Intra-abdominal carcinomatosis after prophylactic oophorectomy in ovarian-cancer-prone families

Serous surface carcinoma of the peritoneum: a clinicopathologic study of 22 cases

Serous surface carcinoma (SSC) of the peritoneum is defined as a primary tumor histologically indistinguishable from serous carcinoma of the ovary, diffusely involving the peritoneal surface but sparing or only superficially invading the ovaries. In this study of 22 cases of SSC, it was found that the main clinical manifestations of SSC were abdominal pain and enlargement. In most cases, SSC evenly involved the entire mesothelial surface but rarely was predominant in or even limited to the pelvis. It frequently invaded the submesothelium, but deep invasion into abdominal and pelvic organs or local metastasis was rare, and distant metastasis was not seen at presentation. Microscopically, SSC was a high-grade tumor frequently showing high mitotic rate, psammomas bodies, and necrosis. The tumor was usually contiguous with hyperplastic mesothelium on either ovarian surface or other locations. Tumor cells in all cases except one showed cytoplasmic or surface neutral or acidic mucin or both. Tumor cells stained positive for keratin (100% of cases), epithelial membrane antigen (100%), Leu-M1 (45%), B72.3 (85%), vimentin (35%), and carcinoembryonic antigen (25%). Electron microscopic studies of six cases showed epithelial differentiation in each. Seven patients (32%) were alive with no clinical disease at 3 to 31 months, one patient (4%) was alive with extensive local disease at 24 months, 11 patients (50%) died almost exclusively of local recurrence at 1 to 70 months, and three patients (14%) died of operative complications. It is concluded that SSC arises from peritoneal mesothelium but has epithelial phenotype. It can be morphologically differentiated from other conditions with similar laparotomy findings, such as malignant mesothelioma, benign papillary mesothelioma, cystic mesothelioma, and benign or borderline peritoneal serous tumors. The prognosis of SSC is poor, and most patients die of uncontrollable local disease.

Hereditary carcinoma of the ovary and associated cancers: a study of two families

Increasing attention has been given to host factors in the etiology of ovarian carcinoma. Case/control studies have shown a significant excess of this disease among primary relatives of ovarian cancer affected. Pedigree studies have demonstrated its occurrence on a site-specific basis, in association with carcinoma of the breast (breast/ovarian carcinoma syndrome), and in other hereditary disorders. The complexity of this heterogeneity clearly warrants more intensive family studies. We have described genetic and clinicopathologic nuances in two extended ovarian cancer-prone families. The absence of premonitory physical stigmata and/or biomarkers which signify the cancer-prone genotype compels the physician to employ the best posits from the pedigree to identify those patients who are at inordinately high risk for ovarian and/or syndrome-associated cancer so that surveillance strategies can be more focused. Because of limitations of current surveillance strategies for the early detection of ovarian carcinoma, the clinician's responsibility includes the identification and counseling of candidates for prophylactic oophorectomy.

Multiple focal extraovarian serous carcinoma; three case reports

Three patients with multiple focal extraovarian serous carcinoma are discussed. The disease is characterized by carcinomatosis peritonei of papillary adenocarcinoma type without an evident primary tumor. The clinical aspect is that of ovarian carcinoma. It is proposed that these tumors might originate from the extragenital Müllerian epithelium.

Extraovarian peritoneal serous papillary carcinoma. A clinicopathologic study of 31 cases

The rate and clinical features of patients admitted to King George V Hospital with extraovarian peritoneal serous papillary carcinoma during a 9-year period were reviewed. In this time, 31 of 236 (13%) patients with an initial diagnosis of invasive serous ovarian carcinoma fulfilled the surgicopathologic criteria for this entity. All patients had disseminated tumor equivalent to ovarian Stage III and IV disease (International Federation of Gynecology and Obstetrics [FIGO]) and with predominantly high-grade neoplasms. They were managed by surgical exploration, tumor debulking where possible, and postoperative chemotherapy. A comparison with a contemporaneous series of 139 patients with primary epithelial ovarian carcinoma matched for stage and grade of disease and managed similarly showed no difference in actuarial survival. The median survival times were 11.3 months for patients with extraovarian serous papillary carcinomas and 13.5 months for patients with equivalent primary ovarian neoplasms. The features of the disease and the treatment regimens used are discussed.

