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Year : 2018  |  Volume : 7  |  Issue : 2  |  Page : 26-27

Transitional morphology spill-out in high-grade ovarian serous carcinoma: Dilemmas and disputes in diagnosis

Department of Pathology, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital (SJH), New Delhi, India

Date of Submission28-Nov-2019
Date of Acceptance11-Oct-2021
Date of Web Publication14-Mar-2022

Correspondence Address:
Meetu Agrawal
Department of Pathology, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital (SJH), New Delhi.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijhi.IJHI_8_19

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How to cite this article:
Agrawal M, Singh J. Transitional morphology spill-out in high-grade ovarian serous carcinoma: Dilemmas and disputes in diagnosis. Int J Histopathol Interpret 2018;7:26-7

How to cite this URL:
Agrawal M, Singh J. Transitional morphology spill-out in high-grade ovarian serous carcinoma: Dilemmas and disputes in diagnosis. Int J Histopathol Interpret [serial online] 2018 [cited 2023 Sep 29];7:26-7. Available from: https://www.ijhi.org/text.asp?2018/7/2/26/339629

Dear Editor,

Transitional cell morphology in ovarian cancers has been identified by the presence of solid and cystic nests of multilayered epithelium (resembling urothelium). Initially classified as the Brenner family of ovarian tumors, these neoplasms have well-defined benign and malignant counterparts.[1],[2],[3]

The benign Brenner tumor (BT) is easily diagnosed owing to its classic morphology. There are solid nests of cells with pale chromatin, longitudinal grooves, and pale cytoplasm embedded against fibrous stroma. However, when a malignant tumor with transitional morphology is encountered, the approach to diagnosis must essentially address two aspects: first, to establish whether a tumor in question is originating from a preexisting BT or a de novo transitional cell carcinoma (TCC) of the ovary and second in cases with widespread involvement of the pelvic organs, origin from the urinary bladder must be ruled out.

The previous World Health Organization (WHO) classifications have combined the malignant Brenner’s and transitional carcinomas because of the overlapping features between them. With more specific and elaborate treatment protocols, it is known that malignant BTs have a better outcome than TCCs of the ovary. Therefore, they should not be clubbed under one umbrella category.[4]

In this short communication, we are addressing this diagnostic dilemma through a case that had certain overlapping morphological features.

Our patient was a 50-year-old postmenopausal married woman who was being investigated for abdominal fullness. Her radiological investigations revealed bilateral heterogenous tubo-ovarian masses with the presence of free fluid in the pelvic cavity. The urinary bladder was free from any tumor involvement. Extensive sampling of both the ovarian masses revealed tumors with similar morphology. There was extensive necrosis of the tumor with few viable areas. The viable areas showed the presence of tumor cells with broad papillary fronds covered with multilayered transitional epithelium [Figure 1]A and B. The individual tumor cells were columnar to polygonal with nuclear stratification; there were marked nuclear pleomorphism and brisk mitotic activity [Figure 1]C. In the sections from the right ovary, there were two foci showing nests of mildly atypical cells embedded in a fibrous stroma [Figure 1]D and E. The morphological possibilities considered were a malignant BT versus a TCC of the ovary. The immunohistochemical profile of the tumor including the solid islands was consistent with a TCC (strong ER+, WT1+, strong p16+, p53+, CK7−, and CK20−) [Figure 1]F–H. In diagnostic accordance with WHO 2014, the tumor was called a high-grade serous carcinoma with transitional cell morphology.
Figure 1: (A and B) Necrotic and viable areas showing broad undulating fronds of multilayered epithelium. H&E, 100×. (C) Cells showing high nuclear pleomorphism and hyperchromasia. Increased mitosis is also noted. H&E, 400×. (D and E) Both photomicrographs showing areas with entrapped solid islands of cells surrounded by a desmoplastic reaction. H&E, 100×, 200×. Nuclear positivity seen with (F) p16 (G) ER and (H) WT1

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Histopathology in correlation with immunohistochemistry favored a diagnosis of TCC. Ali et al.[4] have studied histopathological and immunohistochemical features of both TCCs and malignant BTs of the ovary and have mentioned the presence of a nested architectural pattern in an otherwise conventional TCC of the ovary. Our case too was a diagnostic problem due to the presence of nests of cells in a fibrotic stroma. These findings in our case could also be explained by this variant morphology of ovarian TCC.

The current WHO book, however, does not enlist the TCC as a separate entity. “Transitional” is just a pattern recognized in high-grade serous carcinomas that are defined as the presence of a papillary pattern with thick undulating bands of epithelial cells closely resembling urothelial carcinoma.[5]

This case is presented here as it is a classic example of a tumor entity that has been earlier separately described by WHO as a TCC. According to WHO 2014, this case is a high-grade serous carcinoma, albeit with a transitional morphology. Our dilemma in this case is the presence of small focus of islands resembling solid Brenner’s islands surrounded by a fibrotic stroma. But immunohistochemistry helped us to conclusively reach a diagnosis. This case also endorses that the carcinomas with transitional cell morphology are actually high-grade serous ovarian carcinomas and should be classified as such. A note must be made of the transitional morphology in the report. Further reporting of these tumors would better help to delineate their outcome.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Lee KR, Tavassoli FA, Prat J. Surface epithelial-stromal tumours. In: Tavassoli FA, Devilee P, editors. Pathology and Genetics: Tumours of the Breast and Female Genital Organs. World Health Organization Classification of Tumours 2003. Lyon: IARC Press; 2003. p. 177-45.  Back to cited text no. 1
Cuatrecasas M, Catasus L, Palacios J, Prat J. Transitional cell tumors of the ovary: A comparative clinicopathologic, immunohistochemical, and molecular genetic analysis of Brenner tumors and transitional cell carcinomas. Am J Surg Pathol 2009;33:556-67.  Back to cited text no. 2
Seldenrijk CA, Willig AP, Baak JP, Kühnel R, Rao BR, Burger CW, et al. Malignant Brenner tumor: A histologic, morphometrical, immunohistochemical, and ultrastructural study. Cancer 1986;58:754-60.  Back to cited text no. 3
Ali RH, Seidman JD, Luk M, Kalloger S, Blake Gilks C. Transitional cell carcinoma of the ovary is related to high-grade serous carcinoma and is distinct from malignant Brenner tumor. Int J Gynecol Pathol2012;31:499-506.  Back to cited text no. 4
Kurman RJ, Carcangiu ML, Herrington CS, Young RH, WHO Classification of Tumours of Female Reproductive Organs. 4th ed. Lyon: IARC; 2014.  Back to cited text no. 5


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