Ovarian/Primary Peritoneal Carcinoma

  • Ben DavidsonEmail author


Ovarian cancer is the sixth most common cancer among women worldwide, accounting for nearly 4% of all female malignancies, and it has the highest fatality-to-case ratio of all gynecologic cancers. Globally, an estimated 230,555 new cases were diagnosed and 141,452 women died of ovarian cancer in 2007.1 The disease has variable incidence in different geographic regions and among different ethnic groups, with a high incidence in Northern Europe and in the U.S., and a low incidence in Japan and in developing countries. Ovarian cancer is rarely diagnosed in women under the age of 30 years; disease incidence increases with age, reaching its peak at the age of 60 years. The majority of cases are sporadic, and only 10% of the affected women have family history of breast or ovarian cancer. Hereditary ovarian cancer is most frequently related to germline mutations in the BRCA1 or BRCA2 genes, the remaining cases being due to hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch Syndrome.2 - 4


Lynch Syndrome Malignant Mesothelioma Clear Cell Carcinoma Mucinous Carcinoma Serous Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    American Cancer Society. Global Cancer Facts and Figures 2007. Atlanta, GA: American Cancer Society; 2008.Google Scholar
  2. 2.
    Berek JS, Bast RC Jr. Ovarian cancer. In: Kufe DW, Bast RC Jr, Hait WM, Hong WK, Pollock RE, Weichselbaum RR, Holland JF, Frei E III, eds. Cancer Medicine. 7th edn. Chap. 104. Hamilton: BC Decker Inc, 2006:1543–1568.Google Scholar
  3. 3.
    McLemore MR, Miaskowski C, Aouizerat BE, Chen LM, Dodd MJ. Epidemiological and genetic factors associated with ovarian cancer. Cancer Nurs. 2009;32:281-288.PubMedCrossRefGoogle Scholar
  4. 4.
    Cannistra SA. Cancer of the ovary. N Engl J Med. 2004;351:2519-2529.PubMedCrossRefGoogle Scholar
  5. 5.
    Jacob IJ, Shepherd JH, Oran DH, et al., eds. Ovarian Cancer. Oxford: Oxford University Press; 2002.Google Scholar
  6. 6.
    Holschneider CH, Berek JS. Ovarian cancer: epidemiology, biology, and prognostic factors. Semin Surg Oncol. 2000;19:3-10.PubMedCrossRefGoogle Scholar
  7. 7.
    Hennessy BT, Coleman RL, Markman M. Ovarian cancer. Lancet. 2009;374:1371-1382.PubMedCrossRefGoogle Scholar
  8. 8.
    Kurman RJ, Visvanathan K, Roden R, Wu TC, Shih IEM. Early detection and treatment of ovarian cancer: shifting from early stage to minimal volume of disease based on a new model of carcinogenesis. Am J Obstet Gynecol. 2008;198:351-356.PubMedCrossRefGoogle Scholar
  9. 9.
    Heintz AP, Odicino F, Quinn MA Maisonneuve P, et al. Carcinoma of the ovary. FIGO 6th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006;95(Suppl 1):S161-S192.PubMedCrossRefGoogle Scholar
  10. 10.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225-249.PubMedCrossRefGoogle Scholar
  11. 11.
    Nossov V, Amneus M, Su F, et al. The early detection of ovarian cancer: from traditional methods to proteomics. Can we really do better than serum CA-125? Am J Obstet Gynecol. 2008;199:215-223.PubMedCrossRefGoogle Scholar
  12. 12.
    Weinberg LE, Rodriguez G, Hurteau JA. The role of neoadjuvant chemotherapy in treating advanced epithelial ovarian cancer. J Surg Oncol. 2010;101:334-343.PubMedCrossRefGoogle Scholar
  13. 13.
    Armstrong DK, Bundy B, Huang HQ Wenzel L, et al. Gynecologic Oncology Group. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006;354:34-43.PubMedCrossRefGoogle Scholar
  14. 14.
