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Ordulu Z, Watkins J, Ritterhouse LL. Molecular Pathology of Ovarian Epithelial Neoplasms: Predictive, Prognostic, and Emerging Biomarkers. Clin Lab Med 2024; 44:199-219. [PMID: 38821641 DOI: 10.1016/j.cll.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
This review focuses on the diagnostic, prognostic, and predictive molecular biomarkers in ovarian epithelial neoplasms in the context of their morphologic classifications. Currently, most clinically actionable molecular findings are reported in high-grade serous carcinomas; however, the data on less common tumor types are rapidly accelerating. Overall, the advances in genomic knowledge over the last decade highlight the significance of integrating molecular findings with morphology in ovarian epithelial tumors for a wide-range of clinical applications, from assistance in diagnosis to predicting response to therapy.
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Affiliation(s)
- Zehra Ordulu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02124, USA
| | - Jaclyn Watkins
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02124, USA
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Giannecchini GV, da Silva JL, de Oliveira Bretas G, Dos Santos ALS, Baltar LFR, de Melo AC. Exploring novel approaches in the systemic therapy of low-grade serous carcinoma of the ovary: a literature review. Front Med (Lausanne) 2024; 11:1366603. [PMID: 38835797 PMCID: PMC11148250 DOI: 10.3389/fmed.2024.1366603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/26/2024] [Indexed: 06/06/2024] Open
Abstract
By presenting a comprehensive analysis of low-grade serous carcinomas (LGSCs), a subset of epithelial ovarian cancers, this review delves into their distinct molecular characteristics, clinicopathological features and systemic therapy options, emphasizing their differences from high-grade serous carcinomas (HGSCs). Notably, LGSCs exhibit prevalent RAS/RAF/MEK/MAPK pathway activation, KRAS and BRAF mutations, and infrequent p53 mutations. While chemotherapy is commonly employed, LGSCs display lower responsiveness compared to HGSCs. Hormone therapy, particularly endocrine maintenance therapy, is explored due to the higher estrogen receptor expression. Novel therapeutic approaches involving CDK4/6 inhibitors, MEK inhibitors, and antiangiogenic agents like bevacizumab are also investigated. Ongoing clinical trials are striving to enhance LGSC treatment strategies, offering valuable insights for future therapeutic advancements in this challenging ovarian cancer subtype.
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Affiliation(s)
| | - Jessé Lopes da Silva
- Oncoclínicas&Co - Medica Scientia Innovation Research (MEDSIR), Sao Paulo, Brazil
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3
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Novikov FV, Anufriev AG, Efremov GD. High-grade Serous Carcinoma Occurring in a Serous Cystadenoma on the Background of a Serous Tubal Intraepithelial Carcinoma (STIC)-like Lesion: A Case Report With Literature Review. Int J Gynecol Pathol 2024:00004347-990000000-00157. [PMID: 38661558 DOI: 10.1097/pgp.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
At present, the prevailing concept is that high-grade serous carcinoma (HGSC) arises from the fallopian tubes (FTs). We report an HGSC case occurring in a serous ovarian cyst against the background of a serous tubal intraepithelial carcinoma (STIC)-like lesion. We also provide a literature review that contains references to clinical cases of the occurrence of STIC-like lesions in the ovary and phylogenetic studies that do not always reveal obvious bonds between early dysplastic serous lesions and HGSC. The article discusses cases of association between HGSCs of serous borderline tumors (SBTs) and low-grade serous carcinomas (LGSCs) in the context of their possible histogenetic relationship. We propose a concept in which high-grade serous carcinogenesis, represented by the p53-signature-STIC-HGSC continuity, occurs in the serous epithelium of both the FT and other locations.
