Ovarian cancer early signs.

ovarian cancer early signs

The purpose of this paper is to quantify the in­ci­dence of different histological types of ovarian tumors and to demonstrate the clinical importance of an effective screening program, considering the paucisymptomatic na­ture of this pathology. The incidence of ovarian epithelial tumors varied across age groups, our study group including women aged between 34 and 64 years old. Knowing the age distribution plays an important role in the implementation of screening pro­grams.

All cases presented with similar symptomatology: pelvic pain, abdominal distension and ascites. The gross appearance of these tumors was overlapping in different histological subtypes, showing ovarian cancer early signs cystic and solid components. The histological subtypes included in our study were: serous carcinoma, low grade and high grade, mucinous carcinoma, endometrioid carcinoma and clear cell carcinoma.

A positive correct diagnosis of the his­to­lo­gical subtype is essential for therapy and follow-up, and immunohistochemial studies should be performed in difficult cases. There is a large ovarian cancer early signs of antibodies used ovarian cancer early signs the positive diagnosis of ovarian carcinoma, so the pathologist should know what algorithm to use in approaching a diagnosis in order to obtain a correct result. Scopul acestei lucrări este de a cuantifica incidența diferitelor tipuri histologice de tumori ovariene și de a demonstra importanța clinică a unui program eficient de screening, având în vedere na­tura paucisimptomatică a acestei patologii.

Incidența tumorilor epiteliale ovariene a variat în funcție de grupurile de vârstă, grupul nostru de studiu incluzând femei cu vârsta cuprinsă între 34 și 64 de ani. Cunoașterea distribuției pe vârste joacă un rol im­por­tant în implementarea programelor de screening. Toa­te cazurile au prezentat simptomatologie similară: durere pelviană, distensie abdominală și ascită.

Aspectul macroscopic al acestor tumori se suprapune în diferite sub­tipuri histologice, prezentând componente variabile chis­tice și solide. Subtipurile histologice incluse în studiul nos­tru au fost carcinomul seros, de grad scăzut sau ovarian cancer early signs, carcinomul mucinos, carcinomul endometrioid și carcinomul cu celule clare.

Un diagnostic corect pozitiv al subtipului his­to­logic este esențial pentru terapie și follow-up, iar studiile imu­no­histochimice trebuie efectuate în cazuri dificile.

Există o serie mare de anticorpi folosiți pentru diagnosticul pozitiv al carcinomului ovarian, astfel încât anatomopatologul ar trebui să știe ce algoritm să utilizeze în abordarea unui diagnostic pentru a obține un rezultat corect. Cuvinte cheie epiteliu carcinom ovar imunohistochimie Introduction Ovarian cancer is a public health problem that affects women of reproductive age and is a major cause of morbidity and mortality.

Early diagnosis is the primary method of ameliorating complications and long-term prognosis, but this is hampered by reduced symptomatology, with most patients presenting in advanced stages. From tothe incidence rate and the mortality rate decreased by 0.

Utilitatea imunohistochimiei în diagnosticul carcinomului ovarian

The most important factor in determining the prognosis of the patient is the tumor stage. For epithelial ovarian cancer, current screening methods ultrasound and tumor markers have not been as effective as in cervical or breast tumors. Ovarian ovarian cancer early signs tumors represent a heterogeneous class of neoplasia, classified by cell type ovarian cancer early signs serous, mucinous, endometrioid and clear cell.

Because there are no benign equivalent tissues in the ovary, the mechanism of carcinogenesis was attributed initially to the ovarian epithelium mesotheliumbut recent studies have proposed that serous tumors are secondary tumors, derived from lesions of the fallopian tube fimbria, while endometrioid tumor or clear cells tumors are secondary to ovarian endometriosis 4.

Ovarian epithelial tumors are classified according to the degree of nuclear atypia, tumor proliferation and the presence or absence of stromal invasion, in benign, borderline and malignant conditions.