    Rao G, Crispens M, Rothenberg ML. Intraperitoneal chemotherapy for ovarian cancer: overview and perspective. J Clin Oncol. 2007;25:2867-2872.PubMedCrossRefGoogle Scholar
  15. 15.
    Hirabayashi K, Graham J. The genesis of ascites in ovarian cancer. Am J Obstet Gynecol. 1970;106:492-497.PubMedGoogle Scholar
  16. 16.
    Feldman GB, Knapp RC, Order SE, Hellman S. The role of lymphatic obstruction in the formation of ascites in a murine ovarian carcinoma. Cancer Res. 1972;32:1663-1666.PubMedGoogle Scholar
  17. 17.
    Nagy JA, Masse EM, Herzberg KT, et al. Pathogenesis of ascites tumor growth: vascular permeability factor, vascular hyperpermeability, and ascites tumor accumulation. Cancer Res. 1995;55:360-368.PubMedGoogle Scholar
  18. 18.
    Nagy JA, Meyers MS, Masse EM, Herzberg KT, Dvorak HF. Pathogenesis of ascites tumor growth: fibrinogen influx and fibrin accumulation in tissues lining the peritoneal cavity. Cancer Res. 1995;55:369-375.PubMedGoogle Scholar
  19. 19.
    Nagy JA, Morgan ES, Herzberg KT, Manseau EJ, Dvorak AM, Dvorak HF. Pathogenesis of ascites tumor growth: angiogenesis, vascular remodeling, and stroma formation in the peritoneal lining. Cancer Res. 1995;55:376-385.PubMedGoogle Scholar
  20. 20.
    Sorbe B, Frankendal B. Prognostic importance of ascites in ovarian carcinoma. Acta Obstet Gynecol Scand. 1983;62:415-418.PubMedCrossRefGoogle Scholar
  21. 21.
    Shen-Gunther J, Mannel RS. Ascites as a predictor of ovarian malignancy. Gynecol Oncol. 2002;87:77-83.PubMedCrossRefGoogle Scholar
  22. 22.
    Rice LW, Mark SD, Berkowitz RS, Goff BA, Lage JM. Clinicopathologic variables, operative characteristics, and DNA ploidy in predicting outcome in ovarian epithelial carcinoma. Obstet Gynecol. 1995;86:379-385.PubMedCrossRefGoogle Scholar
  23. 23.
    Ayhan A, Gultekin M, Taskiran C, et al. Ascites and epithelial ovarian cancers: a reappraisal with respect to different aspects. Int J Gynecol Cancer. 2007;17:68-75.PubMedCrossRefGoogle Scholar
  24. 24.
    Chi DS, Liao JB, Leon LF, et al. Identification of prognostic factors in advanced epithelial ovarian carcinoma. Gynecol Oncol. 2001;82:532-537.PubMedCrossRefGoogle Scholar
  25. 25.
    Clark TG, Stewart ME, Altman DG, Gabra H, Smyth JF. A prognostic model for ovarian cancer. Br J Cancer. 2001;85:944-952.PubMedCrossRefGoogle Scholar
  26. 26.
    Puls LE, Duniho T, Hunter JE, Kryscio R, Blackhurst D, Gallion H. The prognostic implication of ascites in advanced-stage ovarian cancer. Gynecol Oncol. 1996;61:109-112.PubMedCrossRefGoogle Scholar
  27. 27.
    Makar AP, Baekelandt M, Tropé CG, Kristensen GB. The prognostic significance of residual disease, FIGO substage, tumor histology, and grade in patients with FIGO stage III ovarian cancer. Gynecol Oncol. 1995;56:175-180.PubMedCrossRefGoogle Scholar
  28. 28.
    Omura GA, Brady MF, Homesley HD, et al. Long-term follow-up and prognostic factor analysis in advanced ovarian carcinoma: the Gynecologic Oncology Group experience. J Clin Oncol. 1991;9:1138-1150.PubMedGoogle Scholar
  29. 29.
    Curtin JP, Malik R, Venkatraman ES, Barakat RR, Hoskins WJ. Stage IV ovarian cancer: impact of surgical debulking. Gynecol Oncol. 1997;64:9-12.PubMedCrossRefGoogle Scholar
  30. 30.
