Supplementary MaterialsAdditional document 1: Supplementary table 1. diagnosis was reached by the review of full Haematoxylin and Eosin stained sections, with concern Ibotenic Acid of immunohistochemical results. The integrated diagnoses were compared with the original diagnoses, and the degree of agreement was evaluated by percentage and Kappa statistics. Results Though limited by selection bias, the results suggest lower rates of ovarian cancer in East Africa compared to a North American populace from Alberta, Canada. There was a higher proportion of sex cord stromal tumors and germ cell tumors in the East African populace. Diagnostic accuracy for main ovarian tumor type categories was substantial (Kappa 0.70), but only fair for specific ovarian carcinoma histotypes (Kappa 0.34). Poor Haematoxylin Ibotenic Acid and Eosin stain was the main factor hindering the correct diagnosis, which was not related to tissue processing. Conclusions In a resource-limited setting, where immunohistochemistry is not routinely carried out, diagnostic accuracy for the main categories of ovarian carcinoma is usually substantial and could be further improved by standardization of the basic Haematoxylin and Eosin stain. Epithelia, Germ Cell Tumors, Lymphomas, Sex Cord Stromal Tumors, Sarcomas, Non Malignant Histotype specific agreement between initial diagnosis and revised diagnosis In a revised diagnosis, the specific histotypes were assigned based on 2014 WHO Classification of Tumors of Female Reproductive Organs. There was a fair agreement between initial diagnoses and revised diagnoses (Kappa?=?0.343, 95% CI: 0.277 to 0.409), as shown in Supplementary Table?2. In summary, a good concordance was seen in Lymphomas, followed by Germ Cell Tumors (92.9 and 81%, respectively). For epithelial tumors (carcinoma), a total number of 84 (57.9%) situations weren’t classified (carcinoma not in any other case specified (NOS)). Pursuing review, a complete Ibotenic Acid variety of 36 (42.9%) situations were reclassified to HIGH QUALITY Serous Carcinoma (HGSC). Significant amounts of carcinoma NOS acquired poor H&E discolorations, where the medical diagnosis was straightforward pursuing recut and brand-new H&E stain at Calgary lab. Two situations acquired a medical diagnosis of carcinoma NOS. Pursuing H&E re-stain, one was adult granulosa cell tumor, and the other was HGSC with positive staining with WT-1 and p53 mutant type (observe Fig.?2). There were 13 cases of HGSC in the original diagnosis, and the concordance with the revised diagnosis was 76.9%. Among 17 cases originally diagnosed as Endometrioid Carcinoma (EC), the concordance with a revised diagnosis was 58.8%, and 5 (29.4%) were reclassified to HGSC. The concordance of 21.7% was seen in Mucinous Carcinoma (MC), and 6 (26.1%) were reclassified to EC, whereas 4 (17.4%) were metastasis from GI. There were three cases of Low Grade Serous Carcinoma (LGSC), with a concordance of 33.3%, one case was EC, and the other was a metastasis from GI. Ibotenic Acid There was one case of neuroblastoma which was reclassified as small cell carcinoma hypercalcemic type (SCCOHT) with loss of BRG1 staining in tumor cells and Rabbit polyclonal to ARHGAP26 positive staining of stromal cells (Observe Fig.?3a & b), and one case of carcinoma NOS was reclassified as mixed carcinoma (EC/LGSC). Open in a separate windows Fig. 2 The case (a) shows a poor morphology diagnosed as carcinoma NOS, and following re-stain (b), the morphology was that of adult granulosa cell tumor. c is usually another case that shows poor morphology with obvious mitotic figures diagnosed as carcinoma NOS, and IHC shows focal WT-1 stain and p53 mutant type staining pattern Open in a separate windows Fig. 3 A case of SCCOHT showing diffuse small cells with dark nuclei and pseudo follicles with eosinophilic material (a), and the loss of BRG1 staining in tumor cells (b) and positive staining of stroma cells (Arrow). c shows a case on EC with mucinous features (in the beginning diagnosed as MC) with loss of MSH6 and ARID1A (insets) in tumor cells with positive staining in stromal tissue and lymphocytes. D is usually a case with Loss of ARID1A with no internal control (no staining of stromal tissue or lymphocytes) IHC markers expression in ovarian.