gynecology and obstetrics
Ovarian, Fallopian Tube, and Peritoneal Cancer
Pathology of Ovarian Cancer
Ovarian cancers are histologically diverse (see table). Most (90%) ovarian cancers develop from epithelial cells; the rest (germ cell tumors, sex-cord stromal tumors) develop from other ovarian cell types. Epithelial ovarian carcinoma may be divided into five subtypes: High-grade serous Low-grade serous Endometrioid Clear cell Mucinous High-grade serous ovarian carcinoma is the most common subtype (> 70%) of epithelial carcinomas and usually manifest at an advanced stage. High-grade serous epithelial ovarian, fallopian tube, and peritoneal carcinomas share clinical behavior and treatment. Most high-grade serous carcinomas that manifest as an ovarian mass or as peritoneal disease originate in the fallopian tubes, based on studies of women withBRCAmutations after risk-reducing bilateral salpingo-oophorectomy. Mucinous ovarian cancers are more likely to manifest at stage I than other histologies and account for nearly 27% of patients with stage I epithelial ovarian cancer. Ovarian cancer spreads by Direct extension Exfoliation of cells into the peritoneal cavity (peritoneal seeding) Lymphatic dissemination to the pelvis and around the aorta Less often, hematogenously to the liver or lungs 