Challenging Salpingectomy as a Risk-Reducing Measure for Ovarian Cancer: Histopathological Analysis of the Tubo-Ovarian Interface in Women Undergoing Risk-Reducing Salpingo-oophorectomy

2017 ◽  
Vol 27 (4) ◽  
pp. 703-707 ◽  
Author(s):  
Chloe Ayres ◽  
Gayanie Ratnayake ◽  
Orla McNally ◽  
Michael Quinn
Keyword(s):  
Ovarian Cancer ◽  
High Risk ◽  
Fallopian Tube ◽  
High Risk Patient ◽  
Primary Site ◽  
Serous Carcinoma ◽  
Histopathological Analysis ◽  
High Grade ◽  
Bilateral Salpingectomy ◽  
Risk Reducing

ObjectiveOpportunistic bilateral salpingectomy is now promoted for women at the time of hysterectomy for a benign disease, consequent to the fimbrial end of the fallopian tube emerging as the primary site for carcinogenesis in high-grade serous carcinomas. In high-risk women with an identified germ line mutation, bilateral salpingo-oophorectomy offers the greatest risk reduction for ovarian cancer. Currently, no prospective evidence exists with respect to the effectiveness of opportunistic salpingectomy alone in preventing ovarian cancer. Although it is thought that there is no direct connection between the ovary and its adjacent fallopian tube, we often find remnants of the fimbria adherent to the ovary at the time of surgery. If this tubo-ovarian interface is not separate, then practices such as salpingectomy and radical fimbriectomy may be incomplete, and the effectiveness of this technique as a prophylactic strategy may need reconsideration. We aimed to establish whether there might exist a direct attachment of the fimbria to the ovary by examining this interface in surgically removed specimens.MethodsThe tubes and ovaries of 20 women undergoing risk-reducing salpingo-oophorectomy were examined using the Sectioning and Extensively Examining the Fimbriated End of the Tubes protocol and p53 immunohistochemistry for lesions suspicious of serous intraepithelial tubal carcinoma.ResultsThree specimens showed fimbria adherent to the ovary at the histopathological analysis. One p53 signature was identified, but there were no occult cancers or serous intraepithelial tubal carcinomas.ConclusionsAlthough only a small study, the findings show that microscopic fimbriae are adherent to the ovary. This relationship challenges the recommendation for bilateral salpingectomy alone for risk-reducing surgery because the primary site of carcinogenesis may be left on the ovary to later develop into a high-grade serous carcinoma. A larger study is needed to assess our findings related to the tubo-ovarian interface and its implications for long-term ovarian cancer development. Until then, caution on using this technique alone in the high-risk patient should be adopted.

scholarly journals Cell Origins of High-Grade Serous Ovarian Cancer

Cancers ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 433 ◽  
Author(s):  
Jaeyeon Kim ◽  
Eun Park ◽  
Olga Kim ◽  
Jeanne Schilder ◽  
Donna Coffey ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
High Risk ◽  
Fallopian Tube ◽  
Malignant Tumors ◽  
Clinical Importance ◽  
Serous Carcinoma ◽  
High Grade ◽  
Serous Ovarian Cancer ◽  
Clinical Behavior ◽  
High Risk Women

High-grade serous ovarian cancer, also known as high-grade serous carcinoma (HGSC), is the most common and deadliest type of ovarian cancer. HGSC appears to arise from the ovary, fallopian tube, or peritoneum. As most HGSC cases present with widespread peritoneal metastases, it is often not clear where HGSC truly originates. Traditionally, the ovarian surface epithelium (OSE) was long believed to be the origin of HGSC. Since the late 1990s, the fallopian tube epithelium has emerged as a potential primary origin of HGSC. Particularly, serous tubal intraepithelial carcinoma (STIC), a noninvasive tumor lesion formed preferentially in the distal fallopian tube epithelium, was proposed as a precursor for HGSC. It was hypothesized that STIC lesions would progress, over time, to malignant and metastatic HGSC, arising from the fallopian tube or after implanting on the ovary or peritoneum. Many clinical studies and several mouse models support the fallopian tube STIC origin of HGSC. Current evidence indicates that STIC may serve as a precursor for HGSC in high-risk women carrying germline BRCA1 or 2 mutations. Yet not all STIC lesions appear to progress to clinical HGSCs, nor would all HGSCs arise from STIC lesions, even in high-risk women. Moreover, the clinical importance of STIC remains less clear in women in the general population, in which 85–90% of all HGSCs arise. Recently, increasing attention has been brought to the possibility that many potential precursor or premalignant lesions, though composed of microscopically—and genetically—cancerous cells, do not advance to malignant tumors or lethal malignancies. Hence, rigorous causal evidence would be crucial to establish that STIC is a bona fide premalignant lesion for metastatic HGSC. While not all STICs may transform into malignant tumors, these lesions are clearly associated with increased risk for HGSC. Identification of the molecular characteristics of STICs that predict their malignant potential and clinical behavior would bolster the clinical importance of STIC. Also, as STIC lesions alone cannot account for all HGSCs, other potential cellular origins of HGSC need to be investigated. The fallopian tube stroma in mice, for instance, has been shown to be capable of giving rise to metastatic HGSC, which faithfully recapitulates the clinical behavior and molecular aspect of human HGSC. Elucidating the precise cell(s) of origin of HGSC will be critical for improving the early detection and prevention of ovarian cancer, ultimately reducing ovarian cancer mortality.

