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Il carcinoma ovarico: nuove acquisizioni sulla patogenesi e nella diagnostica di laboratorio

Ovarian carcinoma: new insight on pathogenesis and diagnostic markers

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La Rivista Italiana della Medicina di Laboratorio - Italian Journal of Laboratory Medicine

Riassunto

Il carcinoma ovarico è tra le prime cause di morte per neoplasie ginecologiche, con un rischio cumulativo, nella popolazione generale, di sviluppare la neoplasia nell’arco della vita intorno all’1–1,8% e la sopravvivenza globale a 5 anni delle pazienti intorno al 50%. Oltre il 60% dei tumori ovarici, sia benigni che maligni, origina dall’epitelio di rivestimento dell’ovaio. Attualmente, secondo la classificazione patogenetica, i carcinomi ovarici sono distinti in 2 classi: neoplasie di tipo 1, a basso grado e a lenta progressione e di tipo 2, costituite da carcinomi sierosi ad alto grado e a rapida progressione. Recenti dati mostrano come le forme ad alto grado siano caratterizzate da pattern genetici differenti rispetto a quelle a basso grado, per cui si potrebbe ipotizzare che possano esistere due sedi di origine differenti per queste forme tumorali. Per alcuni istotipi ad alto grado è stato ipotizzato, come possibile precursore, il tessuto epiteliale di rivestimento delle fimbrie. Queste nuove acquisizioni potrebbero aiutare a identificare dei biomarker più affidabili, di quelli attualmente in uso, soprattutto per la diagnosi precoce dei carcinomi ovarici. Le ricerche in questo settore hanno permesso di identificare alcuni marcatori molecolari tra cui l’HE4 da poter affiancare al marcatore Ca125, che, oggi, risulta l’unico raccomandato da associare all’ecografia trans-vaginale per la diagnosi differenziale di una massa pelvica. HE4 sembra essere più sensibile di Ca125 soprattutto negli stadi precoci di malattia e nelle pazienti in età pre- e perimenopausale nelle quali è più arduo differenziare una massa annessiale benigna da una maligna.

Summary

Ovarian cancer is among the most lethal malignant diseases in women who have a lifetime probability of around 1.8%of developing the disease and the 5-year survival rate is near 50%. About 60% of the ovarian lesions derive from the ovarian surface epithelium. Recently, proposals of dividing ovarian carcinoma into two broad categories have been considered: type I, which tends to develop slowly and is a low-grade neoplasm; type II which spreads rapidly and has a higher degree of malignancy. Type I and type II tumors are characterized by distinct gene expression patterns. It may be due to the different histological precursors. In particular, type II tumors might derive from fimbrial epithelium. This new insight may provide a molecular platform for the discovery of new ovarian cancer markers. Several studies underline the high sensitivity of a new marker for ovarian carcinoma: HE4. It seems to be really useful when associated with Ca125 as they distinguish a malignant ovarian lesion from a benign one previously identified by transvaginal ultrasonography, especially in the early stages of the disease and in the pre-menopausal period.

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Correspondence to Alfonso Catalano.

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Orciari, S., Micucci, C., Procopio, A.D. et al. Il carcinoma ovarico: nuove acquisizioni sulla patogenesi e nella diagnostica di laboratorio. Riv Ital Med Lab 7, 195–204 (2011). https://doi.org/10.1007/s13631-011-0028-z

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