Definition/General
Clinical Features
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Gross Description
Microscopic Description
Immunohistochemistry
Molecular/Genetic
Differential Diagnosis
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
Bilateral salpingo-oophorectomy specimen, right ovary measuring [X x Y x Z] cm, left ovary measuring [X x Y x Z] cm
Gross Description
Bilateral solid ovarian masses with smooth, bosselated surfaces, gray-white cut surface with gelatinous areas, [preserved/distorted] ovarian contour
Diagnosis
Bilateral ovarian signet ring cell carcinoma, [primary/metastatic - specify primary site if known]
Histological Features
Signet ring cells (>50% of tumor) with eccentric nuclei, abundant intracytoplasmic mucin, single-file infiltration pattern, desmoplastic stroma
Mucin Studies
PAS: Positive (intracytoplasmic mucin), Mucicarmine: Positive, Alcian Blue: [Positive/Negative]
Immunohistochemistry
CK7: [Positive/Negative], CK20: [Positive/Negative], CDX2: [Positive/Negative], CEA: [Positive/Negative], PAX8: [Positive/Negative], ER: [Positive/Negative]
Primary Site Assessment
Immunohistochemical profile [favors/consistent with]: [gastric/colorectal/breast/primary ovarian] primary
Staging
[Primary ovarian: FIGO Stage IV] / [Metastatic: Ovarian metastases from [primary site]]
Clinical Correlation
Clinical correlation with upper GI endoscopy, colonoscopy, and imaging studies recommended to identify primary site
Molecular Testing Recommendations
Consider: HER2 testing if gastric primary, MSI testing, CDH1 mutation testing if family history of diffuse gastric cancer
Prognostic Factors
High-grade morphology, bilateral involvement, [primary site], [stage], signet ring cell differentiation (poor prognostic factor)
Comments
Bilateral ovarian signet ring cell carcinoma is most commonly metastatic from GI tract. Clinical correlation and multidisciplinary team discussion essential.
Final Diagnosis
Bilateral ovarian signet ring cell carcinoma, [consistent with metastatic [primary site]/primary ovarian], Grade 3