Cytologic studies of the fallopian tube in patients undergoing salpingo-oophorectomy
15
Citation
34
Reference
10
Related Paper
Citation Trend
Abstract:
Mounting evidence suggests the fallopian tube as the origin for ovarian high grade serous carcinoma (HGSC). We attempted to identify the tubal cytological features that allow us to distinguish malignant from benign conditions.Tubal specimens (n = 56) were collected from patients who underwent bilateral salpingo-oophorectomy (BSO) due to various clinical indications. A standard procedure to collect fallopian tube brushings from freshly received surgical specimens was developed. Cytological diagnoses were classified into three categories: benign, atypical, and suspicious for malignancy/malignant. Cytological variables of individual cells and epithelia were subjected to statistical analysis. The fallopian tube histology was used as diagnostic reference for confirmation of cytology diagnosis.Among the 56 fallopian tube specimens, 2 (3.7 %) showed inadequate cellularity preventing further evaluation, 11 (20.4 %) were diagnosed as malignant or suspicious of malignancy, 7 were atypical, and 36 were benign. The presence of three dimensional clusters (p < 0.0001, Fisher's Exact Test), or prominent nucleoli (p = 0.0252, Fisher Exact test) was highly correlated with the diagnosis of malignancy. The suspicious malignant/malignant cytological diagnosis was also highly correlated with presence of HGSC with or without serous tubal intraepithelial carcinoma (STIC).Tubal cytology may be useful for ovarian cancer screening and early detection.Keywords:
Fallopian tube
Fallopian tube cancer
Serous carcinoma
Fallopian tube cancer is a rare tumor which accounts for only 1% of all gynaecological cancers. It is closely related and generally treated with a similar approach to ovarian cancer. We used the publicly available databases to provide a description of epidemiological patterns, clinical outcomes, and mutational landscape of fallopian tube cancer and compare it with that of ovarian cancer. We extracted clinical and epidemiological data of fallopian tube and ovarian cancers from the SEER database [13 reg; Nov 2020 Submission]. The average annual percentage change (AAPC) of incidence rates was calculated using The NIH's Joinpoint Regression Program. Sequencing data were obtained through The American Association of Cancer Research (AACR) project GENIE database. We included 4,240 cases of fallopian tube cancer and 74,837 cases of ovarian cancer diagnosed between 1992 and 2018. The overall incidence of fallopian tube cancer was 0.39 [95% CI, 0.38-0.40], whereas the overall incidence of ovarian cancer was 6.97 [95% CI, 6.92-7.02]. Between 1992 and 2018, there was a significant increase in the incidence of fallopian tube cancer (AAPC = 6.1% 95% CI, [4.6, 7.9], p<0.001) and a decrease in the incidence of Ovarian cancer (AAPC = -1.7% 95% CI, [-2, -1.4], p<0.001). The median overall survival of fallopian tube cancer was significantly higher than ovarian cancer (80 months vs 43 months, P<0.001). A presentation with stage IV disease was significantly less frequent in fallopian tube cancer compared to ovarian cancer (50% vs 70%, P<0.001). In 166 patients with fallopian tube cancer and 5,303 patients with ovarian cancer in GENIE, the most frequently mutated genes were TP53, SPTA1, LRP1B, FAT3, and NF1; and TP53, CSMD3, DNAH9, ARID1A, and PDE4DIP; for fallopian tube cancer and ovarian cancer respectively. Fallopian tube cancer is a distinct disease entity different in genetic, epidemiological, and clinical characteristics from ovarian cancer. Cases with fallopian tube cancer are less likely to present with distant metastasis and have longer overall survival compared to cases with ovarian cancer. The most frequently mutated genes of both cancers are different.
Fallopian tube
Fallopian tube cancer
Cite
Citations (0)
A review of the pathology and cytopathology of 295 endometrial adenocarcinomas treated surgically at King Edward Memorial Hospital for Women, with full 5-year follow-up, revealed 16 cases of pure serous carcinoma (USC), 10 cases of mixed serous and endometrioid carcinoma with a predominant serous component (mixed USC-EAC) and six cases of mixed serous and endometrioid carcinoma with a predominant endometrioid component (mixed EAC-USC). The mixed carcinomas may be characterized microscopically by classical serous features side by side with classical endometrioid features, or additionally by features intermediate between the two. Many of these features are reproduced in preoperative cervicovaginal smears. USC and mixed USC-EAC were found to be indistinguishable clinically and prognostically, with an identical corrected 5-year survival of 40%, although numbers are small. Mixed EAC-USC (which contained 10-25% serous differentiation in this series), however, were similar in many respects to a control population of 95 EAC of Grade 2 and 3. The corrected 5-year survival in these two groups was 67% and 79%, respectively, which is not statistically significant in this small series. This study suggests that the behavior of a mixed tumor containing 50% or more serous differentiation is similar to that of pure serous carcinoma, and that the behavior of a mixed tumor containing less than 25% serous differentiation is similar to that of the other component. Given the poor correlation between pathologic findings in curettage and subsequent hysterectomy specimens, however, identification of any significant serous element in curettage material may prove vital in optimizing surgical and adjuvant therapy.
