Neoadjuvant chemotherapy for low-grade serous carcinoma of the ovary

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5571-5571
Author(s):  
K. M. Schmeler ◽  
C. C. Sun ◽  
D. C. Bodurka ◽  
M. T. Deavers ◽  
R. L. Coleman ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Progression Free Survival ◽  
Exploratory Laparotomy ◽  
Complete Response ◽  
Serous Carcinoma ◽  
Ca 125 ◽  
Low Grade ◽  
High Grade ◽  
Ovarian Carcinomas ◽  
Platinum Based Chemotherapy

5571 Background: Neoadjuvant chemotherapy (NACT) has been associated with significant tumor reduction prior to interval debulking surgery, enabling optimal cytoreduction in up to 50% of patients with high-grade ovarian carcinomas deemed initially unresectable. Since low-grade serous carcinoma (LGSC) appears to be relatively less chemosensitive, we sought to evaluate the outcomes of women with ovarian LGSC treated with platinum-based NACT. Methods: Using institutional databases, we identified 18 women with low-grade serous carcinomas of the ovary who were treated with neoadjuvant platinum-based chemotherapy between 1978 and 2003. Patient demographic and clinical variables were abstracted from the medical records. Progression-free survival (PFS) and overall survival (OS) were estimated using the method of Kaplan-Meier. Results: The median age at diagnosis was 44 years (range, 21 to 81 years). NACT was given for extensive or non-resectable disease in 16 patients (89%) and for unknown reasons in 2 patients (11%). Ten patients (42%) underwent exploratory laparotomy with biopsy only prior to beginning chemotherapy. A median of 6 cycles of chemotherapy was given (range, 2 to 16) and included the following regimens: platinum/taxane (n=12 patients); platinum/cyclophosphamide (n=3 patients); and platinum/leuprolide acetate (n=3 patients). Of the 13 patients who had CA-125 levels available, 8 (62%) had a ≥50% reduction between pre- and post-NACT levels. However, response, determined by radiographic survey at completion of NACT, demonstrated one patient (6%) with a complete response, no patients (0%) with a partial response, and 16 patients (89%) with stable disease. One patient (6%) was not evaluable. Fifteen patients (83%) underwent interval cytoreductive surgery, which was optimal in 8 cases (53%), suboptimal in 4 cases (27%) and unknown in 3 cases (20%). Median PFS and OS for all patients were 18.6 and 56.1 months, respectively. Conclusions: A low response rate to platinum-based NACT was observed among women with LGSC of the ovary. These findings suggest that LGSC is not as responsive to conventional chemotherapy as high-grade serous carcinoma. Prospective clinical trials, focusing specifically on LGSC, are needed to make meaningful advances for this group of patients. No significant financial relationships to disclose.

scholarly journals Impact of Age and Primary Disease Site on Outcome in Women With Low-Grade Serous Carcinoma of the Ovary or Peritoneum: Results of a Large Single-Institution Registry of a Rare Tumor

2015 ◽  
Vol 33 (24) ◽  
pp. 2675-2682 ◽  
Author(s):  
David M. Gershenson ◽  
Diane C. Bodurka ◽  
Karen H. Lu ◽  
Lisa C. Nathan ◽  
Ljiljana Milojevic ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariable Analysis ◽  
Progression Free Survival ◽  
Hazard Ratio ◽  
Serous Carcinoma ◽  
Low Grade ◽  
Primary Therapy ◽  
Free Survival ◽  
Platinum Based Chemotherapy ◽  
Carcinoma Of The Ovary

