ovary chapter aca

Chemotherapy Response Score (CRS) in Ovarian Cancer

• CRS assigns chemotherapy response scores based on the examination of the omentum.

  • CRS1: Mainly viable tumor with minimal regression.

  • CRS2: Appreciable tumor response with viable tumor present.

  • CRS3: Either no residual tumor or minimal tumor scattered as individual cells or nodules (up to 2 mm).

• Only CRS3 indicates significant prognostic potential, with patients being more likely to be long-term survivors.

Prognosis of Ovarian Carcinoma

• Overall prognosis for ovarian carcinoma is poor, especially for high-grade serous carcinoma (HGSC), which presents in advanced stages.

• Stage and Histotype: Both have independent significance in prognosis, as detailed in Table 35.2.

• Grading: Assigned histotype-specifically.

  • HGSC, low-grade serous, and clear cell carcinomas: grading is not performed.

  • Endometrioid carcinoma: graded using the FIGO system.

  • Mucinous carcinoma: commonly graded using the WHO system without specific grading criteria.

Germ Cell Tumors

• Comprise 20% of ovarian neoplasms, predominantly seen in children and young adults, with the majority being benign cystic teratomas.

• Malignant germ cell tumors: Associated with immunohistochemical advances.

  • Mixed germ cell tumors: ~8% cases, often dysgerminoma combined with yolk sac tumors.

  • Treatment: Combination chemotherapy (bleomycin, etoposide, cisplatin) has over 95% disease-free survival rates.

Dysgerminoma

• Less than 1% of ovarian tumors, predominantly occurring in young women (81% <30 years).

• Bilateral occurrence in 15% of cases; may display hypercalcemia.

• Histological Features: Grouped in nests separated by lymphocytic infiltrates; uniform cells with prominent nuclei and abundant cytoplasm.

• Prognosis: 95% survival rate, initial treatment typically involves oophorectomy.

Cytology in Ovarian Carcinoma

• Key role in identifying malignant cells in the peritoneal cavity.

• Peritoneal washings help in detecting microscopic disease spread; serous carcinomas often show positive results.

• Interpretation can be complicated by reactive mesothelial cells and distinguishing from mesothelioma.

  • Markers: Calretinin (mesothelioma), BerEP4 (carcinomas).

Therapy for Ovarian Tumors

• Epithelial Tumors: Treated primarily with surgery; benign ones may involve conservative surgeries.

• Complete surgical staging traditionally included multiple procedures, but trends show less extensive surgery for low-stage cancers like mucinous and endometrioid lesions.

• Neoadjuvant chemotherapy has gained acceptance, showing comparable survival rates with less morbidity.

Yolk Sac Tumor and Embryonal Carcinoma

• History of confusing classifications; yolk sac tumor often linked to embryonal carcinoma.

• Yolk Sac Tumors: Typically diagnosed in young patients with elevated serum alpha-fetoprotein; grossly may appear smooth, cystic, with large necrotic regions.

• Embryonal Carcinoma: Occurs in young patients, presenting with high serum hCG levels and significant necrosis.

  • Treatment involves aggressive chemotherapy within multi-drug regimens, improving outcomes drastically.

Choriocarcinoma and Immature Teratoma

• Choriocarcinomas: Generally metastatic from uterine tumors, rarely primary ovarian cases, diagnosed by solid cytotrophoblastic elements.

• Immature Teratomas: Composed of embryonal and adult derivatives; grading based on the tissue components. Improved monitoring and treatment strategies are noted, emphasizing serum alpha-fetoprotein tracking.

Conclusion

• Although the prognosis for ovarian carcinoma can be grim, advancements in treatment protocols and understanding of tumor classifications and responses remain essential for improving survival outcomes.