PURPOSE: To assess the differences between imaging findings of mucinous and serous cystadenocarcinomas of the ova r y, as seen on computed tomography (CT). MATERIALS AND METHODS: The CT findings of 24 patients with mucinous cystadenocarcinoma (25 tumors) and 26 with serous cystadenocarcinoma (47 tumors) of the ovary were retrospectively analysed. Images were evaluated for tumor size, contour, CT attenuation of locules within the mass, the presence of septal vegetation, the proportion of solid portion within the mass, the presence of calcification, and carcinomatosis peritonei. RESULTS: Mucinous cystadenocarcinomas tend to have a smooth contour (96%), variable CT attenuation of locules (80 %), and even size of locules within the mass (88.0%). Serous cystadenocarcinomas, on the other hand, tend to have an rregular lobulated contour (89.4 %), unevenly sized locules (76.6%), septal vegetation (57.4 %), and a prominent solid portion (59.6%). Bilaterality and carcinomatosis peritonei were more common in serous than in mucinous cystadenocarcinoma. CONCLUSION: Features which are valuable for the differentiation of mucinous and serous cystadenocarcinomas of the ova r y, as seen on CT, are tumor size, contour, varying locule attenuation and size, septal vegetation, a solid portion, bilaterality and peritoneal seeding.
Carcinoma ; Cystadenocarcinoma, Mucinous ; Cystadenocarcinoma, Serous* ; Female ; Hand ; Humans ; Mucins* ; Ovary ; Ovum ; Retrospective Studies

Cystic lesions of the pancreas are being incidentally recognized with increasing frequency and become a common finding in clinical practice. Despite of recent remarkable advances of radiological and endoscopic assessment and a better understanding of natural history of certain subgroups of cystic lesions, differentiating among lesions and making an optimal management plan is still challenging. A multimodal approach should be performed to evaluate incidentally detected cystic lesions. Emerging evidence supports selective nonoperative management for the majority of patients with cystic lesions, but, for those in whom a suspicion of malignancy remains, surgery is indicated. Concerning long-term follow-up, there is limited data to support the ideal modality, intensity, and duration. Therefore, evidence-based guidelines for the diagnosis, management, and follow-up of cystic lesions of the pancreas should be established.
Cystadenocarcinoma, Mucinous/diagnosis/epidemiology/therapy ; Cystadenocarcinoma, Papillary/diagnosis/epidemiology/therapy ; Cystadenocarcinoma, Serous/diagnosis/epidemiology/therapy ; Humans ; Incidence ; Incidental Findings ; Pancreatic Cyst/*diagnosis/epidemiology/therapy ; Pancreatic Neoplasms/*diagnosis/epidemiology/therapy ; Tomography, X-Ray Computed ; Tumor Markers, Biological/blood

This study presents the cytologic features of peritoneal washings, with particular emphasis on the cytologic discrimination among serous, mucinous, and endometrioid adenocarcinoma of the ovary. We selected histologically confirmed 27 cases of peritoneal washing : 8 cases of serous cystadenocarcinomas, 5 cases of mucinous cystadenocarcinomas, and 14 cases of endometrioid adenocarcinomas. The most frequent cytologic pattern of three tumors was clusters. Ball pattern was found in serous cystadenocarcinoma(36%) and acinar pattern in endometrioid adenocarcinoma (36%). Mucinous adenocarcinoma showed mucoid background(100%) and endometrioid adenocarcinoma revealed inflammatory background(43%). The cytoplasmic vacuoles were noted in 80%, 13%, and 43% of mucinous, serous, and endometrioid adenocarcinoma, respectively. The endometrioid adenocarcinoma showed prominent nucleoli(64%). In conclusion, the cytologic findings of mucinous cystadenocarcinoma were different from that of serous and endometrioid carcinomas, such as mucoid background, abundant cytoplasm with vacuolated cytoplasm, and peripherally located cytoplasm. Although endometrioid carcinoma showed acinar pattern and prominent nucleoli, the differential diagnosis between serous cystadenocarcinoma and endometrioid adenocarcinoma in peritoneal washing cytology was not always possible.
Adenocarcinoma, Mucinous ; Carcinoma, Endometrioid* ; Cystadenocarcinoma, Mucinous ; Cystadenocarcinoma, Serous ; Cytoplasm ; Diagnosis, Differential* ; Discrimination (Psychology) ; Female ; Mucins* ; Ovary ; Vacuoles

