Ovarian TCC is back!

In 1987, Austin and Norris wrote an important article showing the differences between malignant Brenner tumors and ovarian TCC. At the same time, we were reviewing the medical records and the H&E slides of 900 cases of ovarian epithelial tumors looking for patients with long survival and high grade, high stage cancer. It was amazing that the cases with longer survival were mostly cases that we had classified as TCC. We believed in this entity because we were not reviewing cases of TCC. The incidence of TCC in our cases was 9% of all ovarian carcinomas. Two other groups working with Dr Costa, and Dr Silverberg evaluated the survival rate of their cases of TCC of the ovary but could not confirm our results. I believe the main difference was the selection of the cases because in both series the incidence of TCC was 25%. There was another study from Dr Kommos showing that TCC of the ovary had a better prognosis. In his series, TCC represented 4% of high grade ovarian carcinoma.

During the preparation of the new edition of the WHO book, I tried to persuade the other pathologists to have TCC as a different type of carcinoma because of the different prognosis and also because having it separate would facilitate research into different genes. If we started with different tumors, it would be easier to find different genes. The consensus was that TCC was part of serous carcinoma because they are frequently found together, both are positive for p53, and different genes have not been found in serous carcinoma and in TCC. Every one of these points can be argued, but "the worst blind person is the one that does not want to see".

There are already at least three studies showing the association of TCC as part of the SET ( solid, pseudo endometrioid, and TCC) group of tumors associated with the BRCA genotype, and better survival. Recently, a review of 29,000 patients showed that TCC morphology in ovarian cancer is an independent predictor of survival.

Soslow R et al. Modern Path 25:625-636,2012

Garg K et al. AJSP 37:138-146,2013

Howitt B et al AJSP 39:287-293,2015

Nasioudis D et al Int J Gynec Cancer 26:1624-1629,2016