Epithelial ovarian cancer Pathology

Etiology and pathogenesis of epithelial ovarian cance

  1. Ovarian cancer is complex disease composed of different histological grades and types. However, the underlying molecular mechanisms involved in the development of different phenotypes remain largely unknown. Epidemiological studies identified multiple exogenous and endogenous risk factors for ovarian cancer development
  2. Amongst gynecologic malignancies ovarian cancer is the second most common and the #1 cause of death. In this article we review the diagnosis and current management of epithelial ovarian cancer (EOC) which accounts for over 95 percent of the ovarian malignancies. The clinical presentation of EOC can either be acute or subacute
  3. UPDATE ON EPITHELIAL OVARIAN CANCER 0889-8545/94 $0.00 + .20 PATHOLOGY OF EPITHELIAL OVARIAN CANCER Carmen Tornos, MD, and Elvio G. Silva, MD Most ovarian epithelial tumors are thought to derive from invaginations of the ovarian surface epithelium
  4. Epithelial tumors - derived from the cells on the surface of the ovary. This is the most common form of ovarian cancer and occurs primarily in adults. Germ cell tumors - derived from the egg producing cells within the body of the ovary. This occurs primarily in children and teens and is rare by comparison to epithelial ovarian tumors

It is generally accepted that benign and malignant ovarian epithelial tumors arise from surface epithelium and its cystic derivatives because they both, but particularly the latter, have a potential to differentiate into epithelia similar to those of normal müllerian derivation (tubal, endometrial, and endocervical epithelia) and their tumors resemble those of the fallopian tube, endometrium, and endocervix New insights into ovarian cancer pathology Malignant epithelial tumors (carcinomas) are the most common ovarian cancers and also the most lethal gynecological malignancies. Based on histopathology and molecular genetic alterations, ovarian carcinomas are divided into five main types [high-grade serous (70%), endometrioid (10%), clear-cell (1

The ovary is a highly specialized organ physiologically dedicated to ovum production It is composed mainly of stromal cells that support maturing germ cells, covered by a monolayer modified mesothelium (so called ovarian surface epithelium) Most ovarian cancers are epithelial, but most testicular tumors derive from germ cells or sex cord strom Mucinous tumors are epithelial ovarian tumors formed by cells that resemble either those of the endocervical epithelium (endocervical or müllerian type) or, more frequently, those of the intestinal epithelium (intestinal type). Benign mucinous tumors are multiloculated cysts that are filled with opaque, thick, mucoid material Ovarian cancer is a group of diseases that originate in the ovaries, or in the related areas of the fallopian tubes and the peritoneum. The ovaries are a woman's reproductive organs. Women have two ovaries that are located in the pelvis—one on each side of the uterus. The ovaries have a size and shape comparable to a large olive Treatment of Ovarian Epithelial Cancer . Stage I - Generally women with Stage I ovarian cancer have a total abdominal hysterectomy, removal of both ovaries and fallopian tubes, omentectomy, biopsy of lymph nodes and other tissues in the pelvis and abdomen. Young women whose disease is confined to one ovary are often treated by a unilateral.

Epithelial ovarian cancer: An overvie


  1. THE MORPHOLOGIC AND MOLECULAR HETEROGENEITY OF EPITHELIAL OVARIAN CANCER One of the major problems in elucidating the pathogenesis of ovarian cancer is that it is a heterogeneous disease composed of different types of tumors with widely differing clinicopathologic features and behavior
  2. ed by a pathologist's microscopic exa
  3. Epithelial ovarian carcinomas (EOC) account for ~90% of all ovarian malignancies. During the last decade it has become apparent that EOC encompasses 5 distinct diseases, with different presentations (age of development, distribution of disease), response to chemotherapy, prognosis, molecular features, and site of origin 1, 2

