Download Papillary Serous Cyst Adenocarcinoma

In
The
Name
of
God
17th
century
microscopes
PARISA REZAEI,M.D.,AP.CP
Ascites fluid of a 65
year old woman
WHAT IS YOUR DIAGNOSIS ?
ALL RIGHT !
Papillary
Serous Cyst
Adenocarcinoma
of The Ovary
Papillary Serous Cyst Adenocarcinoma
• The cells occur singly and in structured, approximately spherical
and papillary clusters .
• The cytoplasm is usually delicate and finely vacuolated.
• The dominant feature of these cells is nuclear abnormalities:
 nuclear enlargement
 irregular nuclear configuration
 presence of prominent, often
multiple nucleoli
• Such malignant cells may be occasionally
confused with benign mesothelial or
epithelial cells which, however, are usually
much smaller.
Papillary Serous Cyst Adenocarcinoma
• Papillary clusters of cancer cells with nuclear hyperchromasia ,
of the type commonly observed in cells of ovarian cancer in
cervicovaginal material are less common but may occur
• A central core of connective tissue may be sometimes
observed in the papillary clusters, a feature
that is usually better seen in cell block
preparations
• Psammoma bodies may occur, but, unless
accompanied by cancer cells, have
limited diagnostic value
Differential Diagnosis
• Tumors mimicking ovarian serous carcinomas may originate in the
peritoneum . Various names have been applied to this group of rare
tumors:
 Peritoneal papillary serous carcinoma ( large cohesive clusters of cancer cells)
 Multifocal extraovarian serous carcinoma
 Serous surface papillary carcinoma
• The survival of patients is very poor,
probably because these rare tumors are
disseminated at the time of diagnosis.
• The cytologic presentation of such tumors
in fluids is similar to that of primary
ovarian tumors
Differential Diagnosis
• The low-grade (borderline) serous ovarian tumors shed atypical but
not clearly cancerous epithelial cells, usually forming cohesive
clusters.
• The nuclear abnormalities are usually more modest than in high
grade carcinomas, specifically the
nucleoli are usually small and inconspicuous,
but in some cases the cells are similar
to those of a well-differentiated serous
carcinoma.
• The borderline tumors displayed less
nuclear pleomorphism and were diploid,
whereas the carcinomas were aneuploid.
STAGING OF PRIMARY CARCINOMA OF THE OVARY
I Growth limited to the ovaries
la Growth limited to one ovary; no ascites; no tumor on the external
surface; capsule intact
Ib Growth limited to both ovaries; no ascites; no tumor on the external
surfaces; capsules intact
lc** Tumor either stage la or Ib, but with (1) tumor on
At least surface of one or both ovaries or (2) capsule(s) ruptured
or (3) ascites present containing malignant cells or
(4) positive peritoneal washings
II
Growth involving one or both ovaries with pelvic extension
IIa
Extension and/or metastases to the uterus and/or tubes
IIb Extension to other pelvic tissues
IIc** Tumor either stage IIa or IIb, but with (1) tumor on surface of one or
both ovaries or (2) capsule(s) ruptured or (3) ascites present containing
malignant cells or (4) positive peritoneal washings
(FIGO)
STAGING OF PRIMARY CARCINOMA OF THE OVARY
III
Tumor involving one or both ovaries with peritoneal implants outside the
pelvis and/or positive retroperitoneal or inguinal nodes (superficial liver
metastasis equals stage III);tumor is limited to the true pelvis, but with
histologically proven malignant extension to small bowel or omentum
IIIa Tumor grossly limited to the true pelvis with negative nodes but with
histologically confirmed microscopic seeding of abdominal peritoneal
surfaces
IIIb Tumor of one or both ovaries with histologically confirmed
implants of abdominal peritoneal surfaces, none
exceeding 2cm in diameter; nodes are negative
IIIc Abdominal implants> 2 cm in diameter and/or positive
retroperitoneal or inguinal nodes
IV Growth involving one or both ovaries with distant metastases;
if pleural effusion is present, there must be positive cytology to allot a
case to stage IV(parenchymal liver metastasis equals stage IV)
(FIGO)
Special thanks :
Dr. Mansour Mehzad
THANKS FOR YOUR
ATTENTION
ESFAHAN
ZAYANDE ROOD RIVER