thus, the sensitivity of cytological diagnosis was 83%, specificity was 97% and accuracy was 93%. USG-guided FNAC seems to be a relatively safe, simple, fast and cost-effective procedure where most ovarian malignancies either present late in their course or no screening method is available. In addition, cyto-radiological correlation through this procedure may be useful in deciding management guidelines prior to any surgical intervention.

English

OBJECTIVE: The aim of the study was to know the morphological pattern of benign and malignant ovarian neoplasms and their distribution in different age groups in rural population of India. MATERIAL AND METHODS: A retrospective study of all cases of ovarian neoplasms diagnosed at department of pathology, Maharaja Medical College, Agroha during period of five year (Aug, 07— Oct.12) was done. The tumors were classified according to WHO classification after thorough examination of slides and their distribution in different age groups was also noted. RESULTS: There were total fifty three cases of ovarian tumors noted during this period. Benign tumors comprised 81.13% and malignant tumors were18.86%. Surface epithelial tumor emerged as the commonest variety accounting for 60.37%, followed by germ cell tumor (32.07%) and sex cord stromal tumors were least common comprising 7.54 % of all ovarian neoplasm. No metastatic tumor or tumors with borderline malignancy were seen. Serous cystadenoma was the commonest tumor (43.39%) followed by mature cystic teratoma (30.23%).Among the malignant tumor, malignant germ cell tumor were the commonest type (40%), followed by 30 %of each surface epithelial tumor and sex cord stromal tumor. CONCLUSION: Benign ovarian tumors are seen more common than malignant tumor. Malignant epithelial tumors are seen after the age of 30 years and malignant germ cell tumor are seen below the age of 30 years. Bilaterality is more commonly seen in malignant ovarian neoplasm.

Cystatin B is a progression marker of human epithelial ovarian tumors mediated by the TGF-β signaling pathway

Advanced ovarian cancer is a devastating disease. Gaining biomarkers of early detection during ovarian tumorigenesis may lead to earlier diagnosis and better therapeutic strategies. Cystatin B (CSTB) functions as an inhibitor to suppress intracellular cysteine proteases and has been implicated in several types of cancers. The present study explored the expression of CSTB in human ovarian tumors, to investigate CSTB expression associated with clinicopathological features, and to examine the effect of transforming growth factor-β (TGF-β), which plays a key role in ovarian tumorigenesis, on CSTB expression in ovarian cancer cells. The ovarian tissue samples from 33 patients were retrieved. The expression of CSTB in ovarian tissue was examined by immunohistochemistry. We found that CSTB was over-expressed in human ovarian surface epithelial tumors, including serous, mucinous and clear cell tumors. The immunoreactive staining of CSTB was strong in borderline and malignant tumors, weak in benign tumors, and negative in normal tissue counterparts, but was not correlated with the clinicopathological features of patients with ovarian tumors, such as age, histological types, tumor size, lymph node metastasis and clinical stages. The CSTB at mRNA and protein levels in two types of epithelial ovarian cancer cells, OVCAR-3 and SK-OV-3, was decreased after TGF-β1 treatment detected by quantitative PCR and western blot analysis, respectively. The inhibitory effect of TGF-β1 on CSTB expression was abolished in the presence of SB-431542, a TGF-β type I receptor kinase inhibitor. Our data suggest that CSTB is tumor tissue-specific and overexpressed in ovarian borderline and malignant tumors. The increased CSTB expression in ovarian tissue represents tumor progression and is dysregulated by the TGF-β signaling pathway. CSTB may become a novel diagnostic intracellular biomarker for the early detection of ovarian cancer.