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Němejcová K, Šafanda A, Bártů MK, Michálková R, Drozenová J, Fabian P, Hausnerová J, Laco J, Matěj R, Méhes G, Škapa P, Stružinská I, Dundr P. A comprehensive immunohistochemical analysis of 26 markers in 250 cases of serous ovarian tumors. Diagn Pathol 2023; 18:32. [PMID: 36855066 PMCID: PMC9972686 DOI: 10.1186/s13000-023-01317-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND We examined a large cohort of serous tubo-ovarian tumors with 26 immunohistochemical markers, with the aim to assess their value for differential diagnosis and prognosis. METHODS Immunohistochemical analyses with 26 immunomarkers were performed on 250 primary tubo-ovarian tumors including 114 high grade serous carcinomas (HGSC), 97 low grade serous carcinomas (LGSC), and 39 serous borderline tumors (micropapillary variant, mSBT). The associations of overall positivity with clinicopathological characteristics were evaluated using the chi-squared test or Fisher's Exact test. RESULTS We found significantly different expression of p53, p16, ER, PR, PTEN, PAX2, Mammaglobin, RB1, Cyclin E1, stathmin, LMP2, L1CAM, CD44, and Ki67 in HGSCs compared to LGSCs. No significant differences were found between LGSC and mSBT. None of the other included markers (PAX8, ARID1A, HNF1B, Napsin A, CDX2, SATB2, MUC4, BRG1, AMACR, TTF1, BCOR, NTRK) showed any differences between the investigated serous tumors. Regarding the prognosis, only PR and stathmin showed a statistically significant prognostic meaning in LGSCs, with better overall survival (OS) and recurrence-free survival (RFS) in cases positive for PR, and worse outcome (RFS) for stathmin. None of the study markers showed prognostic significance in HGSCs. CONCLUSION We provided an extensive immunohistochemical analysis of serous ovarian/tubo-ovarian tumors. Although we found some differences in the expression of some markers in HGSCs compared to LGSCs, only p53, p16, and Ki67 seem to be useful in real diagnostic practice. We also suggested the best discriminative cut-off for Ki67 (10% of positive tumor cells) for distinguishing HGSC from LGSC. We found prognostic significance of PR and stathmin in LGSCs. Moreover, the high expression of stathmin could also be of predictive value in ovarian carcinomas as target-specific anti-stathmin effectors are potential therapeutic targets.
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Affiliation(s)
- Kristýna Němejcová
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800, Prague, Czech Republic.
| | - Adam Šafanda
- grid.411798.20000 0000 9100 9940Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic
| | - Michaela Kendall Bártů
- grid.411798.20000 0000 9100 9940Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic
| | - Romana Michálková
- grid.411798.20000 0000 9100 9940Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic
| | - Jana Drozenová
- grid.4491.80000 0004 1937 116XDepartment of Pathology, Charles University, 3rd Faculty of Medicine, University Hospital Královské Vinohrady, 10034 Prague, Czech Republic
| | - Pavel Fabian
- grid.419466.8Department of Oncological Pathology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Jitka Hausnerová
- grid.10267.320000 0001 2194 0956Department of Pathology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Jan Laco
- grid.4491.80000 0004 1937 116XThe Fingerland Department of Pathology, Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Radoslav Matěj
- grid.411798.20000 0000 9100 9940Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic ,grid.4491.80000 0004 1937 116XDepartment of Pathology, Charles University, 3rd Faculty of Medicine, University Hospital Královské Vinohrady, 10034 Prague, Czech Republic ,grid.4491.80000 0004 1937 116XDepartment of Pathology and Molecular Medicine, Third Faculty of Medicine, Charles University, Thomayer University Hospital, Prague, Czech Republic
| | - Gábor Méhes
- grid.7122.60000 0001 1088 8582Department of Pathology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Petr Škapa
- grid.412826.b0000 0004 0611 0905Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Ivana Stružinská
- grid.411798.20000 0000 9100 9940Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic
| | - Pavel Dundr
- grid.411798.20000 0000 9100 9940Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12800 Prague, Czech Republic
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Rashid S, Arafah MA, Akhtar M. The Many Faces of Serous Neoplasms and Related Lesions of the Female Pelvis: A Review. Adv Anat Pathol 2022; 29:154-167. [PMID: 35180738 PMCID: PMC8989637 DOI: 10.1097/pap.0000000000000334] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ovarian serous tumors and related lesions are one of the most common conditions of the female genital tract. While ovarian high-grade serous carcinoma carries high mortality and adverse prognosis, most other serous lesions have better clinical behavior. In recent years, significant progress has been made in understanding the nature and histogenesis of these lesions that has contributed to better and more precise clinical management. Most of the high-grade serous carcinomas involve the ovaries and/or peritoneum, although in most cases, their origin seems to be in the fallopian tube. This view is supported by the recognition of precursor lesions in the fallopian tube, such as p53 signature and serous tubular in situ carcinoma. This paper presents salient morphologic, immunohistochemical, and molecular data related to serous tumors and related lesions of the female pelvis and discusses the histogenetic interrelationship among these lesions in light of current knowledge.
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Affiliation(s)
- Sameera Rashid
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Maria A. Arafah
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Akhtar
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
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Silva EG, Lawson BC, Ramalingam P, Liu J, Shehabeldin A, Marques-Piubelli ML, Malpica A. Precursors in the Ovarian Stroma, Another Pathway to Explain the Origin of Ovarian Serous Neoplasms. Hum Pathol 2022; 127:136-145. [DOI: 10.1016/j.humpath.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022]
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Ordulu Z, Watkins J, Ritterhouse LL. Molecular Pathology of Ovarian Epithelial Neoplasms: Predictive, Prognostic, and Emerging Biomarkers. Surg Pathol Clin 2021; 14:415-428. [PMID: 34373093 DOI: 10.1016/j.path.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review focuses on the diagnostic, prognostic, and predictive molecular biomarkers in ovarian epithelial neoplasms in the context of their morphologic classifications. Currently, most clinically actionable molecular findings are reported in high-grade serous carcinomas; however, the data on less common tumor types are rapidly accelerating. Overall, the advances in genomic knowledge over the last decade highlight the significance of integrating molecular findings with morphology in ovarian epithelial tumors for a wide-range of clinical applications, from assistance in diagnosis to predicting response to therapy.