scholarly journals Solitary CNS Metastasis on Initial Presentation of High Grade Serous Carcinoma of the Fallopian Tube

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Felicity Harl ◽  
Cassandra Niemi ◽  
Lori Mankowski Gettle ◽  
Paul Weisman ◽  
Stephen Rose
Keyword(s):  
Fallopian Tube ◽  
Brain Lesion ◽  
Primary Site ◽  
Initial Presentation ◽  
Serous Carcinoma ◽  
High Grade ◽  
Metastatic Adenocarcinoma ◽  
Cns Metastasis ◽  
Small Primary ◽  
History Of

A 68-year-old woman presented with a three-week history of confusion and anomic aphasia. Imaging of her head demonstrated a single large left frontal mass. Pathology revealed metastatic adenocarcinoma of Müllerian origin. Subsequent surgery revealed a small primary site in a fallopian tube, high left para-aortic lymphadenopathy, and no disseminated intraperitoneal disease. This case was remarkable in that CNS metastasis was her presenting symptom and was restricted to a solitary brain lesion, and other disease sites were limited to retroperitoneal lymphadenopathy and a small fallopian tube primary.

scholarly journals Performance of the MasSpec Pen for Rapid Diagnosis of Ovarian Cancer

2019 ◽  
Vol 65 (5) ◽  
pp. 674-683 ◽  
Author(s):  
Marta Sans ◽  
Jialing Zhang ◽  
John Q Lin ◽  
Clara L Feider ◽  
Noah Giese ◽  
...  
Keyword(s):  
Machine Learning ◽  
Ovarian Cancer ◽  
Fallopian Tube ◽  
Mass Spectrometer ◽  
Cancer Diagnosis ◽  
Ion Trap ◽  
Serous Carcinoma ◽  
High Grade ◽  
Clinical Sensitivity ◽  
Tissue Diagnosis

Abstract BACKGROUND Accurate tissue diagnosis during ovarian cancer surgery is critical to maximize cancer excision and define treatment options. Yet, current methods for intraoperative tissue evaluation can be time intensive and subjective. We have developed a handheld and biocompatible device coupled to a mass spectrometer, the MasSpec Pen, which uses a discrete water droplet for molecular extraction and rapid tissue diagnosis. Here we evaluated the performance of this technology for ovarian cancer diagnosis across different sample sets, tissue types, and mass spectrometry systems. METHODS MasSpec Pen analyses were performed on 192 ovarian, fallopian tube, and peritoneum tissue samples. Samples were evaluated by expert pathologists to confirm diagnosis. Performance using an Orbitrap and a linear ion trap mass spectrometer was tested. Statistical models were generated using machine learning and evaluated using validation and test sets. RESULTS High performance for high-grade serous carcinoma (n = 131; clinical sensitivity, 96.7%; specificity, 95.7%) and overall cancer (n = 138; clinical sensitivity, 94.0%; specificity, 94.4%) diagnoses was achieved using Orbitrap data. Variations in the mass spectra from normal tissue, low-grade, and high-grade serous ovarian cancers were observed. Discrimination between cancer and fallopian tube or peritoneum tissues was also achieved with accuracies of 92.6% and 87.9%, respectively, and 100% clinical specificity for both. Using ion trap data, excellent results for high-grade serous cancer vs normal ovarian differentiation (n = 40; clinical sensitivity, 100%; specificity, 100%) were obtained. CONCLUSIONS The MasSpec Pen, together with machine learning, provides robust molecular models for ovarian serous cancer prediction and thus has potential for clinical use for rapid and accurate ovarian cancer diagnosis.

scholarly journals Loss of tubal ciliated cells as a risk for “ovarian” or pelvic serous carcinoma

2020 ◽  
Author(s):  
Yue Wang ◽  
Wanrun Lin ◽  
Yiying Wang ◽  
Yan Wang ◽  
Setsuko Chambers ◽  
...  
Keyword(s):  
High Risk ◽  
Fallopian Tube ◽  
Low Risk ◽  
Serous Carcinoma ◽  
Secretory Cells ◽  
High Grade ◽  
Ciliated Cells ◽  
Anatomic Site ◽  
Pelvic Serous Carcinoma

