Silverberg developed a histologic grading system for grading primary ovarian epithelial carcinomas. The grading system correlates well with survival for most tumors. The author is at the University of Maryland in Baltimore.
Carcinomas included: serous, mucinous, clear cell, endometrioid, transitional cell, carcinosarcoma, malignant Brenner, unclassified carcinoma
Parameters:
(1) architectural pattern
(2) nuclear pleomorphism
(3) mitotic count
Mitotic counting instructions:
(1) Counts done in areas of greatest mitotic activity ("most brisk")
(2) Counted only if mitosis in definite metaphase, anaphase or telophase.
(3) Hyperchromatic and apoptotic nuclei were excluded from the count.
(4) A minimum of 30 high power fields (hpf) were counted (3 groups of 10). The highest value was used for scoring.
(5) Area of count was 0.345 square mm (using a Nikon Optiphot with 10x eyepiece and 40x objective)
|
Parameter |
Finding |
Points |
|
architectural pattern |
predominantly glandular |
1 |
|
|
predominantly papillary |
2 |
|
|
predominantly solid growth |
3 |
|
mitotic count |
<= 9 per 10 high power fields (hpf) |
1 |
|
|
10 - 24 per 10 hpf |
2 |
|
|
>= 25 per 10 hpf |
3 |
where:
• The total area counted in 10 hpf would be 3.45 square mm. It should be possible to adjust the number of mitoses seen with a different microscope as:
equivalent mitotic count for 10 hpf with different microscope =
= 3.45 * (mitotic count in 10 hpf) / (area count in square mm)
|
Nuclear Features |
1 Point |
2 Points |
3 Points |
|
variation in size and shape |
relatively uniform and vesicular |
intermediate |
marked variation |
|
nuclear to cyto-plasmic ratio |
low |
intermediate |
high |
|
chromatin clumping |
none |
some |
prominent |
|
nuclear membrane |
NA |
NA |
thick |
|
nucleoli |
none |
small |
large and eosinophilic |
|
bizarre cells |
none |
none |
may be present |
where:
• The scale has similarities with the Bloom-Richardson score for invasive ductal carcinomas of the breast.
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 3
• maximum score: 9
|
Total Score |
Grade |
|
3, 4 or 5 |
well differentiated |
|
6 or 7 |
moderately differentiated |
|
8 or 9 |
poorly differentiated |
Performance:
• Shimizu et al found the score simple and reproducible. It correlated with survival for early and advanced stages and for all major histologic types except for clear cell carcinoma.
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
ICD-10: ,