Clinicomorphological Study Of Ovarian Lesions

This prospective study was conducted at College of Medical Sciences-Teaching Hospital (CMS-TH) during December 2008 to May 2010. One hundred and fifty cases were analyzed. Age of the patients, parity, presenting symptoms, types of sur­gery, clinical diagnosis and complications were retrieved from case sheets. Surface epithelial tumors were more frequently observed above 30 years of age, (62.07%) cases. During 1st to 3rd decades of life, 62.8% germ cell tumors were seen; and sex cord tumors were seen in age group 41-60 years only. For all age groups, benign tumors were common than malignant tumors. There were 10.7% unmarried patients, 5.33% nulliparous, 35.55% of parity 1 to 2; 4% pregnant and 20 % postmeno­pausal women. There were 86.67% cases neoplastic, and 13.33% non-neoplastic ovarian lesions; 93.85% benign, 5.38% malignant and 0.77% borderline tumors. Surface epithelial tumors were the most common tumors (53.84%) followed by germ cell tumors (43.85%), constituted 46.7% and 38% among all ovarian lesions. The commonest benign tumors were serous cystadenomas and mature cystic teratomas, constituted 40% cases each. Dysgerminoma was the common malignant neoplasm (2.31%), all were seen in adolescents. Most of the other malignant neoplasms were observed above 40 years of age. Seventy percent (70%) of non-neoplastic lesions were hemorrhagic corpus luteum cysts. The commonest presenting symptom was pain in the lower abdomen (82%) followed by abdominal mass/ or distension (48.7%). Constitutional symp­toms were observed in malignant cases only. Grossly, majority of the ovarian lesions were of size ranging 5 to 15 cm; and 89.93% cystic lesions. There were 48.7% lesions in the right ovary and 45.3% in the left ovary; 6% bilateral ovarian lesions, all of which were observed in benign and non-neoplastic lesions. The common complication observed was torsion (6.7%) followed by rupture of the cysts (6%). Journal of Chitwan Medical College 2013; 3(4); 17-24 DOI: http://dx.doi.org/10.3126/jcmc.v3i4.9549

A histological study of ovarian tumors in different age groups

Background: Tumours are the most common type of lesion encountered in the ovary. With exception of these neoplasms, the ovary appears remarkably resistant to disease. There are numerous types of ovarian tumours, both benign and malignant. About 80% are benign and these occur mostly in younger women between the ages 20 and 45 years. The malignant tumours are more common in age groups between 40 and 65. Aims & Objective: To study the histopathology of ovarian tumors in different age groups. Materials and Methods: This retrospective study included all consecutive cases with histopathologically proven ovarian tumors, reported from Department of Pathology of N.H.L Municipal Medical College. These included those patients who were operated at V.S Hospital or were operated somewhere else but the specimen was processed in Department of Pathology of N.H.L Municipal Medical College, irrespective of the surgical procedure by which tumor was removed. World Health Organization classification of ovarian tumors was used for classifying the tumors. Hematoxylin and eosin is the routine method for histological study. Hematoxylin is used to define the nucleus by its blue-black colour and its finer details. Commonly used Eosin is Eosin \'Y\'. Results: Out of 100 ovarian tumors included, 73% were benign and 27% were malignant. Surface epithelial tumors were most common (59%), followed by germ cell tumors (14%). Benign surface epithelial tumors comprised 80% (59/73) of all benign tumors whereas their malignant counterpart formed 70.37% (19/27) of all malignant tumors. Conclusion: Benign tumors are more common than malignant ones for all age groups. Surface epithelial tumors are most common class of tumors in both benign and malignant tumours. Serous cystadenoma is the most common ovarian tumor overall as well as most common benign tumor whereas serous cystadenocarcinoma is most common malignancy. Malignant ovarian tumors are more common above 40 years.

The relative frequency and histopathological pattern of ovarian masses - 11 year study at tertiary care centre

Background: Ovarian tumours are one of the major cause of gynaecological problems in females and present marked variation in their histological types. Relative frequency of these lesions is different for Western and Asian countries. Aims & Objective: This study was designed to find out frequency of various histological patterns of ovarian tumours in patients attending Pathology department of a teaching institute in Gujarat. Material and Methods: A retrospective – series study was conducted on 337 cases of ovarian masses, reported from January 2002 to December 2012. Results: Mean age of the subjects was 33.6 years, ranging from 8 to 70 years. In a total 337 cases of ovarian masses, 197 (58.46%) were non-neoplastic and 140 (41.54%) were neoplastic. Among neoplastic lesions, 77.14% (108/140) were benign, 3.57% (5/140) were borderline and 19.29% (27/140) were malignant. The commonest non-neoplastic lesion was luteal cyst (59/197) followed by simple serous cyst (56/197). The commonest malignant tumour was serous cystadenocarcinoma (11/27) followed by mucinous cystadenocarcinoma (5/27). The commonest borderline tumour was borderline serous tumour (4/5). Conclusion: Non-neoplastic lesions were more common than neoplastic lesions. Among neoplastic lesions benign tumours were common. The commonest benign tumour was serous cystadenoma and malignant was serous cystadenocarcinoma. The commonest non-neoplastic lesion was luteal cyst. Among histological types of ovarian tumours, surface epithelial tumours dominated the other types.