Purpose Low-grade serous carcinoma of the ovary (LGSOC) or peritoneum (LGSPC) is a rare subtype of ovarian or peritoneal cancer characterized by young age at diagnosis and relative resistance to chemotherapy. The purpose of this study is to report our updated experience with women diagnosed with LGSOC or LGSPC to assess the validity of our original observations. Patients and Methods Eligibility criteria for patients from our database were: stage I to IV LGSOC or LGSPC, original diagnosis before January 2012, and adequate clinical information. All patients were included in progression-free survival, overall survival, and multivariable Cox regression analyses. A subset analysis was performed among patients with stage II to IV low-grade serous carcinoma treated with primary surgery followed by platinum-based chemotherapy. Results We identified 350 eligible patients. Median progression-free survival was 28.1 months; median overall survival was 101.7 months. In the multivariable analysis, compared with women age ≤ 35 years, those diagnosed at age > 35 years had a 43% reduction in likelihood of dying (hazard ratio, 0.53; 95% CI, 0.37 to 0.74; P < .001). Having disease present at completion of primary therapy was associated with a 1.78 increased hazard of dying compared with being clinically disease free (P < .001). Similar trends were noted in the smaller patient cohort. In this cohort, women with LGSPC had a 41% decreased chance of dying (hazard ratio, 0.59; 95% CI, 0.36 to 0.98; P = .04) compared with those with LGSOC. Conclusion Women age < 35 years with low-grade serous carcinoma and those with persistent disease at completion of primary therapy have the worst outcomes. Patients with LGSPC seem to have a better prognosis than those with LGSOC.

scholarly journals Clinicopathological Spectrum of Surface Epithelial Ovarian Carcinoma and its Association with Serum CA-125 Levels: A Cohort Study

2021 ◽  
Author(s):  
Nisha Singla ◽  
Sarita Nibhoria ◽  
Kanwardeep Kaur Tiwana ◽  
Prince Gupta
Keyword(s):  
Cohort Study ◽  
Ovarian Carcinoma ◽  
World Health ◽  
Serous Carcinoma ◽  
Ca 125 ◽  
Categorical Variables ◽  
Low Grade ◽  
High Grade ◽  
History Of ◽  
Epithelial Tumours

Introduction: The ovaries are the primary female reproductive organs and endocrine glands. Ovarian carcinoma has often been called as the silent killer because the symptoms may develop so late that the chances of cure are very poor. According to World Health Organisation (WHO) ovarian tumours are classified based upon their most probable tissue of origin: surface epithelial (65%), germ cell (15%), sex cord-stromal (10%), metastases (5%) and miscellaneous. The malignant surface epithelial tumours are further classified by cell type into serous, mucinous, endometrioid, clear cell, brenner, seromucinous and undifferentiated carcinoma. The most widely used tumour marker in ovarian carcinoma is CA-125 which is considered as gold standard. Aim : To find the utility of serum CA-125 levels in histopathological variants of malignant surface epithelial tumours, degree of differentiation and their distribution according to clinical data pertaining to age, parity, history of use of oral contraceptive pills/ovulation inducing drugs and family history of carcinoma ovary/breast or colon. Materials and Methods: A prospective study (cohort study) was done at Guru Gobind Singh Medical College and Hospital, Faridkot over a period of 1.5 year (April 2017-oct 2018) on 50 ovarian masses which were diagnosed as ovarian carcinoma. Data was represented as frequencies and percentages for categorical variables and as means and standard deviations for continuous variables. Analysis was done using Statistical Package for Social Sciences (SPSS) v 20.0.0. Results: Serous carcinoma (80%) topped among all the histological variants. Serous high grade carcinoma was more common than serous low grade carcinoma. Maximum rise of serum CA-125 levels were seen in serous carcinoma. Among serous carcinomas, mean serum CA-125 levels were more in high grade serous carcinoma than low grade serous carcinoma and the results were statistically significant. conclusion: Serum CA-125 level is a great tool for diagnosis, follow-up and prognosis of ovarian carcinomas.

scholarly journals Effect of prophylactic salpingectomy on ovarian function in premenopausal women in tertiary referral center

2017 ◽  
Vol 6 (10) ◽  
pp. 4243
Author(s):  
Tamer M. Abdel Dayem ◽  
Amira M. Badawy
Keyword(s):  
Ovarian Function ◽  
Premenopausal Women ◽  
Serous Carcinoma ◽  
Low Grade ◽  
Type I ◽  
Ovarian Cancer Risk ◽  
High Grade ◽  
Ovarian Carcinomas ◽  
Ovarian Cancers ◽  
Prophylactic Salpingectomy

