Low-grade serous primary peritoneal carcinoma☆,☆☆
Research Highlights
► This study is the first reported series of women with low-grade serous primary peritoneal cancer. ► The pathogenesis and clinical behavior of low-grade serous ovarian and primary peritoneal are distinct from high-grade serous tumors. ► Women with low-grade primary peritoneal cancer have high rates of persistent disease at the completion of primary treatment, yet have a prolonged survival.
Introduction
Primary peritoneal carcinoma (PPC) is a malignancy that diffusely involves the peritoneal surfaces while sparing or minimally involving the ovaries [1], [2], [3], [4]. It is histologically indistinguishable from epithelial ovarian cancer, and has similar clinical characteristics, patterns of spread, response to treatment, and survival rates [3], [5], [6], [7], [8], [9]. Previous reports have suggested that women with PPC have similar epidemiologic features to women with epithelial ovarian cancer, with the exception of an older age at diagnosis and increased rate of obesity [8], [10], [11], [12], [13], [14]. The recommended treatment for serous PPC is similar to that for serous ovarian carcinoma; however, optimal cytoreduction may be more difficult to achieve in women with PPC due to widespread peritoneal disease without the presence of a predominant pelvic or ovarian mass [15].
To date, most of the literature evaluating PPC has focused on patients with high-grade serous tumors, with little published about low-grade serous PPC. There is now an increasing body of literature on low-grade serous ovarian carcinomas. Low-grade serous ovarian carcinomas represent approximately 10% of ovarian carcinomas [16] and have distinct histologic, pathologic and clinical features [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27]. Previous studies have reported that women with low-grade serous ovarian carcinomas are diagnosed at a younger age, have a longer overall survival, and yet have a lower response rate to platinum-based chemotherapy compared with women with high-grade serous ovarian carcinoma [28], [29], [30]. However, it remains unclear if these features are similar in women with low-grade PPC. A systematic MEDLINE search (keywords primary peritoneal cancer, low-grade serous ovarian and peritoneal cancer, English language, 1950 to 2010) revealed no reports of low-grade serous PPC. To further explore this issue, we retrospectively evaluated the clinical and pathologic characteristics of women with low-grade serous PPC.
Section snippets
Materials and methods
Following the approval from The University of Texas MD Anderson Cancer Center Institutional Review Board, we searched the institutional databases of the Departments of Gynecologic Oncology and Pathology to identify patients with low-grade serous primary peritoneal carcinoma. Although a histopathologic review of all cases had been performed at the time of original diagnosis and/or presentation to MD Anderson Cancer Center, all cases were re-reviewed by a gynecologic pathologist for the purposes
Results
Our database search identified 53 eligible patients with low-grade serous PPC evaluated at The University of Texas MD Anderson Cancer Center between 1986 and 2009. Patient demographics are shown in Table 1. Eighteen patients (34%) had undergone previous bilateral salpingo-oophorectomy (BSO) a median of 12.8 years (range, 3.0 to 27.7) prior to the diagnosis of PPC. The findings at BSO included endometriosis (n = 5), ovarian serous cystadenoma (n = 1), and normal ovaries removed at the time of
Discussion
To our knowledge, this is the first series of women with low-grade serous PPC ever reported. The principal findings of our study are that patients with low-grade serous PPC have higher rates of persistent disease at the completion of primary treatment and a longer survival when compared with previously published reports of patients with high-grade serous ovarian and PPC. In addition, our data suggest that differences may exist between women diagnosed with low-grade serous PPC and published data
Conflict of interest statement
The authors report no conflict of interest.
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Recurrent low grade serous ovarian cancer in a 20 year old woman: A case from the Ohio State University College of Medicine
2017, Gynecologic OncologyCitation Excerpt :This treatment strategy is derived from large clinical trials performed in women with advanced ovarian cancer in which patients with low-grade serous carcinoma comprise a small proportion of the study population. Unfortunately, retrospective data suggests that almost two-thirds of patients with low-grade serous carcinoma who undergo maximal cytoreductive surgery followed by adjuvant chemotherapy have persistent or progressive disease following completion of therapy [18]. This poor response to chemotherapy has also been shown in both the neoadjuvant and recurrent settings.
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Presented in part at the 46th annual meeting of the American Society of Clinical Oncologists, Chicago, Illinois, June 2010.
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This study was supported in part by the MD Anderson Low-Grade Serous Ovarian Cancer Research Fund.