Clinical Outcome of Isolated Serous Tubal Intraepithelial Carcinomas (STIC)

Wethington, Stephanie L.; Park, Kay J.; Soslow, Robert A.; Kauff, Noah D.; Brown, Carol L.; Dao, Fanny; Otegbeye, Ebunoluwa; Sonoda, Yukio; Abu‐Rustum, Nadeem R.; Barakat, Richard R.; Levine, Douglas A.; Gardner, Ginger J.

doi:10.1097/igc.0b013e3182a80ac8

Cited by 103 publications

(93 citation statements)

References 29 publications

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“…This patient underwent additional surgery, including peritoneal and diaphragmatic biopsies and pelvic and para-aortic lymphadenectomy. No further malignancy was detected and there was no evidence of recurrence 16 mo after surgery (25). In this study, there was a median follow-up of 28 mo and no recurrences were identified (25).…”

Section: Discussionmentioning

confidence: 75%

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Serous Tubal Intraepithelial Carcinoma (STIC)-like Lesions Arising in Ovarian Serous Cystadenofibroma

Craig

Clarke

Rushton

et al. 2015

International Journal of Gynecological Pathology

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Recent studies have demonstrated that most so-called ovarian high-grade serous carcinomas are likely to arise from the epithelium of the distal fimbrial portion of the fallopian tube from a precursor lesion known as serous tubal intraepithelial carcinoma (STIC). We report 2 cases in patients aged 56 and 71 of lesions morphologically identical to STIC (referred to as STIC-like lesions) arising from the benign ciliated epithelium of ovarian serous cystadenofibromas. In 1 case, 2 glands within the serous cystadenofibroma exhibited high-grade nuclear atypia and mitotic activity and in the other similar changes were multifocal. No invasion of the stroma was seen. In both cases, the STIC-like lesion exhibited aberrant "mutation-type" staining with p53 (1 diffuse intense positivity, 1 null pattern). As far as we are aware, a STIC-like lesion involving the epithelium of a benign ovarian serous neoplasm has not been reported previously. Both patients were followed up without adjuvant treatment. One case is recent, and follow-up in the other patient is uneventful at 12 mo.

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Section: Discussionmentioning

confidence: 75%

“…Possible options include follow-up only, surgical staging, or adjuvant chemotherapy. One recent study looked at longitudinal follow-up of 12 patients with incidentally detected STIC at RRSO (25). In this study, the overall frequency of STIC in patients who underwent RRSO was 2% (12 of 593 patients).…”

Section: Discussionmentioning

confidence: 89%

Serous Tubal Intraepithelial Carcinoma (STIC)-like Lesions Arising in Ovarian Serous Cystadenofibroma

Craig

Clarke

Rushton

et al. 2015

International Journal of Gynecological Pathology

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“…A provocative hypothesis of the tubal origin of high-grade serous ovarian-peritoneal carcinoma has been advanced, developed from studies of prophylactic salpingo-oophorectomies in women with germline BRCA mutations, in which microscopic foci of ''atypia'' are found in up to 50% of the distal tubes, but not in the ovaries including its surface epithelium (35,36). This theory postulates that tubal precursor lesions, that are preferentially located in the fimbria, directly implant into the ovary, perhaps when its surface is disrupted by ovulation, or onto other peritoneal sites given the direct access of the tube to the peritoneal cavity (37), and grow into larger tumors that have traditionally been classified as ovarian or primary peritoneal carcinoma, respectively. The role of tubal stem cells is also being investigated (38).…”

