Primary peritoneal serous carcinoma (PPSC) is uncommon and precursor lesions and prognostic factors are incompletely understood or described. Charts of 22 women with PPSC were reviewed for clinical and pathology data. Glass slides were reviewed for areas of PPSC, ovarian surface epithelium (OSE), ovarian cortical inclusion cysts (OCICs), tubal epithelial atypia (TEA), and serous tubal intraepithelial carcinoma (STIC). p53 and p16 immunohistochemical staining was scored and expression between the sites was compared. PPSC outcome was correlated with biomarker expression and clinicopathologic variables. p53 and p16 scores were significantly higher among PPSC and tubes than OSE and OCICs. Approximately 64% of PPSC, 46% of fallopian tubes, and none of the OSE overexpressed both biomarkers. OCICs were more frequently negative. Tubal pathologies of STIC, TEA and/or p53 signatures were present in approximately 46% of PPSC cases and the association with tubal p53 overexpression was significant. Statistically significant associations between tubal pathologies, OSE and OCICs biomarker expression profiles and their PPSC expression profiles did not occur. The median overall survival was 53 months and low-grade tumors had a better prognosis (P=0.02). A role for p53 and p16 overexpression in the formation of some PPSC, and p53 overexpression in the generation of precursor tubal pathology was identified. The high frequency of tubal pathology overexpressing p53 and low frequency of OSE and OCICs expressing either biomarker highlights a possible precursor role for the tube in some PPSC. Tumor grade was the only significant prognostic factor.

A malignant Mullerian mixed tumor (MMMT) is a biphasic homologous or heterologous malignancy of the female genital tract. WT1 (Wilms tumor 1) is both a tumor suppressor gene and oncogene overexpressed in the nuclei of some gynecologic carcinomas. Expression in MMMT is incompletely described. Whole sections from 16 MMMTs were stained with WT1 (N terminus) using a standard immunoperoxidase technique. There were 7 heterologous and 9 homologous tumors and 10 were endometrial, 5 were ovarian, and 1 was of peritoneal origin. The tissue and cell staining pattern and score (intensity by amount) were evaluated and correlated with the tumor subtype and anatomic location. Among the 16 tumors, 81.3% showed mostly stromal and cytoplasmic staining and a score of 3 or 6. Staining was positive in 80% of the endometrial and ovarian tumors and the 1 peritoneal tumor and in all heterologous and 66.7% of the homologous tumors. The immunoprofile correlated with tumor subtype but not with anatomic location. Stromal and epithelial staining was more frequent (83.3%) in homologous tumors and differed significantly (P=0.009) from the heterologous types where stromal staining prevailed (85.7%). MMMT is another genital tract malignancy which can over express WT1 and the immunoprofile may assist in tumor subtyping.

Vaginal polyps and premalignant-malignant cervico-vaginal polyps are rare. Vaginal polyps are larger and multiple and cervico-vaginal polyps in younger and older women are at greater risk of premalignant-malignant changes.

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