Background: Epithelial ovarian cancers (EOCs) are the most common cause of death from gynaecological malignancy. Serous ovarian carcinomas represent (68%) of Epithelial ovarian cancers, they are further divided into low-grade (type I) and high-grade (type II) serous ovarian carcinomas. There has been increasing evidence that fallopian tubes are considered the most important site of origin of pelvic high grade serous carcinoma. Salpingectomy is thought to be effective in reducing ovarian cancer risk in the future and prolonging average life expectancy, however, there are some concerns regarding ovarian function after elective salpingectomy in premenopausal women. The current study was carried out to assess the effect of salpingectomy on ovarian function in premenopausal women.Methods: 60 premenopausal cases were recruited and subjected to open abdominal hysterectomy without oophorectomy (for benign indications). Included cases were below 45 years, with documented active ovarian functions. Cases with genital malignancy, ovarian gross pathology and suspected or known ovarian failure were excluded. Cases were randomly allocated to one of two groups; group-A (where salpingectomy was performed), and group-B (where salpingectomy was not done). For all patients, ovarian functions were assessed prior operation, and at one and three months after operation using serum anti-Mullarian hormone (AMH) as well as early follicular antral follicular count (AFC), serum follicle stimulating hormone (FSH) and serum oestradiol (E2).Results: The mean pre-operative AFC, AMH, FSH, and E2 levels showed no significant changes after operation at one and three months postoperative follow up in both studied groups, denoting preserved ovarian function in both groups.Conclusions: Prophylactic salpingectomy is a safe and simple procedure that has no effect on ovarian reserve or function when performed in premenopausal women.

scholarly journals Bilateral Serous Psammocarcinoma of Ovary: Rare Variant Low Grade Serous Carcinoma

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Saubhagya Kumar Jena ◽  
Pritinanda Mishra ◽  
Vandana Mohapatra ◽  
Sweta Singh
Keyword(s):  
Rare Variant ◽  
Elevated Serum ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Serous Carcinoma ◽  
Ca 125 ◽  
Low Grade ◽  
Primary Debulking Surgery ◽  
Stage Disease ◽  
Enhanced Computed Tomography

Serous psammocarcinoma is a rare variant of serous carcinoma arising from either ovary or peritoneum, characterized by massive psammoma body formation, low grade cytologic features, and invasiveness. Its clinical behavior is similar to serous borderline tumors with relatively favorable prognosis. We report herein a case of a 60-year-old postmenopausal woman who presented with abdominal distension. Contrast enhanced computed tomography (CECT) revealed calcified pelvic masses with ascites. Elevated serum CA-125 (970 U/mL) suggested malignant ovarian neoplasm. Patient underwent exploratory laparotomy with primary debulking surgery. Histopathology showed bilateral serous psammocarcinoma of ovary with invasive implants on omentum. Adjuvant chemotherapy was advised in view of advanced stage disease, although its benefits are poorly defined due to rarity of the tumor. However, patient opted out of it and is now on follow-up.

scholarly journals MILO/ENGOT-ov11: Binimetinib Versus Physician’s Choice Chemotherapy in Recurrent or Persistent Low-Grade Serous Carcinomas of the Ovary, Fallopian Tube, or Primary Peritoneum

2020 ◽  
Vol 38 (32) ◽  
pp. 3753-3762 ◽  
Author(s):  
Bradley J. Monk ◽  
Rachel N. Grisham ◽  
Susana Banerjee ◽  
Elsa Kalbacher ◽  
Mansoor Raza Mirza ◽  
...  
Keyword(s):  
Kras Mutation ◽  
Mapk Pathway ◽  
Randomized Study ◽  
Progression Free Survival ◽  
Low Grade ◽  
Ovarian Carcinomas ◽  
End Points ◽  
End Point ◽  
Platinum Based Chemotherapy ◽  
Response To Chemotherapy