Epithelial Ovarian Cancer. Epithelial cell neoplasms account for 50-55 % of all ovarian tumors. There are benign, borderline tumors (of borderline malignancy or low malignant potential), and malignant forms. Malignant epithelial tumors are called carcinoma and constitute approximately 90 % of all ovarian cancers Molecular pathogenesis and therapeutic targets in epithelial ovarian cancer. Chien JR(1), Aletti G, Bell DA, Keeney GL, Shridhar V, Hartmann LC. Author information: (1)Department of Experimental Pathology, Mayo Clinic, Rochester, Minnesota, USA Ovarian Cancer. : Recent Insights Unveiling Opportunities in Prevention. The authors declare that they have nothing to disclose. Correspondence: C. Blake Gilks, MD, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, 910 West 10th Avenue, Vancouver, BC, Canada. E-mail: Blake.Gilks@vch.ca

Recent morphologic, immunohistochemical, and molecular genetic studies have led to the development of a new paradigm for the pathogenesis and origin of epithelial ovarian cancer based on a dualistic model of carcinogenesis that divides epithelial ovarian cancer into 2 broad categories designated types I and II Epithelial ovarian neoplasms are rare in patients under the age of 21 years. This is a report of a series of such patients documenting their presentation, histologic type, stage of disease, treatment, and outcome. METHODS. Clinical findings, histology, stage, treatment, and outcomes of 19 patients with epithelial ovarian neoplasia are reported CA125 and HE4 are examples of ovarian cancer biomarkers used in diagnosis and follow-up. Currently, somatic or germinal mutations on BRCA1 and BRCA2 genes are the most important biomarkers in epithelial ovarian cancer, having prognostic and predictive value

Ovarian Cancer - Johns Hopkins Patholog

  1. Pathology. The origin and pathogenesis of epithelial ovarian cancer are poorly understood 5. Despite extensive studies, no precursor lesions have been found 5. Classification. Ovarian epithelial neoplasms are histologically classified according to: resemblance to normal gynecological cell line 7. serous - resembling epithelium lining the.
  2. A family history of ovarian cancer is a risk factor for ovarian cancer. People with hereditary nonpolyposis colon cancer (Lynch syndrome), and those with BRCA-1 and BRCA-2 genetic abnormalities are at increased risk.. The major genetic risk factor for ovarian cancer is a mutation in BRCA1 or BRCA2 genes, or in DNA mismatch repair genes, which is present in 10% of ovarian cancer cases
  3. The three main types of ovarian cancer and their subtypes are discussed briefly in the current article, with special consideration of key aspects related to tumor registration and epidemiology. A more compre-hensive and detailed discussion of the pathology of ovarian tumors can be found in specialized publica
  4. The association between residual disease status and mortality hazard did not differ significantly among histologic subtypes of ovarian cancer (p for interaction=0.32). In covariate adjusted models, compared to suboptimal cytoreduction, cytoreduction to no gross disease was associated with a hazard reduction of 42% in high-grade serous carcinoma.
  5. The role of proteolytic enzymes in the pathology of epithelial ovarian carcinoma. Stack MS (1), Ellerbroek SM, Fishman DA. (1)Northwestern University Medical School, 303 E. Chicago Ave, Tarry 4-751, Chicago, IL 60611, USA. Epithelial ovarian cancer is the leading cause of death from gynecologic malignancy among North American women
  6. 368 S.C. Mok et al. / Etiology and pathogenesis of epithelial ovarian cancer cer, which may provide insights into the development of the disease. 2. Histology Epithelial ovarian tumors are classified as benign, low malignant potential (borderline), or malignant ac-cording to the World Health Organization (WHO) cri-teria [3]
Surface epithelial-stromal tumor - Wikipedia

Leitao MM, Soslow RA, Baergen RN, et al. Mutation and expression of the TP53 gene in early stage epithelial ovarian carcinoma. Gynecol Oncol. 2004 ; 93 (2): 301 -6. 25 Epithelial ovarian cancer. Ng JS (1), Low JJ, Ilancheran A. Author information: (1)Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, National University Hospital, NUHS Tower Block, Singapore, Singapore. drjoeng@nus.edu.sg. The incidence of epithelial ovarian cancer in women aged 40 years and younger is 3-17% Ovarian cancer is the most lethal gynecologic malignancy. Efforts at early detection and new therapeutic approaches to reduce mortality have been largely unsuccessful, because the origin and pathogenesis of epithelial ovarian cancer are poorly understood Pathology of ovarian cancer precursors. Robert E. Scully MD. Corresponding Author. Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Bostan, MA 02114 It is generally accepted that benign and malignant ovarian epithelial tumors arise from surface epithelium and its cystic derivatives becasuse they both, but.