OBJECTIVE: The study was to evaluate the biological significance of Ki-67 expression in common epithelial ovarian carcinomas. We investigated the correlation between Ki-67 expression and clinicopathological parameters. METHODS: One hundred patients with epithelial ovarian carcinomas stage I-IV treated at Department of Obstertrics and Gynecology, Korea University Hospital from January 1994 to December 2004 were used as study group. We determined expression of Ki-67 by immunohistochemistry using MIB-1 monoclonal antibody reactivity. RESULTS: Ki-67 overexpression was higher in high stage (III-IV) than low stage (I-II) (P<0.013). Ki-67 overexpression was higher in serous cystadenocarcinoma (76.3%) than mucinous cystadenocarcinoma (53.6%), endometrioid carcinoma (54.5%) and clear cell carcinoma (58.3%) but it was not statistically significant (P<0.191). Ki-67 expression was higher in high grade but it was not statistically significant (P<0.096). Ki-67 overexpression was not correlated with serum CA-125 level (P<0.172). Overall survival revealed significant survival difference between patients whose tumor showed Ki-67 overexpressions compared with remaining patients. CONCLUSIONS: Ki-67 overexpressions was a poor prognostic indicator in epithelial ovarian carcinomas.
Antibodies, Antinuclear ; Antibodies, Monoclonal ; Carcinoma, Endometrioid ; Cystadenocarcinoma, Mucinous ; Cystadenocarcinoma, Serous ; Female ; Gynecology ; Humans ; Immunohistochemistry ; Ki-67 Antigen ; Korea ; Ovary

This study was performed to assess the significance of plasma level and histochemical character of carcinoembryonic antigen(CEA) in early diagnosis and prognosis of ovarian tumor. Plasma level of CEA was measured using EIA method and immunohistochemical tissue staining of CEA was done using biotin-strepto avidin complex immunoperoxidase technique. The percentage of patients with positive CEA level(above 2.5 ng/ml) was 23.1%(6/26) in malignant ovarian tumor and 15.6%(12/77) in benign ovarian tumor. Positive tissue staining of CEA was 42.3%(11/26) in malignant ovarian tumor and 19.5%(15/77) in benign ovarian tumor. In histologic typing, positive tissue staining of CEA was 18.1%(2/11) in serous cystadenocarcinoma, 85.7%(6/7) in mucinous cystadenocarcinoma, 37.5%(3/8) in other malignant ovarian tumors, 7.1%(1/15) in serous cystadenoma, 7.1%(1/14) in mucinous cystadenoma and 27.1%(13/48) in other benign ovarian tumors. Among 5 cases of malignant ovarian tumors with positive CEA level, 3 cases(60%) showed positive tissue staining of CEA, whereas among 21 cases of malignant ovarian tumors with negative CEA level, 8 cases (38.1%) showed positive tissue staining of CEA. However, among 11 cases of benign ovarian tumors with positive CEA level, 4 cases(36.4%) showed positive tissue staining of CEA, whereas among 66 cases of benign ovarian tumors with negative CEA level, 11 cases(16.7%) showed positive tissue staining of CEA. In the 3 year follow-up study of 12 cases with malignant ovarian tumor, among 3 cases with positive tissue staining of CEA, 2 cases(66.7%) survived. In 9 cases with negative tissue staining of CEA, 6 cases(66.7%) survived. In conclusion, these results suggest that the measurement of tumor CEA may be of value in the differential diagnosis of malignant and benign ovarian tumor, especially in diagnosing mucinous cystadenocarcinoma. However, due to the small amount of cases available for study, it was difficult to determine the correlation between the prognosis and tissue CEA staining of ovarian tumors.
Avidin ; Carcinoembryonic Antigen* ; Cystadenocarcinoma, Mucinous ; Cystadenocarcinoma, Serous ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Diagnosis, Differential ; Early Diagnosis ; Follow-Up Studies ; Humans ; Immunoenzyme Techniques ; Plasma* ; Prognosis