Section: Selected Topics In Fallopian Tube Pathologymentioning

confidence: 97%

A Small Organ Takes Center Stage

Rutgers

Lawrence

2014

International Journal of Gynecological Pathology

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In this paper we consider a number of non-neoplastic and neoplastic lesions of the fallopian tube. Emphasis has been placed on diagnostically difficult entities, some of which result in misdiagnosis and consequent alteration of treatment, including "pseudocarcinomas" that represent a florid epithelial response to acute and/or chronic salpingitis. Endometriosis-related lesions may cause infertility, or undergo malignant transformation to a Mullerian carcinoma, most frequently endometrioid and clear cell types. Pregnancy-related tubal lesions include the easily misdiagnosed metaplastic papillary tumor as well as several manifestations of ectopic pregnancy. Covered briefly are familial conditions such as the Peutz-Jeghers syndrome and its association with tubal mucinous metaplasia, clear cell papillary cystadenoma associated with von Hippel-Lindau syndrome, and the Li Fraumeni syndrome's germline p53 mutation and its association with distal tubal p53 signatures. Miscellaneous tumors discussed include the common adenomatoid tumor and the uncommon female adnexal tumor of probable Wolffian origin. Important issues including the updated staging of fallopian tube carcinomas, and the histopathologic variants of endometrioid carcinomas and their sometimes unusual patterns that engender the potential for confusion with other tumors are briefly noted. The final section covers the relatively recent and novel concept of the fallopian tube as the predominant site of origin of ovarian and peritoneal carcinomas. Discussed are the histologic, immunohistochemical, and molecular biologic evidence that support the tubal fimbria as the site of serous tubal intraepithelial carcinoma, possibly the immediate precursor to high-grade ovarian and peritoneal serous carcinoma.

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“…1 In fact, it has been demonstrated in one small series that the yield of surgical staging for STIC is low, and short-term clinical outcomes are favorable without chemotherapy. 6 It is therefore, at least with the current science, not reasonable to suggest that STIC by itself is a malignant lesion capable of clinically relevant metastasis but instead is truly an in situ cancer. This is similar to the in situ cancers of other epithelial organs, in which the invasive potential of such lesions is in question.…”

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confidence: 99%

Does one size fit all? The updated ovarian cancer staging: Still a work in progress

Duska

Kohn

2015

Cancer

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Staging is an essential part of cancer treatment. It is crucial to both cancer care practice and the reporting of cancer data and statistics. The staging system serves multiple fundamental purposes across cancers. First, the staging system allows for the assignment of appropriate treatment. In particular, in the case of clinical trials, the stage of disease is always part of the inclusion criteria, thus allowing the appropriate assignment of patients to experimental therapy that is addressing specific treatment question(s). Second, the staging system allows health care providers to offer prognostic information regarding the cancer to their patient. This information should factor into both treatment planning and establishment of goals of life care. Third, the staging system allows a standard categorization of cancer and a recognized and accepted terminology that then facilitates data collection and reporting. Finally, the ideal staging system is based on the current scientific understanding of how the particular cancer grows and metastasizes.The recently revised International Federation of Gynecology and Obstetrics (FIGO) staging system for epithelial ovarian cancer and the accompanying introductory text re-reported in this issue of Cancer 1 together make an attempt to incorporate the most up-to-date scientific understanding of ovarian cancer within the staging system. The first point is the incorporation of new data identifying the etiology of ovarian cancer by recognizing that most (if not all) high-grade serous Mullerian cancers (most likely) arise in the fallopian tube epithelium. This science is paradigm-shifting as serous tubal intraepithelial carcinoma (STIC) is the first accepted precursor lesion for epithelial ovarian cancer. Transition zones from STIC to invasive malignancy have been identified to demonstrate the continuity of the pathology (Figs. 1-3). That FIGO has recognized this discovery in the current publication 1 formally acknowledges its importance. However, the problem with this acknowledgment lies in the potential assumption that the STIC lesion is relevant for all epithelial ovarian cancers. In fact, it is likely that STIC is a precursor lesion only for high-grade serous tumors.2 As the authors themselves note, other epithelial ovarian cancer types have different biologic origins.1 For example, low-grade serous tumors do not arise from STIC but rather progress from serous low malignant potential, or borderline, tumors. 3Clear cell ovarian cancers are biologically, genetically, and prognostically different from serous tumors, with the current belief that most if not all clear cell cancers arise in endometriosis. 4 Clear cell cancers have mutations in ARID1a, a member of the SWI/SNF complex; these mutations also have been identified in the endometriosis precursors. Furthermore, transition zones have been observed between endometriosis and clear cell cancers.5 Germ cell and stromal ovarian tumors do not arise from STICs and are not epithelial cancers. Thus, the updated staging system with the i...

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Clinical Outcome of Isolated Serous Tubal Intraepithelial Carcinomas (STIC)

Cited by 103 publications

References 29 publications

Serous Tubal Intraepithelial Carcinoma (STIC)-like Lesions Arising in Ovarian Serous Cystadenofibroma

Serous Tubal Intraepithelial Carcinoma (STIC)-like Lesions Arising in Ovarian Serous Cystadenofibroma

A Small Organ Takes Center Stage

Does one size fit all? The updated ovarian cancer staging: Still a work in progress

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