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Background: Ovarian cancer is one of the most common malignancies in female patients. In recent years, immunohistochemistry (IHC) has emerged as an important tool in the diagnosis of ovarian tumors. The study aimed to assess estrogen receptors (ERs), progesterone receptors (PRs), Her-2-neu, and Ki-67 by IHC in surface epithelial ovarian tumors and to correlate the findings with different variables. Materials and Methods: It was a cross-sectional study. Oophorectomy/salpingo-oophorectomy/cystectomy specimens were included in this study. IHC was done on 10% neutral buffer formalin-fixed paraffin-embedded tissue sections by using Dako FLEX Ready to use mouse monoclonal antibodies and DakoEnvisionTM FLEX/ HRP detection reagent. Results: The study includes 81 cases of surface epithelial ovarian tumors (a benign serous tumor [20], a benign mucinous tumor [18], a borderline mucinous tumor [5], low-grade serous carcinoma [8], high-grade serous carcinoma [19], mucinous carcinoma [7], endometrioid carcinoma [2], borderline Brenner tumor [1], and malignant Brenner tumor [1]. ER had higher expression in malignant cases (51.33%) than in benign cases (15.8%). PR had higher expression in malignant tumors (54.05%) incomparable to benign (18.42%) and borderline tumors (16.66%). PR had higher expression in high grade. Expression of Her-2-neu positivity was found to be 29.7% out of the total 81 cases. Her-2-neu was found in 11 high-grade tumors among 31 malignant cases. CA-125 levels were significantly higher in malignant ovarian tumors (P = 0.0143). Proliferation activity was considered low if proliferation index (PI) <10% and high if PI >10%. The study showed high PI in malignant tumors. Conclusion: Expression of these marks in adjunct to H&E diagnosis may prove beneficial in differentiating benign, borderline, and malignant cases, in which a diagnosis of borderline cases based on sole H & E is doubtful.
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Abstract Objective To evaluate the role of clinical features and preoperativemeasurement of cancer antigen 125 (CA125), human epididymis protein(HE4), and carcinoembryonic antigen (CEA) serum levels in women with benign and malignant non-epithelial ovarian tumors. Methods One hundred and nineteen consecutive women with germ cell, sex cordstromal, and ovarian leiomyomas were included in this study. The preoperative levels of biomarkers were measured, and then surgery and histopathological analysis were performed. Information about the treatment and disease recurrence were obtained from the medical files of patients. Results Our sample included 71 women with germ cell tumors (64 benign and 7 malignant), 46 with sex cord-stromal tumors (32 benign and 14 malignant), and 2 with ovarian leiomyomas. Among benign germ cell tumors, 63 were mature teratomas, and, amongmalignant, fourwere immatureteratomas. Themost common tumors in the sex cordstromal group were fibromas (benign) and granulosa cell tumor (malignant). The biomarker serum levels were not different among benign andmalignant non-epithelial ovarian tumors. Fertility-sparing surgeries were performed in 5 (71.4%) women with malignant germ cell tumor. Eleven (78.6%) patients with malignant sex cord-stromal tumors were treated with fertility-sparing surgeries. Five women (71.4%) with germ cell tumors and only 1 (7.1%) with sex cord-stromal tumor were treated with chemotherapy. One woman with germ cell tumor recurred and died of the disease and one woman with sex cord-stromal tumor recurred. Conclusion Non-epithelial ovarian tumors were benign in the majority of cases, and the malignant caseswere diagnosed at initial stages with good prognosis. Themeasurements of CA125, HE4, and CEA serum levels were not useful in the preoperative diagnosis of these tumors.
