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The role of intratumoral lymphovascular density in distinguishing primary from secondary mucinous ovarian tumors.

Almeida BG, Bacchi CE, Carvalho JP, Ferreira CR, Carvalho FM - Clinics (Sao Paulo) (2014)

Bottom Line: The intratumoral lymphatic vascular density was quantified by counting the number of vessels stained by the D2-40 antibody.Metastases occurred in older patients and were associated with a higher proportion of tumors smaller than 10.0 cm; bilaterality; extensive necrosis; extraovarian extension; increased expression of cytokeratin 20, CDX2, CA19.9 and MUC2; and decreased expression of cytokeratin 7, CA125 and MUC5AC.Lack of MUC2 expression was an important factor excluding metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Objective: Ovarian mucinous metastases commonly present as the first sign of the disease and are capable of simulating primary tumors. Our aim was to investigate the role of intratumoral lymphatic vascular density together with other surgical-pathological features in distinguishing primary from secondary mucinous ovarian tumors.

Methods: A total of 124 cases of mucinous tumors in the ovary (63 primary and 61 metastatic) were compared according to their clinicopathological features and immunohistochemical profiles. The intratumoral lymphatic vascular density was quantified by counting the number of vessels stained by the D2-40 antibody.

Results: Metastases occurred in older patients and were associated with a higher proportion of tumors smaller than 10.0 cm; bilaterality; extensive necrosis; extraovarian extension; increased expression of cytokeratin 20, CDX2, CA19.9 and MUC2; and decreased expression of cytokeratin 7, CA125 and MUC5AC. The lymphatic vascular density was increased among primary tumors. However, after multivariate analysis, the best predictors of a secondary tumor were a size of 10.0 cm or less, bilaterality and cytokeratin 7 negativity. Lack of MUC2 expression was an important factor excluding metastasis.

Conclusions: The higher intratumoral lymphatic vascular density in primary tumors when compared with secondary lesions suggests differences in the microenvironment. However, considering the differential diagnosis, the best discriminator of a secondary tumor is the combination of tumor size, laterality and the pattern of expression of cytokeratin 7 and MUC2.

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Related in: MedlinePlus

Mucinous carcinomas with intestinal (A), Mullerian (B) and gastric (C) phenotypes. Focal cytokeratin 7 expression in a metastatic mucinous carcinoma is shown.
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f2-cln_69p660: Mucinous carcinomas with intestinal (A), Mullerian (B) and gastric (C) phenotypes. Focal cytokeratin 7 expression in a metastatic mucinous carcinoma is shown.

Mentions: Cases of mucinous tumors in the ovary were identified from the surgical pathology files of the Division of Pathology of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (São Paulo/SP) and from Consultoria em Patologia (Botucatu/SP), which is a private reference pathology laboratory. We included cases with borderline and malignant mucinous histologies for which the following were available: information about the primary site, paraffin blocks and at least one representative histologic section taken from each centimeter of the tumor. A total of 124 cases from 1996 to 2005 (Universidade de São Paulo) and from 2004 to 2011 (Consultoria em Patologia) met the inclusion criteria. The distribution of these cases according to their diagnosis and the primary site is shown in Table 1. The age of this cohort ranged from 16 to 81 years (50.2±15.8 years). From both the pathology report and the surgery description, we obtained information about laterality, tumor size and extraovarian extension, including the presence of pseudomyxoma. Slides from all cases were reviewed by two pathologists (BGLA and CRF). Doubtful cases were analyzed under a dual-head microscope by a third pathologist (FMC). The tumors were classified according to the presence and type of stromal invasion (infiltrative/destructive, multinodular and expansive/confluent) (Figure 1), cellular type (Mullerian, intestinal, pyloric, gastrointestinal, mixed Mullerian/intestinal and indeterminate) (Figure 2), histologic grade according to the Silverberg System 8, necrosis extension (focal, less than 50% or more than 50%) and peritumoral vascular involvement.