Primary papillary serous neoplasia of the peritoneum: a clinicopathologic and ultrastructural study of eight cases

The well-documented but rare primary papillary serous peritoneal tumors are difficult problems for the pathologist and the clinician. Because of their unusual location, these tumors are often classified as mesothelioma or advanced ovarian carcinoma. In this study, we report the clinicopathologic features of eight primary peritoneal serous papillary tumors and compare their histologic and ultrastructural features to 12 serous ovarian tumors and 16 epithelial mesotheliomas (two peritoneal and 14 pleural). The eight peritoneal serous papillary tumors occurred in women aged 19 to 75 years; two were serous tumors of low malignant potential (borderline) and six were serous carcinomas. The tumors were located in the mesosalpinx, left pelvis, omentum, and/or surface of the ovary. The two patients with borderline neoplasms had long disease-free survival (11 years and 20 years), while three of the four patients with carcinoma with more than 1 year of follow-up died of disease. The peritoneal serous papillary tumors were morphologically identical to serous ovarian tumors of equivalent grade. Well-differentiated papillary structures with distinct fibrovascular cores and one or several layers of columnar, crowded cells, dense overlapping nuclei with a long axis perpendicular to the surface of the papillary cores, and numerous psammoma bodies were features of the peritoneal and ovarian serous tumors. In contrast, the tubulo-alveolar, solid, or poorly defined papillary structures lined by well-spaced polygonal to cuboidal cells with abundant cytoplasm, absence of nuclear polarity, and infrequent psammoma bodies characterized the mesotheliomas. Epithelial mucin and carcinoembryonic antigen (CEA) immunoreactivity, when present, supported a diagnosis of serous tumor in these generally mucin-poor and CEA-negative neoplasms. Ultrastructurally, the cells of serous tumors had slender, straight microvilli of variable length interspersed with or without cilia, while the nonciliated cells of mesothelioma had long, exuberant, wavy microvilli. The morphologic and clinical features of the peritoneal papillary serous tumors are distinctive enough to warrant their separation from mesotheliomas.

Ovarian cancer incidence and mortality in Denmark, 1943-1982

Trends in ovarian cancer incidence and mortality were examined using data from the Danish Cancer Registry and national mortality statistics respectively. The study population comprised 17,956 incident cases diagnosed between 1943 and 1982 and 11,904 deaths between 1953 and 1982 due to cancer in the ovaries, Fallopian tube, and broad ligament. A significant 50% increase in incidence occurred from 1943 to 1972, whereafter a slight decrease was observed. This rise could be ascribed entirely to an increasing incidence among women born between 1863 and 1898. No change was seen in women born after 1900. Analysis of mortality confirmed the increasing ovarian cancer risk among women born during the last century, but indicated that the risk of dying from ovarian cancer decreased with time among women born after 1900. The observed trends were compatible with cohort-specific changes in fertility in Danish women born between 1890 and 1934. The effect of age on ovarian cancer incidence, overall and by histologic type, agreed well with previous findings.

Ovarian cancer

A comprehensive research effort has been focused on ovarian cancer during the past decade and this research focus has resulted in substantial improvements in accurate staging and effective treatment. On the basis of prospectively performed clinical trials in well-staged early ovarian cancer patients, a subset can be identified in whom no further therapy is necessary. Consequently, these patients can be spared the toxicities associated with long-term use of adjuvant chemotherapy. For patients with advanced disease, cisplatin-based combination chemotherapy regimens have produced higher complete response rates, prolongation of disease-free survival, and, in several large studies, a statistically significant prolongation of overall survival. In addition, recent clinical and laboratory data has confirmed the importance of dose and dose intensity in the optimum management of patients with ovarian cancer, and preliminary results of high-dose regimens are encouraging. Unfortunately, high-dose cisplatin-based chemotherapy regimens are associated with increased toxicity. However, pharmacologic techniques to decrease toxicity have been proven effective in murine models and clinical trials in patients have recently been initiated. Furthermore, the development of new cisplatin analogs may also permit further dose escalations with decreased long-term toxicities. There are also new promising clinical approaches that may be useful in treatment of patients who are left with small volume residual disease. It seems that approximately 30% of these patients can achieve disease-free status with intraperitoneal cisplatin therapy. While these results need to be confirmed in larger prospective trials, they do suggest that some patients with residual disease can be salvaged with intraperitoneal chemotherapy. Our understanding of the biology of ovarian cancer has been greatly facilitated by the development of relevant experimental model systems. These model systems have been used to help unravel the mechanisms associated with broad cross-resistance that currently limits the effectiveness of combination chemotherapy. In addition, pharmacologic techniques have already been shown to be capable of reversing resistance both in vitro and in vivo and these exciting new approaches will be entering clinical trial in the not too distant future. Finally, biological agents have also shown marked efficacy in these model systems of human ovarian cancer.(ABSTRACT TRUNCATED AT 400 WORDS)

