Serous adenocarcinoma

Einally, it should be noted that while many serous adenocarcinomas of endometrium resemble ovarian serous carcinomas, there are some important differences. We will discuss these differences in the Ovary section. The most important of these is infrequent WTl expression in endometrial serous carcinomas (seen in at most 20% to 30% of such cases) and the very common diffuse nuclear expression of WTI in ovarian, tubal, and primary peritoneal examples (at least 70% to 80% of such cases). 

The hereditary breast/ovarian cancer syndrome, and perhaps less frequently the site-specific ovarian cancer syndrome, are linked to mutations in the BRCAl and BRCA2 genes [4]. The vast majority of Bl CAl-associated cancers are serous adenocarcinomas and present at an average age at diagnosis of 48 years. BJ CAl-associated cancers may have a longer median survival than sporadic ovarian cancer [4]. 

Fig. 10.1. Imaging characteristics of a malignant ovarian lesion. Sagittal T2-weighted image demonstrates a large adnexal lesion extending to above the umbilical level. It is clearly separated from the uterus and compresses the rectum. It is composed of multiple solid elements and multiple cysts. Throughout the lesion and within the cysts, papillary projections (arrows) can be identified. Histopathological diagnosis was a serous adenocarcinoma...

Serous adenocarcinoma is the most common type of ovarian cancer and accounts for approximately half of the epithelial ovarian cancers [2]. Two-thirds of these tumors involve both ovaries [2]. 

Primary malignant neoplasms of the fallopian tube are extremely rare and account for only 0.3%-l.l% of all gynecologic cancers [4]. Most fallopian tube carcinomas present as papillary serous adenocarcinomas. The intraperitoneal spread of fallopian tube carcinomas is... 

Epithelial ovarian tumors are composed of cells that cover the surface of the ovary, such as serous, mucinous, endometrioid, clear cell, and poorly differentiated adenocarcinomas. 

Calu-3 (American type culture collection ATCC HTB-55) is a human bronchial epithelial cell line derived from an adenocarcinoma of the lung [59], This cell line has been shown to exhibit serous cell properties and form confluent monolayers of mixed cell phenotypes, including ciliated and secretory cell types [60], but the cilia are formed very irregularly and seem to disappear with increasing passage number (unpublished observations, C.E. and B.F.). Calu-3 cells have shown utility as a model to examine transport [61-63] and metabolism in human bronchial epithelial cells for many therapeutic compounds [64], Furthermore, they have been used in a number of particlecell interaction studies [65-67], The interactions between respiratory epithelial cells and particulates are discussed more in detail in Chap. 19. 

FIGURE 4.5 Representative spectrum examples of SELDI analysis of pancreatic juice samples bound to IMAC-3 cupper ProteinChip array. A peak of 16,570 Da (arrow) was present in the four pancreatic juice samples from patients with pancreatic adenocarcinoma (PC4, PCS, PC 18, PC24) but absent in the four patients with other pancreatic diseases (IPMN islet cell tumor (ICT) serous cystadenoma (SC)). (Reprinted from Rosty et al. [26], used with permission from the American Association of Cancer Research.)... 

Neoplasms that are essentially negative with most CEA antibodies include adenocarcinomas of prostate, kidney, adrenal gland, and endometrium,220 along with serous ovarian tumors and mesotheliomas. Liver cell-derived tumors are nonreacti ve with the monoclonal CEA antibodies but do react with the polyclonal antibodies... 

Longatto Filho A, Bisi H, Alves VA, et al. Adenocarcinoma in females detected in serous effusions. Gytomorphologic aspects and immunocytochemical reactivity to cytokeratins 7 and 20. Acta Cytol. 1997 41 961-971. 

Afify AM, al-Khafaji BM. Diagnostic utility of thyroid transcription factor-1 expression in adenocarcinomas presenting in serous fluids. Acta Cytol. 2002 46 675-678. 

Mesothelin is a 40-kD glycoprotein of unknown function that is strongly expressed in mesothelial cells, ovarian serous cells, and pancreatic-bile duct cells. Using monoclonal antibody 5B2, Ordonez found it to immu-nostain normal mesothelial cells, mesotheliomas, non-mucinous ovarian carcinomas, and occasionally other neoplasms. Ordonez concluded that mesothelin staining could be used to diagnose mesotheliomas, although it was expressed in 14 of 14 ovarian carcinomas, 12 of 14 pancreatic ductal adenocarcinomas, 7 of 12 desmoplastic small round cell tumors, and 9 of 9 synovial sarcomas. Therefore, this antibody should be interpreted carefully. 

