CASE 2 CASE 2

58 year old female

Elvio G. Silva, M.D.
Baylor Hospital, Dallas December 97 – Stage IIIC – ovarian
Cedars-Sinai Medical Center, Los Angeles
M.D. Anderson Cancer Center, Houston
carcinoma

CASE 2
December 97 – Surgery – Toxol and CisPlatinin X6
June 2000 – Recurrence – Toxol and Hexalen
July 2002 – Recurrence – Topotecan
September 2002 – Doxcil, Hemcetavine
December 2003 – BP 16
March 2004 – Tamoxifen
July 2007 – Arymidex
December 2007 – Pain medicine

Serous Tumors
Cystadenoma Borderline High grade
Low grade Ca Ca
Cell
Detachments Invasion Atypia &
Mitoses

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 Low Grade High Grade
Serous Ca
vs.
Serous Ca Serous Carcinoma
Power Homogeneous Heterogeneous 5 year 10 year
survival survival
Cellular Mild to Marked
Atypia Moderate Low grade 70% 40%

High grade 20% 5%

Mitoses ≤ 12/10 HPF > 12 HPF

Calcification Always 50%

Low Grade Serous Ca

vs.
High Grade Serous Ca

Different grades vs. Different tumors?

Low Grade Serous Ca Borderline Serous Tumor

vs. vs.
High Grade Serous Ca Low Grade Serous Ca
Different Tumors
1. There is no transformation of the low Invasion 3mm
grade cases into high grade
Micropapillary Pattern?
2. Both tumors have different mutations

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 Low Grade Serous Tumors with
Extensive Micropapillary Pattern Low Grade Serous Tumors with
behave as Low Grade Serous Ca > 10% of Micropapillary Pattern

Extensive = > 10% of the entire tumor Non-invasive low grade serous ca
Recurrent rate 92%

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 Low Grade Serous Low Grade Serous
Carcinoma Carcinoma
Noninvasive – Borderline tumor > Invasion
10% of micropapillae Non Epithelial Lined Spaces
Glands
Invasive

Low Grade Serous

Carcinoma
NELS

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Low Grade Serous
Carcinoma
Invasion by glands

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 Low Grade Serous Ca
Special Features
Orphan Papillae
Calcification – Psammo Ca
Mucin

Low Grade Serous

Carcinoma
Orphan Papillae

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9 8

Low Grade Serous

Carcinoma
Calcifications – Psammo Ca

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 Low Grade Serous
Carcinoma
Mucin

Low Grade Serous Carcinoma

Non-invasive – a borderline tumor with > 10% of micropapillae

>3mm
NELS, if borderline tumor invasion
Invasive desmoplasia
Glands

•Orphan Papillae
•Calcifications always present
Psammo Ca
•Mucin present in 70% of the cases
•Invasive implants are low grade serous ca

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Thank You

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