Familial ovarian carcinoma. Clinical nuances

Familial ovarian carcinoma has been recognized with increased frequency during the past decade commensurate with physician attention to family history. Putative autosomal dominant inheritance of this heterogeneous problem mandates attention to both paternal and maternal lineages. A family with probable paternal transmission of breast/ovarian carcinoma is presented. One family member had findings consonant with papillary serous adenocarcinoma of ovarian origin, which may have arisen directly from extra-ovarian pelvic mesothelium. These and other clinical nuances of familial ovarian carcinoma are discussed in order to aid physicians in understanding the natural history, surveillance, and management of familial ovarian carcinoma.

Familial peritoneal ovarian carcinomatosis: a new clinical entity?

A familial form of ovarian carcinoma is now widely recognized. There are at least several ovarian cancer-prone genotypes, consistent with genetic heterogeneity. Prophylactic oophorectomy has been employed for women who were judged to be at 50% risk for this disease by virtue of their position in the pedigree. However, recent evidence has disclosed that a fraction of such patients who underwent prophylactic oophorectomy and who had ovaries which appeared to be histologically normal at surgical resection, subsequently developed intraabdominal carcinomatosis with histologic findings showing the lesions to be indistinguishable from ovarian carcinoma. Given the embryologic derivatives of the ovary, which comprise gonadal ridges composed of mesodermal cells covered by coelomic epithelium, we postulate that patients with hereditary predisposition to ovarian carcinoma harbor the first germinal hit in both the epithelial cells of the ovary as well as their derivatives in the coelomic mesothelium. These patients may then be inordinately susceptible to carcinogenesis from the second (somatic) hit in these same tissues.

Hereditary ovarian carcinoma. Biomarker studies

Three ovarian-cancer-prone kindreds were studied, two of which contained identical twin sisters concordant for ovarian carcinoma. In one kindred, both identical twin sisters had daughters with ovarian carcinoma. In another kindred, one of the identical twin sisters had an ovarian-cancer-affected daughter. Ovarian carcinoma showed vertical transmission in all three families in a pattern consonant with an autosomal dominant mode of inheritance. Medical-genetic survey of each family included detailed questionnaires with retrieval of primary medical and pathology documents on cancer of all anatomic sites. Putative biomarker determinations included: (1) in vitro hyperdiploidy in dermal monolayer cultures; and (2) lower serum levels of alpha-L-fucosidase (less than or equal to 275 IU/ml) in all cancer-affected patients and statistically significant lower levels in 50% risk individuals when compared to spouse and published controls (P = 0.04 and P = 0.0002, respectively). These findings are discussed in context with the eventual development of a risk factor profile which, given acceptable sensitivity and specificity, would enable identification of individuals who would be prime candidates for intensive surveillance/management programs.

Preservation of the ovary: a reevaluation

The incidence of routine ovariectomy approximates 20% to 30% of all women at hysterectomy. The propriety of this practice is evaluated from three perspectives: the review of the longevity of ovarian hormonal function throughout life, the review of the low risk of subsequent disease in the retained ovary, and the review of epidemiologic considerations. Because oophorectomy and the loss of its steroid contribution has such a profound influence on many body functions, with the most devastating relation to osteoporosis, and because there are no meaningful data in the literature to support the value of routine oophorectomy, removal of ovaries should only be performed when the ovaries are diseased.