Diagnostic Pathology of Ovarian Tumors

317 Pages·2011·54.09 MB·English

by  Robert A. Soslow M.D. (auth.), Robert A. Soslow, Carmen Tornos (eds.)

Diagnostic Pathology of Ovarian Tumors
Robert A. Soslow • Carmen Tornos
Editors
Diagnostic Pathology
of Ovarian Tumors
Editors
Robert A. Soslow, MD Carmen Tornos, MD
Department of Pathology Department of Pathology
Memorial Sloan-Kettering Cancer Center Stony Brook University Medical Center
1275 York Avenue SUNY Stony Brook
New York, NY 10065 Hospital Level 2, Room 766
USA Stony Brook, NY 11794
USA
ISBN 978-1-4419-9750-0 e-ISBN 978-1-4419-9751-7
DOI 10.1007/978-1-4419-9751-7
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011931785
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Preface
By Robert A. Soslow, M.D. and Carmen Tornos, M.D.
This book attempts a comprehensive overview of ovarian neoplasia. The primary focus is
diagnostic pathology, although the breadth of information provided here should be of interest
to those who study or practice gynecologic oncology, clinical genetics, molecular genetics,
oncogenesis, and epidemiology.
We have divided the book into four major parts. The introductory chapters, which are gen-
eral in scope, review the importance of morphologic patterns in diagnosis, diagnostic discrep-
ancies that arise in practice, and frozen section evaluation. The latter two chapters include
information on quality assurance issues. Chapters about morphologic patterns and diagnostic
discrepancies also serve as an index to guide the reader though later portions of the book. A
special feature of the frozen section chapter is that it contains fgures photographed from actual
frozen sections and a short discussion of the use of telepathology.
The second part of the book focuses on the most common types of ovarian neoplasms, those
usually referred to as “surface-epithelial” tumors. In addition to the expected chapters about
serous, endometrioid, clear cell, mucinous, and metastatic neoplasms (included in this part
because of frequent diagnostic problems distinguishing them from primary ovarian surface
epithelial tumors), we also present here a chapter that documents the state of the art in clinical
management of ovarian cancer and a special pathology oriented chapter that offers a compel-
ling rationale supporting rigorous separation of different types of surface epithelial tumors.
This chapter makes the important points that older data that rely on distinctions between ovar-
ian carcinoma subtypes are likely to be inaccurate, and that clinical trials must make use of
clinically validated pathologic criteria, instead of historical conventions that were empirically
derived. Although the clinical chapter focuses primarily on the management of high grade
serous carcinoma, by far the most common lethal malignancy of its type, a unifying theme
emphasized throughout the pathology oriented chapters is that each type of ovarian carcinoma
represents a distinct disease entity, with unique morphologic, immunophenotypic, genotypic,
and clinical features. Several recent concepts are presented in each chapter. Examples include:
the existence of low- and high-grade serous carcinomas; that most undifferentiated and transi-
tional cell carcinomas represent high grade serous carcinomas; that architectural features are
more important than the presence of clear cytoplasm for a diagnosis of clear cell carcinoma;
the importance of “confrmatory endometrioid features” in the diagnosis of endometrioid car-
cinoma; the indolent clinical course of endometrioid and mucinous carcinoma when high
grade serous carcinoma and metastases have been excluded; the importance of immunohis-
tochemistry as a validated diagnostic adjunct; and the presence of type-specifc abnormalities
that may be targeted with new therapeutic agents in the near future. These include PARP in
high grade serous carcinoma, BRAF and KRAS in low grade serous carcinoma, PIK3CA in
clear cell carcinoma, and Her2neu in mucinous carcinoma.
Although relatively much less important than the aforementioned substantive issues, the
problem of accommodating different preferences in terminology remained a concern of the
editors throughout. We encouraged each of the authors to use terms with which they felt most
comfortable, provided familiar synonymous terms were also referenced. For example, the
v
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terms “atypical proliferative tumor” and “borderline tumor,” and “disseminated peritoneal
adenomucinosis” and “low grade mucinous neoplasm” are used interchangeably.
The next part of the text details some of the most unusual ovarian neoplasms, those assigned
to the sex cord stromal, germ cell, and mesenchymal categories, and those of uncertain histo-
genesis. There is an inherent paradox here; these chapters are longer and in some cases even
