Ovarian cancer is one of the most fatal malignant diseases in women. In 2004, it accounted for approx 16,090 deaths (1). About 25,000 new cases are diagnosed annually, of which approx 75% are diagnosed at an advanced stage. Ovarian cancer is a heterogenous group of tumors, but the most common type is surface epithelial tumors, which are classified into serous, mucinous, endometrioid, clear cell, and Brenner (transitional) tumors corresponding to different types of epithelia in the organs of the female reproductive tract (2-4). The tumors in each of the categories are further sub-classified into three groups, benign, intermediate (borderline tumor), and malignant to reflect their clinical behavior.

Despite considerable efforts aimed at elucidating the molecular mechanisms in the development of ovarian carcinoma, its pathogenesis is still largely unknown because of the lack of correlated morphological and molecular genetic studies (5,6). Based on a review of clinicopathological and molecular studies, a model for their development has been proposed. In this model, surface epithelial tumors are broadly divided into two categories designated type I and type II tumors, which correspond to two main pathways of tumorigenesis. Type I tumors are made up of low-grade serous carcinomas, mucinous carcinomas, endometrioid carcinomas, malignant Brenner tumors, and clear cell carcinomas. They tend to be low-grade neoplasms that arise in a stepwise fashion from borderline tumors whereas type II tumors are high-grade neoplasms for which

From: Current Clinical Oncology: Molecular Pathology of Gynecologic Cancer Edited by: A. Giordano, A. Bovicelli, and R. Kurman © Humana Press Inc., Totowa, NJ

morphologically recognizable precursor lesions have not been identified, so-called "de novo" development. This model reconciles the relationship of borderline tumors to invasive carcinoma of different histological types and provides a morphological and molecular framework for studies aimed at elucidating the pathogenesis of ovarian cancer. This chapter will describe the proposed model with special emphasis on serous tumors, as they are the most common surface epithelial tumors.

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