PURPOSE Low-grade serous ovarian carcinomas (LGSOCs) have historically low chemotherapy responses. Alterations affecting the MAPK pathway, most commonly KRAS/BRAF, are present in 30%-60% of LGSOCs. The purpose of this study was to evaluate binimetinib, a potent MEK1/2 inhibitor with demonstrated activity across multiple cancers, in LGSOC. METHODS This was a 2:1 randomized study of binimetinib (45 mg twice daily) versus physician’s choice chemotherapy (PCC). Eligible patients had recurrent measurable LGSOC after ≥ 1 prior platinum-based chemotherapy but ≤ 3 prior chemotherapy lines. The primary end point was progression-free survival (PFS) by blinded independent central review (BICR); additional assessments included overall survival (OS), overall response rate (ORR), duration of response (DOR), clinical-benefit rate, biomarkers, and safety. RESULTS A total of 303 patients were randomly assigned to an arm of the study at the time of interim analysis (January 20, 2016). Median PFS by BICR was 9.1 months (95% CI, 7.3 to 11.3) for binimetinib and 10.6 months (95% CI, 9.2 to 14.5) for PCC (hazard ratio,1.21; 95%CI, 0.79 to 1.86), resulting in early study closure according to a prespecified futility boundary after 341 patients had enrolled. Secondary efficacy end points were similar in the two groups: ORR 16% (complete response [CR]/partial responses[PRs], 32) versus 13% (CR/PRs, 13); median DOR, 8.1 months (range, 0.03 to ≥ 12.0 months) versus 6.7 months (0.03 to ≥ 9.7 months); and median OS, 25.3 versus 20.8 months for binimetinib and PCC, respectively. Safety results were consistent with the known safety profile of binimetinib; the most common grade ≥ 3 event was increased blood creatine kinase level (26%). Post hoc analysis suggests a possible association between KRAS mutation and response to binimetinib. Results from an updated analysis (n = 341; January 2019) were consistent. CONCLUSION Although the MEK Inhibitor in Low-Grade Serous Ovarian Cancer Study did not meet its primary end point, binimetinib showed activity in LGSOC across the efficacy end points evaluated. A higher response to chemotherapy than expected was observed and KRAS mutation might predict response to binimetinib.

scholarly journals A Modified 2 Tier Chemotherapy Response Score (CRS) and Other Histopathologic Features for Predicting Outcomes of Patients with Advanced Extrauterine High-Grade Serous Carcinoma after Neoadjuvant Chemotherapy

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 704
Author(s):  
Yanping Zhong ◽  
Jinsong Liu ◽  
Xiaoran Li ◽  
Shannon N. Westin ◽  
Anais Malpica ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Prognostic Significance ◽  
Clinical Information ◽  
Progression Free Survival ◽  
Serous Carcinoma ◽  
Chemotherapy Response ◽  
High Grade ◽  
Entire Cohort ◽  
The Impact ◽  
Response Score

Background: The impact of chemotherapy response score (CRS) on prognosis has varied among studies. We addressed the prognostic significance of CRS and the prognostic value of previously undescribed histologic features using a cohort of 245 patients. Methods: Retrospective study in patients with advanced extrauterine high-grade serous carcinomas treated with neoadjuvant chemotherapy followed by interval tumor reductive surgery from 1990 to 2018 in our hospital. Gynecologic pathologists assessed tumor CRS and other histologic features. Clinical information was collected, and multivariate analyses were conducted. Results: A modified 2 tier CRS (CRS 1/2 versus CRS 3) was significantly associated, independent of scoring site (omental versus adnexal), with overall survival (OS) (omentum, p = 0.018; adnexa, p = 0.042; entire cohort, p = 0.002) and progression-free survival (PFS) (p = 0.021, p = 0.035, and p = 0.001, respectively). On multivariate survival analysis, 2 tier CRS, oncocytic change, inflammation, and desmoplasia were significant for OS (p = 0.034, p = 0.020, p = 0.007, and p = 0.010, respectively). Likewise, 2 tier CRS, inflammation, and desmoplasia were significant for PFS (p = 0.012, p = 0.003, p = 0.011, respectively). Conclusions: The modified 2 tier CRS was significantly associated with survival, independent of scoring site. Additional histologic features including oncocytic change, inflammation, and desmoplasia can also predict patient outcomes.

BRCA1, Ki67, and β-Catenin Immunoexpression Is Not Related to Differentiation, Platinum Response, or Prognosis in Women With Low- and High-Grade Serous Ovarian Carcinoma

2018 ◽  
Vol 28 (3) ◽  
pp. 437-447 ◽  
Author(s):  
Luis Felipe Sallum ◽  
Liliana Andrade ◽  
Larissa Bastos Eloy da Costa ◽  
Susana Ramalho ◽  
Amanda Canato Ferracini ◽  
...  
Keyword(s):  
Residual Disease ◽  
International Federation ◽  
Clinicopathological Features ◽  
Low Grade ◽  
High Grade ◽  
Poor Survival ◽  
Ovarian Carcinomas ◽  
Gynecology And Obstetrics ◽  
Stage Disease ◽  
Platinum Based Chemotherapy