    Bristow RE, Montz FJ, Lagasse LD, Leuchter RS, Karlan BY. Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer. Gynecol Oncol. 1999;72:278-287.PubMedCrossRefGoogle Scholar
  31. 31.
    Akahira JI, Yoshikawa H, Shimizu Y, et al. Prognostic factors of stage IV epithelial ovarian cancer: a multicenter retrospective study. Gynecol Oncol. 2001;81:398-403.PubMedCrossRefGoogle Scholar
  32. 32.
    Bonnefoi H, A’Hern RP, Fisher C, et al. Natural history of stage IV epithelial ovarian cancer. J Clin Oncol. 1999;17:767-775.PubMedGoogle Scholar
  33. 33.
    Dauplat J, Hacker NF, Nieberg RK, Berek JS, Rose TP, Sagae S. Distant metastases in epithelial ovarian carcinoma. Cancer. 1987;60:1561-1566.PubMedCrossRefGoogle Scholar
  34. 34.
    Liu PC, Benjamin I, Morgan MA, King SA, Mikuta JJ, Rubin SC. Effect of surgical debulking on survival in stage IV ovarian cancer. Gynecol Oncol. 1997;64:4-8.PubMedCrossRefGoogle Scholar
  35. 35.
    Soslow RA. Histologic subtypes of ovarian carcinoma: an overview. Int J Gynecol Pathol. 2008;27:161-174.PubMedGoogle Scholar
  36. 36.
    Dubeau L. The cell of origin of ovarian epithelial tumours. Lancet Oncol. 2008;9:1191-1197.PubMedCrossRefGoogle Scholar
  37. 37.
    Pentheroudakis G, Pavlidis N. Serous papillary peritoneal carcinoma: unknown primary tumour, ovarian cancer counterpart or a distinct entity? A systematic review. Crit Rev Oncol Hematol. 2010;75:27-42.PubMedCrossRefGoogle Scholar
  38. 38.
    Carlson JW, Miron A, Jarboe EA, et al. Serous tubal intraepithelial carcinoma: its potential role in primary peritoneal serous carcinoma and serous cancer prevention. J Clin Oncol. 2008;26:4160-4165.PubMedCrossRefGoogle Scholar
  39. 39.
    Pereira TC, Saad RS, Liu Y, Silverman JF. The diagnosis of malignancy in effusion cytology: a pattern recognition approach. Adv Anat Pathol. 2006;13:174-184.PubMedCrossRefGoogle Scholar
  40. 40.
    Yu GH, Sack MJ, Baloch ZW, DeFrias DV, Gupta PK. Occurrence of intercellular spaces (windows) in metastatic adenocarcinoma in serous fluids: a cytomorphologic, histochemical, and ultrastructural study. Diagn Cytopathol. 1999;20:115-119.PubMedCrossRefGoogle Scholar
  41. 41.
    Ito H, Hirasawa T, Yasuda M, Osamura RY, Tsutsumi Y. Excessive formation of basement membrane substance in clear-cell carcinoma of the ovary: diagnostic value of the “raspberry body” in ascites cytology. Diagn Cytopathol. 1997;16:500-504.PubMedCrossRefGoogle Scholar
  42. 42.
    Ahr A, Arnold G, Göhring UJ, Costa S, Scharl A, Gauwerky JF. Cytology of ascitic fluid in a patient with metastasizing malignant Brenner tumor of the ovary. A case report. Acta Cytol. 1997;41(4 Suppl):1299-1304.PubMedCrossRefGoogle Scholar
  43. 43.
    Driss M, Mrad K, Dhouib R, Doghri R, Abbes I, Ben Romdhane K. Ascitic fluid cytology in malignant Brenner tumor: a case report. Acta Cytol. 2010;54:598-600.PubMedCrossRefGoogle Scholar
  44. 44.
    Motoyama T, Watanabe H. Ascitic fluid cytologic features of a malignant mixed mesodermal tumor of the ovary. Acta Cytol. 1987;31:63-67.PubMedGoogle Scholar
  45. 45.