Three hundred seventy treatment-naive patient samples with epithelial ovarian cancer from mixed histology were collected from the Phase III ICON7 clinical trial 14, and the clinical. BRCA1+ tumors are usually not borderline or mucinous ( Hum Pathol 2000;31:1420 ) Higher risk of BRCA1 or BRCA2 mutation if ovarian carcinoma (any age), breast cancer (any age), early onset breast cancer. BRCA1 prevalence is 1-2% in US Ashkenazi Jews, 0.24% in other US whites ( Cancer Epidemiol Biomarkers Prev 2004;13:2078 ) Note: 1-2% of.

Ovarian cancer is a spectrum of several histologically distinct tumor types that differ in etiology, response to therapy, and prognosis. In resource-limited settings, the diagnosis of ovarian cancer can be challenging. This study describes the distribution of ovarian cancer tumor types in East Africa as well as assessing the diagnostic accuracy by using contemporary methods Epithelial ovarian cancer (EOC) is the the leading cause of death from gynaecological malignancies and the fifth most common cause of cancer-related death in women [].Etiological factors involved in ovarian carcinogenesis remain poorly defined and the pitiable percentage of survival to incidence is related to cases being diagnosed in an advanced stage, most often stage III and IV, i.e. having. Purpose: Germline mutations in the BRCA1 and BRCA2 genes confer increased susceptibility to ovarian cancer. There is evidence that tumors in carriers may exhibit a distinct distribution of pathological features, but previous studies on the pathology of such tumors have been small. Our aim was to evaluate the morphologies and immunophenotypes in a large cohort of patients with familial ovarian. Pathological Features. Microcystic stromal tumors are solid-cystic, solid, or predominantly cystic and display a mean diameter of 8.7 cm. Their solid components are firm and tan or white-tan. Microscopically, these ovarian tumors contain microcysts with variable amounts of solid cellular tissue and fibrous stroma Ovarian cancer has several subtypes, including epithelial ovarian cancer (EOC) with a whopping incidence rate of 239,000 per year, making it the sixth most common gynecological malignancy worldwide

Pathology of ovarian cancer precursor

Advanced epithelial ovarian cancer often comes back months or years after the initial treatment. Sometimes, more surgery is recommended. Most women with recurrent or persistent ovarian cancer are treated with some form of chemo. Which chemo drugs are used depends on what was used the first time and how well it worked (how long the cancer stayed. Ovarian cancer molecular pathology. June 2012; Cancer The m / z at 9744 corresponds to the Cter fragment of RegAlpha. b Epithelial ovarian cancer tissue section with a benign and a cancerous. The detection of CA125 has been used in the follow up of ovarian cancer. At present, some scholars believe that serum CA125 has no clinical value for the follow-up monitoring the recurrence for postoperative patients with epithelial ovarian cancer, but in our clinical follow-up found that when the serum CA125 value is <35 U/ml, postoperative patients of epithelial ovarian carcinoma had already.

Epithelial ovarian cancer (EOC) accounts for over 95% of ovarian malignancies. 16, 18 Nonepithelial cancers represent up to 5% of ovarian cancers and include predominantly germ cell and sex-cord stromal cancers, as well as rare, small cell carcinoma and ovarian sarcoma. 16 Given the high incidence and mortality of EOC relative to other ovarian. In the United States, ovarian cancer is the eighth most common cancer among women, according to the Centers for Disease Control and Prevention (CDC). While there are more than 30 types of ovarian cancer, all begin in one or both ovaries, or in the nearby fallopian tubes or peritoneum (the tissue that covers organs in the abdomen) pure serous epithelial ovarian cancers. Patients excluded from analysis were those with 1) mixed his-tology epithelial ovarian cancer (24 patients had mixed serous and endometrioid pathology) and 2) a previous malignancy other than endometrial or basal cell skin carcinoma. Of the 1261 patients for whom ovarian cancer was their first cancer. Type I ovarian tumors, where precursor lesions in the ovary have clearly been described, include endometrioid, clear cell, mucinous, low grade serous, and transitional cell carcinomas, while type II tumors, where such lesions have not been described clearly and tumors may develop de novo from the tubal and/or ovarian surface epithelium, comprise high grade serous carcinomas, undifferentiated.