ObjectiveThe purpose of this study was to compare the immunohistochemical expression of BRCA1, Ki67, and β-catenin in women with low-grade (LGSOC) and high-grade serous ovarian carcinomas (HGSOC) and their relationship with clinicopathological features, response to platinum-based chemotherapy, and survival.MethodsFor this study, 21 LGSOC and 85 HGSOC stage I to IV cases, diagnosed and treated from 1996 to 2013 and followed-up until December 2016, were included. BRCA1, Ki67, and β-catenin expression was assessed using tissue microarray-based immunohistochemistry.ResultsWomen with HGSOC were significantly more likely to have advanced-stage disease (P < 0.001), higher CA125 levels (P < 0.001), postsurgery residual disease (P < 0.01), and higher rates of disease progression and recurrence (P = 0.001). The percentage of women with HGSOC whose tumors expressed Ki67 was significantly higher compared with women with LGSOC (P < 0.001). The expression of BRCA1 and β-catenin did not differ between LGSOC and HGSOC (P = 0.12 and P = 1.00, respectively). The clinicopathological features and the response to platinum-based chemotherapy did not differ according to the BRCA1, Ki67, and β-catenin expression in either group. In HGSOC, only International Federation of Gynecology and Obstetrics stage was independently associated with poor survival (PFS and OS).ConclusionsKi67 expression was significantly higher in HGSOC. BRCA1 and β-catenin expression did not differ between LGSOC and HGSOC samples. BRCA1, Ki67, and β-catenin expression was neither related to clinicopathological features, response to platinum-based chemotherapy, nor survival. Only International Federation of Gynecology and Obstetrics stage remained associated with poor survival in women with HGSOC.

The efficacy of palliative radiation therapy in the treatment of recurrent and metastatic ovarian cancer.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 129-129
Author(s):  
Anish Butala ◽  
Roshal Patel ◽  
Joshua Adam Jones ◽  
Neil Taunk
Keyword(s):  
Ovarian Cancer ◽  
Radiation Therapy ◽  
Clinical Response ◽  
Complete Response ◽  
Optimal Timing ◽  
Low Grade ◽  
Primary Therapy ◽  
High Grade ◽  
Symptomatic Disease ◽  
Platinum Based Chemotherapy

129 Background: Ovarian cancer is the 2nd most common gynecologic malignancy with surgery and platinum-based chemotherapy as the mainstay of initial treatment. However, ovarian cancer has generally high rates of recurrence and metastasis after primary therapy. For patients with progressive or symptomatic disease, radiation therapy (RT) can be utilized as an effective option for palliation. Methods: A retrospective review was conducted of patients treated with palliative RT for symptomatic or recurrent ovarian cancer between 2015-2019 at a single institution. 17 women were identified who received 20 courses of RT. Response was classified as complete response (CR), partial response (PR), and progressive disease (PD). Overall response rate (ORR) was the sum of CR and PR. Results: Median age at RT was 57 (range 36-76). Histologic subtypes were high grade serous (65%), low grade serous (12%), clear cell (12%), and other (12%). The most common indications were pain (65%), bleeding (30%), and asymptomatic progression (20%). 18 of 20 RT courses were delivered to soft tissue or nodal metastases. RT techniques included 2D/3D (60%), IMRT (30%), and SBRT (10%). Dose ranged from 20-60 Gy in 3-28 fractions. 20 Gy in 5 fractions (25%) and 30-31 Gy in 10 fractions (25%) were most common. Of the 16 RT courses for symptomatic disease, clinical ORR was 87.5% within 3 months of RT (50% PR and 37.5% CR). 3 treatments had sustained response beyond 3 months. 2 developed PD. Of 11 RT courses with follow-up imaging, radiographic ORR was 36.1% (27% PR and 9.1% CR) within 3 months of RT. 1 had sustained PR beyond 3 months. Of the 10 RT courses for symptomatic high grade serous histology, PR and CR was seen in 50% and 40% of patients within 3 months (90% ORR). Conclusions: Palliative RT offers high rates of clinical response for symptomatic patients with metastatic ovarian cancer within 3 months of treatment delivery. Rapid clinical response rates were particularly favorable for those with high grade serous histology. RT should be considered as a standard palliative option for patients with symptomatic ovarian cancer metastases. Further prospective studies are warranted to establish the optimal timing, dose, and relation to chemosensitivity in this setting.