    Murugan P, Siddaraju N, Sridhar E, Soundararaghavan J, Habeebullah S. Unusual ovarian malignancies in ascitic fluid: a report of 2 cases. Acta Cytol. 2010;54:611-617.PubMedGoogle Scholar
  46. 46.
    Valente PT, Schantz HD, Edmonds PR, Hanjani P. Peritoneal cytology of uncommon ovarian tumors. Diagn Cytopathol. 1992;8:98-106.PubMedCrossRefGoogle Scholar
  47. 47.
    Ikeda K, Tate G, Suzuki T, Mitsuya T. Cytomorphologic features of immature ovarian teratoma in peritoneal effusion: a case report. Diagn Cytopathol. 2005;33:39-42.PubMedCrossRefGoogle Scholar
  48. 48.
    Geisinger KR, Hajdu SI, Helson L. Exfoliative cytology of nonlymphoreticular neoplasms in children. Acta Cytol. 1984;28:16-28.PubMedGoogle Scholar
  49. 49.
    Selvaggi SM, Guidos BJ. Immature teratoma of the ovary on fluid cytology. Diagn Cytopathol. 2001;25:411-414.PubMedCrossRefGoogle Scholar
  50. 50.
    Selvaggi SM. Cytologic features of malignant ovarian monodermal teratoma with an ependymal component in peritoneal washings. Int J Gynecol Pathol. 1992;11:299-303.PubMedCrossRefGoogle Scholar
  51. 51.
    Kashimura M, Tsukamoto N, Matsuyama T, Kashimura Y, Sugimori H, Taki I. Cytologic findings of ascites from patients with ovarian dysgerminoma. Acta Cytol. 1983;27:59-62.PubMedGoogle Scholar
  52. 52.
    Hajdu SI, Nolan MA. Exfoliative cytology of malignant germ cell tumors. Acta Cytol. 1975;19:255-260.PubMedGoogle Scholar
  53. 53.
    Roncalli M, Gribaudi G, Simoncelli D, Servida E. Cytology of yolk-sac tumor of the ovary in ascitic fluid. Report of a case. Acta Cytol. 1988;32:113-116.PubMedGoogle Scholar
  54. 54.
    Davidson B, Abeler VM. Primary ovarian angiosarcoma presenting as malignant cells in ascites: case report and review of the literature. Diagn Cytopathol. 2005;32:307-309.PubMedCrossRefGoogle Scholar
  55. 55.
    Hirakawa E, Kobayashi S, Miki H, et al. Ascitic fluid cytology of adenosarcoma of the ovary: a case report. Diagn Cytopathol. 2001;24:343-346.PubMedCrossRefGoogle Scholar
  56. 56.
    Delahaye M, van der Ham F, van der Kwast TH. Complementary value of five carcinoma markers for the diagnosis of malignant mesothelioma, adenocarcinoma metastasis, and reactive mesothelium in serous effusions. Diagn Cytopathol. 1997;17:115-120.PubMedCrossRefGoogle Scholar
  57. 57.
    Motherby H, Kube M, Friedrichs N, et al. Immunocytochemistry and DNA-image cytometry in diagnostic effusion cytology I. Prevalence of markers in tumour cell positive and negative smears. Anal Cell Pathol. 1999;19:7-20.PubMedGoogle Scholar
  58. 58.
    Maguire B, Whitaker D, Carrello S, Spagnolo D. Monoclonal antibody Ber-EP4: its use in the differential diagnosis of malignant mesothelioma and carcinoma in cell blocks of malignant effusions and FNA specimens. Diagn Cytopathol. 1994;10:130-134.PubMedCrossRefGoogle Scholar
  59. 59.
    Davidson B, Risberg B, Kristensen G, et al. Detection of cancer cells in effusions from patients diagnosed with gynaecological malignancies. Evaluation of five epithelial markers. Virchows Arch. 1999;435:43-49.PubMedCrossRefGoogle Scholar
  60. 60.
