Ramalingam Preetha
Oncology (Williston Park). 2016 Feb;30(2):166-76.
Epithelial ovarian cancer comprises a heterogeneous group of tumors. The four most common subtypes are serous, endometrioid, clear cell, and mucinous carcinoma. Less common are transitional cell tumors, including transitional cell carcinoma and malignant Brenner tumor. While in the past these subtypes were grouped together and designated as epithelial ovarian tumors, these tumor types are now known to be separate entities with distinct clinical and biologic behaviors. From a therapeutic standpoint, current regimens employ standard chemotherapy based on stage and grade rather than histotype. However, this landscape may change in the era of personalized therapy, given that most subtypes (with the exception of high-grade serous carcinoma) are relatively resistant to chemotherapy. It is now well-accepted that high-grade and low-grade serous carcinomas represent distinct entities rather than a spectrum of the same tumor type. While they are similar in that patients present with advanced-stage disease, their histologic and molecular features are entirely different. High-grade serous carcinoma is associated with TP53 mutations, whereas low-grade serous carcinomas are associated with BRAF and KRAS mutations. Endometrioid and clear cell carcinomas typically present as early-stage disease and are frequently associated with endometriosis. Mucinous carcinomas typically present as large unilateral masses and often show areas of mucinous cystadenoma and mucinous borderline tumor. It must be emphasized that primary mucinous carcinomas are uncommon tumors, and metastasis from other sites such as the appendix, colon, stomach, and pancreaticobiliary tract must always be considered in the differential diagnosis. Lastly, transitional cell tumors of the ovary, specifically malignant Brenner tumors, are quite uncommon. High-grade serous carcinoma often has a transitional cell pattern, and adequate sampling in most cases shows more typical areas of serous carcinoma. Immunohistochemical markers are routinely employed in the diagnosis of epithelial ovarian carcinomas. However, molecular testing of these tumors, unlike in endometrial carcinoma, is not routinely used in clinical practice.
上皮性卵巢癌由一组异质性肿瘤组成。四种最常见的亚型是浆液性、子宫内膜样、透明细胞和黏液性癌。较少见的是移行细胞肿瘤，包括移行细胞癌和恶性布伦纳瘤。过去这些亚型被归为一类并称为上皮性卵巢肿瘤，但现在已知这些肿瘤类型是具有不同临床和生物学行为的独立实体。从治疗角度来看，目前的治疗方案是根据分期和分级而非组织学类型采用标准化化疗。然而，在个性化治疗时代，这种情况可能会改变，因为大多数亚型（高级别浆液性癌除外）对化疗相对耐药。现在人们普遍认为，高级别和低级别浆液性癌代表不同的实体，而非同一肿瘤类型的不同谱系。虽然它们的相似之处在于患者多表现为晚期疾病，但其组织学和分子特征完全不同。高级别浆液性癌与TP53突变相关，而低级别浆液性癌与BRAF和KRAS突变相关。子宫内膜样癌和透明细胞癌通常表现为早期疾病，且常与子宫内膜异位症相关。黏液性癌通常表现为单侧大肿块，常可见黏液性囊腺瘤和黏液性交界性肿瘤区域。必须强调的是，原发性黏液性癌并不常见，在鉴别诊断时必须始终考虑来自其他部位如阑尾、结肠、胃和胰胆管的转移。最后，卵巢移行细胞肿瘤，特别是恶性布伦纳瘤，相当少见。高级别浆液性癌常具有移行细胞形态，大多数情况下充分取材可显示更典型的浆液性癌区域。免疫组织化学标志物常用于上皮性卵巢癌的诊断。然而，与子宫内膜癌不同，这些肿瘤的分子检测在临床实践中并不常规使用。
