Correlates of Papillary Infarction and Microinvasion in Ovarian Atypical Proliferative (Borderline) Serous and Seromucinous Tumors (APST/APSMT)
JA Kraus, JD Seidman. Washington Hospital Center, Washington, DC
Background: Although papillary infarction in ovarian APST/APSMT is commonly observed, there are few data regarding its significance, including any association with microinvasion and peritoneal implants, which are also poorly understood. Recent reports suggest that microinvasion is found in 25-50% of these tumors, in contrast to reports of 10% stated in the older literature. This study characterizes the features associated with papillary infarcts and microinvasion to further understand these phenomena.
Design: From consecutive hospital-based (non-consultation) cases, 23 APST/APSMT in 19 patients (4 bilateral) were reviewed and evaluated for papillary infarcts, peritoneal implants, autoimplants, microinvasion (<5 mm), bilaterality, calcification, salpingoliths (tubal mucosal calcifications), and endometriosis.
Results: Tumors were sampled with a mean of 2.1 sections per cm of maximum tumor diameter. Infarcts were identified in 47% of patients, and microinvasion in 26%. Those with infarcts had a mean age of 50 years and a mean tumor size of 8 cm, versus 58 years and 6.4 cm for those without infarcts (not significant). All tumors with papillary infarcts were serous as compared to 40% of those without infarcts (p = 0.0108). Microinvasion was found in 44% of those with infarcts as compared to 10% of those without infarcts (p=0.14). Noninvasive peritoneal implants were found in 22% of those with infarcts as compared to 0% of those without infarcts (p=0.21). Other features evaluated showed no meaningful correlations with papillary infarction. Microinvasive tumors were significantly more likely to be bilateral (60% v. 7%, p=0.037) and more often had noninvasive peritoneal implants (40% v. 0%, p=0.0585). All tumors with microinvasion were serous as compared to 57% of those without microinvasion (p=0.13). Among patients with APST, 38% had microinvasion. Other features evaluated showed no meaningful correlations with microinvasion.
Conclusions: Papillary infarcts and microinvasion are more common in APST as compared to APSMT. Microinvasion in APST is more common than previously appreciated, and APSTs with microinvasion are significantly more likely to be bilateral than those without microinvasion. Findings suggesting a possible relationship between papillary infarction, microinvasion and noninvasive peritoneal implants warrant further study.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 156, Monday Morning