    Davidson B, Nielsen S, Christensen J, et al. The role of Desmin and N-cadherin in effusion cytology: a comparative study using established markers of mesothelial and epithelial cells. Am J Surg Pathol. 2001;25:1405-1412.PubMedCrossRefGoogle Scholar
  61. 61.
    Yuan Y, Nymoen DA, Tuft Stavnes H, et al. Tenascin-X is a novel diagnostic marker of malignant mesothelioma. Am J Surg Pathol. 2009;33:1673-1682.PubMedCrossRefGoogle Scholar
  62. 62.
    Ordóñez NG. Value of immunohistochemistry in distinguishing peritoneal mesothelioma from serous carcinoma of the ovary and peritoneum: a review and update. Adv Anat Pathol. 2006;13:16-25.PubMedCrossRefGoogle Scholar
  63. 63.
    Fetsch PA, Abati A, Hijazi YM. Utility of the antibodies CA 19-9, HBME-1, and thrombomodulin in the diagnosis of malignant mesothelioma and adenocarcinoma in cytology. Cancer. 1998;84:101-108.PubMedCrossRefGoogle Scholar
  64. 64.
    Reich R, Vintman L, Nielsen S, et al. Differential expression of the 67 kilodalton laminin receptor in malignant mesothelioma and carcinomas that spread to serosal cavities. Diagn Cytopathol. 2005;33:332-337.PubMedCrossRefGoogle Scholar
  65. 65.
    Kleinberg L, Holth A, Fridman E, Schwartz I, Shih IeM, Davidson B. The diagnostic role of claudins in serous effusions. Am J Clin Pathol. 2007;127:928-937.PubMedCrossRefGoogle Scholar
  66. 66.
    Davidson B, Baekelandt M, Shih IeM. MUC4 is upregulated in ovarian carcinoma effusions and differentiates carcinoma cells from mesothelial cells. Diagn Cytopathol. 2007;35:756-760.PubMedCrossRefGoogle Scholar
  67. 67.
    Davidson B, Skrede M, Silins I, Shih IeM, Trope’ CG, Flørenes VA. Low molecular weight cyclin E forms differentiate ovarian carcinoma from cells of mesothelial origin and are associated with poor survival in ovarian carcinoma. Cancer. 2007;110:1264-1271.PubMedCrossRefGoogle Scholar
  68. 68.
    Wieczorek TJ, Krane JF. Diagnostic utility of calretinin immunohistochemistry in cytologic cell block preparations. Cancer. 2000;90:312-319.PubMedCrossRefGoogle Scholar
  69. 69.
    Afify AM, Stern R, Michael CW. Differentiation of mesothelioma from adenocarcinoma in serous effusions: the role of hyaluronic acid and CD44 localization. Diagn Cytopathol. 2005;32:145-150.PubMedCrossRefGoogle Scholar
  70. 70.
    McKnight R, Cohen C, Siddiqui MT. Utility of paired box gene 8 (PAX8) expression in fluid and fine-needle aspiration cytology: an immunohistochemical study of metastatic ovarian serous carcinoma. Cancer Cytopathol. 2010;118:298-302.PubMedCrossRefGoogle Scholar
  71. 71.
    Zhu W, Michael CW. WT1, monoclonal CEA, TTF1, and CA125 antibodies in the differential diagnosis of lung, breast, and ovarian adenocarcinomas in serous effusions. Diagn Cytopathol. 2007;35:370-375.PubMedCrossRefGoogle Scholar
  72. 72.
    Hecht JL, Lee BH, Pinkus JL, Pinkus GS. The value of Wilms tumor susceptibility gene 1 in cytologic preparations as a marker for malignant mesothelioma. Cancer. 2002;96:105-109.PubMedCrossRefGoogle Scholar
  73. 73.
    Ascoli V, Carnovale-Scalzo C, Taccogna S, Nardi F. Utility of HBME-1 immunostaining in serous effusions. Cytopathology. 1997;8:328-335.PubMedCrossRefGoogle Scholar
  74. 74.