Molecular pathology of epithelial ovarian cancer. British Menopause Society Journal 2006 12: 2, 57-63 Download Citation. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click on download biomarkers in epithelial ovarian cancer having prognostic and predictive value. This article will review the histo-logical and molecular characteristics of the five subtypes of ovarian cancer, describing the most important biomarkers and mutations that can guide in diagnosis, screening and tailored treatment strategy Pathology Major Histopathologic Categories of Ovarian Cancer 1- Epithelial Serous, mucinous, endometrioid, clear cell, transitional cell (Brenner), undifferentiated 2- Germ Cell Dysgerminoma, endodermal sinus tumor, teratoma (immature, mature, specialized), embryonal carcinoma, choriocarcinoma, gonadoblastoma, mixed germ cell, polyembryona 3. Ovarian cancer is the fifth most common cancer in US women. It is also the fifth leading cause of cancer death in women. Three cell types make up the normal ovary: the multipotential surface (coelomic) covering epithelium, the totipotential germ cells, and the multipotntial sex cord/stromal cells Other cancers that are similar to epithelial ovarian cancer Primary peritoneal carcinoma. Primary peritoneal carcinoma (PPC) is a rare cancer closely related to epithelial ovarian cancer. At surgery, it looks the same as an epithelial ovarian cancer that has spread through the abdomen. In the lab, PPC also looks just like epithelial ovarian cancer

New insights into ovarian cancer patholog

Purpose: Ovarian cancer is a heterogeneous disease that can be divided into multiple subtypes with variable etiology, pathogenesis, and prognosis. We analyzed DNA methylation profiling data to identify biologic subgroups of ovarian cancer and study their relationship with histologic subtypes, copy number variation, RNA expression data, and outcomes. Experimental Design: A total of 162 paraffin. When does ovarian cancer typically present? and how severe is it? 5th or 6th decade - #1 cause of gynecologic cancer death, difficult to detect before dissemination (65% diagnosed at late stage) What factors increase risk for epithelial ovarian cancer The standard initial management of epithelial ovarian cancer consists of surgical staging, operative tumour debulking including total abdominal hysterectomy and bilateral salpingo-oophorectomy, and administration of six cycles of intravenous chemotherapy with carboplatin and paclitaxel. Extensive and largely retrospective experience has shown that optimum surgical debulking to leave residual.

Epithelial ovarian cancer is one of the most common gynecologic malignancies, with 50% of all cases occurring in women older than 65 years. These cancers are diseases in which malignant (cancer) cells form in the tissue covering the ovary, or lining the fallopian tube or peritoneum (the serous membrane lining the cavity of the abdomen and. Introduction. Ovarian cancer is the leading cause of gynecological cancer mortality world wide 15.4 in the USA) . Unfortunately though, when compared to other cancers, the mortality rate for ovarian cancer is high, resulting in more than 850 deaths per annum in Australia and 15,000 in the USA Epithelial ovarian cancer is the sixth most common cancer in women and is the second most common female genital tract malignancy after endometrial cancer. They are usually found in postmenopausal women and are the commonest cause of death among women with gynaecologic malignancies in the USA, accounting for approximately 15,000 deaths annually

Qiao&#39;s Pathology: Mucinous cystadenoma of Ovary

Epithelial ovarian cancer is thought to arise from epithelium covering the fimbria of the fallopian tubes, or the ovaries, both of which are derived from the coelomic epithelium in fetal development Patterns of clinicopathological features and outcome in epithelial ovarian cancer patients: 35 years of prospectively collected data —which represents around 90% of ovarian cancer cases—is a collection of discrete or cases where histotype has been confirmed by contemporary pathology review by an expert gynaecological pathologist. Introduction. Ovarian cancer (OC) is the fifth most common type of cancer death for women, and the most lethal gynaecologic cancer in the Western world [].The majority of patients (70%) are diagnosed in advanced stages (International Federation of Gynaecologic Oncology (FIGO) stage III-IV) having a 5-year survival rate less than 30% [].OC is known to be a heterogenic disease, consisting of. Among epithelial ovarian cancer subtypes is mucinous epithelial ovarian cancer (mEOC), a relatively rare subtype accounting for approximately 14% of invasive ovarian cancer cases . mEOC has a distinct natural history compared to other epithelial subtypes, especially the most common serous subtype. mEOCs are more often diagnosed in younger women.