Resumo Objetivo Avaliar o papel das características clínicas e a medida pré-operatória dos níveis séricos de CA125, HE4, e CEA em mulheres com tumores de ovário não epiteliais benignos e malignos. Métodos Cento e dezenovemulheres consecutivas comtumores ovarianos de células germinativas, do cordão sexual-estroma, e miomas ovarianos foram incluídas neste estudo. Os níveis pré-operatórios dos biomarcadores foram medidos, a cirurgia e a análise histopatológica foram realizadas. Informações sobre tratamento e recorrência da doença foram obtidas dos prontuários médicos das pacientes. Resultados Nossa amostra incluiu 71 mulheres com tumores de células germinativas (64 benignos e 7 malignos), 46 com tumores do cordão sexual-estroma (32 benignos e 14 malignos), e 2 com leiomiomas ovarianos. Entre os tumores benignos de células germinativas, 63 eram teratomas maduros, e, entre os malignos, quatro eram teratomas imaturos. Os tumores mais comuns do grupo do cordão sexual-estroma foram fibromas (benignos) e tumores de células da granulosa (malignos). Os níveis séricos dos biomarcadores não diferiram entre os tumores de ovário não epiteliais benignos e malignos. A cirurgia preservadora de fertilidade foi realizada em 5 (71,4%) mulheres com tumores malignos de células germinativas. Onze (78,6%) mulheres com tumores do cordão sexual-estromamalignos foram tratadas comcirurgia preservadora de fertilidade. Cinco (71,4%)mulheres com células germinativas e apenas 1 (7,1%) com tumor do cordão sexual-estroma foram tratadas com quimioterapia. Uma mulher com tumor de células germinativas recidivou e morreu da doença. Uma mulher com tumor do cordão sexual-estroma recidivou. Conclusão Os tumores de ovário não epiteliais foram benignos namaioria dos casos e os malignos foram diagnosticados em estágios iniciais, com bom prognóstico. A medida dos níveis séricos de CA125, HE4, e CEA não foram úteis no diagnóstico préoperatório desses tumores.
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Humans , Female , Adult , Ovarian Neoplasms/surgery , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/blood , Ovarian Neoplasms/epidemiology , Biomarkers, Tumor/blood , Sex Cord-Gonadal Stromal Tumors/surgery , Sex Cord-Gonadal Stromal Tumors/diagnosis , Sex Cord-Gonadal Stromal Tumors/blood , Sex Cord-Gonadal Stromal Tumors/epidemiology , Neoplasms, Germ Cell and Embryonal/surgery , Neoplasms, Germ Cell and Embryonal/diagnosis , Neoplasms, Germ Cell and Embryonal/blood , Neoplasms, Germ Cell and Embryonal/epidemiology , Carcinoembryonic Antigen/blood , Cross-Sectional Studies , CA-125 Antigen/blood , WAP Four-Disulfide Core Domain Protein 2/analysis , Middle AgedABSTRACT
Background: Epithelial ovarian carcinoma is worldwide the sixth most common female cancer. This malignancy carries the highest mortality among all gynecological cancers. Aim and objectives: To perform and interpret p53 immunostaining on the diagnosed serous and mucinous malignant surface epithelial ovarian tumors and to correlate expression of p53 with histological type of malignancy. Materials and methods: 2 year prospective study was done i.e. from October 2011 to September 2013 on “p53 interpretation on surface epithelial ovarian tumors” in MGM Hospital, Warangal. All the ovarian surface epithelial tumor specimens, received in the pathology department during this period were considered. Results: A total of 120 cases were studied, out of which benign tumors were the most common (64.2%), followed by malignancy (25.8 %) and 12 cases (10%) of borderline malignancy. Most of the benign tumors were unilateral, the cases which showed bilateral involvement were mostly malignant. The maximum number of cases in the present study was seen in the age group of 31-60 years. The youngest patient was 16 years old and the oldest was 68 years old. Serous cyst adenoma was the most common neoplasm found and accounted for 53 cases (44.2%) , followed by mucinous cystadenoma, which accounted for 21 cases (17.5%). 9 cases of serous cystadenofibroma (7.5%), 3 borderline serous tumors (2.5%) and 11 serous cystadenocarcinoma (9.1%) were found in the present study. Out of the 44 mucinous tumors, 21 were benign (17.5%), 3 were of borderline malignancy (2.5%) and 20 were malignant (16.7%). One case of mucinous cystadenocarcinoma was found to be associated with T. T. Sreeja, S. Chandrasekhar, S. Lokesh Rao Magar, K. Durga. 2 years study on p53 expression on serous and mucinous tumors of ovary. IAIM, 2016; 3(7): 150-158. Page 151 adenocarcinoma of ascending colon. One case of benign Brenner tumour was also found in the present study. Conclusion: The rate of p53 abnormalities varies with histologic type, grade and stage of the tumor. P53 expression was more in malignant serous tumors as compared to the malignant mucinous tumors.