Proliferative Brenner Tumor with Borderline Mucinous Cystadenocarcinoma of the Ovary in a 75-Year-Old Woman

We report here an extremely rare case of proliferative Brenner tumor with borderline mucinous cystadenocarcinoma of the ovary, metastasizing to the pleura in a 75-year-old woman. Massive pleural effusion were present due to metastasis and pseudo-Meigs’ syndrome. The cytological findings from pleural effusion, ascites and tumor imprint were similar, suggesting mucus-producing malignant tumors. After receiving a thoracic drainage for pleural effusion, the patient underwent an exploratory laparotomy to remove the left-ovarian tumor. Histopathological examination revealed proliferative Brenner ovarian tumor with borderline mucinous cystadenocarcinoma, and immunohistochemical examinations for the tumors, even mucus-rich tumor cells were positive for CK 7 and negative for CK 20, suggesting the tumor arising from transitional cells, not from mucus-producing ovarian surface epithelial tumor cells. She underwent four courses of chemotherapy with paclitaxel and carboplatin. The patient showed no signs of recurrence 16 months after the surgery.

Immunohistochemistry: A diagnostic aid in differentiating primary epithelial ovarian tumors and tumors metastatic to the ovary

Introduction:Among cancers of the female genital tract, the incidence of ovarian cancer ranks below only carcinoma of the cervix and the endometrium. Recent years have witnessed significant development in the use of immunohistochemistry in diagnostic ovarian pathology.Materials and Methods:We received 95 specimens and biopsies of primary ovarian neoplasms and neoplasms metastatic to the ovary in a period of 2 years. Of these 30 cases were of the primary surface epithelial neoplasms and seven of metastatic tumors.Discussion:The most common tumors metastasizing to the ovary originate from the gastrointestinal tract followed by the endometrium. We used a panel of six markers including cytokeratin-7 (CK7), CK20, carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), estrogen receptor (ER) and Wilms’ tumor 1 (WT1) to help classify various surface epithelial tumors as well as to differentiate them from tumors metastatic to the ovary.Conclusion:CK7 is the most helpful marker to differentiate primary ovarian carcinoma from metastatic colorectal carcinoma of the ovary. Nearly, 96% of ovarian adenocarcinomas were positive for CK7 in contrast to metastatic colorectal, which showed only 25% positivity. We also found that CK7, CK20 and CEA are useful markers to differentiate primary serous tumors from primary mucinous tumors; however, these are less helpful in differentiating ovarian mucinous adenocarcinomas from colorectal adenocarcinomas metastasizing to the ovaries. WT1 helps in typing primary surface epithelial tumors of the ovary and is also significant in determining whether a serous carcinoma within the ovary is primary or metastatic.

Intra-Abdominal Desmoid Tumour (DT) with Pelvic Extension-A Case Report.

Desmoid Tumour (DT) is a rare benign, myofibroblastic tumour originating from muscle fascia with tendency to recur but, it rarely metastasizes. We are reporting here a case of DT that presented as an intra-abdominal mass with pelvic extension in a patient who underwent hysterectomy for fibroid uterus seventeen years ago. A clinical diagnosis of ovarian malignancy was made. Ovarian tumour markers for surface epithelial and germ cell tumours were negative. Imaging studies suggested DT and the same was excised surgically. A histopathological diagnosis of DT was made and confirmed with immunohistochemistry (IHC) markers. DT should always be considered especially in female patients with previous history of surgery. A complete surgical excision is the treatment of choice with recurrent cases requiring radiotherapy. A differential diagnosis like sarcoma and further toxic chemotherapy can be avoided with careful histopathological evaluation and IHC confirmation of DTs.