The borderline tumors are called this way because they present cytological and histological aspects that are intermediate between benign and malignant. Materials and method The purpose of this paper is to quantify the incidence of different histological types of ovarian tumors and to demonstrate the clinical importance of an effective scre­ening program, considering the paucisymptomatic nature of this pathology.

Symptoms suggestive for this pathology were noted to demonstrate the silent clinical appearance of ovarian neoplasia. Specimens were obtained from limited tumor excision, but also from oophorectomy and hysterectomy with bilateral anexectomy, formalin fixed and paraffin embedded, then stained with Hematoxylin-Eosin. In some cases, ovarian cancer early signs immunohistochemical stains were needed to clarify the diagnosis.

Results This study included data from a ovarian cancer early signs of 23 ovarian carcinomas, selected from ovarian pathology patients.

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The incidence of ovarian epithelial tumors varies across age groups, our study group including women aged between 34 and 64 years old. Knowing the age distribution plays an important role in the implementation of screening programs. All cases presented with similar symptomatology: pelvic pain, abdominal distension and ascites in two cases. In the category of malignant serous tumors, we included 9 patients, 6 low-grade and 3 high-grade.

The low-grade serous carcinoma was non-invasive and showed a papillary-type development, with small nuclei, rare mitoses and a hyalinized stroma with occasional psamoma bodies. Immunohistochemical assays showed positivity to CK7 and ER.

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Figure 1. The immunohistochemical assays showed, by contrast to the previous low-grade serous cases, a mutated expression of p53 and high Ki67 index. The pattern of p53 immunosay is very important and the result should refer to the presence or absence of a mutation.

A strong and diffuse immunoexpression of p53, as well as a completely negative immunostaining should be interpreted as an indicator of a TP53 gene mutation. In our cases, all high grade showed mutated status of TP53 gene. Hormone receptor testing showed no difference from the low-grade cases and is not useful in the differential diagnosis. Also, all cases of both low-grade and high-grade serous carcinoma exhibited diffuse nuclear positivity with WT1. Figure 2. High-grade serous carcinoma of the ovary, HE, 40x, and p53 mutated, 40x The cases of carcinomas with glandular architecture, atypical cells and foci of squamous metaplasia were classified as endometroid carcinomas due to ovarian cancer early signs resemblance to the ovarian cancer early signs 5 cases.

The immunohistochemical profile of endometriod carcinomas is similar to that of benign endometrial tumors, presenting a positive reaction for cytokeratins and both estrogenic and progesterone receptors and different values of Ki67, depending on the aggresive character of the tumor.

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In one case, the initial intraoperative diagnosis elimination papillomavirus humain endometriod cyst, while extensive grossing for the final diagnosis revealed the presence of a small area of endometrioid carcinoma Figure 3. Figure 3. Endometrioid ovarian carcinoma and associated endometrioid cyst, HE, 40x A third histopathological category of ovarian epithelial tumors were the mucinous tumors, which represented 2.

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On gross examination, two cases showed cystic appearance and the rest were solid with dimensions between 6 and 14 cm. In one case, the mucinous adenocarcinoma has shown an expansive pattern of development, without any stromal invasion and complex architecture, while the rest were infiltrative.

Figure 4. The year-old patient who was diagnosed with this tumor had epiploic metastasis at admission.

Because all bilateral or large mucinous ovarian tumors should be considered secondary dissemination until proven otherwise, immunohistochemical tests are compulsory. In our cases, three tumors turned out to be primary ovarian cancer early signs, two were metastasis from a colorectal adenocarcinoma and one of them was a Krukenberg tumor metastasis from a gastric carcinoma.

Figure 5. Primary mucinous ovarian adenocarcinoma, HE, 40x, ovarian cancer early signs CK7 positive The Krukenberg tumor showed a specific pattern, with signet ring infiltrating tumoral cells, Ck20, CDx2 and CEA positive, but the diagnosis cannot be relied solely on histological and immunohistochemical pattern and it had to be confirmed by the clinical context.

Figure 7. Krukenberg tumor, HE, x and CK20 positive, x Clear cell carcinomas are rare tumors and we only found two cases that showed very different histological pattern: one had hobnail cell that protruded into the lumina, while the other showed clear cytoplasm.

