Epithelial ovarian cancer is the fifth leading cause of cancer-related deaths in women and the most lethal gynecological malignancy. Extracellular matrix (ECM) is an integral component of both the normal and tumor microenvironment. ECM composition varies between tissues and is crucial for maintaining normal function and homeostasis. Dysregulation and aberrant deposition or loss of ECM components is implicated in ovarian cancer progression. The mechanisms by which tumor cells induce ECM remodeling to promote a malignant phenotype are yet to be elucidated. A thorough understanding of the role of the ECM in ovarian cancer is needed for the development of effective biomarkers and new therapies.

/pdf/the-extracellular-matrix-in-epithelial-ovarian-cancer-a-48yhum6cbe.pdf

The Extracellular Matrix in Epithelial Ovarian Cancer - A Piece of a Puzzle.

The clinicopathologic features of 21 cases of otherwise typical serous borderline tumors that contained small foci of stromal invasion were reviewed. The mean age of the patients was 43 years and six of them were pregnant at the time of diagnosis. Nineteen tumors were stage I, one was stage III (para-aortic lymph node involvement) and one was stage IV (parenchymal liver metastasis). The tumor invaded the stroma predominantly as individual cells or nests or clusters of cells with abundant eosinophilic cytoplasm (17 cases), as small confluent nests with a cribriform pattern (two cases) and as rounded aggregates of papillae (two cases). Seven women were treated with bilateral salpingo-oophorectomy and hysterectomy; 13 had less than bilateral oophorectomy. Of the 17 patients for whom followup data were available, 16 were without evidence of disease 1 to 11 (mean, 5.2) years postoperatively, and one patient had a serous borderline tumor with microinvasion in a conserved contralateral ovary 2.8 years postoperatively, but was well 6 months after a partial oophorectomy. These data suggest that serous borderline tumors with microinvasion have a prognosis similar to that of the usual serous borderline tumor, and that conservation of the contralateral ovary and uterus may be acceptable therapy in young women who wish to preserve their fertility.

Ovarian Serous Borderline Tumors with Stromal Microinvasion: A Report of 21 Cases

Transmural spread by colorectal carcinoma can result in tumor invasion of the serosal surface and, hence, more likely dissemination within the peritoneal cavity and potentially to additional metastatic sites. The adverse prognostic significance of serosal invasion is widely accepted and its presence may be considered an indication for chemotherapy in patients with node negative disease. However, controversy persists regarding the most appropriate criteria for diagnosis and there are also practical difficulties associated with histological assessment in some cases. Therefore, serosal invasion may be under-diagnosed in a significant proportion of tumors, potentially leading to sub-optimal treatment of high-risk patients. The examination of multiple microscopic sections combined with ancillary studies such as cytology preparations, elastin stains, and immunohistochemistry may prove beneficial in selected problematic cases, but these are not used routinely. The relative prognostic significance of serosal invasion and of direct tumor spread to other organs, both of which are incorporated within the pT4 category of the AJCC/UICC TNM staging system, remains unclear. Further studies are required to demonstrate whether recent adjustments to the TNM staging of pT4 tumors are appropriate.

https://www.mdpi.com/2072-6694/3/1/164/pdf

Assessment of Serosal Invasion and Criteria for the Classification of Pathological (p) T4 Staging in Colorectal Carcinoma: Confusions, Controversies and Criticisms.

