Serous Tubal Intraepithelial Carcinoma: Its Potential Role in Primary Peritoneal Serous Carcinoma and Serous Cancer Prevention

Abstract

Purpose A diagnosis of primary peritoneal serous carcinoma (PPSC) requires exclusion of a source in other reproductive organs. Serous tubal intraepithelial carcinoma (STIC; stage 0) has been described in asymptomatic women with BRCA mutations and linked to a serous cancer precursor in the fimbria. This study examined the frequency of STIC in PPSC and its clinical outcome in BRCA-positive women. Patients and Methods Presence or absence of STIC was recorded in consecutive cases meeting the 2001 WHO criteria for PPSC, including 26 patients with nonuniform sampling of the fallopian tubes (group 1) and 19 patients with complete tubal examination (group 2; sectioning and extensively examining the fimbriated end, or SEE-FIM protocol). In selected cases, STIC or its putative precursor and the peritoneal tumor were analyzed for p53 mutations (exons 1 to 11). Outcome of STIC was ascertained by literature review. Result Thirteen (50%) of 26 PPSCs in group 1 involved the endosalpinx, with nine STICs (35%). Fifteen (79%) of 19 cases in group 2 contained endosalpingeal involvement, with nine STICs (47%). STIC was typically fimbrial and unifocal, with variable invasion of the tubal wall. In five of five cases, the peritoneal and tubal lesion shared an identical p53 mutation. Of 10 reported STICs in BRCA-positive women, all patients were without disease on follow-up. Conclusion The fimbria is the source of nearly one half of PPSCs, suggesting serous malignancy originates in the tubal mucosa but grows preferentially at a remote peritoneal site. The generally low risk of recurrence in stage 0 (STIC) disease further underscores STIC as a possible target for early serous cancer detection and prevention.

Epithelial ovarian cancer stem cells: underlying complexity of a simple paradigm

“…Recently, growing evidence has challenged this theory and identified the secretory cell of the distal fallopian tube as the putative EOC precursor (Dubeau 1999, Piek et al 2001, Carcangiu et al 2004, Lee et al 2007, Carlson et al 2008, Mehra et al 2011. The balance of evidence suggests that the distal FTE is a major site of origin of HGSEOC; however, the OSE or derived cortical inclusion cysts are likely to also contribute progenitors to this disease (Roh et al 2009, Crum et al 2012, 2013.…”

Liquid-based cytology aids in primary fallopian tube cancer diagnosis

“…We must be especially vigilant about the possibility of PFTC to avoid misdiagnosis or delay. Lastly, since there is little difference between advanced ovarian serous and primary peritoneal carcinomas (Jaaback et al, 2006;Carlson et al, 2008), the dyskaryotic glandular cells may be seen in primary peritoneal carcinomas, so either the appendix carcinoma or primary peritoneal carcinoma should not be ignored.…”

Cancer of the ovary, fallopian tube, and peritoneum

“…Tumor extension into the submucosa or muscularis and to and beyond the serosa can therefore be defined. These features, together with the laterality and the presence or absence of ascites, should all be taken into consideration [1,3,6,7].…”

“…As noted above, it has been previously presumed that fallopian tube malignancies were rare; however, this has been challenged by evidence to show that many tumors that were classified as serous carcinomas of the ovary or peritoneal cancers appear to have their origin in the fallopian tube [3][4][5][6][7]. When the origin is uncertain, the convention of designating all serous cancers, as originating in the ovary should no longer be used and the term "undesignated origin" may be applied at the discretion of the pathologist [18].…”