The arhitecture was heterogenous in both cases, with tubular-cystic, papillary cores with hyalinization and solid area. The immunohistochemical tests are useful mainly for the differential diagnosis with serous and mucinous carcinoma.

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Also, Ki67 had a high value in both cases, as these types of tumors are rather aggressive Figure 8. Figure 8. Clear cell carcinoma of the ovary - EMA positive, x, and Ki67 positive, x Discussions Malignant ovarian neoplasms are the seventh most common form of cancer diagnosed in the female population.

The utility of immunohistochemistry in the diagnosis of ovarian carcinoma

Another important aspect of this pathology is the reduced symptomatology of the incipient stages. The main symptoms are abdominal pain, palpable abdominal mass, or vaginal bleeding, which are predominantly found in borderline and malignant tumors 8. In some cases, the rapid increase in size leads to torsion of the ovary and important pain. The screening for this pathology consists in several methods, such as: transvaginal ultrasonography with ovarian cancer early signs without contrast, BRCA mutation testing, or tumor marker dosing.

An element of interest in this pathology is represented by risk factors still incompletely elucidated. The main process involved in pathogenic epithelial ovarian tumors is inflammation of the surface epithelium. The inflammatory changes occurring at the time ovarian cancer early signs ovulation and hyaline body formation cause alterations of epithelial cell DNA A positive correct diagnosis of the histological subtype is essential for therapy and follow-up.

False negative results, that might come up intraoperatively, should be solved by extensive grossing of the surgical specimen.

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In our study, only one case showed false negative result. Most cases of ovarian carcinoma will need immunohistohemical confirmation, especially the mucinous subtypes. Ovarian mucinous tumors represent a wide range of neoplasms, from benign to malignant, and are distinct from other histological and molecular ovarian epithelial tumor subtypes.

The assessment of ovarian mucosal tumors requires the correlation of clinical data, imaging aspects, contralateral ovary status, the presence or absence of intraperitoneal mucin and the macroscopic aspect of the appendix. Although in most cases a positive hpv high risk of a benign lesion does not pose diagnostic problems, the differential diagnosis between a primary ovarian tumor and a metastasis is difficult to perform intraoperatively or ovarian cancer early signs the classic histological examination.

The prognosis and therapeutic management are different for each histological entity, so positive diagnosis is essential. Malignant tumors of the ovary are characterized by positivity to CK7 and P53, and negative for CK20 Conclusions In conclusion, epithelial ovarian neoplasia affects an increased number of women, mainly of reproductive age.

The most affected age categories are the third and fourth decades, with a maximum incidence in the fourth decade.

ovarian cancer early signs

Thus, ovarian epithelial tumors also have socio-economic importance, in addition to public health, affecting the active occupational categories. Reducing the morbidity and mortality of this pathology through effective screening programs becomes a priority of the health system.

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As ovarian cancer early signs ovarian cancer early signs progressed towards a more targeted approach, there have been changes and advances in the understanding of virus del papiloma humano genital tratamiento carcinoma.

Also, the ovarian tumors of the epithelial type present a large histological variety, each exhibiting several developmental patterns and requiring additional immunohistochemical tests.

Bibliografie 1. Gynecologic pathology: A volume in the series foundations in diagnostic pathology. Edinburgh: Churchill Livingstone, Elservier. Diagnostic Gynecologic and Obstetric Pathology. The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am J Surg Pathol ; Mutter G, Prat J. Epidemiology of ovarian cancer: a review.

Cancer Biol Med, ; 14 1 Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer, ; 2 Prediagnostic symptoms of ovarian carcinoma: A case-control study. Gynecologic oncology, ; 2 Value in Health, ; 20 4 Risk factors for epithelial ovarian cancer by histologic subtype.

Am J Epidemiol, ; 1 Kriplani D, Patel MM. Immunohistochemistry: A diagnostic aid in differentiating primary epithelial ovarian tumors and tumors metastatic to the ovary.

Screening for Ovarian Cancer

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