Warning: fopen(/home/virtual/jptm/journal/upload/ip_log/ip_log_2023-03.txt): failed to open stream: Permission denied in /home/virtual/lib/view_data.php on line 83 Warning: fwrite() expects parameter 1 to be resource, boolean given in /home/virtual/lib/view_data.php on line 84
1Department of Pathology and Laboratory Medicine, Sinai Health System and University of Toronto, Toronto, ON, Canada
2Department of Pathology, University of Chicago Medical Center, Chicago, IL, USA
© 2021 The Korean Society of Pathologists/The Korean Society for Cytopathology
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
- Fallopian tube: STIC present, or mucosal HGSC present, or part or all of the fallopian tube is inseparable from tubo-ovarian mass.
- Ovary: both fallopian tubes are separate from ovarian mass, and no STIC or mucosal HGSC present in either fallopian tube.
- Tubo-ovarian: fallopian tubes and ovaries are unavailable for complete examination, and pathologic findings are consistent with extrauterine HGSC.
- Peritoneal (exceedingly rare): both fallopian tubes and ovaries are fully examined using a SEE-FIM (Sectioning and Extensively Examining the FIMbriated end) protocol, and no gross or microscopic evidence of STIC or HGSC present in either fallopian tube or ovary.
- These criteria classify approximately 80% of HGSCs as primary tubal.
- Obsolete terminology no longer recommended includes atypical proliferative serous tumor, serous tumor of low malignant potential, semimalignant serous tumor and non-invasive LGSC / micropapillary serous borderline tumor (the latter no longer considered definitionally synonymous with non-invasive LGSC).
- Composed of multiple architectural patterns (tubular, glandular/pseudoendometrioid, ductal, papillary, solid), intraluminal eosinophilic colloid-like material, dense or vesicular chromatin, inconspicuous nucleoli and nuclear crowding, and lacking squamous or mucinous differentiation.
- Positive for GATA3, TTF1, CD10 (luminal) and PAX8, and negative for hormone receptors and WT1, with wild-type p53 expression.
- Usually unilateral and diagnosed at stage I in postmenopausal women.
- May arise from paraovarian mesonephric remnants or Müllerian carcinomas displaying secondary mesonephric transdifferentiation.
- May be associated with endometriosis, cystadenomas, adenofibromas, borderline tumors and LGSC.
- The most common molecular alterations include KRAS mutations, 1p loss and 1q gain, while NRAS or PIK3CA mutations are rare.
- Tumors with coexisting serous neoplasms show shared molecular alterations (KRAS or NRAS mutations).
- Clinical outcome is unknown due to rarity.
- A biphasic tumor composed of an undifferentiated carcinoma (sheet-like growth of monotonous, discohesive, round, rhabdoid to spindle cells with brisk mitoses, often necrosis and abundant tumor-infiltrating lymphocytes) and a differentiated (usually low grade endometrioid adenocarcinoma, rarely serous carcinoma) component, often with abrupt interface in between (Fig. 2).
- Undifferentiated areas are focally positive for EMA, pan-keratin and CK18, focally positive to negative for PAX8, and negative for hormone receptors and E-cadherin, with common loss of SMARCA4 (BRG1), SMARCA2 (BRM), SMARCB1 (INI1) or ARID1A, DNA mismatch repair deficiency in onethird of cases and typically wild-type p53 expression.
- Usually diagnosed at advanced stages, with pelvic and para-aortic lymph node involvement and poor prognosis.
- A biphasic neoplasm composed of high grade carcinomatous and sarcomatous elements.
- Now considered a variant of carcinoma rather than a true mixed epithelial-mesenchymal tumor.
- True mixed carcinomas are uncommon.
- Should only be diagnosed when at least two tumor types are clearly recognizable on hematoxylin-eosin-stained sections, with distinct morphologic and preferably immunophenotypic differences.
- Each histotype with their percentages should be reported (no minimum percentage requirement).
- Endometriosis-associated histotypes are most common, e.g. endometrioid and clear cell carcinomas (Fig. 3).
- DICER1-mutant tumors show somatic (~50%) or germline (69%) hotspot mutations in the RNase IIIb domain of DICER1, an endoribonuclease involved in microRNA processing and gene expression regulation.
- FOXL2-mutant tumors show c.402C>G (p.Cys134Trp) mutations that upregulate CYP19A1 encoding aromatase.
- Defined as a sex cord-stromal tumor with an admixure of female (adult-type or juvenile GCT) and male (Sertoli cell tumor or SLCT) elements.
- Most commonly composed of a predominant SLCT component and a smaller component of juvenile GCT, both expressing sex cordstromal markers, sometimes with shared DICER1 mutations.