However, our understanding of DNA demethylation in cancer biology and its clinical significance remain limited. This study showed that TET1 expression correlated with poor survival in advanced‐stage epithelial ovarian carcinoma (EOC), and with cell migration, anchorage‐independent growth, cancer stemness, and tumorigenicity Purpose: A better understanding of the molecular pathways underlying the development of epithelial ovarian cancer (EOC) is critical to identify ovarian tumor markers for use in diagnostic or therapeutic applications. The aims of this study were to integrate the results from 14 transcript profiling studies of EOC to identify novel biomarkers and to examine their expression in early and late. Palacios, J., de la Hoya, M., Bellosillo, B. et al. Mutational Screening of BRCA1/2 Genes as a Predictive Factor for Therapeutic Response in Epithelial Ovarian Cancer: A Consensus Guide from the Spanish Society of Pathology (SEAP-IAP) and the Spanish Society of Human Genetics (AEGH)

Pathology Outlines - Surface epithelial tumors-overview

Endometrial Lesions Identified in Patients With Epithelial Ovarian Cancer per Histologic Subtype of Ovarian Cancer Open in new tab Atypical hyperplasia was frequently identified in all histologic subtypes of EOC but most common in concurrence with endometrioid cancers ( Table 2 ) The PARP inhibitor olaparib has been approved in the maintenance setting of platinum-sensitive epithelial ovarian cancer patients with germline or somatic BRCA1/2 mutation. Therefore, the availability of a tumor BRCA test has become a clinical need. We report the results of the clinical implementation of a tumor BRCA test within the frame of an institutional workflow for the management of. In previous studies, the overall sensitivity for TP53 mutation detection based on P53 immunostaining in high-grade serous ovarian cancer was 99%, and for epithelial ovarian cancer, the accuracy of TP53 mutation diagnosis based on immunohistochemistry was as high as 95% [26, 27] Epithelial ovarian tumors are responsive to steroid hormone stimulation and the ovarian stroma may have a direct role in this process. We evaluated immunohistochemical markers of sex-steroid.

Pathology and classification of ovarian tumors - Chen

Epithelial ovarian cancer is a highly heterogeneous disease characterized by multiple histological subtypes. Molecular diversity has been shown to occur within specific histological subtypes of epithelial ovarian cancer, between different tumors of an individual patient, as well as within individual tumors. Recent advances in the molecular characterization of epithelial ovarian cancer tumors. What is epithelial ovarian cancer? Epithelial ovarian cancer is the most common type of ovarian cancer and happens when a tumor forms from the epithelial cel..

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Ovarian Cancer & Ovarian Pathology - Ovarian Cancer

Ovarian low and high grade serous carcinomas: hidden

Treatment Options - Ovarian Cancer Johns Hopkins Patholog

Objective An increasing body of evidence has suggested that epithelial ovarian cancer (EOC) patients can broadly be divided into 2 groups on the basis of histopathologic parameters and molecular profiles. Type 1 tumors are slow-growing tumors with inherent mutations such as KRAS or BRAF mutations, whereas type 2 tumors are more rapidly growing tumors of which many contain TP53 mutations Br J Cancer 2018; 119: 1075-1085. Colombo N, Sessa C, du Bois A et al. ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease. Ann Oncol 2019; 30: 672-705 Recommendation 1.1. All women diagnosed with epithelial ovarian cancer should be offered germline genetic testing for BRCA1, BRCA2, and other ovarian cancer susceptibility genes, irrespective of their clinical features or family cancer history.Somatic tumor testing for BRCA1 and BRCA2 pathogenic or likely pathogenic variants should be performed in women who do not carry a germline pathogenic. ovarian cancer relapse or progression The higher the level, the greater the probability of malignancy A decrease of ≥25% suggests therapeutic response • ROMA o Premenopausal >1.14 - high likelihood of finding epithelial ovarian cancer ≤1.14 - low likelihood of finding epithelial ovarian cancer o Postmenopausa Ovarian cancer is the most lethal cancer of the female reproductive organs. There are $5$ major histological subtypes of epithelial ovarian cancer, each with distinct morphological, genetic, and clinical features. Currently, these histotypes are determined by a pathologist's microscopic examination of tumor whole-slide images (WSI). This process has been hampered by poor inter-observer.