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Affiliation(s)
- Zehra Ordulu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02124, USA
| | - Jaclyn Watkins
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02124, USA
| | - Lauren L Ritterhouse
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02124, USA.
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Ribeiro E Ribeiro R, Valenzuela A, Beffa L, Sung CJ, Quddus MR. Low-grade serous carcinoma with extensive osseous metaplasia arising from ovarian serous cystadenofibroma. Gynecol Oncol Rep 2021; 36:100707. [PMID: 33553558 PMCID: PMC7851766 DOI: 10.1016/j.gore.2021.100707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 11/24/2022] Open
Abstract
Bilateral ovarian low-grade serous carcinoma presenting with extensive osseous metaplasia. Both lesions arising directly from ovarian cystadenofibromas, skipping the “borderline phase”. No micropapillary serous borderline component was identified. This case may represent a “skipped step” in low-grade serous carcinogenesis.
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Affiliation(s)
- Renan Ribeiro E Ribeiro
- Women & Infants Hospital, Providence, RI, USA.,Brown University, Providence, RI, USA.,Laboratório Cicap - Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - Ashley Valenzuela
- Women & Infants Hospital, Providence, RI, USA.,Brown University, Providence, RI, USA
| | - Lindsey Beffa
- Women & Infants Hospital, Providence, RI, USA.,Brown University, Providence, RI, USA
| | - C James Sung
- Women & Infants Hospital, Providence, RI, USA.,Brown University, Providence, RI, USA
| | - M Ruhul Quddus
- Women & Infants Hospital, Providence, RI, USA.,Brown University, Providence, RI, USA
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Chui MH, Boroujeni AM, Mandelker D, Ladanyi M, Soslow RA. Characterization of TP53-wildtype tubo-ovarian high-grade serous carcinomas: rare exceptions to the binary classification of ovarian serous carcinoma. Mod Pathol 2021; 34:490-501. [PMID: 32801341 PMCID: PMC8409220 DOI: 10.1038/s41379-020-00648-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 01/04/2023]
Abstract
While TP53 mutation is widely considered to be a defining feature of tubo-ovarian high-grade serous carcinoma (HGSC), rare TP53-mutation-negative cases have been reported. To gain further insight into this rare subset, a retrospective review was conducted on 25 TP53-wildtype tubo-ovarian HGSCs, constituting 2.5% of 987 HGSCs profiled by the MSK-IMPACT sequencing platform. Consistent with serous differentiation, positive staining for Pax8 and WT1 was present in virtually all TP53-wildtype HGSCs. Other characteristic features of HGSC, such as serous tubal intraepithelial carcinoma, or genetic alterations of CCNE1 and BRCA1/2 were identified in these tumors, furthering supporting their classification as bona fide HGSC, despite lacking TP53 mutations. Overall, the level of chromosomal instability of TP53-wildtype HGSCs was intermediate between low-grade serous carcinoma (LGSC) and TP53-mutated HGSC. Morphologic assessment by observers blinded to mutation status revealed a significant subset of tumors with Grade 2 nuclear atypia (which exceeds the degree of atypia allowed for LGSC, but less than typically encountered for HGSC) combined with micropapillary features (6/19, 32%, chemotherapy-naive TP53-wildtype HGSCs compared to 0/21, 0%, TP53-mutated HGSCs; p = 0.007). Some TP53-wildtype HGSCs harbored driver mutations in KRAS (n = 3), BRAF (n = 1) or NRAS (n = 2). Overall, 10 (40%) cases had "LGSC-like" morphology (i.e., Grade 2 nuclear atypia and micropapillary features) and/or RAS/RAF mutation, and most of these showed a wildtype p53 pattern of expression by immunohistochemistry (7/9, 78%). The remaining TP53-wildtype HGSCs (n = 15, 60%) exhibited severe nuclear atypia (Grade 3) and were morphologically indistinguishable from conventional TP53-mutated HGSC. Despite lacking genetic alterations of TP53, these "usual HGSC-like" tumors often showed evidence of p53 dysfunction, including downregulation of expression ('null' or equivocal p53 staining in 9/14, 64%) or MDM2 amplification (n = 2). Our results support the existence of TP53-wildtype HGSCs, which comprise a heterogeneous group of tumors which may arise via distinct pathogenic mechanisms.