PURPOSE: To evaluate the usefulness of MRI findings in the differentiation of benign from malignant ovarian lesions. MATERIALS AND METHODS: Using MR findings, 29 surgically proven ovarian masses in 22 patients (14 bilateral tumors) were evaluated Twenty-one benign tumors in 16 patients (5 simple cysts, 4 mucinous cystadenomas, 4 serous cystadenomas, 4 endometriomas, 3 cystic teratomas and 1 tuboovarian abscess), and eight malignant tumors in six patients (4 serous papillary cystadenocarcinomas and 4 mucinous cystadenocarcinomas) were included. MRI was performed with SE T1WI, FSE T2WI and Gd-T1WI. MRI findings of lesion size, thickness of wall and of internal septations, number of internal septations, nodularities, and ancillary findings such as adhesion in the pelvic cavity, dissemination, ascites and lymphadenopathy were retrospectively analyzed. RESULTS: Malignant ovarian lesions were larger (18 cm : 11 cm) and had more internal septations, more solid components and nodularities (63 % : 5 %) than benign lesions. On T1WI, cystic lesions, both benign and malignant, showed low signal intensity. Hemorrhage, fat components and mucin containing lesions showed high signals and solid components and nodularities were isointense with muscle on T1WI. Solid components and nodularities were well-enhanced after gadolinium enhancement. Adhesion (50 % : 10 %), dissemination (38 % : 0 %) and ascites (63 % : 24 %) were more frequent in malignant lesions. CONCLUSION: MRI, especially with gadolinium-enhanced T1W1 is useful in the differentiation of benign from malignant ovarian lesions.
Ascites ; Cystadenocarcinoma, Papillary ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Endometriosis ; Female ; Gadolinium ; Hemorrhage ; Humans ; Lymphatic Diseases ; Magnetic Resonance Imaging* ; Mucins ; Retrospective Studies ; Teratoma

OBJECTIVETo study the clinicopathologic and immunohistochemical features of cystic neoplasms of the pancreas.

METHODSNinety-two cases of cystic neoplasm of pancreas were retrieved from the Department archival file during the period from 1999 to 2005. Histologic features were studied and the tumors were typed according to WHO classification. Immunohistochemistry was also carried out using paraffin-embedded tissues.

RESULTSThe age of patients ranged from 16 to 80 years. The patients included 33 males and 59 females. The tumors varied from 2 cm to 21 cm in diameter. They consisted of intraductal papillary mucinous neoplasm (36/92), serous cystic neoplasm (18/92), solid pseudopapillary tumor (18/92), mucinous cystic neoplasm (14/92), cystic pancreatic ductal adenocarcinoma (4/92) and cystic pancreatic endocrine neoplasm (2/92). Immunohistochemical study revealed variable staining patterns, with frequent overlaps between different tumor types. In general, serous cystic neoplasm expressed MUC1, while mucinous cystic neoplasm was positive for MUC-5AC, intraductal papillary mucinous neoplasm for MUC-2 and cystic pancreatic ductal adenocarcinoma for MUC-1. On the other hand, solid pseudopapillary tumor expressed alpha-antitrypsin, alpha-antichymotrypsin, vimentin and progesterone receptor.

CONCLUSIONSAccurate diagnosis of pancreatic cystic neoplasms requires correlation of clinical findings, radiologic examination, histologic features and immunostaining results. Pathologic distinction is important because of different prognostic significance. Two-thirds of pancreatic cystic neoplasms are premalignant or malignant and warrant surgical resection, whereas the remaining one-third (including pseudocyst and serous cystadenoma) are benign and can be treated conservatively.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Papillary ; metabolism ; pathology ; Cystadenocarcinoma, Mucinous ; metabolism ; pathology ; Cystadenocarcinoma, Serous ; metabolism ; pathology ; Cystadenoma, Mucinous ; metabolism ; pathology ; Cystadenoma, Serous ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Mucin 5AC ; metabolism ; Mucin-1 ; metabolism ; Neoplasms, Cystic, Mucinous, and Serous ; metabolism ; pathology ; Pancreatic Neoplasms ; metabolism ; pathology ; Young Adult

OBJECTIVETo detect hypermethylated tumor-specific RASSF1A DNA in the circulation and its significance in ovarian cancers patients.

