Plain Language Explanation of Ovarian Cancer Pathology Findings
This biopsy confirms invasive ovarian cancer that has spread beyond the ovaries, with specific features indicating it is a high-grade serous carcinoma—the most common and aggressive type of ovarian cancer.
What the Microscope Shows
Under the microscope, the pathologist found cancer cells growing in sheets and clusters within fatty tissue, surrounded by dense scar-like tissue (desmoplastic stroma). 1 This pattern of growth—where cancer cells form solid masses rather than organized glands—is characteristic of aggressive ovarian cancer. 1
The cancer cells themselves have several concerning features:
- Enlarged, darkly stained nuclei (the control centers of cells) that look abnormal and vary in size—this is called "moderate pleomorphism" 1
- Prominent nucleoli (structures inside the nucleus) that are easily visible, indicating very active cells 1
- Abundant pink cytoplasm (the cell body surrounding the nucleus) when stained with standard dyes 1
What the Special Stains Tell Us
The immunohistochemistry results—special protein stains that act like molecular fingerprints—confirm this cancer originated in the ovary rather than spreading from another organ. 2, 3, 4
The positive stains include:
- CK7 and AE1/3 (cytokeratins): These mark the cells as epithelial cancer (cancer arising from surface or glandular tissue) 3, 4, 5
- PAX8 and WT1: These two markers together strongly indicate ovarian origin, as they are typically positive in ovarian cancers but negative in cancers from the colon or other abdominal organs 3, 4, 6
The negative stains help rule out other cancer sources:
- CK20 and CDX2 negative: This essentially excludes colorectal cancer that has spread to the ovary, since colon cancers are almost always positive for these markers 3, 5, 6
The p53 Finding
The p53 overexpression found in the fluid around your abdomen (ascitic fluid) is a hallmark of high-grade serous ovarian carcinoma. 4 The p53 protein normally acts as a "brake" on cell growth, but when mutated (as indicated by overexpression), cells grow uncontrollably. This finding appears in approximately 96% of high-grade serous ovarian cancers and confirms the aggressive nature of this tumor. 4
What This Means Clinically
The presence of cancer cells in ascitic fluid with these features indicates at least Stage III disease—meaning the cancer has spread beyond the pelvis to the abdominal cavity. 1, 7 The combination of:
- Invasive cancer in solid sheets and nests 1
- Desmoplastic stroma (dense scar tissue response) 1, 7
- Cancer cells in abdominal fluid 1, 4
...confirms this is not early-stage disease confined to the ovaries. 1, 7
Important Context
High-grade serous carcinoma requires platinum-based chemotherapy and complete surgical removal of all visible disease when possible. 1 The specific immunohistochemical profile (PAX8+/WT1+/CK7+/CK20-/CDX2-) definitively establishes ovarian origin, which is crucial because treatment differs significantly from other abdominal cancers. 2, 3, 4
The pathologist's thorough analysis using multiple tissue samples and special stains follows standard guidelines to ensure accurate diagnosis and appropriate treatment planning. 1