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Background: This study aims to evaluate the expression of estrogen receptor alpha (ER α), progesterone receptor A (PRA), Her-2-neu, p53, and Ki-67 in epithelial ovarian tumors and their correlation with various clinicopathologic variables. Materials and Methods: This study included 60 consecutive cases of epithelial ovarian tumors. Sections of 4 μm were taken from paraffin embedded tissue blocks for immunohistochemistry (IHC). Statistical analysis was done using Chi square test, ANOVA. Results: ER α had lower expression in benign (29%) and PRA higher expression in malignant (63.6%) tumors. ERα, PRA had higher expression in serous (72.72%, 57.14%), postmenopausal (81.8%, 71.42%), advanced stage (63.63%, 52.38%), grade 3 (45.45%, 38.09%), and tumors with ascites (90.90%, 85.7%). Her-2-neu, p53 were negative in benign and higher in malignant (21%, 57.6%), serous (71.42%, 57.89%), grade 3 (57.14%, 31.57%), and tumors with ascites (85.7%, 84.21%). Ki-67 had a significant higher expression in malignant (48.6± 26.76), serous (55.43± 27.85), and grade 3 tumors (68 ± 22). CA-125 levels were significantly higher in malignant, serous, advanced stage, grade 3 and ER α, Her-2-neu and p53 positive tumors. Conclusion: ERα, PRA expression in tumors with adverse prognostic factors support the mitogenic role of estrogen and estrogenic regulation of PR. Her-2-neu and p53 expression only in malignant tumors suggest their carcinogenic role and aid in the differentiation of borderline and malignant tumors. Higher Ki-67 in tumors with adverse prognostic factors would help in prognostication and differentiation. Lack of co-expression of markers proves the extreme heterogeneity of ovarian tumors. These markers may aid in differentiation and prognostication of ovarian tumors.
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OBJECTIVE: The purpose of this study was (1) to evaluate the expressions of clusterin, bax, Ki-67, p53, and apoptotic index in epithelial ovarian tumors, borderline and malignant ovarian tumors, (2) to find out the correlation between their expressions and clinicopathological parameters, and (3) to evaluate the effect on the patient's survival according to their expressions. METHODS: The histological and clinical findings of 22 cases of ovarian cystadenomas, 44 cases of borderline tumors and 96 cases of carcinomas were evaluated. Expressions of clusterin, bax, Ki-67, p53, and apoptotic index were studied on paraffin-embedded tissue sections by immunohistochemical methods. RESULTS: The expressions of clusterin, p53, and Ki-67 were higher in ovarian carcinomas than borderline tumors. The overexpression of p53, and Ki-67 were frequent in high stage, poorly differentiated and bilateral ovarian carcinomas. The overexpressions of clusterin, bax, p53, and Ki-67 showed a statistically significant correlation with histologic type. Apoptotic index was higher in bax overexpression group, but there was no correlation with overexpression of clusterin or p53. Ki-67 was higher in p53 overexpression group, but there was no correlation with overexpression of clusterin or p53. There was no statistically significant correlation with each other between the overexpressions of clusterin, bax, p53, and Ki-67. The overexpressions of clusterin, Ki-67, p53 was associated with overall patient's survival in borderline significance. CONCLUSION: The overexpression of p53, and Ki-67 were frequent in poorly differentiated ovarian carcinomas. So the overexpression of p53, and Ki-67 can be used as prognostic factor. The overexpression of clusterin was more in epithelial ovarian carcinomas than in borderline tumors but showed no significant correlation with the overall patient's survival. Further studies are required to clarify the possibility of using clusterin for target therapy in epithelial ovarian carcinomas.
