Prophylactic Oophorectomy: A Morphologic and Immunohistochemical Study

Department of Pathology, Mount Sinai School of Medicine, New York, New York 10029, USA.
Cancer (Impact Factor: 4.89). 01/2004; 98(12):2599-606. DOI: 10.1002/cncr.11848
Source: PubMed


The tumorigenesis of ovarian carcinoma is poorly understood. The authors studied morphologic features and immunohistochemical expression patterns of neoplasia-associated markers in prophylactically removed ovaries, normal ovaries, and papillary serous ovarian carcinomas to identify possible preneoplastic changes in ovarian surface epithelium.
Morphologic features and immunohistochemical expression patterns of CA-125, Ki-67, p53, E-cadherin, and Bcl-2 were evaluated in 21 normal ovaries, 31 ovaries that were removed prophylactically for increased carcinoma risk, and 7 ovarian papillary serous carcinomas. Representative slides from formalin-fixed, paraffin-embedded tissue blocks were submitted to immunohistochemical staining and were evaluated independently by three gynecologic pathologists. For statistical analyses, Fisher exact tests, multivariate analyses, Spearman rank correlation coefficients, Wald statistics, Kruskal-Wallis tests, and Mann-Whitney tests were used. Immunohistochemical staining results were correlated with morphologic findings.
The authors found progressive increases in reactivity with the lowest expression in normal ovarian epithelium, stronger expression in epithelium from prophylactically removed ovaries, and the highest expression in carcinomas for Ki-67 and p53. A similar trend was observed for CA-125. Positivity for Ki-67 and p53 was seen predominantly in the epithelium of inclusion cysts and deep invaginations, including those areas that had been identified as hyperplastic or dysplastic on routine hematoxylin and eosin-stained sections.
The current results suggest biologic/molecular evidence for the existence of preneoplastic changes in ovarian surface epithelium and support the previously proposed concept of ovarian dysplasia. Subtle morphologic alterations of the ovarian epithelium may be biologically significant.

7 Reads
  • Source
    • "The postulate that these markers would be expressed in dysplastic tissues could thus confirm their preinvasive nature and help in the diagnosis. Schlosshauer et al. [34] found an increasing gradient in these two markers, comparing normal ovarian epithelium (low expression), dysplastic epithelium (high expression), and ovarian cancer (even higher expression), which could also be a molecular argument in favour of the existence of dysplasia. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Faced with the catastrophic prognosis for ovarian cancer due to the fact that it is most often diagnosed late at the peritoneal carcinomatosis stage, screening and early detection could probably reduce the mortality rate. A better understanding of the molecular characteristics of the different ovarian cancer subtypes and their specific molecular signatures is indispensable prior to development of new screening strategies. We discuss here the early natural history of ovarian cancer and its origins.
    Full-text · Article · Apr 2014
  • Source
    • "That these changes originate in the OSE rather than as deposits of oviductal epithelium is indicated by areas of transition from nonspecific to metaplastic OSE, and by the greater frequency of metaplasia in inclusion cysts vs. ovarian surface. Importantly, OSE from asymptomatic women with BRCA mutations shows preneoplastic changes [6] [7] [8] [9], in keeping with a role in ovarian neoplastic progression. The histotypic variability among ovarian cancers, and in particular their differentiation which mimics the Mullerian duct-derived oviductal, endometrial and endocervical epithelia, has been ascribed to the capacity of adult OSE to differentiate along the developmental pathways of these epithelia. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cultured human umbilical vein endothelial cells (HUVECs) are a valuable model for investigation of endothelial functions, but they enter senescence at low passage. Transfection of early passage HUVECs with the early genes of SV40 greatly extends the replicative potential of these cells, but eventually results in marked changes in growth, morphology, and biochemistry. Here we report a modified approach that appears to have overcome the problem of late passage decline after transfection. Plasmid pX-8 containing the SV40 early genes was transfected into passage four HUVECs. At passage five, these transfectants were cloned by limiting dilution and selected on the basis of both morphological and biochemical resemblance to their untransfected counterparts. Two clones that expressed factor VIII and in which the basal and the tumor necrosis factor-alpha inducible levels of interleukin 6 and endothelial adhesion molecules were normal were chosen. Vimentin and fibronectin distribution in these clones resembled untransfected cells. At passage 25, growth pattern changes were becoming evident, but recloning these late passage clones recovered numerous subclones of normal, cobblestone appearance. Two of these were further characterized and found to resemble their original parental clone by all of the biochemical criteria listed above. These subclones appeared to transform more rapidly than the parental clone, but repeated subcloning again rescued clones with normal morphologies and normal biochemical characteristics. We conclude that periodic recloning may indefinitely perpetuate lines that are useful equivalents of their original counterparts.
    Full-text · Article · Jan 2011 · Biochemistry and Cell Biology
  • Source
    • "Identification of the early molecular events leading to ovarian carcinoma has been hindered by the lack of an identifiable preneoplastic lesion and the limited occurrence of early-stage neoplasms. Although it has been proposed that ovarian carcinoma originates from the surface epithelium of the ovary and/or the epithelial lining of ovarian inclusion cysts, there have been few reports of intraepithelial neoplasms at these sites [1] [2]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Microinvasive carcinomas and high-grade intraepithelial neoplasms are commonly discovered within the fallopian tube of BRCA1 mutation carriers at the time of risk-reducing salpingo-oophorectomy, suggesting that many BRCA1-mutated ovarian carcinomas originate in tubal epithelium. We hypothesized that changes in gene expression profiles within the histologically normal fallopian tube epithelium of BRCA1 mutation carriers would overlap with the expression profiles in BRCA1-mutated ovarian carcinomas and represent a BRCA1 preneoplastic signature. Laser capture microdissection of frozen sections was used to isolate neoplastic cells or histologically normal fallopian tube epithelium, and expression profiles were generated on Affymetrix U133 Plus 2.0 gene expression arrays. Normal-risk controls were 11 women wild type for BRCA1 and BRCA2 (WT-FT). WT-FT were compared with histologically normal fallopian tube epithelium from seven women with deleterious BRCA1 mutations who had foci of at least intraepithelial neoplasm within their fallopian tube (B1-FTocc). WT-FT samples were also compared with 12 BRCA1 ovarian carcinomas (B1-CA). The comparison of WT-FT versus B1-FTocc resulted in 152 differentially expressed probe sets, and the comparison of WT-FT versus B1-CA resulted in 4079 differentially expressed probe sets. The BRCA1 preneoplastic signature was composed of the overlap between these two lists, which included 41 concordant probe sets. Genes in the BRCA1 preneoplastic signature included several known tumor suppressor genes such as CDKN1C and EFEMP1 and several thought to be important in invasion and metastasis such as E2F3. The expression of a subset of genes was validated with quantitative reverse transcription-polymerase chain reaction and immunohistochemistry.
    Full-text · Article · Dec 2010 · Neoplasia (New York, N.Y.)
Show more