histological classification 2013 Tumours of the Ovary

7/24/2019 histological classification 2013 Tumours of the Ovary

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Epithelial-stromal tumoursSerous tumours

BenignSerous cystadenomaSerous surface papilloma

Serous adenofibroma

Borderline TumoursAtypical proliferative serous tumor, Serous borderline tumor, usualtype (Surface or Cystic)Non-invasive micropapillary (low grade) serous carcinoma, Serous

borderline tumor, micropapillary typeMalignant

Low grade serous adenocarcinomaHigh grade serous adenocarcinomaTransitional-like adenocarcinoma

WHO histological classification 2013

Tumours of the Ovary


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Transitional cell tumours

Benign Brenner tumour

Atypical proliferative Brenner tumour, Borderline Brennertumour

Malignant Brenner tumour

WHO histological classification 2013Tumours of the Ovary


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a) High-grade ovarian carcinomas withstromal invasion

b) Urologic TCC component >10%

c) Large cystic spaces (70%), broad

undulating papillae with smooth

borders (60%), microspaces (90%)

d) Lack of benign or borderline

Brenner component

e) Frequent high-grade serouscarcinoma component

Eichhorn JH & Young RH Am J Surg Pathol 2004

Transitional Cell Carcinoma (TCC)

Eichhorn AJSP 2004


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Transitional Cell Tumors (TCT)(Material)

19 TCT

5 Benign

1 Malignant

13 Brenner Tumors

6 Transitional cell carcinomas (TCC)

7 Borderline

Cuatrecasas M et al. AJSP 2009


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Transitional Cell Tumors (TCT)(Methods)

EGFRRASCyclin D1p16

Rbp53

Immunohistochemistry(TMA)

MutationalAnalysis

FISH

K-RAS

BRAF

CTNNB1PIK3CA

p53

-- EGFR

Hypermethylation p16Rb

LOH --p16


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TCT


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Transitional Cell Tumors of the Ovary

(Mutations)p53mutations (4/4)Transitional cell carcinomas (4)

9

Malignant Brenner Tumor Transitional Cell Carcinoma

Exon 9PIK3CA mutations (2):

Borderline Brenner (1)

Malignant Brenner (1)

Cuatrecasas M et al. AJSP 2009


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- +++

-

MalignantBrenner

TCC

p16 LOH

P53 (chromosome instability)

Molecular Genetics

+++

+

+

EGFR-RAS-MAPK

PIK3CA mutations

Cuatrecasas M. et al. AJSP 2009


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67%

WT1

TCC

Mg Brenner

p53 ER p16 Cyclin D1 PiK3ca

86% 71% 29%

- -- - + +


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80-90%

10-20%

43%90%

70-100%

30%

Malignant

Brenner

TCC

Stage I

Stages II-IV

Stage I survival


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, 2012

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Histologic Subtypes of OvarianCarcinomas

Serous high grade

Serous low grade Clear cell

Endometrioid Mucinous


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New classification: Frequency

HG serous

LG serous

Clear cell

Endometrioid

Mucinous

Unclassifiable

TP44


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HGC

CCC

ECMC

LGSC


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Stage ClearCell

Endometrioid Mucinous Low-GradeSerous

CarcinomaNOS

I-II 26.2% 29.4% 8.5% 1.9% 30% 4.0%

III-IV 4.9% 3.5% 1.1% 4.9% 84.2% 1.4%

All 10.4% 10.3% 3.6% 3.5% 70% 2.1%

High-GradeSerous

Ovarian Carcinomas:Stage at presentation (early vs advanced) according to

Histologic Subtype

Gilks CB et al.

Mod Pathol 2009; 22:215A

E d t i id d Cl C ll T d l


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Endometrioid and Clear Cell Tumors develop

from Ovarian Endometriosis

Endometriosis

Retrogrademenstruation

Borderline

tumor

Carcinoma


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Ovarian Atypical Endometriosis

Endometrioid or Clear Cell Carcinomas

15-32% of cases


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Clear cell carcinoma


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I Tumor confined to ovaries or fallopian tube(s) T1

IA Tumor limited to one ovary (capsule intact) or fallopian tube, T1a

No tumor on ovarian or fallopian tube surface

No malignant cells in the ascites or peritoneal washings

IB Tumor limited to both ovaries (capsules intact) or fallopian tubes T1b

No tumor on ovarian or fallopian tube surface

No malignant cells in the ascites or peritoneal washings

IC Tumor limited to one or both ovaries or fallopian tubes, T1c

with any of the following:

