© 1997 by Oxford University Press
Journal Of The National Cancer Institute, Vol 89, 437-441, Copyright © 1997 by Oxford University Press
M Wan, WZ Li, BD Duggan, JC Felix, Y Zhao and L Dubeau
BACKGROUND: Ovarian epithelial tumors include benign lesions lacking
invasive and metastatic abilities (cystadenomas) in addition to malignant
lesions (carcinomas). An intermediate category, called tumors of low
malignant potential (LMP), is also recognized. The merit of this
classification is being challenged because the clinical behavior of LMP
tumors appears closer to that of cystadenomas than to that of carcinomas.
PURPOSE: To verify our hypothesis that the expression of the enzyme
telomerase distinguishes these two categories of ovarian epithelial tumors,
we examined and compared such expression in ovarian cystadenomas and
carcinomas. By examining the expression of telomerase in LMP tumors, we
then sought to determine if these tumors were more closely related to
cystadenomas or to carcinomas with regard to telomerase expression.
METHODS: We examined a total of 64 consecutive ovarian tumors subdivided
into 20 carcinomas, 17 LMP tumors, and 27 cystadenomas. We subsequently
discarded three of the 27 cystadenomas because of the presence of admixed
normal ovarian stroma in those specimens. Tumor subtyping was done without
knowledge of the telomerase results, and telomerase assays were likewise
interpreted without knowledge of tumor types. Telomerase activity was
determined by use of the TRAP (i.e., telomeric repeat amplification
protocol) assay. Differences between the proportions of tumors expressing
this enzyme in each subgroup were evaluated by use of Fisher's exact test
(two-sided). RESULTS: Telomerase activity was detected in all 20 carcinomas
and in all 17 LMP tumors examined. In contrast, it was not detected in 19
of the 24 cystadenomas. These differences between rates of telomerase
expression in either carcinomas or LMP tumors and those in cystadenomas
were statistically significant (P<.0001). All five of the telomerase-
positive cystadenomas belonged to a variant called papillary cystadenomas,
whereas none of the telomerase-negative cystadenomas belonged to this
variant (P<.0001). CONCLUSIONS AND IMPLICATIONS: The presence of
telomerase expression in ovarian LMP tumors supports the merit of
continuing to separate these tumors from cystadenomas, in spite of their
apparent benign clinical course. The finding of telomerase expression in
papillary cystadenomas suggests that such tumors may be mechanistically
related to LMP tumors and should perhaps be reclassified as variants of LMP
tumors. Lack of telomerase expression in ovarian cystadenomas raises
questions about the alleged immortality of these tumors because expression
of this enzyme is thought to be essential for continuous growth in adult
tumors.
ARTICLES
Telomerase activity in benign and malignant epithelial ovarian tumors
Department of Pathology, University of Southern California, Los Angeles 90033, USA.
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