    Bassarova AV, Nesland JM, Davidson B. D2-40 is not a specific marker for cells of mesothelial origin in serous effusions. Am J Surg Pathol. 2006;30:878-882.PubMedCrossRefGoogle Scholar
  75. 75.
    Hanna A, Pang Y, Bedrossian CW, Dejmek A, Michael CW. Podoplanin is a useful marker for identifying mesothelioma in malignant effusions. Diagn Cytopathol. 2010;38:264-269.PubMedGoogle Scholar
  76. 76.
    Al-Hussaini M, Stockman A, Foster H, McCluggage WG. WT-1 assists in distinguishing ovarian from uterine serous carcinoma and in distinguishing between serous and endometrioid ovarian carcinoma. Histopathology. 2004;44:109-115.PubMedCrossRefGoogle Scholar
  77. 77.
    Hashi A, Yuminamochi T, Murata S, Iwamoto H, Honda T, Hoshi K. Wilms tumor gene immunoreactivity in primary serous carcinomas of the fallopian tube, ovary, endometrium, and peritoneum. Int J Gynecol Pathol. 2003;22:374-377.PubMedCrossRefGoogle Scholar
  78. 78.
    Han L, Pansare V, Al-Abbadi M, Husain M, Feng J. Combination of MUC5ac and WT-1 immunohistochemistry is useful in distinguishing pancreatic ductal carcinoma from ovarian serous carcinoma in effusion cytology. Diagn Cytopathol. 2010;38:333-336.PubMedGoogle Scholar
  79. 79.
    Nonaka D, Chiriboga L, Soslow RA. Expression of pax8 as a useful marker in distinguishing ovarian carcinomas from mammary carcinomas. Am J Surg Pathol. 2008;32:1566-1571.PubMedCrossRefGoogle Scholar
  80. 80.
    Tong GX, Devaraj K, Hamele-Bena D, Yu WM, Turk A, Chen X, Wright JD, Greenebaum E. PAX8: A marker for carcinoma of Müllerian origin in serous effusions. Diagn Cytopathol. 2011;39: 567-574.Google Scholar
  81. 81.
    Wiseman W, Michael CW, Roh MH. Diagnostic utility of PAX8 and PAX2 immunohistochemistry in the identification of metastatic Müllerian carcinoma in effusions. Diagn Cytopathol. 2011;39:651-656.Google Scholar
  82. 82.
    Kato N, Toukairin M, Asanuma I, Motoyama T. Immunocytochemistry for hepatocyte nuclear factor-1beta (HNF-1beta): a marker for ovarian clear cell carcinoma. Diagn Cytopathol. 2007;35:193-197.PubMedCrossRefGoogle Scholar
  83. 83.
    DeLair D, Oliva E, Köbel M, Macias A, Gilks CB, Soslow RA. Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases. Am J Surg Pathol. 2011;35:36-44.PubMedCrossRefGoogle Scholar
  84. 84.
    McCluggage WG, Wilkinson N. Metastatic neoplasms involving the ovary: a review with an emphasis on morphological and immunohistochemical features. Histopathology. 2005;47:231-247.PubMedCrossRefGoogle Scholar
  85. 85.
    Leroy X, Farine MO, Buob D, Wacrenier A, Copin MC. Diagnostic value of cytokeratin 7, CD10 and mesothelin in distinguishing ovarian clear cell carcinoma from metastasis of renal clear cell carcinoma. Histopathology. 2007;51:874-876.PubMedCrossRefGoogle Scholar
  86. 86.
    Gokden N, Gokden M, Phan DC, McKenney JK. The utility of PAX-2 in distinguishing metastatic clear cell renal cell carcinoma from its morphologic mimics: an immunohistochemical study with comparison to renal cell carcinoma marker. Am J Surg Pathol. 2008;32:1462-1467.PubMedCrossRefGoogle Scholar
  87. 87.
    Sugai M, Umezu H, Yamamoto T, et al. Expression of hepatocyte nuclear factor 4 alpha in primary ovarian mucinous tumors. Pathol Int. 2008;58:681-686.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, The Medical FacultyUniversity of OsloOsloNorway

Personalised recommendations