Ovarian carcinoma develops through multiple modes of chromosomal evolution.

Ovarian carcinoma has the highest mortality of all of the gynecologic cancers. The chromosomal changes in this tumor type are highly complex, and the karyotypes typically show severe aneuploidy. Despite the abundance of cytogenetic information, with approximately 400 published karyotypes, very little is known about the mode of karyotypic evolution and the possible presence of cytogenetic pathways related to tumor development. In the present investigation we used 387 ovarian carcinoma karyotypes to identify the most frequent genomic imbalances. Tumor cases were then classified with respect to the presence or absence of these imbalances and statistically analyzed to assess the order of appearance of chromosomal imbalances, as well as possible karyotypic pathways and cytogenetic subtypes. We establish the temporal order by which the different imbalances occur and show that at least two cytogenetic pathways exist, one characterized by +7, +8q, and +12, and one by 6q- and 1q-. We show that ovarian carcinomas develop through at least three phases of karyotypic evolution. At the early stages, Phase I, the karyotypic evolution seems to proceed though step-wise acquisition of changes. The transition to Phase II showed signs of an increased chromosomal instability, most probably caused by extensive telomere crisis and the onset of breakage-fusion-bridge cycles. This process was linked to the presence of imbalances characteristic for the 6q-/1q- pathway. The transition to Phase III involved triploidization and was also linked to the presence of the 6q-/1q- pathway.