Survival Rates for International Federation of Gynecology and Obstetrics Stage III Ovarian Carcinoma by Cell Type: A Study of 262 Unselected Patients With Uniform Pathologic Review

2012 ◽  
Vol 22 (3) ◽  
pp. 367-371 ◽  
Author(s):  
Jeffrey D. Seidman ◽  
Anna Yemelyanova ◽  
Jonathan A. Cosin ◽  
Anthony Smith ◽  
Robert J. Kurman
Keyword(s):  
Ovarian Cancer ◽  
International Federation ◽  
Stage Iii ◽  
Serous Carcinoma ◽  
Published Data ◽  
Low Grade ◽  
High Grade ◽  
Cell Type ◽  
Ovarian Carcinomas ◽  
Gynecology And Obstetrics

ObjectivePublished data are conflicting on the influence of cell type on prognosis in ovarian cancer. The recent separation of low-grade serous carcinoma as a distinctive cell type of ovarian cancer with an indolent behavior, in retrospect, suggests that survival in studies that have not separated this group may be inaccurate.MethodsAn unselected series of 262 International Federation of Gynecology and Obstetrics stage III ovarian carcinomas was studied. Diagnostic classification of each tumor was made with particular attention to recent refinements in cell-type classification. Survival curves were constructed according to Kaplan-Meier and compared with the log-rank test.ResultsThe 5-year survival for 207 high-grade serous carcinomas was 40%, as compared with 71% for 18 patients with low-grade serous carcinoma (P = 0.0113). Low-grade serous carcinoma was significantly more likely to be optimally debulked (P = 0.0039) and significantly less likely to be substage IIIC (P < 0.0001). The survival for carcinosarcoma was significantly inferior to all serous carcinomas (P = 0.0322). The significance of this latter comparison was lost when carcinosarcomas were compared with only high-grade serous carcinoma (P > 0.05).ConclusionsLow-grade serous carcinoma has a significantly better prognosis than high-grade serous carcinoma and also differs with regard to substage distribution and proportion of patients optimally debulked. Because of its excellent prognosis, failure to separate low-grade serous carcinomas, notwithstanding its infrequent occurrence, can change the results of survival analyses that do not make this separation.

scholarly journals What Is New on Ovarian Carcinoma: Integrated Morphologic and Molecular Analysis Following the New 2020 World Health Organization Classification of Female Genital Tumors

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 697
Author(s):  
Antonio De Leo ◽  
Donatella Santini ◽  
Claudio Ceccarelli ◽  
Giacomo Santandrea ◽  
Andrea Palicelli ◽  
...  
Keyword(s):  
Clear Cell ◽  
World Health ◽  
Serous Carcinoma ◽  
Low Grade ◽  
High Grade ◽  
Ovarian Carcinomas ◽  
Histologic Subtype ◽  
Health Organization ◽  
Female Genital

Ovarian carcinomas represent a heterogeneous group of neoplasms consisting of separate entities with distinct risk factors, precursor lesions, pathogenesis, patterns of spread, molecular profiles, clinical course, response to chemotherapy, and outcomes. The histologic subtype and the related molecular features are essential for individualized clinical decision-making. The fifth edition of the World Health Organization classification of tumors of the female genital tract divides ovarian carcinomas into at least five main and distinct types of ovarian carcinomas: high-grade serous carcinoma, low-grade serous carcinoma, endometrioid carcinoma, clear cell carcinoma, and mucinous carcinoma. Molecular pathology has improved the knowledge of genomic landscape of ovarian carcinomas identifying peculiar alterations for every histologic subtype. It is well-known that high-grade and low-grade serous carcinomas are separate entities with entirely different morphologic and molecular characteristics. TP53 and BRCA mutations are typical of high-grade serous carcinoma, whereas BRAF and KRAS mutations frequently occur in low-grade serous carcinoma. Endometrioid and clear cell carcinomas are frequently associated with endometriosis. Endometrioid tumors are characterized by β-catenin alterations, microsatellite instability, and PTEN and POLE mutations, while ARID1A mutations occur in both endometrioid and clear cell carcinomas. Mucinous carcinomas are uncommon tumors associated with copy-number loss of CDKN2A and KRAS alterations and metastasis from other sites should always be considered in the differential diagnosis.

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