Fallopian tube origin of supposed ovarian high-grade serous carcinomas

Diniz, Patricia Martini; Carvalho, Jesus Paula; Baracat, Edmund Chada; Carvalho, Filomena Marino

doi:10.1590/s1807-59322011000100013

Cited by 26 publications

(25 citation statements)

References 27 publications

(42 reference statements)

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“…Histologic and immunohistochemical criteria for STIC (3,5–8,16,20–23), p53 signature (3–8), and atypical lesions intermediate between p53 signature and STIC (3,7,9–16) have been applied in a non-uniform fashion in studies from different institutions (Tables 3–5). Consequently, variability exists for these diagnoses.…”

Section: Discussionmentioning

confidence: 99%

Validation of an Algorithm for the Diagnosis of Serous Tubal Intraepithelial Carcinoma

Vang

Visvanathan

Gross

et al. 2012

International Journal of Gynecological Pathology

127

125

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Summary It has been reported that the diagnosis of serous tubal intraepithelial carcinoma (STIC) is not optimally reproducible based only on histologic assessment. Recently, we reported that the use of a diagnostic algorithm that combines histologic features and coordinate immunohistochemical expression of p53 and Ki-67 substantially improves reproducibility of the diagnosis. The goal of the current study was to validate this algorithm by testing a group of 6 gynecologic pathologists who had not participated in the development of the algorithm (3 faculty, 3 fellows) but who were trained in its use by referring to a website designed for that purpose. They then reviewed a set of microscopic slides, which contained 41 mucosal lesions of the fallopian tube. Overall consensus (≥4 of 6 pathologists) for the 4 categories of STIC, serous tubal intraepithelial lesion (our atypical intermediate category), p53 signature, and normal/reactive was achieved in 76% of lesions with no consensus in 24%. Combining diagnoses into 2 categories (STIC vs. non-STIC) resulted in overall consensus in 93% with no consensus in 7%. The kappa value for STIC vs. non-STIC among all 6 observers was also high at 0.67 and did not significantly differ whether for faculty (κ=0.66) or fellows (κ=0.60). These findings confirm the reproducibility of this algorithm by a group of gynecologic pathologists who were trained on a website for that purpose. Accordingly, we recommend its use in research studies. Before applying it in routine clinical practice, the algorithm should be evaluated by general surgical pathologists in the community setting.

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Section: Discussionmentioning

confidence: 99%

Validation of an Algorithm for the Diagnosis of Serous Tubal Intraepithelial Carcinoma

Vang

Visvanathan

Gross

et al. 2012

International Journal of Gynecological Pathology

127

125

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“…The fallopian tube as the site of origin of ''ovarian cancer'' was proposed by Dutch investigators (18) after several studies of prophylactic salpingo-oophorectomy specimens from high-risk women revealed small tubal carcinomas (1,16). There is now a stream of reports worldwide that confirm and expand on these data with morphologic and molecular studies as well as observations in animal models (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34).…”

mentioning

confidence: 99%

Serous Tubal Intraepithelial Carcinoma Localizes to the Tubal-peritoneal Junction

Seidman

2015

International Journal of Gynecological Pathology

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Recent data suggest that intraepithelial carcinoma of the fallopian tube [serous tubal intraepithelial carcinoma (STIC)] is the precursor of high-grade extrauterine serous carcinoma. A more specific location for the origin of this lesion is suggested by the recently described junction between the fallopian tubal epithelium and the peritoneum [tubal-peritoneal junction (TPJ)]. Fallopian tubes from 202 patients with advanced-stage high-grade extrauterine serous carcinoma or carcinosarcoma were evaluated histologically as were 124 prophylactic salpingo-oophorectomy specimens. These included 54 patients with BRCA or other high-risk mutation or a family history of BRCA mutation and 70 with a personal or family history of breast carcinoma. STIC was found in 81 of 202 patients with serous carcinoma (40.1%). STIC was present in 73 of 141 (52%) cases in which the fimbriae were present and in 62 of 100 (62%) cases in which the TPJ was present (P not significant). In comparison with these groups, when fimbriae and TPJ were absent, STIC was found in 8 of 61 (13%) cases (P<0.0001). None of the prophylactic specimens contained STIC. The mean size of STIC was 1.7 mm. In 32 cases (39.5%), the lesion was flat and in 49 (60.5%), papillary. The mean size of flat STICs was 0.8 mm as compared with 2.3 mm for papillary STICs (P=0.00005). STIC was identified in the same tissue fragment as the junction in 48 cases. The mean distance of STIC to the junction was 1.8 mm. In 11 cases, STIC was flanked by peritoneal mesothelium on one side and tubal epithelium on the opposite side. In 51 patients, the mean distance of invasive carcinoma from the TPJ was 1.8 mm. This distance was 1.9 mm when STIC was present (37 cases) in comparison with 1.5 mm when STIC was absent (14 cases) (P not significant). In 27 of 42 cases (64%), STIC was contiguous with invasive carcinoma. Lamina propria invasion was present in 71% of cases in which STIC was present as compared with 26% of cases in which STIC was absent (P<0.0001). Myosalpingeal invasion was present in 40% of cases in which STIC was present as compared with 26% of cases in which STIC was absent (P not significant). It is concluded that serous tubal intraepithelial carcinoma occurs at and in the immediate vicinity of the TPJ. In combination with the findings that STICs are present in a majority of cases when the TPJ is present, that flat STICs are smaller than papillary STICs, and that lamina propria invasion is more frequent in the presence of STIC, these data support STIC as the precursor of extrauterine high-grade serous carcinoma, they provide important clues to the site of origin of high-grade serous carcinoma (ovarian cancer), and can guide further research.

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“…In the context of comparing PPC with OC it is interesting, that STIC can be found in similar proportions of diagnosed PPC and OC, suggesting a tubal origin of up to two third of PPC and OC [33][34][35][36][60][61][62], which might therefore rightly be classified as FC, giving rise to a somewhat different epidemiological picture of the traditionally known very rare FC [63]. This may also explain why a larger proportion of FCs are diagnosed in low stages [20,39], as the higher stage FC might be misclassified as OC or PPC.…”

Section: Discussionmentioning

confidence: 99%

“…Four case studies retrospectively investigated the frequency of STIC and fallopian tube involvement in OC, PPC and FC and reported similar [33][34][35][36].…”

Section: The Fallopian Tube As Origin Of Ppc and Ocmentioning

confidence: 99%

Serous ovarian, fallopian tube and primary peritoneal cancers: A common disease or separate entities — A systematic review

Sörensen

Schnack

Karlsen

et al. 2015

Gynecologic Oncology

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Fallopian tube origin of supposed ovarian high-grade serous carcinomas

Cited by 26 publications

References 27 publications

Validation of an Algorithm for the Diagnosis of Serous Tubal Intraepithelial Carcinoma

Validation of an Algorithm for the Diagnosis of Serous Tubal Intraepithelial Carcinoma

Serous Tubal Intraepithelial Carcinoma Localizes to the Tubal-peritoneal Junction

Serous ovarian, fallopian tube and primary peritoneal cancers: A common disease or separate entities — A systematic review

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