more detailed than chapters in the second part. That mostly refects that these neoplasms are
extraordinarily complex and that pathologists tend to be relatively unfamiliar with a variety of
the entities. It is legitimate to ask why we chose to include certain entities in one chapter and
not in another. When such a question arose, we asked ourselves where in the book a pathology
neophyte would search for a given entity. An example is ovarian adenosarcoma, a tumor that
has historically been categorized with the endometrioid neoplasms; we chose, instead, to
include it in the mesenchymal chapter. A very nice clinical chapter also accompanies the
pathology chapters in this part.
The last part deals with subjects that were previously on the periphery of discussions about
ovarian cancer, yet are included here because a grasp of these concepts is essential to accurate
diagnosis and clinical management of “ovarian cancer” patients. Chapter 17 deals with tumors
of the fallopian tube and peritoneum. It makes the case that many high grade serous ovarian
carcinomas arise in the tubal fmbria, as noted earlier in Chaps. 4 and 6, and that what we cur-
rently recognize as “high grade ovarian serous carcinoma” may represent tubal carcinoma with
disproportionate presentation in the ovary. This is then the perfect lead in to Chap. 18, which
provides a theoretical and practical approach to understanding, processing, and diagnosing
lesions in patients suspected of having hereditary breast/ovarian cancer syndrome. Last, but
not least, is a chapter that covers the cytologic evaluation of peritoneal fuids from patients
suspected of having ovarian cancer.
Acknowledgment
The publication of this book would not have been possible without the invaluable contributions
of many individuals, particularly pathologists and gynecologists who have taken time from
their busy lives to produce beautifully illustrated chapters containing the newest information
about ovarian cancer. Jen Grady and Alex MacDonald, members of the Gynecology Service’s
editorial team at Memorial Sloan-Kettering Cancer, have been absolutely essential, hardwork-
ing team constituents, always helpful, supportive and knowledgeable. Thanks also go to the
expert photography staff in Memorial Sloan-Kettering Cancer Center’s Department of
Pathology, Kin Kong and Allyne Manzo. Our spouses, Roman Perez-Soler and Michael
Ogborn, deserve recognition and thanks for their support and encouragement. Finally, Carmen
and I would like to acknowledge the power of mentorship, collaborations, and friendship. We
were introduced by mutual colleagues, subsequently had the great fortune of working together
and now count the other as the best of friends. We hope the reader fnds that this book repre-
sents a composition that is greater than the sum of its parts. If so, it will be because of the spirit
of cooperation and teamwork that has colored this work from its inception.
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Contents
1 Morphologic Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Robert A. Soslow
2 Common Diagnostic Discrepancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Robert A. Soslow
3 Frozen Section of Ovarian Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Carmen Tornos and Robert A. Soslow
4 Surface Epithelial Tumors: Pathology Introduction . . . . . . . . . . . . . . . . . . . . . . 37
C. Blake Gilks
5 Surface Epithelial Tumors: Clinical Introduction . . . . . . . . . . . . . . . . . . . . . . . . 47
Katherine M. Bell-McGuinn and Mario M. Leitao Jr.
6 Pathology of Serous Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
C. Blake Gilks
7 Pathology of Endometrioid Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Melissa P. Murray and Kay J. Park
8 Pathology of Clear Cell Tumors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Robert A. Soslow and Deborah F. DeLair
9 Pathology of Mucinous Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Jeffrey D. Seidman and Anna Yemelyanova
1 0 Uncommon Epithelial Ovarian Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Jeffrey D. Seidman and Anna Yemelyanova
1 1 Metastatic Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Anna Yemelyanova and Jeffrey D. Seidman
1 2 Germ Cell and Sex Cord Stromal Tumors: Clinical Introduction . . . . . . . . . . . 145
Ginger J. Gardner and Jason A. Konner
1 3 Pathology of Germ Cell Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Charles J. Zaloudek
1 4 Sex Cord Stromal Tumors of the Ovary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Gkeok Stzuan Diana Lim and Esther Oliva
1 5 Pathology of Mesenchymal and Hematopoietic Tumors . . . . . . . . . . . . . . . . . . . 235
Esther Oliva
1 6 Tumors of Uncertain Histogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Gkeok Stzuan Diana Lim and Esther Oliva
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