Refined Diagnostic Criteria for Implants Associated With Ovarian Atypical Proliferative Serous Tumors (Borderline) and Micropapillary Serous Carcinomas

Department of Pathology, Division of Gynecologic Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21231, USA.
American Journal of Surgical Pathology (Impact Factor: 5.15). 05/2001; 25(4):419-32. DOI: 10.1097/00000478-200104000-00001
Source: PubMed


Characterization of invasive peritoneal implants from patients with noninvasive serous ovarian tumors has important prognostic and treatment implications, but the criteria for distinguishing invasive and noninvasive implants vary among investigators and can be difficult to apply. The authors studied 148 implants from 60 patients, 33 with primary atypical proliferative serous tumor, and 27 with primary noninvasive micropapillary serous carcinoma, with a mean follow-up of 62 months (median follow-up, 52 months). Previously reported and newly proposed histologic features for implant classification were evaluated and correlated with clinical outcome. Three criteria were applied for the diagnosis of "invasive" implants: invasion of underlying normal tissue, micropapillary architecture, and solid epithelial nests surrounded by clefts. Implants displaying any one of these three features were classified as "invasive," whereas those lacking all three features were classified as "noninvasive." Sixty-six implants were invasive and 82 were noninvasive. Of the 31 patients with invasive implants, six were dead of disease (DOD), 13 were alive with progressive disease (AWPD), and 12 were alive with no evidence of disease (NED). Of the 29 patients with noninvasive implants, two were DOD, one was dead of uncertain causes, one was AWPD, and 25 were alive with NED. Eighty-nine percent of invasive implants had a micropapillary architecture and 83% had solid epithelial nests surrounded by clefts. A minority of invasive implants (14% of those with underlying normal tissue) demonstrated invasion of normal underlying tissue. Nuclear atypia, mitoses, calcification, necrosis, and identification of individual cells "infiltrating" the stroma did not correlate with implant type. The proposed criteria permitted recognition of implants that correlated strongly with adverse outcome. Sixty-one percent of patients with implants displaying any one of the three features used to diagnose invasive implants were AWPD or DOD compared with 10% of patients whose implants lacked these features (p = 0.00001). Because implants associated with an adverse outcome can be identified before they invade underlying normal tissue, the term invasive implant to describe them is inaccurate and misleading. These implants resemble patterns of growth in micropapillary serous carcinoma of the ovary and the recurrent tumor that is obvious carcinoma. Accordingly, we propose that these extraovarian lesions be designated "well-differentiated serous carcinoma."

