A 49-year-old woman with a long history of laparoscopically confirmed endometriosis presents with a pelvic mass and raised CA-125. Histology of the resected ovarian tumour shows sheets of hobnail-shaped cells with clear cytoplasm lining tubulocystic spaces. Which feature of this tumour type most influences management?

• A Exquisite sensitivity to platinum-based chemotherapy
• B Invariable response to bevacizumab monotherapy
• C Uniform sensitivity to hormonal therapy alone
• D Relative chemoresistance compared with high-grade serous carcinoma ✓

Explanation

Clear cell carcinoma of the ovary is strongly associated with endometriosis and shows hobnail cells with clear cytoplasm. Its key therapeutic implication is relative resistance to standard platinum-paclitaxel chemotherapy, giving a worse outcome at advanced stage despite lower CA-125 levels than serous cancers. Complete surgical cytoreduction is therefore paramount. Hormonal therapy alone is inadequate for overt carcinoma, and neither platinum sensitivity nor bevacizumab monotherapy response characterises this histotype.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.