PRIMARY SOLID CARCINOMA
Primary solid ovarian carcinomas, also designated as the undifferentiated or unclassiﬁed group, may be arbitrarily divided on the basis of the architectural pattern of the epithelial and connective tissue elements into solid adenocarcinoma, medullary carcinoma, scirrhous carcinoma, alveolar carcinoma, plexiform carcinoma, clear cell, endometrioid, and adenocarcinoma with squamous cell metaplasia (adenoacanthoma). Primary solid carcinomas of the ovary are less common than the cystic variety. They may be unilateral or bilateral, small or large, ovoid or round, smooth or nodular, grayish- pink in color and solid. The consistency and color are dependent upon the proportionate amounts of epithelial and connective tissue elements. If very cellular, they are apt to be relatively soft, meaty, and pink, often with areas of degeneration. If less cellular, they may be ﬁrm and whitish gray. Focal necrosis, hemorrhage, cavitation, deposition of calcium, and psammoma bodies are not infrequent. In advanced cases, penetration of the capsule, inﬁltration, extension, and metastases occur.
Clear cell carcinoma is an ovarian tumor made up of cells containing
large amounts of glycogen that gives them a clear or “hobnailed” appearance.
These tumors may also arise in the endocervix, endometrium, and vagina.
Cervical and vaginal tumors have been linked to in utero exposure to
diethylstilbestrol. Despite the presence of hobnail cells that are similar to those
seen in the endometrium, cervix, and vagina of women exposed to
diethylstilbestrol (DES) in utero, there is no evidence that DES has a role in
clear cell ovarian tumors. These tumors represent 5% to 11% of ovarian cancers.
They present as a pelvic mass (up to 30 cm)— partially cystic with yellow,
gray, and hemorrhagic areas with papillary projections generally present,
giving the mass a velvety appearance; 40% of tumors are bilateral. These tumors
are usually found as a malignant tumor and require surgical exploration and
extirpation, includ- ing the uterus and contralateral ovary. Adjunctive
chemotherapy or radiation therapy is often included based on the location and
stage of the disease. In those sus- pected of having recurrent disease and
other selected patients, second-look surgery may be desirable to assess
progress and discover occult disease.
Endometrioid tumors consist of epithelial cells resembling those of the
endometrium. In the ovary, these neoplasms are less frequent (approximately 5%)
than either the serous or mucinous tumors, but the malignant variety accounts
for approximately 20% of ovarian carcinomas. Endometrioid carcinomas usually
occur in women in their 40s and 50s. They may be seen in conjunction with
endometriosis and ovarian endometriomas, although an origin from endometriosis
is rarely demonstrated. Most endometrioid carcinomas arise directly from the
surface epithelium of the ovary, as do the other epithelial tumors.
Medullary carcinoma is rich in epithelial elements, with very little
connective tissue. It is a virulent type of ovarian malignancy that occurs in
young women, usually between the ages of 15 and 30 years. Because of its
histologic appearance, it has been designated a small cell carcinoma. The tumor
is often but not always accompanied by hypercalcemia. Even when found with
early-stage disease, this is an aggressive almost uniformly fatal malignancy
that has been refractory to surgery, chemotherapy, or radiation.
In scirrhous carcinoma, the ﬁbrous tissue predominates, whereas the
epithelium is distributed in narrow columns or nests. Alveolar carcinoma is
evidenced by irregular groups of epithelial cells, separated by connective
Carcinoma simplex refers to a fairly equal division between the cellular and ﬁbrous tissues. Plexiform carcinoma resembles scirrhous carcinoma, except that the epithelium is arranged in narrow anastomosing columns. Adenoacanthoma of the ovary refers to squamous cell metaplasia in adenocarcinoma. The squamous cells are large, polyhedral prickle cell . Keratinization and pearl formation may be observed.