Features Aiding Differential Diagnosis of Ovarian Tumors





Appendix 1: Ovarian Tumors With Mucinous Epithelium


Primary Tumors





  • Surface epithelial tumors




    • Mucinous cystic tumors of intestinal and endocervical-like type



    • Surface epithelial tumors of mixed cell type with a mucinous component



    • Mixed müllerian tumors (adenofibroma, adenosarcoma, MMMT a


      a Malignant müllerian mixed tumor.

      )



    • Brenner tumors




  • Germ cell tumors




    • Teratomas (mature and immature)



    • Mucinous and strumal carcinoid tumors




  • Other




    • Sertoli–Leydig cell tumor with heterologous elements



    • Adult granulosa cell tumor b


      b Mucinous epithelium in adult granulosa cell tumors is a rare finding.




    • Small cell carcinoma of hypercalcemic type




Metastatic Tumors





  • Mucinous carcinoma arising elsewhere in the female genital tract, especially the cervix



  • Mucinous carcinoma from the colon, appendix, small bowel, stomach, pancreas, biliary tract



  • Urinary bladder and urachus



  • Low-grade mucinous tumors from the appendix





Appendix 2: Ovarian Tumors That May Have an Endometrioid-Like Glandular Pattern


Primary Tumors





  • Endometrioid carcinoma



  • Mucin-poor mucinous adenocarcinoma



  • Endometrioid-like yolk sac tumor



  • Sertoli–Leydig cell tumor



  • Tumors of probable wolffian origin



  • Ependymomas



Metastatic Tumors





  • Endometrioid carcinoma arising elsewhere in female genital tract or endometriosis



  • Intestinal adenocarcinoma of typical and clear cell type



  • Other gastrointestinal, pancreatic, and biliary adenocarcinomas



  • Mucin-poor mucinous adenocarcinomas from other sites, e.g. lung



  • Breast carcinoma



  • Malignant mesothelioma





Appendix 3: Endometrioid Tumors of Ovary and Endometrium: Endometrial Primary and Ovarian Secondary Tumors




  • 1.

    Histologic similarity of the tumors


  • 2.

    Large endometrial tumor and small ovarian tumor(s)


  • 3.

    Atypical endometrial hyperplasia also present


  • 4.

    Deep myometrial invasion



    • a.

      Direct extension into adnexa


    • b.

      Vascular space invasion in myometrium



  • 5.

    Spread elsewhere in typical pattern of endometrial carcinoma


  • 6.

    Ovarian tumors, bilateral and/or multinodular


  • 7.

    Hilar location, vascular space invasion, surface implants, a


    a Rare primary ovarian endometrioid carcinomas may arise from endometriosis on the ovarian surface.

    or combination in ovary


  • 8.

    Ovarian endometriosis absent


  • 9.

    Aneuploidy with similar DNA indices or diploidy of both tumors b


    b The possibility of tumor heterogeneity must be taken into account in the evaluation of the ploidy findings.



  • 10.

    Similar molecular genetic or karyotypic abnormalities in both tumors





Appendix 4: Endometrioid Tumors of Ovary and Endometrium: Ovarian Primary and Endometrial Secondary Tumors




  • 1.

    Histologic similarity of the tumors


  • 2.

    Large ovarian tumor and small endometrial tumor


  • 3.

    Ovarian endometriosis present


  • 4.

    Location in ovarian parenchyma


  • 5.

    Direct extension from ovary predominantly into outer wall of uterus


  • 6.

    Spread elsewhere in typical pattern of ovarian carcinoma


  • 7.

    Ovarian tumor unilateral (80–90% of cases) and forming single mass


  • 8.

    No atypical hyperplasia in endometrium


  • 9.

    Aneuploidy with similar DNA indices or diploidy of both tumors a


    a The possibility of tumor heterogeneity must be taken into account in the evaluation of the ploidy findings.



  • 10.

    Similar molecular genetic or karyotypic abnormalities in both tumors





Appendix 5: Endometrioid Tumors of Ovary and Endometrium: Independent Ovarian and Endometrial Primary Tumors




  • 1.

    Histologic dissimilarity of the tumors


  • 2.

    No or only superficial myometrial invasion of endometrial tumor


  • 3.

    No vascular space invasion of endometrial tumor


  • 4.

    Atypical endometrial hyperplasia also present


  • 5.

    Absence of other evidence of spread of endometrial tumor


  • 6.

    Ovarian tumor unilateral (80–90% of cases)


  • 7.

    Ovarian tumor located in parenchyma


  • 8.

    No vascular space invasion, surface implants, a


    a Rare primary ovarian endometrioid carcinomas may arise from endometriosis on the ovarian surface.

    or predominant hilar location in ovary


  • 9.

    Absence of other evidence of spread of ovarian tumor


  • 10.

    Ovarian endometriosis present


  • 11.

    Different ploidy or DNA indices, if aneuploid, of the tumors b


    b The possibility of tumor heterogeneity must be taken into account in the evaluation of the ploidy findings.



  • 12.

    Dissimilar molecular genetic or karyotypic abnormalities in the tumor





Appendix 6: Ovarian Tumors and Tumor-Like Lesions That May Contain Clear Cells


Primary Tumors





  • Clear cell carcinoma



  • Endometrioid carcinoma



  • Brenner tumor



  • Dysgerminoma



  • Yolk sac tumor



  • Struma ovarii



  • Malignant melanoma



  • Sertoli cell tumor



  • Steroid cell tumors



  • Epithelioid smooth muscle tumors



  • Solid pseudopapillary tumor



Metastatic Tumors





  • Clear cell carcinoma arising elsewhere in the female genital tract



  • Renal cell carcinoma



  • Clear cell intestinal carcinoma



  • Malignant melanoma



Tumor-Like Lesions





  • Arias-Stella reaction in endometriosis



  • Epithelial inclusion glands and cysts with hydropic change


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Feb 9, 2020 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Features Aiding Differential Diagnosis of Ovarian Tumors
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