Ovarian dysplasia: A review

The late diagnosis in the vast majority of ovarian carcinomas and the high lethality due to this neoplasm are related to the paucity of early symptoms and virtual absence of any screening system. Premalignant, non-invasive histologic lesions have been described in most epithelial neoplasms (larynx, colon, stomach, etc). In the realm of gynecologic pathology, precursor lesions of cervical and endometrial malignancies have been extensively studied and their etiologic factors (viral for the cervix, hormonal for the endometrium) have been widely documented. This has contributed to a dramatic decrease in morbidity and mortality due to uterine cancer. For ovarian cancer, unfortunately, histogenesis, etiology and natural history are still poorly understood and early detection is still elusive. The use of tumor markers has been, by and large, rather disappointing as far as early diagnosis of ovarian cancer is concerned. The description of morphologic changes that identify preinvasive neoplasms has contributed to the dramatic changes due to early detection of cancers in accessible locations such as breast, uterine cervix, vulva, etc. The secluded location of the ovaries has been an obstacle in the study of such precancerous lesions because of the amplitude of the surgical procedures necessary to approach this tissue. With the use of vaginal sonography and laparoscopic surgery, the ovaries became more accessible; molecular genetic studies are aimed to identify a population at risk for ovarian carcinoma and amenable to prophylactic oophorectomy. These developments, along with the continuous search for specific and sensitive tumor markers for early ovarian cancer are important complementary factors to the identification of morphologic changes of ovarian dysplastic and potentially precancerous changes.