METHODSMethylation-specific polymerase chain reaction (MSP) was used to study the hypermethylation of RASSF1A in preoperative serum samples from 51 ovarian cancer patients.

RESULTSThe RASSF1A gene was not methylated in peripheral blood samples from 51 normal patients and 51 patients with benign ovarian tumors. Hypermethylation of RASSF1A gene was found in circulating tumor-specific DNA in 43.1% of patients (22 out of 51 cases) with ovarian cancers (P < 0.05). There was no difference in hypermethylation of RASSF1A gene amongst various ovarian cancer subtypes (P < 0.05). On the other hand, hypermethylation of RASSF1A gene was more frequently encountered in stage III and IV than stage I and II tumors (P < 0.05). It was rarely seen in well and moderately differentiated groups, as compared with poorly differentiated group (P < 0.05).

CONCLUSIONSThere is a higher frequency of RASSF1A hypermethylation in circulating tumor-specific DNA of ovarian cancer patients. RASSF1A has been postulated to play an important role as tumor suppressor gene and can be silenced by promoter hypermethylation. This methylation correlates with clinical stage and histopathologic grade. Such observation may carry diagnostic and prognostic implications when assessing ovarian tumors.

Carcinoma, Endometrioid ; blood ; pathology ; Cystadenocarcinoma, Mucinous ; blood ; pathology ; Cystadenocarcinoma, Serous ; blood ; pathology ; DNA Methylation ; Female ; Humans ; Neoplasm Staging ; Ovarian Neoplasms ; blood ; pathology ; Tumor Suppressor Proteins ; blood ; genetics

OBJECTIVETo investigate hypermethylation of promoter region of RASSF1A and its relationship with ovarian malignant epithelial tumors.

METHODSMethylation-specific PCR (MSP) was used to determine the hypermethylation of promoter region of ras association domain family 1 (RASSF1A) gene in 80 cases of ovarian malignant epithelial tumors.

RESULTSNo methylation of promoter region of RASSF1A gene was found in all 80 normal control tissues (0). Of 80 ovarian malignant epithelial tumors 42 were hypermethylated in promoter region of RASSF1A gene (52.5%). There was no statistically significant difference in the frequency of hypermethylation of RASSF1A gene among serious adenocarcinomas, mucinous adenocarcinomas and endometrioid adenocarcinomas (54.2%, 52.4% and 45.5%, respectively; P > 0.05). Hypermethylation of RASSF1A gene happened more often in tumors in stage III and IV (66.7% and 77.8%) than that in stage I and II (21.4% and 16.7%; P < 0.05). It was less frequently observed in well and moderately differentiated tumors (34.5% and 35.0%) than in poorly differentiated tumors (80.6%; P < 0.05).

CONCLUSIONHigh frequency of methylation of RASSF1A promoter exists in ovarian malignant epithelial tumors as a tumor suppressor gene, its suppressor activity may be abrogated by an epigenetic mechanism. Hypermethylation of RASSF1A promoter in patients with epithelial malignant ovarian tumors is related to clinical stage and histopathological grade. It indicates poor prognosis.

Carcinoma, Endometrioid ; genetics ; Cystadenocarcinoma, Mucinous ; genetics ; Cystadenocarcinoma, Serous ; genetics ; DNA Methylation ; Female ; Humans ; Ovarian Neoplasms ; genetics ; Promoter Regions, Genetic ; genetics ; Tumor Suppressor Proteins ; genetics

Ovarian tumors comprise a heterogeneous group of lesions, displaying distinct tumor pathology and oncogenic potentiel. These tumors are subdivided into three main categories: epithelial, germ cell, and sex-cord stromal tumors. We report herein the newly described molecular abnormalities in epithelial ovarian cancers (carcinomas). Immunohistochemistry and molecular testing help pathologists to decipher the significant heterogeneity of this disease. Our better understanding of the molecular basis of ovarian carcinomas represents the first step in the development of targeted therapies in the near future.
Carcinoma, Endometrioid ; pathology ; Cystadenocarcinoma, Mucinous ; pathology ; Cystadenocarcinoma, Serous ; pathology ; Female ; Humans ; Mixed Tumor, Malignant ; pathology ; Neoplasms, Glandular and Epithelial ; pathology ; Ovarian Neoplasms ; genetics ; pathology