Blood and lymphatic vessel invasion (BLVI) has been long recognised as a category I prognostic factor in colorectal carcinomas (CRC) along with the pT and pN categories of the Tumour-Node-Metastasis system, preoperative carcinoembryonal antigen levels and the residual tumour (R) classification.1

Small vessel involvement includes the invasion of capillary-type vessels (figure 1A), where a reliable distinction between lymphatic and blood capillaries cannot be made on H&E-stained or general endothelial marker (eg, CD31, CD34) immunostained sections. Theoretically, the two types of capillary invasion lead to different consequences: lymphatic vessel invasion (LI) precedes and may be predictive of lymph node metastasis, whereas blood capillaries may be the source of systemic dissemination.2–4 The development of lymphatic endothelial markers like podoplanin (D2-40) or lymphatic endothelial hyaluronan receptor (LYVE-1) enables a distinction between lymphatic and blood capillaries: lymphatics can be defined as D2-40, LYVE-1, CD31 and CD34 positive capillaries, whereas blood capillaries are D2-40 and LYVE-1 negative but can be highlighted by CD31 or CD34 antibodies.4–7 Without such a distinction, small vessel invasion is best recorded as (lympho-)vascular invasion (LVI) or angiolymphatic invasion.1 The impact of LI or LVI is mainly seen in patients with conservative removal (eg, polypectomy) of invasive carcinomas without a resection allowing the histopathologic assessment of the lymph nodes.



Figure 1 
Types of vessel invasion in colorectal carcinomas. (A) Small vessel (ie, capillary) invasion corresponding to (lympho-)vascular invasion. (B and C) Venous invasion (VI) stained by orcein and elastica van Gieson, respectively. Right to the vein invaded by carcinoma is an accompanying artery, which helps the recognition of VI. (D) Invasion of an artery. ((A) CD34 ×400, (B) Orcein ×100, (C) Elastica van Gieson ×100, (D) Orcein ×100). This figure is only reproduced in colour in the online version.



By contrast, large vessel invasion includes venous invasion (VI) …

https://jcp.bmj.com/content/jclinpath/early/2013/04/15/jclinpath-2013-201587.full.pdf

Diagnosing vascular invasion in colorectal carcinomas: improving reproducibility and potential pitfalls

Serous borderline tumor of ovary (SBT) includes two subtypes of typical serous borderline tumor and micropapillary variant, which have different histopathology features. Although SBTs behave in either way of the benign counterparts or malignant serous carcinomas, microinvasion, peritoneal implants, and nodal involvement are all very common in both subtypes of typical SBT and the micropapillary variant. The prognosis of the patients with serous borderline tumor of ovary and the mechanism of the microinvasion, peritoneal implantation and nodal involvement are still being debated, nor is there universal agreement about the management of SBT. To identify the histopathologic features, prognostic predictors of the SBT, and its association with ovarian serous carcinomas, we reviewed the majority of the relevant papers published in recent literature.

http://www.cancerbiomed.org/index.php/cocr/article/download/200/187

Research developments on the histopathology and prognostic predictors of serous borderline tumor of ovary

Aims: To determine whether elastin stains aid in classifying peritoneal implants associated with ovarian serous borderline tumours (SBT).

Methods and results:  The study group comprised 80 implants (nine invasive and 71 non-invasive) from 28 patients with ovarian SBT. Elastin stains were performed using histochemical and immunohistochemical methods to demonstrate the peritoneal elastic lamina (PEL), and evaluated with regard to assessment of the subtype of implant. The elastin stains demonstrated the PEL in most anatomical sites other than the omentum and the bladder and were considered helpful in 44/80 (55%) cases. The stains were most useful in the assessment of poorly oriented or traumatized biopsy specimens and in confirming the superficial distribution of non-invasive implants. The staining was non-contributory in most of the remaining biopsies, because the PEL was not identified.

Conclusions:  Demonstration of the PEL using elastin stains can be useful in the subclassification of implants associated with ovarian SBT and is of most value in confirming the superficial distribution of non-invasive lesions. However, evaluation is limited by the absence of a defined elastic layer in a proportion of biopsy specimens, possibly reflecting their superficial location, as well as absence of a distinct PEL in sites such as the omentum.

Value of elastin staining in the assessment of peritoneal implants associated with ovarian serous borderline tumours.

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Value of elastin staining in the assessment of peritoneal implants associated with ovarian serous borderline tumours.