Prognostic factors for stage I ovarian carcinoma.

Stage I ovarian carcinoma is relatively uncommon, and data on prognostic factors are conflicting. The clinical and pathologic features of 51 International Federation of Gynecology and Obstetrics stage I ovarian carcinomas were analyzed. There were 22 stage IA, 1 stage IB, and 28 stage IC cases. The mean follow-up was 6.1 years. The 5-year and 10-year disease-specific survival rates for the entire cohort were 92% and 78%, respectively. Among 51 patients, there were 6 tumor deaths, and 1 patient died of unrelated causes. All patients who died of disease were stage IC. Significant adverse prognostic factors were serous histology [relative risk (RR) 5.4, 95% confidence interval (CI) 1.3-22.0] and stage IC (RR 1.3, 95% CI 1.1-1.5). Among factors associated with stage IC, only positive washings or ascites affected survival (RR 9.25, 95% CI 1.9-44.4). The 5-year survival rates for stages IA and IC were 100% and 83%, respectively (P<0.025, log rank test). For comprehensively staged patients, the 5-year survival rate was 96% as compared with 72% for all others (P<0.025, log rank test). Tumor rupture, surface involvement, histologic grade and clear cell histology were not of adverse prognostic significance. Serous histology and positive washings or ascites are adverse prognostic factors in stage I. The prognostic importance of tumor grade, rupture, surface involvement and clear cell histology remains unclear. Patients who are International Federation of Gynecology and Obstetrics stage I on the basis of comprehensive surgical staging have an excellent prognosis.

Ovarian and paraovarian squamous-lined cysts (epidermoid cysts): a clinicopathologic study of 18 cases with comparison to mature cystic teratomas.

The origin of ovarian epidermoid cyst is unknown. Sixteen ovarian and 2 paraovarian squamous-lined cysts unassociated with teratomatous elements were studied. The ovarian cysts represented 1.5% of consecutive ovarian surface epithelial tumors examined and were one-nineteenth as common as mature cystic teratoma. The mean patient age was 57 years. All tumors were unilateral and the majority were incidental findings. The mean tumor size was 1.75 cm and the median, 3.0 cm. In comparison to 120 consecutive patients with mature cystic teratoma who had a mean age of 41 years and a mean tumor size of 6 cm, the ovarian epidermoid cysts were significantly smaller and occurred at a significantly older age (P<0.01). All cysts displayed mature squamous epithelium with a granular layer, with hyperkeratosis in 14 and parakeratosis in 4. In 2 patients, there were contralateral mature cystic teratomas, and in 2 others the cysts contained rare hairs. Two displayed foci of Brenner tumor and 1 appeared to arise in endometriosis. In summary, 7 of 16 ovarian epidermoid cysts displayed features suggesting they reflected insufficiently sampled teratomas, Brenner tumors with squamous metaplasia, or a metaplastic change in endometriosis. Epidermoid cyst of the ovary as defined by histology is a heterogeneous group; pure epidermoid cyst, if it exists at all, probably represents less than 1% of ovarian surface epithelial tumors.

Exploring the histogenesis of ovarian mucinous and transitional cell (Brenner) neoplasms and their relationship with Walthard cell nests: a study of 120 tumors.

CONTEXT: The origin of and relationship between ovarian mucinous and transitional cell (Brenner) neoplasms are enigmatic. The reported association ranges from 1% to 16%, and whether there is an association with Walthard cell nests is unknown. OBJECTIVE: To clarify the histologic relationship between mucinous and Brenner tumors. DESIGN: A total of 40 mucinous cystadenomas, 67 Brenner tumors, and 13 combined tumors were studied. Peritoneal surfaces were examined for Walthard nests in 83 patients compared with 272 controls. RESULTS: A total of 25% of tumors with a mucinous component contained a Brenner component, and 16% of tumors with a Brenner component contained a mucinous component. Most calcifications were spiculated (nonpsammomatous). In 6 combined tumors, the relative volume of the 2 components was less than 1:3000 (transitional-mucinous). Walthard nests were found in 50% of patients with Brenner tumors and 59% of patients with mucinous tumors. This was significantly higher than the 28% found in controls (P = .002 and P < .001, respectively). The number of fallopian tube blocks examined was correlated with the likelihood of finding Walthard nests, and accordingly, sampling accounted for 39% of the increase with Brenner tumors but strengthened the association with mucinous tumors. CONCLUSIONS: The strong association of mucinous and transitional cell components, similar type of calcification, complementary size distributions, and frequent identification of a transitional component in the face of an exceedingly small estimated proportion of that component suggest that this association has been underestimated. The association of Brenner tumors with Walthard nests, although significant, appears weak and not strongly supportive of a histogenetic relationship. The stronger association of Walthard nests with mucinous tumors remains unexplained.