Epithelial ovarian cancer Ovarian cancer Cancer

Ovarian Cancer Pathology SpringerLin

Morphologic, Immunophenotypic, and Molecular Features of Epithelial Ovarian Cancer. This review focuses on the clinicopathologic and molecular features of epithelial ovarian cancer, with specific attention to genetic predisposition, morphologic challenges, immunohistochemistry, and molecular features. Oncology (Williston Park). 30 (2):166-176 Tumors of low malignant potential (i.e., borderline tumors) account for 15% of all epithelial ovarian cancers. Nearly 75% of these tumors are stage I at the time of diagnosis. These tumors must be recognized because their prognosis and treatment is clearly different from the frankly malignant invasive carcinomas Epithelial ovarian cancer is the most common type of ovarian cancer, comprising up to 90% of all ovarian cancer cases, according to the American Cancer Society (ACS)

Pathology of Epithelial Ovarian Tumors Oncohema Ke

Ovarian cancer types include: Epithelial tumors, which begin in the thin layer of tissue that covers the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors. Stromal tumors, which begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other. Epithelial ovarian cancer. This is the most common type of ovarian tumour and occurs in around nine out of every ten cases of ovarian cancer. These tumours arise from the cells that line or cover the ovaries and fallopian tubes (the epithelium). A close-up illustration of the ovaries, fallopian tubes, womb and vagina Epithelial ovarian cancer (EOC) is the most lethal cancer of all the gynecological cancers. It is characterized by late and unspecific onset of symptoms and thus the presence of disseminated disease at the time of diagnosis [].Ten percent of EOC cases are estimated to be caused by genetic mutations, most notably BRCA1 and BRCA2 mutations [].An inverse association with the number of ovulatory.

Origins and molecular pathology of ovarian cancer Modern

cysts - Humpathovarian mucinous cystadenoma - Humpathovarian juvenile granulosa cell tumor - Humpath

Morphology Code. Epithelial Tumors. Serous cystadenocarcinoma. 40% of all ovarian tumors. 8441/3. Mucinous cystadenocarcinoma. 12% of all ovarian tumors. 8470/3. Endometrioid adenocarcinoma It is unclear whether the different histologic subtypes of epithelial ovarian carcinoma have different risk factors. We investigated the relationships between selected epidemiologic variables (i.e., parity, family history of ovarian cancer, oral contraceptive use, a history of tubal ligation and noncontraceptive estrogen use) and the major histologic subtypes of epithelial ovarian cancer in a. Background. Forkhead box (FOX) A1 is a potential therapeutic biomarker that has been investigated in various human cancers. Limited data exist about FOXA1 biologic role in epithelial ovarian cancer (EOC). Aim. This study assessed FOXA1 immunohistochemical (IHC) expression and evaluated its association with clinico-pathological parameters in EOC including overall and diseasefree survivals (OS. Treatment for Relapsing Platinum Sensitive Epithelial Ovarian Cancer. 35 min. 39 slides. -. -. In this E-Learning module the authors place emphasis on the changing paradigm in terms of treatment considerations for relapsed platinum sensitive ovarian cancer. Now the platinum-free interval is not the only parameter to be considered to select. Ovarian cancer starts in the cells of the ovary. A cancerous (malignant) tumour is a group of cells that can grow into and destroy nearby tissue. It can also spread (metastasize) to other parts of the body. Cancerous ovarian tumours are grouped by the type of cells that the cancer starts in. Epithelial ovarian carcinoma starts in epithelial cells Fibroblasts are a major component of cancer tissue and known to contribute to cancer progression. However, it remains unknown whether they are derived from local fibroblasts or of other origin. This study was designed to identify the contribution of local stromal cells to cancer stroma in human epithelial ovarian cancer. Seventy-six cases of surgically resected primary ovarian carcinoma (48.

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