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Clusterin , CystadenomaABSTRACT
Objective To investigate the expression of Ki-67 antigen and Survivin in epithelial ovarian tumor and their relationship.Methods Immunohistochemical assay SP method)was used to examine the expression of Ki-67 antigen and Survivin in 24 cases of benign and 47 cases of malignant epithelial ovarian tumor.Results The staining reaction of Ki-67 was mainly confined to the cellular nucleus.Ki-67 index in malignant tumor(19.59?16.48) was significantly higher than that in benign epithelial ovarian tumor(0.17?0.20)(P
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OBJECTIVE: It is still unclear whether angiogenic potential, which is believed to be a prerequisite for tumor development, is an important prognostic factor in ovarian carcinoma. The current study was designed to examine the relationship among Vascular endothelial growth factor (VEGF) expression, angiogenesis in ovarian neoplasms and clinicopathological prognostic variables. METHODS: A according to the WHO classification and FIGO staging epithelial ovarian carcinoma was classified. Microvessel density and VEGF status were evaluated by immunohistochemistry in 77 epithelial ovarian carcinomas. RESULTS: Positive immunostaining for VEGF was observed in 92.6% (50 out of 54) of ovarian carcinomas, which was significantly higher than that of low malignant potential (LMP) tumors (12 out of 23; 52.2%) (p<0.001). In ovarian carcinomas, positive VEGF immunostaining was also observed more frequently, even though not significantly, in tumor of elder age group (more than 60 years) (p=0.05) and less differentiated (p=0.05). CD34 immunostaining revealed increased microvessel density in ovarian carcinomas larger than 10 cm in size (p=0.029) and in mucinous type tumors (p=0.025). Microvessel counts of epithelial ovarian carcinomas examined were not correlated with VEGF expression. Histologic type (p=0.0428), differentiation (p=0.0083) and FIGO stage (p=0.0004) also influenced overall survival of ovarian carcinomas in univariate analysis. But multivariate analysis revealed that disease stage was the only significant and independent prognostic factor of ovarian carcinomas (p=0.001). In advanced ovarian tumors (stage III/IV), microvessel density was the only significant prognostic factor (p=0.002). CONCLUSION: Therefore, the expression of VEGF could be used as an adjuvant indicator of differing borderline tumor from ovarian carcinoma. And microvessel density of advanced ovarian carcinoma may enhance the predictability of patient at high risk for tumor progression who are potential candidate for further aggressive therapy.
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Humans , Classification , Immunohistochemistry , Microvessels , Mucins , Multivariate Analysis , Ovarian Neoplasms , Prognosis , Vascular Endothelial Growth Factor AABSTRACT
OBJECTIVE: A large body of evidence suggests that cyclooxygenase-2 (COX-2) is important in tumorigenesis of gastrointestinal and other cancers. This was the study to determine whether COX-2 was also expressed in benign and malignant ovarian tumors. METHODS: We studied the expression of COX-2 in various ovarian tumors [ Benign epithelial tumors (n=10), borderline epithelial tumors (n=12), malignant epithelial tumor (n=12), nonepithelial tumors(n=10) ] by immunohistochemistry. Results of immunoreactivity was classified semiquantitatively based on the proportion and intensity of tumor cell immunostaining. RESULTS: In the epithelial ovarian tumors, the intensity of immunostaining was stronger in the malignant tumors than the benign and borderline tumors (p<0.001). Especially all serous and mucinous malignant tumors (n=9) showed weak and strong immunoreactivity, with 66.7% strong reactivity. None of the nonepithelial ovarian tumors expressed COX-2 immunoreactivity. CONCLUSION: These preliminary data indicate that COX-2 may have a role in carcinogenesis of epithelial ovarian tumors, especially in the serous and mucinous types. COX-2 maybe a target for future research in the tumorigenesis of the epithelial ovarian malignancies.