Arch Gynecol Obstet DOI 10.1007/s00404-016-4035-8
NEWS AND VIEWS
The new WHO classification of ovarian, fallopian tube, and primary peritoneal cancer and its clinical implications Ivo Meinhold-Heerlein1 • Christina Fotopoulou1 • Philipp Harter1 Christian Kurzeder1 • Alexander Mustea1 • Pauline Wimberger1 • Steffen Hauptmann1 • Jalid Sehouli1
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Received: 19 January 2016 / Accepted: 2 February 2016 Ó Springer-Verlag Berlin Heidelberg 2016
Abstract Introduction Molecular pathological research has contributed to improving the knowledge of different subtypes of ovarian cancer. In parallel with the implementation of the new FIGO staging classification, the WHO classification was revised. The latter is mainly based on the histopathological findings and defines the actual type of tumor. It has, therefore, also an important impact on prognosis and therapy of the patient. Materials and methods The new WHO Classification of Ovarian Cancer published 2014 by Robert Kurman and coauthors is summarized. The major changes compared to the hitherto existing classification are presented. Results The new classification eliminates the previous focus of mesothelial origin of ovarian cancer. Instead, it features a discussion of tubal carcinogenesis of hereditary and some other high-grade serous carcinomas. The previously assumed pathogenesis pathway may be correct for some, but not for all, serous cancers. The new classification was established to classify ovarian cancer in a more consistent way. The earlier transitional cell type of ovarian cancer has been removed while seromucinous tumors have been added as a new entity. The role of some borderline tumors as one possible step in the progression from benign to invasive lesions is incorporated. The article summarizes the essential updates concerning serous, mucinous, seromucinous, endometrioid, clear-cell, and Brenner tumors.
On behalf of the Kommission Ovar of AGO. & Ivo Meinhold-Heerlein imeinhold@ukaachen.de 1
Klinik fu¨r Gyna¨kologie und Geburtsmedizin, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
Conclusion The new WHO classification takes into account the recent findings on the origin, pathogenesis, and prognosis of different ovarian cancer subtypes. The tubal origin of hereditary and some non-hereditary high-grade serous cancers is mentioned in contrast to the hitherto theory of mesothelial origin of tumors. Seromucinous tumors represent a new entity. Keywords High-grade serous Low-grade serous Endometrioid Mucinous Clear cell
Introduction Voluminous scientific studies in recent years have brought a fundamentally new understanding of the tumor biology of ovarian cancer. It is no longer controversial that the term ‘‘ovarian cancer’’ subsumes a heterogeneous group of malignant tumors that differ with respect to essential features of etiology, pathogenesis, prognosis, pathology, and molecular pathology [1]. Numerous clinical studies have also identified the most important factors that determine prognosis, and their clinical relevance is now informing therapeutic decisions. In parallel with the FIGO classification for the staging of ovarian cancer [2, 3] the WHO classification was revised [4, 5] and is valid since 2014. Most of the current clinical guidelines of ovarian cancer refer to the previous FIGO and WHO classification systems, therefore we conducted this manuscript to clarify the clinical implications of the news definitions [6–11]. Both qualities—the tumor stage (according to FIGO classification) and the type of tumor (according to WHO classification)—are essential criteria for the treatment decision-making process of a differentiated therapy.
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