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    • "A tumor showing a stromal invasion of less than 3-5 mm without a desmoplastic reaction has been designated as a microinvasive tumor.15 Microinvasion is described in the borderline tumor category as one of the associated features while dealing with SBT.26 Microinvasion can be found in otherwise typical SBT and these microinvasive tumors have similar biologic behaviors and prognosis to those of tumors lacking this feature.15-18,26 Accordingly, SBTs with microinvasion should be distinguished from serous carcinoma. "
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    ABSTRACT: Cancer registration in Korea has a longer than 30-years of history, during which time cancer registration has improved and become well-organized. Cancer registries are fundamental for cancer control and multi-center collaborative research. However, there have been discrepancies in assigning behavior codes. Thus, we intend to propose appropriate behavior codes for the International Classification of Disease Oncology, 3rd edition (ICD-O-3) for microinvasive tumors of the ovary and breast not only to improve the quality of the cancer registry but also to prevent conflicts. As in series I, two pathology study groups and the Cancer Registration Committee of the Korean Society of Pathologists (KSP) participated. To prepare a questionnaire on provisional behavior code, the relevant subjects were discussed in the workshop, and consensus was obtained by convergence of opinion from members of KSP. Microinvasive tumor of the breast should be designated as a microinvasive carcinoma which was proposed as malignant tumor (/3). Serous borderline tumor with microinvasion of the ovary was proposed as borderline tumor (/1), and mucinous borderline tumor with microinvasion of the ovary as either borderline (/1) or carcinoma (/3) according to the tumor cell nature. Some issues should be elucidated with the accumulation of more experience and knowledge. Here, however, we present our second proposal.
    06/2012; 46(3):226-32. DOI:10.4132/KoreanJPathol.2012.46.3.226
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    ABSTRACT: Se estudiaron por métodos histológicos e inmunohistoquímicos 40 casos de tumores metastáticos o de posible origen pulmonar utilizando el Factor 1 de Transcripción Tiroidea (TTF-1) con 23 casos positivos (57%) y 17 casos negativos (43%). Se discute el diagnóstico diferencial de estos casos y se señalan la importancia de TTF-1, en los casos positivos y en los negativos, para precisar el sitio del tumor primario, pulmón o tiroides y especialmente su utilidad en casos de tumores metastáticos de origen desconocido.
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    ABSTRACT: Die Borderline-Tumoren des Ovars stehen morphologisch wie klinisch zwischen den benignen epithelialen Tumoren (Zystadenome, Adenofibrome) und den eindeutig malignen Ovarialkarzinomen. Sie enthalten atypisch proliferierte Epithelien ohne destruierende Stromainfiltration. Seröse und muzinöse Typen machen die große Mehrzahl aller Borderline-Tumoren aus. Herde einer Mikroinvasion sind prognostisch sehr wahrscheinlich unbedeutsam und mit einem Borderline-Tumor vereinbar. Die Inzidenz der Borderline-Tumoren scheint zuzunehmen, der Inzidenzgipfel liegt ca. 10 Jahre unter dem invasiver Karzinome. Bei unspezifischer Symptomatik steht diagnostisch die sorgfältige histopathologische Aufarbeitung des Tumorresektats im Vordergrund. Für die verlässliche Erfassung der Tumorausbreitung ist ein operatives Staging erforderlich. Mit wenigen Ausnahmen ist die Prognose bei Borderline-Tumoren ausgezeichnet (10-Jahres-Überlebensrate ≥90%). Entscheidende Prognosefaktoren sind Tumorstadium, invasive Implantate, Tumorrest, histologischer Typ, Lebensalter. Die Bedeutung der Ploidie wird kontrovers diskutiert. Die chirurgische Therapie umfasst bei abgeschlossener Familienplanung die bilaterale Adnexexstirpation (ggf. mit Hysterektomie) die infrakolische Omentektomie, peritoneale Biopsien, die Peritoneallavage, bei muzinösen Tumoren die Appendektomie. Besteht Kinderwunsch, ist fertilitätserhaltendes Vorgehen möglich. Im Stadium FIGO I/II und FIGO III (mit nichtinvasiven Implantaten) ist eine adjuvante Chemotherapie nicht indiziert. Rezidive werden chirurgisch entfernt. Die Nachsorge erfolgt nach bei Ovarialkarzinomen üblichen Maßstäben. Borderline tumors of the ovary are intermediate between benign epithelial tumors (cystadenomas, adenofibromas) and invasive carcinomas, both morphologically and clinically. They contain atypical epithelial proliferations without destructive stromal invasion. Most borderline tumors are of the serous or mucinous types. There seems to be an increasing incidence of borderline tumors, the peak incidence being ten years earlier as compared to invasive carcinomas. There are no specific symptoms. A definitive diagnosis can only be made after meticulous histopathologic examination. Only surgical staging can reliably reveal the extent of tumor spread. Prognosis is very good in a vast majority of cases (ten year survival rate ≥90%). The most important prognostic factors are stage, invasive implants, residual tumor, histological type, and age of the patient. The significance of DNA ploidy is still a matter of controversy. If the conservation of fertility is not desired, surgical treatment of borderline tumors consists of bilateral adnexectomy (with optional hysterectomy), omentectomy, peritoneal biopsies, peritoneal washing, and appendectomy (in cases of mucinous borderline tumor). A less radical approach is possible for patients who wish to preserve fertility. No adjuvant chemotherapy is indicated in borderline tumors of the FIGO stage I/II and III (no invasive implants). Surgical resection is the preferred treatment for recurrent disease. Patients with borderline tumors should be followed up as recommended for ovarian cancer.
    Der Gynäkologe 01/2001; 34(11):1003-1012. DOI:10.1007/s00129-001-1109-9
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