Table Of ContentEssentials of Diagnostic Gynecological Pathology
Series Editors: Naveena Singh · W. Glenn McCluggage
Nafi sa Wilkinson Editor
Pathology of
the Ovary,
Fallopian Tube and
Peritoneum
Essentials of Diagnostic Gynecological
Pathology
Series Editors
Naveena Singh
W. Glenn McCluggage
For further volumes:
http://www.springer.com/series/10115
Nafi sa Wilkinson
Editor
Pathology of the Ovary,
Fallopian Tube and
Peritoneum
Editor
Nafi sa Wilkinson
Department of Histopathology
Leeds Teaching Hospitals NHS Trust
Leeds
UK
ISBN 978-1-4471-2941-7 ISBN 978-1-4471-2942-4 (eBook)
DOI 10.1007/978-1-4471-2942-4
Springer London Heidelberg New York Dordrecht
Library of Congress Control Number: 2014949138
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This series is dedicated to the respected memory of Professor
Harold Fox (1931–2012), one of the foremost gynecological
pathologists of all time, in recognition of the ageless legacy of
his teaching and written word which will continue to inspire
many generations of gynecological pathologists.
Preface to the Series
This is a most exciting time to be submitting the second volume in the
Essentials of Diagnostic Gynecological Pathology series for publication.
Over the last decade there have been dramatic changes in the way we think
about ovarian cancer. Ovarian epithelial cancer is no longer considered to be
a single disease, but has been shown to comprise fi ve major disease subtypes,
distinct in their pathogenesis, pathology and clinical behaviour. It has become
apparent that the most common type of ‘ovarian’ cancer, high grade serous
carcinoma, probably originates in the fi mbrial end of the fallopian tube in the
majority of cases. A new FIGO staging system for ovarian cancer has recently
been published, combining the staging of ovarian, tubal and primary perito-
neal cancers, in recognition that distinction between these has no clinical or
therapeutic relevance. The 2014 WHO ‘blue book’ on ovarian tumors is
eagerly awaited, formalising all of these changes.
Gynecological pathology forms a large part of the diagnostic pathology
workload of most histopathology laboratories. Research fi ndings result in
changes in diagnostic criteria and staging systems as well as descriptions of
new ancillary techniques and diagnostic entities. Pathologists need to keep up
to date with these changes, in view of the ever increasing pressure from clini-
cians, the public and the health service provider for accurate and timely diag-
nosis. The female genital tract is a complex system with several different
organs, and in-depth knowledge of all areas is not necessarily the requirement
of all pathologists.
T he British Association of Gynecological Pathologists (BAGP) supports
the development and maintenance of the highest standards of practice in diag-
nostic gynecological pathology. This is achieved through various educational
activities including courses, workshops, meetings, cases of interest ( w ww.
thebagp.org ) and quick dissemination of information on new developments
via email to its members. The sponsorship of this textbook series is a part of
this educational campaign. The series is intended for consultant and trainee
pathologists, as well as clinicians and researchers, who may have a require-
ment for in-depth and up-to-date information on one area of Gynecological
pathology rather than all areas. Those with an interest in all areas will benefi t
from division of topics into smaller volumes concentrating on different parts
of the female genital tract. These multi-author textbooks have the advantages
of being more affordable and amenable to timely and responsive updating
alongside major practice changes in the fi eld of Gynecological pathology.
vii
viii Preface to the Series
W e hope that this volume will be a useful addition to the existing literature
on the subject. This textbook acknowledges the new histotype approach to
ovarian cancer diagnosis and will be one of the fi rst texts to incorporate the
2013 FIGO staging system, together with providing practical guidance on the
assignment of primary site in cases of high grade serous carcinoma where
multiple sites are involved. It is our intention that, like its successful prede-
cessor, Pathology of the Vulva and Vagina , this volume will present the reader
with the essentials of diagnostic ovarian, tubal and peritoneal pathology in a
compact but comprehensive format.
Belfast, UK W. Glenn McCluggage , FRCPath
London, UK Naveena Singh , FRCPath
Preface to This Volume
T he pathology of the ovary, Fallopian tube, and peritoneum is a vast area, and
it is diffi cult to cover this entire subject comprehensively, but we have
attempted to try and provide the kind of information that a diagnostic histo-
pathologist would need at their fi ngertips when involved with making a diag-
nosis of an ovarian neoplasm. With this in mind, we have covered diagnostic
aspects and the handling of biopsies as well as per operative frozen sections
with a consideration of pitfalls. A great deal of information can be gleaned
from the examination of the resected ovarian tumor specimen and the exami-
nation of the gross specimen cannot be overemphasized. This aspect is
explored in a chapter on “cut up.” The individual types of ovarian neoplasms
are discussed in detail with a generous use of illustrations.
There have been many recent and exciting developments in the pathology of
the ovary, Fallopian tube, and peritoneum, which makes this volume timely.
The amendments to the FIGO staging of the ovary and Fallopian tube have
been incorporated, as have the new ideas regarding the origin of ovarian car-
cinoma in particular high-grade serous carcinoma.
In the United Kingdom, carcinoma of the ovary and Fallopian tube is man-
aged within cancer centers supported by a robust multidisciplinary team
(MDT). MDT meetings are an extremely valuable source of clinical informa-
tion, including a way of obtaining the past medical history, particularly if the
patient has had a previous neoplasm. It is by working as a team with the
gynecological oncologists, medical oncologists, clinical oncologists, and of
course radiologists that we can endeavor to offer a high-quality diagnostic
service to patients with ovarian cancer. Ultimately, a better understanding of
the disease and its behavior will lead to targeted therapy and improved sur-
vival of patients with this disease. It is likely that the pathologist will play a
role in determining sensitivities of ovarian tumors by immunohistochemistry
when targeted therapy becomes normal practice.
We have, I hope, in this volume managed to capture some of the major
changes in ovarian tumor pathology and incorporate them into what we would
like to become a useful benchbook for the diagnostic histopathologist with
some useful information regarding the management of the patient.
Leeds, UK Nafi sa Wilkinson , MA, MBBChir, FRCPath
ix
