Ovarian epithelial neoplasms

Updated:08/12/2022

General feature

Most common type of ovarian tumor
Derived from surface epithelium (mesothelium)
Most important risk factor: Family history
Other risk factors: Excessive gonadotropins, androgen stimulation, pelvic inflammation, ovarian exposure to contaminants and carcinogens (talc and asbestos), nulliparity, refractory infertility, obesity
Subtypes

Seromucinous

Undifferentiated

Carcinogenesis

Associated with borderline tumors or endometriosis

Stepwise development from a lower grade tumor

Chromosomally stable

Rapidly growing

Usually wide spread at the time of diagnosis

No recognizable precursors

Largely variable DNA copy number

Clinical features

Commonly asymptomatic if benign
Abdominal enlargement, lower abdominal pain, etc
Acute abdominal pain if torsion occurs
Metastasis: Often contralateral ovary, pelvic peritoneum, umbilicus (Sister Joseph’s nodule)

Commonly used serum cancer markers

Molecular abnormalities

Type I: KRAS (mucinous and low-grade serous), BRAF (low-grade serous), HER2 (mucinous), PTEN (endometrioid, clear cell), etc
Type II (high-grade serous): p53, BRCA 1, BRCA 2

Syndromes associated with ovarian epithelial tumors

Hereditary Breast and Ovary Cancer syndrome: BRCA1 and BRCA2
Lynch syndrome: DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2)
Peutz-Jeghers syndrome: STK11
Cowden syndrome: PTEN
Coffin-Siris Syndrome: ARID1A
Li-Fraumeni syndrome: p53
Other germline mutations that are correlated to ovarian carcinoma affect BRIP1, CHEK2, RAD51

Pathology Notes