open access: Ten problematical issues identified by pathology review for multidisciplinary gynaecological oncology meetings -- McCluggage 65 (4): 293 -- Journal of Clinical Pathology

Ten problematical issues identified by pathology review for multidisciplinary gynaecological oncology meetings

• Accepted 16 August 2011
• Published Online First 19 October 2011   
• J Clin Pathol 2012;65:293-301 doi:10.1136/jclinpath-2011-200352

Take-home message

Pathology review of gynaecological cancer specimens is often carried out as part of the working of gynaecological oncology multidisciplinary team meetings. Some errors are interpretational errors while others are non-interpretational but may result in the incorrect information being relayed to the clinician. Studies have identified more numerous and clinically significant diagnostic discrepancies in the field of gynaecological oncology than in other areas of pathology.

Ovarian carcinomas: five distinct diseases with different origins, genetic alterations, and clinicopathological features.

Abstract

Malignant epithelial tumors (carcinomas) are the most common ovarian cancers and also the most lethal gynecological malignancies.
Based on histopathology and molecular genetic alterations, ovarian carcinomas are divided into five main types (high-grade serous (70%), endometrioid (10%), clear cell (10%), mucinous (3%), and low-grade serous carcinomas (5%)) that account for over 95% of cases.

These types are essentially distinct diseases, as indicated by differences in epidemiological and genetic risk factors, precursor lesions, patterns of spread, and molecular events during oncogenesis, response to chemotherapy, and prognosis. For a successful specific treatment, reproducible histopathological diagnosis of the tumor cell type is critical.

The five tumor types are morphologically diverse and resemble carcinomas of the uterus. Actually, recent investigations have demonstrated that a significant number of cancers, traditionally thought to be primary ovarian tumors (particularly serous, endometrioid, and clear cell carcinomas), originate in the fallopian tube and the endometrium and involve the ovary secondarily. This review summarizes recent advances in the molecular pathology which have greatly improved our understanding of the biology of ovarian carcinoma and are also relevant to patient management.