An Approach to Ovarian Tumor Diagnosis

Abstract

The often complex task of correctly diagnosing ovarian tumors, particularly when they are in any way unusual, depends on a great array of clinical and pathologic features, which impact the diagnosis to varying degrees in individual cases. The first important clinical feature is the patient age as some tumors are rare in young individuals and conversely many of those common in the young are uncommon in the older female. Another important clinical feature is current evidence of a neoplasm elsewhere, or history of such, which can be crucial in recognizing the relatively common phenomenon of a tumor metastatic in the ovary mimicking a primary neoplasm. Gross findings such as bilaterality and evidence of associated endometriosis (which is prone to give rise to certain specific tumors), adenofibroma, or a dermoid cyst, play an important role; also, often crucial is thorough sampling. Ultimately, the diagnosis rests in most cases on awareness of the great array of patterns and cell types that may be seen in ovarian tumors and their frequency in individual neoplasms. Among the most common patterns are tubulo-glandular, cords, trabeculae, nests, and follicles that can range from small to large, diffuse, and papillary. Major cell types are small round cells, spindle cells, mucinous cells of varying characters, clear cells, hobnail cells, oxyphilic cells, and transitional cells. Squamous differentiation, often abortive, can be crucial in certain circumstances such as the common differential between a sex cord tumor and an endometrioid carcinoma with sex cord-like patterns. Certain specific or almost specific immunohistochemical findings aid, but the help provided is disproportionate to the number of such stains obtained in contemporary practice. The above are all reviewed in context of the personal experience of the writer and all he learnt from a master of ovarian pathology, Dr. Robert E. Scully.