Abstract Background Recent advances suggest the fallopian tube as the main anatomic site for high-grade ovarian or pelvic serous carcinoma (O/PSC). Human fallopian tube is mainly lined by two cell types, secretory and ciliated cells. Large number of studies on the biologic role of tubal secretory cells in O/PSC have been performed in the last decade. However, the role of tubal ciliated cells in relation to the development of O/PSC has rarely been explored. The purpose of this study was to determine if change of the tubal ciliated cells shows difference in age and location and to examine their association with serous neoplasia. Methods Three groups (low-risk or benign control, high-risk, and O/PSC) of patients were age matched. The age data was stratified by 10-year intervals ranging from age 20 to older than 80. Ciliated cells from both tubal fimbria and ampulla segments were counted by microscopy and by tubulin immunohistochemical staining. The data was analyzed by standard contingency table, Poisson distribution methods, nonparametric Mann–Whitney U-tests and Spearman correlation analysis after age justification. Results The study revealed that the absolute number of tubal ciliated cells decreased significantly with age within each group. A reduction in ciliated cells within the fallopian tube remained a significant risk factor for serous neoplasia after age adjustment. A dramatic decrease of tubal ciliated cells in both tubal segments was identified in patients with high-risk and with O/PSC compared to those in the low-risk (benign control) group (p < 0.001). Further, within the fimbria segment, a reduced number of tubal ciliated cells was more prevalent in the high-risk group when compared to those in O/PSC group. Conclusion Our findings suggest that reduced number of ciliated cells within the fallopian tube represents a hallmark of early serous carcinogenesis. Findings also support a relationship between loss of tubal ciliated cells and aging, the presence of high-risk factors, and co-existing ovarian or pelvic high-grade serous cancers. This represents an early study identifying the role of tubal ciliated cells in the process of high-grade O/PSC development.

scholarly journals A genetically engineered ovarian cancer mouse model based on fallopian tube transformation mimics human high-grade serous carcinoma development

2014 ◽  
Vol 233 (3) ◽  
pp. 228-237 ◽  
Author(s):  
Cheryl A Sherman-Baust ◽  
Elisabetta Kuhn ◽  
Blanca L Valle ◽  
Ie-Ming Shih ◽  
Robert J Kurman ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Mouse Model ◽  
Fallopian Tube ◽  
Genetically Engineered ◽  
Serous Carcinoma ◽  
High Grade ◽  
Model Based

The Fallopian Tube Origin and Primary Site Assignment in Extrauterine High-grade Serous Carcinoma

2017 ◽  
Vol 36 (3) ◽  
pp. 230-239 ◽  
Author(s):  
W. Glenn McCluggage ◽  
Lynn Hirschowitz ◽  
C. Blake Gilks ◽  
Nafisa Wilkinson ◽  
Naveena Singh
Keyword(s):  
Fallopian Tube ◽  
Primary Site ◽  
Serous Carcinoma ◽  
High Grade ◽  
Site Assignment

Effectiveness of Risk-Reducing Salpingo-Oophorectomy in Preventing Ovarian Cancer in a High-Risk French Canadian Population

2012 ◽  
Vol 22 (6) ◽  
pp. 974-978 ◽  
Author(s):  
Omar Moreira Bacha ◽  
Jean Gregoire ◽  
Katherine Grondin ◽  
Maria Isabel Edelweiss ◽  
Rachel Laframboise ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
High Risk ◽  
Fallopian Tube ◽  
French Canadian ◽  
Breast And Ovarian Cancer ◽  
Surgical Morbidity ◽  
Canadian Population ◽  
Increased Risk ◽  
Risk Reducing

BackgroundWomen with germ line BRCA1 or BRCA2 mutations have a marked increased risk of breast and ovarian cancer compared with the general population, whereas risk-reducing salpingo-oophorectomy (RRSO) significantly lowers the incidence of these cancers. The objective of this study was to review the clinical and pathological characteristics of a French Canadian population undergoing RRSO. Surgical morbidity was also evaluated.Materials and MethodsFrom December 1999 to December 2009, all women who underwent RRSO at our institution were identified. Medical records were retrospectively reviewed. Descriptive statistics, the Fischer exact test, and the Student t test were used for analysis.ResultsDuring the study period, RRSO was performed on 119 women. Mean age at surgery was 49 years (35–72 years), and 63 patients (53%) were premenopausal. Sixty-two women (52%) had a history of in situ or invasive breast cancer. BRCA1 and BRCA2 mutations were present in 34 patients (29%) and 42 patients (35%), respectively, whereas 43 patients (36%) were considered to have an increased risk of breast and ovarian cancer, despite a personal genetic test, which was either negative (n = 23) or unknown because the patient declined genetic testing (n = 20). Most patients with a uterus in place had a complementary hysterectomy (65%). Six complications occurred (3 hematomas, 2 cardiac arrhythmias, and 1 cystotomy). In one patient (0.8%), a high-grade stage II ovarian cancer was discovered at the time of surgery. Fallopian tube atypias were identified on final pathology in 8 cases (6.7%). After a median follow-up of 22 months, 4 women (3.4%) developed breast cancer and one woman (0.8%) developed peritoneal cancer.ConclusionsRisk-reducing salpingo-oophorectomy is highly effective in preventing ovarian, fallopian tube, and breast cancers in a high-risk French Canadian population; and the surgical morbidity is low.

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