Ovary tumor
Other tumors not specific to ovary
Undifferentiated carcinoma

Authors: Nalini Gupta, M.D. (see Authors page)

Revised: 7 July 2016, last major update July 2014

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Undifferentiated carcinoma [title] ovary
Cite this page: Undifferentiated carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/ovarytumorundifferentiated.html. Accessed December 5th, 2016.
Definition / General
  • Undifferentiated carcinomas are characterized by a patternless solid, sheet-like growth of tumor cells, with an aggressive clinical course (Mod Pathol 2010;23:781)
  • There are no nests, papillae, glands, trabeculae or spindled patterns, no squamous or mucinous metaplasia, and no/minimal neuroendocrine differentiation
  • If areas of a differentiated component are found, the tumor is called dedifferentiated carcinoma (Int J Gynecol Pathol 2006;25:52)
Epidemiology
Clinical Features
  • Abdominal pain or swelling
Radiology Description
  • USG: solid adnexal mass with variable hemorrhage and necrosis
Prognostic Factors
  • Poor prognosis
  • Presence of undifferentiated component in a differentiated tumor carries similar prognosis as pure undifferentiated carcinoma
  • 83% cases present in FIGO stage III-IV (Mod Pathol 2010;23:781)
Case Reports
Treatment
  • Primary ovarian tumor treated primarily with chemotherapy followed by surgery
  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) with or without lymphadenectomy
Gross Description
  • Large tan-brown, fleshy adnexal masses with areas of necrosis, mostly with ovarian surface involvement
Gross Images

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Surgical specimen

Micro Description
  • Sheets of dyshesive round to ovoid cells, frequently resembling large cell lymphoma, separated by delicate fibrovascular septa
  • No evidence of gland formation, trabecular or nested growth pattern
  • May have foci of spindling / keratinization / necrosis
  • Vascular invasion in 20%
  • Frequent mitoses and apoptosis; mitotic rate of 5 to 50 per 10 high power fields
Micro Images

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Cells growing in masses

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Atypical nuclei



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Atypical nuclei

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Malignant neoplasm of small round cells

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Abrupt transition between differentiated and undifferentiated

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Vague spindling

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Abrupt keratinization

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Areas of necrosis

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Small basophilic cells

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Prototypic undifferentiated carcinoma

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Large multinucleate cells

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Rhabdoid cells

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Prominent tumor-infiltrating lymphocytes

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CK18

Positive Stains
  • Focal but strong positivity for AE1 / AE3, EMA, CK18, ER, PR
  • Variable staining for S100, chromogranin, synaptophysin (Mod Pathol 2010;23:781)
Negative Stains
  • HMB45
Electron Microscopy Images

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Undifferentiated neoplasm of polygonal cells

Molecular / Cytogenetics Description
  • May have loss of MMR proteins, most frequently MLH1 and PMS2, but sometimes MSH2 / MSH6
  • May be associated with hereditary nonpolyposis colorectal cancer / Lynch syndrome
Differential Diagnosis