Ovary and Fallopian Tube Pathology 2

Question 1

What are the risk factors for ovarian carcinoma?

Answer 1

• Nulliparity
• Infertility
• Use of ovulation-inducing drugs
• Family history of heritable mutations
• Gonadal dysgenesis
• BRCA1, BRCA2 gene mutations
  
  • 10% of patients have this
  • 20-60% of people with this will develop high grade carcinoma by age 70

Question 2

What is the proposed pathway for development of type I ovarian carcinomas?

Answer 2

• Includes: low grade serous, endometrioid, mucinous malignant brenner, clear cell carcinomas
• Start as secondary mullerian system/OSE/inclusion cysts or endometriosis
• Progresses to cystadenomas and adenofibromas
• Then to “borderline” tumors
• Finally, invasive carcinoma

Question 3

What are the molecular mutations of type I ovarian cancers?

Answer 3

• K-RAS (mucinous/low-grade serous),
• BRAF (low-grade serous),
• PTEN/B-CATENIN/Microsatellite instability (endometrioid);
• (?) p53 (including low-grade serous/endometrioid/mucinous/clear cell carcinoma).

Question 4

What is the pathway for development of Type II ovarian carcinomas?

Answer 4

• Includes conventional high-grade serous carcinoma
• Malignant mixed Mullerian tumor or MMMT or 3MT
• Epithelium from fibriated end of fallopian tube/inclusion cysts
• Progresses to conventional high-grade serous carcinoma

Question 5

What are the molecular changes in type II ovarian tumros?

Answer 5

• p53 (>90% of high-grade serous);
• BRCA1/BRCA2 (10% germline ) (high grade serous carcinoma)