The changing landscape of gynaecological cancer diagnosis: implications for histopathological practice in the 21st century

Abstract

The era of molecular medicine has led to dramatically improved understanding of the genetic events that give rise to different types of cancers. In the case of gynaecological malignancies, this has resulted in distinct shifts in how these tumours are diagnosed in routine surgical pathology practice, with an increased emphasis on accurate subtype diagnosis. This has happened across all sites in the gynaecological tract and for most cell types, but in ways that are site-specific and may appear to be subtle, as in most instances the diagnostic terminology has not changed. For example, the diagnosis of clear cell carcinoma of the ovary is still in use, but the diagnostic criteria and clinical implications are different in 2017 from what they were in 2000. As a result, there can be a failure to appreciate how important these changes are and the resulting necessity of incorporating them into our daily practice. In this review we will describe changes in diagnostic surgical pathology occasioned by improved understanding of molecular events during pathogenesis, for cancers of ovary/tube, endometrium, cervix and vulva, and highlight how current practice differs from that of only a few years ago.

Metastases to the ovary arising from endometrial, cervical and fallopian tube cancer: recent advances

“…However, evidence that extrauterine HGSC arises in the fallopian tube continues to grow, alongside continuing disagreement regarding primary site assignment . The evidence supporting the tubal origin of extrauterine HGSC has been extensively reviewed previously, and only the clinical implications are presented below.…”

“…However, evidence that extrauterine HGSC arises in the fallopian tube continues to grow, 113 alongside continuing disagreement regarding primary site assignment. 113 The evidence supporting the tubal origin of extrauterine HGSC has been extensively reviewed previously, [114][115][116] and only the clinical implications are presented below. The site of origin in extrauterine HGSC has no treatment implications for an individual patient, as all cases are similarly managed, and a diagnosis of invasive HGSC of any stage mandates treatment with a combination of cytoreductive surgery and platinumbased chemotherapy.…”

Ovarian Cancer: Diagnostic Accuracy and Tumor Types Distribution in East Africa compared to North America

“…Historically, reproducibility of diagnosis of ovarian carcinoma based on the cell types (17-19) was low, but nowadays, the inter-observer reproducibility is very good, and, if not excellent, can be improved by the use of ancillary immunohistochemistry tests (20). In this study, the morphological diagnosis of ovarian carcinoma was only fair, likely a result of a failure to use the current criteria for tumor cell types in a routine practice, (21) and the majority of the cases of carcinoma were unspecified. Significant numbers of unspecified carcinomas (~ 43%) in this study were reclassified as HGSC in a revised diagnosis, and these are the diagnoses likely made before 2014, where serous carcinoma were separated into HGSC and LGSC.…”

Ovarian Cancer: Diagnostic accuracy and tumor types distribution in East Africa compared to North America

“…Historically, the reproducibility of diagnosis of ovarian carcinoma based on the cell types (17-19) was low, but nowadays, the inter-observer reproducibility is excellent, and if not, it can be improved by the use of ancillary immunohistochemistry tests (20). In this study, the morphological diagnosis of ovarian carcinoma was only fair, likely a result of a failure to use the current criteria for tumor cell types in routine practice (21), and the majority of the cases of carcinoma were unspeci ed. Signi cant numbers of unspeci ed carcinomas (~43%) in this study were reclassi ed as HGSC in a revised diagnosis, and these are the diagnoses likely made before 2014, where serous carcinomas were separated into HGSC and…”

“…Yet, ovarian neuroblastoma at the age of 30 years is quite uncommon, although it has been reported as primary ovarian or associated with mature teratoma in a few cases (35,36). Lack of awareness for the existence of this diagnosis in the current classi cation was a likely contributing factor, as well as the rarity of this tumor, noting that most of the pathologists would see at most one such case during their practice (21). Foremost, this case illustrates the inability to render a correct diagnosis without access to con rmatory molecular testing for molecularly de ned rare cancers.…”