Morphologic precursors of ovarian epithelial tumors.

OBJECTIVE: To correlate various types of hyperplastic lesions of the ovarian surface epithelium with primary disease of the female genital tract. METHODS: Using whole-organ multiple sections of the ovary, we studied 200 hysterectomy and bilateral salpingo-oophorectomy specimens distributed into four groups: cases without hyperplastic or neoplastic disease in the tube, uterus, or vagina; those with contralateral epithelial ovarian tumors; those with endometrial adenocarcinomas; and those with polycystic ovary disease. RESULTS: We found a high frequency of hyperplastic and metaplastic changes in the surface epithelium or in the inclusion cysts in ovaries with contralateral epithelial ovarian tumors (92%), endometrial adenocarcinomas (76%), and polycystic ovary disease (68%) compared to ovaries without hyperplastic or neoplastic disease (22%). These changes were frequently associated with intracystic papillae and psammoma bodies similar to those observed in epithelial tumors. The inclusion cysts were unrelated morphologically to signs of preceding ovulation, but were related to deep crypts of the ovarian epithelium and to stromal hyperplasia. CONCLUSIONS: The hyperplastic and metaplastic changes of the surface epithelium and related inclusion cysts can be considered morphologic precursors of common epithelial tumors. Similar changes are found as a response to a hormonal ovarian or extraovarian stimulus, which may play an important role in ovarian carcinogenesis.