D2-40, a clone of podoplanin, is a recently developed commercially available antibody directed against the M2A antigen, a 40,000-kD sialoglycoprotein associated with germ cells and lymphatic endothelium. Chu and colleagues evaluated 53 cases of mesothelioma, 28 cases of reactive pleural tissue, 30 cases of pulmonary adenocarcinoma, 35 cases of renal cell carcinoma, 26 cases of ovarian serous carcinoma, 16 cases of invasive breast carcinoma, 11 cases of prostatic adenocarcinoma, and 7 cases of urothelial carcinoma. The authors found D2-40 expression in 51 of 53 (96%) mesotheliomas, 27 of 28 (96%) reactive pleural tissues, and 17 of 26 (65%) ovarian serous carcinomas. They did not find D2-40 in the other tumors examined. The authors also observed that the neoplastic cells immunostained in a cell membrane distribution. 

Chieng DC, Yee H, Schaefer D, et al. Calretinin staining pattern aids in the differentiation of mesothelioma from adenocarcinoma in serous effusions. Cancer. 2000 25 194-200. 

Bollinger DJ, Wick MR, Dehner LP, et al. Peritoneal malignant mesothelioma versus serous papillary adenocarcinoma A his-tochemical and immunohistochemical comparison. Am J Surg Pathol. 1989 13 659-670. 

FIGURE 18.14 Markers of emerging importance in distinguishing uterine endometrioid carcinoma and uterine serous carcinoma include p33, p-catenin, and PTEN. While serous carcinomas characteristically overexpress p53 (A), endometrioid adenocarcinomas, especially when gland-forming, frequently express estrogen receptors (B), commonly show at least focal nuclear and cytoplasmic staining with anti-P-catenin (C), and lose expression of PTEN (D). 

FIGURE 18.16 p53 immunohistochemical staining can be used when the differential diagnosis includes uterine serous carcinoma (USQ and uterine endometrioid carcinoma (UEC). USC shows diffuse and intense nuclear immunoreactivity for p53 (A, B), as does the USC precursor EIC (C, D). Not infrequently, USC can demonstrate a glandular architectural pattern (E). Diffuse and intense p53 immunoreactivity in glandular use (F) can provide support for this entity when simple atypical hyperplasia and endometrioid adenocarcinoma are considerations. 

Includes ovarian, peritoneal, and tubal serous carcinomas. Except in FIGO grade 3 endometrioid adenocarcinoma, about 50% of which express significant ER and PR. 

Data regarding the sources of secondary or metastatic carcinomas to the endometrium are limited, but it is estimated that lobular breast cancers, high-grade serous ovarian and tubal carcinomas, HPV-associated endo-cervical adenocarcinomas, and typical colorectal adenocarcinomas probably constitute at least 90% of such cases. 

Darvishian F, Hummer AJ, Thaler HT, et al. Serous endometrial cancers that mimic endometrioid adenocarcinomas A clinico-pathologic and immunohistochemical study of a group of problematic cases. Am Surg Pathol. 2004 28 1568-1578. 

Albannai RA, Alkushi A, Gilks CB. Serous and endometrioid components of mixed endometrial adenocarcinoma show similar immunostaining profiles. Mod Pathol. 2009 21 194A. 

Moritani S, Ichihara S, Hasegawa M, et al. Serous papillary adenocarcinoma of the female genital organs and invasive micropapillary carcinoma of the breast. Are WTl, CA125, and GCDEP-15 useful in differential diagnosis Hum Pathol. 2008 39 666-671. 

Adenocarcinoma is the most common tumor involving the serous membranes. The most common sites of adenocarcinoma presenting as CUP are lung and... 

Bailey ME, Brown RW, Mody DR, et al. Ber-EP4 for differentiating adenocarcinoma from reactive and neoplastic mesothelial cells in serous effusions. Comparison with carcinoembryonic antigen, B72.3 andLeu-Ml. Acta Cytol. 1996 40 1212-1216. 

Delahaye M, van der Ham F, van der Kwast TH. Complementary value of five carcinoma markers for the diagnosis of malignant mesothelioma, adenocarcinoma metastasis, and reactive mesothelium in serous effusions. Diagn Cytopathol. 1997 Aug 17 115-120. 

Shield PW, Callan JJ, Devine PL. Markers for metastatic adenocarcinoma in serous effusion specimens. Diagn Cytopathol. 1995 11 1-9. 

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