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McConechy MK, Färkkilä A, Horlings HM, Talhouk A, Unkila-Kallio L, van Meurs HS, Yang W, Rozenberg N, Andersson N, Zaby K, Bryk S, Bützow R, Halfwerk JBG, Hooijer GKJ, van de Vijver MJ, Buist MR, Kenter GG, Brucker SY, Krämer B, Staebler A, Bleeker MCG, Heikinheimo M, Kommoss S, Blake Gilks C, Anttonen M, Huntsman DG. Molecularly Defined Adult Granulosa Cell Tumor of the Ovary: The Clinical Phenotype. J Natl Cancer Inst 2016; 108:djw134. [PMID: 27297428 DOI: 10.1093/jnci/djw134] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022] Open
Abstract
The histopathologic features of adult granulosa cell tumors (AGCTs) are relatively nonspecific, resulting in misdiagnosis of other cancers as AGCT, a problem that has not been well characterized. FOXL2 mutation testing was used to stratify 336 AGCTs from three European centers into three categories: 1) FOXL2 mutant molecularly defined AGCT (MD-AGCT) (n = 256 of 336), 2) FOXL2 wild-type AGCT (n = 17 of 336), 3) misdiagnosed other tumor types (n = 63 of 336). All statistical tests were two-sided. The overall and disease-specific survival of the misdiagnosed cases was lower than in the MD-AGCTs (P < .001). The misdiagnosed cases accounted for 71.9% of disease-specific deaths within five years. In the population-based cohort, overall survival of MD-AGCT patients was not different from age-matched, population-based controls. Even though 35.2% of all the MD-AGCT patients in our study experienced a relapse, AGCT is usually an indolent disease. The historical, premolecular data underpinning our clinical understanding of AGCT was likely skewed by inclusion of misdiagnosed cases, and future management strategies should reflect the potential for surgical cure and long survival even after relapse.
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Affiliation(s)
- Melissa K McConechy
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Anniina Färkkilä
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Hugo M Horlings
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Aline Talhouk
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Leila Unkila-Kallio
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Hannah S van Meurs
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Winnie Yang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Nirit Rozenberg
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Noora Andersson
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Katharina Zaby
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Saara Bryk
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Ralf Bützow
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Johannes B G Halfwerk
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Gerrit K J Hooijer
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Marc J van de Vijver
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Marrije R Buist
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Gemma G Kenter
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Sara Y Brucker
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Bernhard Krämer
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Annette Staebler
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Maaike C G Bleeker
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Markku Heikinheimo
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Stefan Kommoss
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Mikko Anttonen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - David G Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
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