Pathogenesis of ovarian, fallopian tubal, and peritoneal serous carcinomas
- Christopher P Crum, MD
Christopher P Crum, MD
- Department of Pathology
- Brigham and Women's Hospital
- Jonathan Bijron, MD
Jonathan Bijron, MD
- University Medical Center Utrecht, The Netherlands
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Rochelle L Garcia, MD
Rochelle L Garcia, MD
- Section Editor — Obstetric and Gynecologic Pathology
- Professor of Pathology
- Adjunct Professor of Obstetrics & Gynecology
- University of Washington Medical Center
The term epithelial ovarian carcinoma has been used to refer to a large group of malignant neoplasms that typically present as ovarian tumors with involvement of the fallopian tube and peritoneum. Accumulating evidence suggests that these epithelial neoplasms can be divided into two groups in terms of probable site of origin: either ovarian or tubal .
The first group of carcinomas, which have a plausible origin in the ovary, include those with the following histologies: endometrioid, mucinous, clear cell, borderline, and low grade serous. Some of these appear to arise from endometriosis, a benign condition that may involve the ovaries. This is the case for endometrioid and clear cell carcinomas.
Müllerian inclusions in the ovarian cortex are another potential source of primary ovarian carcinomas. These have been implicated in the development of mucinous and lower grade serous neoplasms. The evidence for this is morphologic evidence of a gradual spectrum of changes seen in the ovary, potentially proceeding from cortical inclusions to cystadenofibromas to borderline and low grade serous carcinomas.
The fallopian tubes, uterus, cervix, and upper vagina derive from Müllerian (paramesonephric) tissue, while the ovary develops from the primordial germ cells and surrounding surface epithelium . Primary Müllerian neoplasms of the ovary likely originate from cells acquired during the reproductive years, with possibilities including transport of epithelial cells from the fallopian tubes or endometrium (lining of the uterus). An older theory is Müllerian metaplasia of ovarian surface epithelium.
The second group consists of extrauterine pelvic serous carcinomas, particularly those that are high grade and are associated with a poor prognosis. These have traditionally been thought to be primary ovarian carcinomas, with a few designated as fallopian tube carcinoma (if the bulk of disease was in a fallopian tube) or peritoneal carcinoma (if little or no ovarian or fallopian tube disease was present). The consistent features of these carcinomas have been rapid progression, extra-ovarian disease at the time of diagnosis, and the absence of a known precursor lesion. Evidence suggests that many of these neoplasms may originate in the fallopian tube. Based upon this theoretical framework, we will use the term "extrauterine pelvic serous carcinoma" to refer to these carcinomas, implying a possible origin in the ovary, tube, or Müllerian epithelium elsewhere in the peritoneal cavity.
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- POTENTIAL PRECURSOR LESIONS
- Serous tubal intraepithelial neoplasia
- Ovarian cortical inclusion cysts
- CHARACTERISTICS OF PELVIC SEROUS NEOPLASMS
- High grade pelvic serous carcinoma
- - Origins
- - High grade endometrioid carcinoma
- Histologic diagnosis
- Evaluation of rrBSO specimens
- Assigning primary tumor site
- - Targeted therapy (PARP inhibitors)
- Low grade serous neoplasms
- - Origins
- CLINICAL ISSUES
- Classification and chemoresponsiveness
- Treatment of STIC found at rrBSO