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Santandrea G, Piana S, Valli R, Zanelli M, Gasparini E, De Leo A, Mandato VD, Palicelli A. Immunohistochemical Biomarkers as a Surrogate of Molecular Analysis in Ovarian Carcinomas: A Review of the Literature. Diagnostics (Basel) 2021; 11:199. [PMID: 33572888 PMCID: PMC7911119 DOI: 10.3390/diagnostics11020199] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/27/2022] Open
Abstract
The term "ovarian carcinoma" encompasses at least five different malignant neoplasms: high-grade serous carcinoma, low-grade serous carcinoma, endometrioid carcinoma, mucinous carcinoma, and clear cell carcinoma. These five histotypes demonstrated distinctive histological, molecular, and clinical features. The rise of novel target therapies and of a tailored oncological approach has demanded an integrated multidisciplinary approach in the setting of ovarian carcinoma. The need to implement a molecular-based classification in the worldwide diagnostic and therapeutic setting of ovarian cancer demanded a search for easy-to-use and cost-effective molecular-surrogate biomarkers, relying particularly on immunohistochemical analysis. The present review focuses on the role of immunohistochemistry as a surrogate of molecular analysis in the everyday diagnostic approach to ovarian carcinomas.
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Affiliation(s)
- Giacomo Santandrea
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Pathology Unit, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy; (S.P.); (R.V.); (M.Z.); (A.P.)
| | - Simonetta Piana
- Pathology Unit, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy; (S.P.); (R.V.); (M.Z.); (A.P.)
| | - Riccardo Valli
- Pathology Unit, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy; (S.P.); (R.V.); (M.Z.); (A.P.)
| | - Magda Zanelli
- Pathology Unit, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy; (S.P.); (R.V.); (M.Z.); (A.P.)
| | - Elisa Gasparini
- Oncology Unit, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Antonio De Leo
- Molecular Diagnostic Unit, AUSL Bologna, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy;
| | - Vincenzo Dario Mandato
- Unit of Obstetrics and Gynaecology, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Andrea Palicelli
- Pathology Unit, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy; (S.P.); (R.V.); (M.Z.); (A.P.)
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The Many Uses of p53 Immunohistochemistry in Gynecological Pathology: Proceedings of the ISGyP Companion Society Session at the 2020 USCAP Annual9 Meeting. Int J Gynecol Pathol 2020; 40:32-40. [PMID: 33290354 DOI: 10.1097/pgp.0000000000000725] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ancillary immunohistochemistry (IHC) has become a reliable adjunct for subclassification of gynecological neoplasms. An important recent development was optimization and validation of p53 IHC, where 3 abnormal IHC patterns (nuclear overexpression, complete absence, cytoplasmic) were shown to predict underlying TP53 mutations with high accuracy in ovarian carcinomas. p53 IHC now helps in distinguishing high-grade serous from low-grade serous carcinomas. Thereafter, the new interpretation of p53 IHC was quickly adapted for other purposes and similar accuracies were shown in endometrial carcinomas, vulvar squamous cell carcinomas, and ovarian mucinous tumors. However, it required further refinement of the p53 IHC interpretation criteria for each tumor site. A proportion of endometrial endometrioid carcinomas shows an ultramutated or hypermutated genotype due to underlying POLE mutations or mismatch repair deficiency sometimes causing subclonal TP53 mutations, and their distribution can be visualized by p53 IHC. Squamous cell carcinomas and ovarian mucinous tumors show a phenomenon called terminal differentiation where basal cells demonstrate an abnormal pattern of p53 IHC but apical cells do not despite an underlying TP53 mutation. High-grade progression of adult granulosa cell tumors due to a subclonal TP53 mutation has been recently described. Another use of p53 IHC is triaging gynecological sarcomas for molecular testing based on the assumption that TP53-mutated gynecological sarcomas do not harbor cancer driving translocations. Therefore, familiarity with interpretation of p53 IHC is becoming increasingly important for the practicing gynecological pathologist. Furthermore, local optimization of the p53 IHC assay using validated protocols including appropriate low expressing control tissues (eg, tonsil) is vital in order to achieve high diagnostic accuracy, especially for abnormal staining patterns such as complete absence or cytoplasmic, and interlaboratory concordance. p53 IHC is a reliable diagnostic adjunct for histotyping and molecular subtyping of ovarian and endometrial carcinomas, and it paves the way for large-scale studies to validate the prognostic value of p53 IHC in several gynecological tumor types. The technical advances, validated interpretation criteria, and its growing versatility in identifying high-risk neoplasms paired with its widespread availability in pathology departments make p53 IHC perhaps the single most useful IHC stain in gynecological pathology.
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