The role of intratumoral lymphovascular density in distinguishing primary from secondary mucinous ovarian tumors.

Almeida BG, Bacchi CE, Carvalho JP, Ferreira CR, Carvalho FM - Clinics (Sao Paulo) (2014)

Mucinous carcinomas with intestinal (A), Mullerian (B) and gastric (C) phenotypes. Focal cytokeratin 7 expression in a metastatic mucinous carcinoma is shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4221329&req=5

f2-cln_69p660: Mucinous carcinomas with intestinal (A), Mullerian (B) and gastric (C) phenotypes. Focal cytokeratin 7 expression in a metastatic mucinous carcinoma is shown.
Mentions: Cases of mucinous tumors in the ovary were identified from the surgical pathology files of the Division of Pathology of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (São Paulo/SP) and from Consultoria em Patologia (Botucatu/SP), which is a private reference pathology laboratory. We included cases with borderline and malignant mucinous histologies for which the following were available: information about the primary site, paraffin blocks and at least one representative histologic section taken from each centimeter of the tumor. A total of 124 cases from 1996 to 2005 (Universidade de São Paulo) and from 2004 to 2011 (Consultoria em Patologia) met the inclusion criteria. The distribution of these cases according to their diagnosis and the primary site is shown in Table 1. The age of this cohort ranged from 16 to 81 years (50.2±15.8 years). From both the pathology report and the surgery description, we obtained information about laterality, tumor size and extraovarian extension, including the presence of pseudomyxoma. Slides from all cases were reviewed by two pathologists (BGLA and CRF). Doubtful cases were analyzed under a dual-head microscope by a third pathologist (FMC). The tumors were classified according to the presence and type of stromal invasion (infiltrative/destructive, multinodular and expansive/confluent) (Figure 1), cellular type (Mullerian, intestinal, pyloric, gastrointestinal, mixed Mullerian/intestinal and indeterminate) (Figure 2), histologic grade according to the Silverberg System 8, necrosis extension (focal, less than 50% or more than 50%) and peritumoral vascular involvement.

Bottom Line: The intratumoral lymphatic vascular density was quantified by counting the number of vessels stained by the D2-40 antibody.Metastases occurred in older patients and were associated with a higher proportion of tumors smaller than 10.0 cm; bilaterality; extensive necrosis; extraovarian extension; increased expression of cytokeratin 20, CDX2, CA19.9 and MUC2; and decreased expression of cytokeratin 7, CA125 and MUC5AC.Lack of MUC2 expression was an important factor excluding metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Objective: Ovarian mucinous metastases commonly present as the first sign of the disease and are capable of simulating primary tumors. Our aim was to investigate the role of intratumoral lymphatic vascular density together with other surgical-pathological features in distinguishing primary from secondary mucinous ovarian tumors.

Methods: A total of 124 cases of mucinous tumors in the ovary (63 primary and 61 metastatic) were compared according to their clinicopathological features and immunohistochemical profiles. The intratumoral lymphatic vascular density was quantified by counting the number of vessels stained by the D2-40 antibody.

Results: Metastases occurred in older patients and were associated with a higher proportion of tumors smaller than 10.0 cm; bilaterality; extensive necrosis; extraovarian extension; increased expression of cytokeratin 20, CDX2, CA19.9 and MUC2; and decreased expression of cytokeratin 7, CA125 and MUC5AC. The lymphatic vascular density was increased among primary tumors. However, after multivariate analysis, the best predictors of a secondary tumor were a size of 10.0 cm or less, bilaterality and cytokeratin 7 negativity. Lack of MUC2 expression was an important factor excluding metastasis.

Conclusions: The higher intratumoral lymphatic vascular density in primary tumors when compared with secondary lesions suggests differences in the microenvironment. However, considering the differential diagnosis, the best discriminator of a secondary tumor is the combination of tumor size, laterality and the pattern of expression of cytokeratin 7 and MUC2.

Show MeSH
Related in: MedlinePlus