Invasion patterns in stage I endometrioid and mucinous ovarian carcinomas: a clinicopathologic analysis emphasizing favorable outcomes in carcinomas without destructive stromal invasion and the occasional malignant course of carcinomas with limited destructive stromal invasion

Abstract

Stage I, low-grade endometrioid and mucinous ovarian carcinomas have an excellent prognosis. Published data have suggested that destructive stromal invasion, a relatively uncommon finding in these tumors, is a poor prognostic factor. We investigated this by studying all FIGO stage I, grades 1 and 2 (of 3) endometrioid and mucinous ovarian carcinomas that were surgically staged at the Memorial Sloan-Kettering Cancer Center from 1980 to 2000. We undertook a careful review of all available slides using current diagnostic criteria and correlated histopathologic indices with clinical outcome data. Cases studied included 13 endometrioid ovarian carcinomas (stage IA, eight; stage IC, five) and six intestinal mucinous ovarian carcinomas (stage IA, three; stage IC, three). All of the tumors contained areas of expansile invasion, greater than that acceptable for microinvasion, and were thus diagnosed as carcinomas instead of borderline tumors. Nevertheless, nearly all demonstrated borderline tumor (noninvasive) components. Six tumors contained at least one focus of destructive stromal invasion (two endometrioid and four mucinous ovarian carcinomas). Four additional cases showed a focus suspicious for but not diagnostic of destructive invasion ('indeterminate for destructive invasion') (two endometrioid and two mucinous ovarian carcinomas). Follow-up data were available for 17 patients. The median follow-up was 81 months (range, 9-161 months). In all, 14 patients were alive with no evidence of disease (expansile invasion alone, eight; destructive stromal invasion, four; and indeterminate for destructive invasion, two). Three patients died of their disease (destructive stromal invasion, two; and indeterminate for destructive invasion, one). The size, number, and nuclear grade of destructive stromal invasion foci did not appear to have an impact on survival in this relatively limited number of patients. Outcome data in patients with stage I, low-grade endometrioid and mucinous ovarian carcinomas without destructive stromal invasion indicate that these tumors have a very limited malignant potential. The literature has not documented recurrences in this setting when the staging has been complete, the sampling adequate, and the cytologic features no more than grade 2, and metastasis to the ovary has been excluded. In contrast, carcinomas harboring even limited foci of destructive stromal invasion, although frequently cured surgically, can pursue a malignant clinical course. Modern Pathology (2005) 18, 903-911.

Immunohistochemical characterization of mullerian mucinous borderline tumors: possible histogenetic link with serous borderline tumors and low-grade endometrioid tumors

“…Thus, the category of low-grade endometrioid carcinoma in our study will be controversial (carcinoma versus borderline) for some pathologists. Like the relationships between endometrial hyperplasia and endometrioid adenocarcinoma of the uterine corpus, both low-grade endometrioid carcinoma and endometrioid borderline tumor are closely linked within the continuous spectrum of endometrioid tumor and share histologically and biologically overlapping features [25,26]. Low-grade endometrioid carcinoma and endometrioid borderline tumor also have a favorable prognosis, as does MMBT [25].…”

Primary Ovarian Mucinous Adenocarcinoma of Intestinal Type

“…The degree of nuclear atypia was evaluated in the worst area of each type of stromal invasion (expansile or infiltrative) and was classified into 3 grades on the basis of previous description (12,17). Nuclear grade 3 was characterized by variation in size (using nuclear width) >3 times, coarse chromatin granules, and prominent nucleoli.…”

“…KHUNAMORNPONG ET AL the introduction of the expansile invasive pattern in 1996 were reviewed (2,3,8,9,(11)(12)(13)(14)(15)(19)(20)(21)(22). The studies were included if they were case series reported in the English language and contained sufficient data regarding the classification of invasive pattern (infiltrative or expansile type, including specified extent criteria), tumor stage, and clinical follow-up results.…”

Data set for reporting of ovary, fallopian tube and primary peritoneal carcinoma: recommendations from the International Collaboration on Cancer Reporting (ICCR)

“…[92][93][94][95][96][97] The expansile/confluent/non-destructive pattern of invasion is characterised by architecturally complex glands, cysts or papillae lined by atypical epithelium with minimal to no intervening stroma. The destructive/infiltrative pattern is characterised by haphazardly arranged glands, tubules, nests and cords of malignant cells infiltrating stroma with an associated oedematous, inflammatory or desmoplastic response.…”

“…Although several studies have shown the expansile pattern to herald a better prognosis, a recent population-based registry study of mucinous ovarian carcinomas was not able to prognosticate based on the distinction between the two patterns of invasion. [92][93][94][95][96][97] It is recommended that the pattern of invasion in mucinous ovarian carcinomas be recorded.…”