Ovarian cancer accounts for 6 % of all female genital cancer [1]. India has the second-highest incidence of ovarian cancer globally. Ovarian cancer includes a broad spectrum of lesions ranging from localized benign tumors of borderline malignant potential through invasive adenocarcinoma. The incidence, clinical appearance, and the behavior of the different types of ovarian tumors are extremely variable. It is generally impossible to diagnose the nature of the ovarian tumor preoperatively just by clinical examination and even on exploration, though certain investigations like peritoneal fluid analysis, estimation of serum lactate dehydrogenase, fibrin degradation products, and immunological tests have been reported to be of some help in predicting the nature of the pathology.

The commonest category of ovarian tumors is epithelial tumors followed by germ cell tumors [2]. Etiology is not fully understood although the both epidemiological and genetic association has been found. Approximately 20% of ovarian malignancy is due to inherited mutations that confer elevated risk, the majority from BRCA 1 and BRCA 2 [3].

The world health organization histological classification of ovarian tumors according to the tissue of origin; surface epithelial (65%), germ cells (15%), sex cord-stromal (20%), metastasis (5%). Surface epithelial tumors are further classified by cell type (serous, mucinous, etc) and atypia (benign, borderline, or malignant. Her 2 neu (Human epidermal growth factor receptor-2) protoncogene encodes a protein belonging to the EGFR tyrosine kinase receptor family. Overexpression of her 2 neu initiates intracellular signaling pathways involved in cell proliferation, differentiation, apoptosis, and migration [4].

The ovarian epithelial carcinomas have a poor prognosis. The great prognostic significance of tumor grade is for survival. It is proposed that the histopathological factors, as well as tumor stage and histological type, should be included in the international classification of primary epithelial tumors of the ovary. There are many proposed systems of grading but the most popular is the W.H.O. grading which is directed principally at invasive epithelial ovarian carcinomas. The grading has important prognostic and therapeutic implications. The prognostic factors include the FIGO stage, histological types, tumor grade, and clinic-surgical parameters including residual disease

guidelines provided by FIGO. For assessing the association of tumor stage with Her-2/neuexpressions, tumors were divided into early-stage tumors (stage I and II)and tumors with late-stage (III and IV). The sections with tumor and adjacent normal ovarian tissue were processed for her 2 neu immunohistochemical staining.

A case of her 2 neu positive breast carcinoma was used as the positive control. For Her-2/neu staining, after antigen retrieval, slides were stained with a polyclonal antibody against Her-2/neuoncoprotein. No ethical permission was required in this study as it was done on surgical specimens received postoperative.

All the immunostained slides were reviewed and evaluated using the following criteria- Assessment of the immunohistochemical staining for her-2/neuoverexpression. The negative expression included cases with either no staining or faint to weak membranous positivity in less than 10%of tumor cells. The positive expression was considered in cases of moderate to strong membranous positivity in more than 10%of tumor cells.

In study 32 ovarian tumors were studied, out of which 44.5% of tumors were benign, 5.5% were borderline and 50% were malignant.

It was found that out of 32 studied ovarian tumors, 64.9% were epithelial tumors, 21.6% were germ cell tumors, 8.1% were sex cord-stromal tumors and 5.4% were metastatic tumors.

Serous tumors were most common among all epithelial tumors (68.8%) (Table 1).

Table 1: Distribution of various ovarian neoplasm.

Out of a total 16 serous tumors, 45.5% were benign.

Serous adenocarcinoma was the most common malignant tumor accounting for 37.5% of all epithelial tumors and 54.5% were serous tumors (Table 2).

The positive expression of Her-2/neu was more in patients with high-grade ovarian tumors in comparison to low grade. Out of all studied malignant ovarian tumors, maximum Her-2/neu positivity (72.2%) was present in serous adenocarcinoma and its association with Her-2/neu was statistically significant as compared to others.

The current study suggested that her-2/neu deserves further evaluation as a prognostic marker in epithelial tumors (Figure 2) (Figure 3-7).

Fig-1: Distribution of various ovarian neoplasm.

Fig-2: Status of HER-2/NEU and histological type of cancer.

Fig-3: Microphotograph of metastatic adenocarcinoma (Krukenberg tumor) (H and E 400 X).

Fig-6: Microphotograph of poorly differentiated epithelial neoplasm showing membranous positivity of tumor cells (Her-2/neu immunostain).

Fig-7: Microphotograph of yolk sac tumor showing membranous positivity of tumor cells (Her-2/neu immunostain).

Ovarian cancer is the fifth leading cause of cancer death among women and has the highest mortality rate of all gynecologic cancers [5]. Ovarian cancer is diagnosed in later stages because the inaccessible anatomic location of the ovaries and asymptomatic nature of the disease hinders the detection of cancer while it is still confined to the ovary.

The prognostic factors include the FIGO stage, histological type, tumor grade, and clinic-surgical parameters include residual disease after debulking surgery, presence or absence of ascites, performance status, and age. FIGO stage is the most important independent prognostic factor.

The current study evaluated the clinicopathological profile of various ovarian tumors and expression of Her-2/neu in ovarian lesions, its relationship to its type of malignancy, and correlation with clinico-

in concordance with another study [10,11].

Among all malignant epithelial tumors, 61.5% of cases were her-2/neu positive and 39.5% were negative. In germ cells, tumor 18.2% cases were her 2 neu positive and rest 81.8% were negative.So, her-2/neu was statistically significantly associated with epithelial tumors than with other ovarian tumors compared to another study [12] and with non-cordance with another study [13,14]. The non-epithelial tumors of ovary rarely showed her-2/neu expression comparable to another study [8]. HER2 expression is associated with a worse outcome of ovarian cancer, implicating HER2 may be a potential prognostic indicator for ovarian cancer patients [16].

In the present study out of 8 (48.5%) patients with early-stage ovarian cancer (Stage I and 2); 43.7%patients were her-2/neu positive and 56.3% were her-2/neu negative while out of 51.5% patients were with advanced-stage ovarian cancer (stage III/IV), with 64.7% cases were her-2/neu positive and 35.3%were her -2 /neu negative; concluding the expression of her-2/neu is independent of ovarian cancer stage [14,15]. The number of cases the current study received during the period of study was limited. Hence the association of various ovarian tumor type and Her-2/neu co-relation need to be a further study in a large sample size.

Epithelial tumors were commonest among all ovarian tumors studied; most common being serous tumors. The majority of tumors were unilateral and were seen in multiparous women and the majority had a size between 5-14 cms. The majority of tumors were in high grade and presented in advanced stages. Her-2/neu positivity was seen in 24.3% of ovarian tumors. All the benign and borderline tumors were negative for her-2/neu. 48.6% of malignant tumors were her-2/neu positive. Epithelial tumors were significantly associated with her-2 /neu with serous adenocarcinoma showing maximum association as compared to other tumors.

Her-2/neu expression is significantly associated with tumors of high grade but had no correlation with the