Cytopathology of serous neoplasia of the ovary and the peritoneum: differential diagnosis from mesothelial proliferations

Our plain-English summary of Cytopathology of serous neoplasia of the ovary and the peritoneum: differential diagnosis from mesothelial proliferations, by L.R. Pisharodi, C.W. Bedrossian (Diagnostic Cytopathology, 1996).

The study

• Authors: L.R. Pisharodi, C.W. Bedrossian
• Journal: Diagnostic Cytopathology
• Published: 1996;15(4):292-5
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Serous neoplasia of the ovary ranges from benign adenomas through serous borderline tumors to invasive serous adenocarcinoma. This spectrum of neoplasia is at least partially reflected in the cytomorphologic features of the lesions. The objective of this study is to review the cytopathology of serous neoplasia of the ovary. In addition, cytologic features of serous surface papillary carcinoma and its distinction from peritoneal mesothelial proliferations are discussed.

In plain English

This article from Wayne State University in Detroit described how cells in abdominal and pelvic fluid samples look microscopically. It aimed to help distinguish serous tumors of the ovary and peritoneum from mesothelial cell growths, including peritoneal mesothelioma. The authors reviewed fluids from 19 patients with serous borderline tumors (60 washings), 12 with serous adenocarcinoma (26 fluids), two with serous surface papillary carcinoma (four washings) and two with peritoneal mesothelioma (two fluids). For comparison they added two reactive mesothelial hyperplasia fluids from patients with liver cirrhosis. Tumor cells were found in 35 of the 60 borderline-tumor specimens. The authors reported that borderline tumors could be distinguished from serous carcinoma. Cells from serous surface papillary carcinoma looked like serous carcinoma cells. The two mesothelioma fluids showed findings diagnostic of mesothelial neoplasia, differing considerably from serous neoplasia. The article gave no asbestos-exposure histories for its own patients; its discussion cited earlier reports linking peritoneal mesothelioma with asbestos, radiation and repeated peritonitis. The authors concluded that careful characterization of these cells is extremely important because it may alter treatment and prognosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive case series reviewing the cytology (cell appearance) of fluid specimens, with histologic slides reviewed; features graded semiquantitatively
• Who was studied: 92 peritoneal and pelvic washings and ascitic fluids from 35 patients, broken down as: 60 washings from 19 patients with serous borderline tumors, 26 fluids from 12 patients with serous adenocarcinoma, 4 washings from 2 patients with serous surface papillary carcinoma, and 2 ascitic fluids from 2 patients with peritoneal mesothelioma. Two ascitic fluids with reactive mesothelial hyperplasia, from patients with liver cirrhosis, were added for comparison. Cases came from a large inner-city women's hospital and one author's consultation files; study dates are not given.
• Exposure: No exposure was studied. In the discussion, the authors noted that earlier literature has described peritoneal mesothelioma in association with asbestos exposure, radiation therapy and repeated peritonitis. Asbestos exposure of this study's patients was not reported.
• Main results:
  • Serous borderline tumors: neoplastic cells were present in 35 of 60 specimens, and the presence of these cells correlated with ovarian surface involvement seen on histologic sections.
  • Serous borderline tumors: 25 washings contained no tumor cells. In two cytology-positive cases there was no histologically documented surface involvement.
  • Serous borderline tumors: psammoma bodies were present in approximately 50% of cases.
  • Serous carcinoma showed obviously malignant cell features that were distinct from serous borderline tumors.
  • In the two serous surface papillary carcinoma patients, the tumor cells were indistinguishable from serous carcinoma. The only difference observed was a greater abundance of tumor cells in the fluid.
  • In the two peritoneal mesothelioma cases, the fluids were richly cellular with mesothelial-type cells. The findings were diagnostic of mesothelial neoplasia and differed considerably from serous neoplasia.
  • In the two reactive mesothelial hyperplasia specimens, the cells showed a range of reactive changes, including pleomorphism (variation in cell shape and size) and occasional mitotic activity.
• The authors' conclusion: The authors concluded that careful evaluation and characterization of tumor cells in peritoneal and pelvic fluids is extremely important because it may significantly alter treatment and prognosis. They also stated that their study found serous borderline tumors could be separated from serous carcinoma by cell appearance.
• Limitations the authors state:
  • The authors stated that more studies with prolonged follow-up are needed to assess any difference in prognosis between borderline-tumor patients with positive and negative fluid cytology.
  • The series included no examples of serous borderline tumor of the peritoneum. An addendum reported one such case seen after the article was accepted.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Ovarian cancer, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Cytology, Peritoneum, Differential Diagnosis, Adenocarcinoma, Carcinoma.

Related studies

• Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum — R.L. Attanoos, R. Webb, et al. (2002)
• Loss of BAP1 expression is very rare in peritoneal and gynecologic serous adenocarcinomas and can be useful in the differential diagnosis with abdominal mesothelioma — J. Andrici, J. Jung, et al. (2016)
• Is PAX2 a reliable marker in differentiating diffuse malignant mesotheliomas of peritoneum from serous carcinomas of müllerian origin? — F.F. Gao, A.M. Krasinskas, et al. (2012)
• Peritoneal malignant mesothelioma (PMM), and primary peritoneal serous carcinoma (PPSC) and reactive mesothelial hyperplasia (RMH) of the peritoneum. Immunohistochemical and fluorescence in situ hybridisation (FISH) analyses — T. Kawai, S. Tominaga, et al. (2016)
• Mesothelioma of the pelvic peritoneum resembling papillary cystadenocarcinoma of the ovary; case report — M. Swerdlow (1959)
• PAX8 reliably distinguishes ovarian serous tumors from malignant mesothelioma — A.R. Laury, J.L. Hornick, et al. (2010)

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