IC1 Surgical spillIC2 Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface

IC3 Malignant cells in the ascites or peritoneal washings


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1


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II Tumor involves one or both ovaries or fallopian tubes with

pelvic extension (below pelvic brim) or primary peritoneal

cancer T2

IIA Extension and/or implants on the uterus and/or fallopian

tubes/and/or ovaries T2a

IIB Extension to other pelvic intraperitoneal tissues T2b

IIC Any of above, but with ascites or positive peritoneal washings


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Uterine serosa

O i C i i l i


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Ovarian Carcinomas involving

Retroperitoneal LNs Less than 10% of ovarian carcinomas have

extended beyond the pelvis with exclusivelyRetroperitoneal Lymph Node involvement

Literature evidence indicates that these caseshave better prognosis than tumors withabdominal peritoneal involvement

No pathological distinction between high-gradeserous and low-grade serous carcinomas

New Stage III - FIGO 2012


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New Stage III FIGO 2012

III One or both ovaries, fallopian tubes, or primary peritoneal cancer with

pathologically proved spread to the peritoneum outside the pelvis and/ormetastasis to the retroperitoneal lymph nodes

IIIB Macroscopic peritoneal metastasis beyond the pelvis 2 cm or less with or withoutmetastasis to the retroperitoneal lymph nodes

IIIC Macroscopic peritoneal metastasis beyond the pelvis more than 2 cm with orwithout metastasis to the retroperitoneal lymph nodes

(Note 1: includes extension of tumor to capsule of liver and spleen without parenchymal

involvement of either organ)

IIIA Metastasis to the retroperitoneal lymph nodes with or without microscopicperitoneal involvement beyond the pelvis

IIIA1 Positive retroperitoneal lymph nodes only

IIIA1(i) Metastasis ( 1 cm in size)IIIA1(ii) Metastasis (> 1 cm in size)

IIIA2 Microscopic extrapelvic peritoneal involvement with or without positiveretroperitoneal lymph nodes


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Ovarian Carcinomas

Low-grade serous carcinomas may arisein lymph nodes from endosalpingiosis

Djordjevic B, Malpica A.Am J Surg Pathol 2010, 2012

SBT in Lymph Nodes (30%)


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SBT in Lymph Nodes (30%)

LN: Mullerian cysts (endosalpingiosis)

SBT in lymph node


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SBT in lymph node


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Metastatic colonic carcinoma


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Nodal Endosalpingiosis in Ovarian


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Nodal Endosalpingiosis in Ovarian

Serous Borderline Tumors with Lymph Node Involvement

Ovarian

SBT

CervicalADCa

EndometrialEndometrioid

ADCa

SBT withoutLNInv

N. Cases 30 30 30 36 36

NodalEndosalp 33 % 0% 3% 66% 14%

SBT withLNInv

Djordjevic et al

Am J Surg Pathol 2010

NodalEndosalp

+

LNI

Intraglandularpattern

50%

Intraglandularpattern

50%

NodalEndos

LNI

8%8%


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Diagnosis

Serous borderline tumor and low-grade

serous carcinoma (in situ andmicroinvasive) arising from extensivenodal endosalpingiosis

(PCS-5514)


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Metastatic HGSC in LNLN Endosalpingiosis SBT LGSC


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Ovarian Carcinomas involving Lymph Nodes

Less than 10% of ovarian carcinomas have extended beyond the pelvis withexclusively Retroperitoneal Lymph Node involvement

Literature evidence indicates that these cases have better prognosis thantumors with abdominal peritoneal involvement

Low-grade serous carcinomas may arise in lymph nodes fromendosalpingiosis

Most of these cases probably represent separate primary low-grade

serous carcinomas arising in lymph nodes from endosalpingiosiswhich explains their favorable prognosis

New Stage III - FIGO 2012


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Stage III

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Hig-grade Serous

MucinousEndometrioidClear Cell

Low-grade

PIK3CA20q amp

PTENb-catenin

KRASBRAF

ERB2

KRAS TP53/Rb pathwayChromosomal

instability


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histological classification 2013 Tumours of the Ovary