Serous carcinoma
Curettage
Cite
Citations (29)
[Purpose] To investigate the relationship of preoperative serous CA125 with clinicopathological features and prognosis in patients with epithelial ovarian carcinoma.[Methods] The relationship of preoperative serous CA125 with histologic type,grade,FIGO stage,ascites and survival in 279 cases with epithelial ovarian carcinoma were analyzed retrospectively.[Results] The median CA125 value for all 279 patients was 339.2 U/ml(range 3.6～20 220.0U/ml).Preoperative serous CA125 in serous carcinoma was significantly higher than that in non-serous carcinoma(P0.05).For non-serous carcinoma with different histologic types,preoperative serous CA125 in mucinous /clear cell carcinoma was significantly lower than that in serous carcinoma(P0.01),and no significant difference was found between other types of non-serous carcinoma.Preoperative serous CA125 in early stage(stage Ⅰ) patient was significantly lower than that in advanced stage(stage Ⅱ～Ⅳ) patient(P=0.000).For non-mucinous/clear cell carcinoma patient,lower serous CA125 was usually associated with early disease and fairly good prognosis.As compared,higher serous CA125 was usually connected with advanced diseases,among which those with highest CA125 level displayed better survival than those with intermediate CA125 level.[Conclusion] Preoperative serous CA125 might reflect the tumor load for serous and other non-mucinous/clear cell carcinoma in epithelial ovarian carcinoma.
Serous carcinoma
Clear cell carcinoma
Cystadenocarcinoma
Serous membrane
Cite
Citations (0)
Fallopian tube
Fallopian tube cancer
Primary cancer
Cite
Citations (9)
Serous carcinoma
Cite
Citations (38)
A 36-year-old female (para 3 living 3) presented with menorrhagia since one year.On general physical examination, pallor was present with no other significant findings.Speculum examination showed mild erosion of cervix and per vaginal examination revealed an anteverted bulky uterus with clear fornices.Ultrasound revealed an enlarged uterus with endometrial thickness of 1.2 cm with no other significant findings.Dilatation and curettage revealed disordered proliferation.No other findings were appreciated.Thus, patient was then clinically diagnosed to have dysfunctional uterine bleeding and was subjected to total abdominal hysterectomy with bilateral salpingo-oophorectomy and the specimen was sent for histopathological examination.
Fallopian tube
Serous carcinoma
Presentation (obstetrics)
Fallopian tube cancer
Cite
Citations (5)
High-grade serous carcinoma (HGSC) is the most common and lethal subtype of ovarian cancer. Research over the past decade has strongly suggested that "ovarian" HGSC arises in the epithelium of the distal fallopian tube, with serous tubal intraepithelial carcinomas (STICs) being detected in 5-10% of BRCA1/2 mutation carriers undergoing risk-reducing surgery and up to 60% of unselected women with pelvic HGSC. The natural history, clinical significance, and prevalence of STICs in the general population (ie, women without cancer and not at an increased genetic risk) are incompletely understood, but anecdotal evidence suggests that these lesions have the ability to shed cells with metastatic potential into the peritoneal cavity very early on. Removal of the fallopian tube (salpingectomy) in both the average and high-risk populations could therefore prevent HGSC, by eliminating the site of initiation and interrupting spread of potentially cancerous cells to the ovarian/peritoneal surfaces. Salpingectomy may also reduce the incidence of the 2 next most common subtypes, endometrioid and clear cell carcinoma, by blocking the passageway linking the lower genital tract to the peritoneal cavity that enables ascension of endometrium and factors that induce local inflammation. The implementation of salpingectomy therefore promises to significantly impact ovarian cancer incidence and outcomes.
Fallopian tube
Serous carcinoma
Fallopian tube cancer
Cite
Citations (94)
Fallopian tube
Serous carcinoma
CDH1
PAX8
Cystadenocarcinoma
Cite
Citations (19)
Ovarian cancer is the fifth-leading cause of death by cancer for women in the developed world and is the most deadly of the gynecological malignancies (1). Despite significant progress in the field of gynecological cancer treatment during recent decades, the prognosis has remained poor, and preventive strategies are urgently needed. New data on the pathogenesis of ovarian cancer may serve as a basis for a completely new attitude towards this disease (2–4). Recent data indicate that there are two major types of ovarian cancers. Type I, with a slow growth, is confined to the ovaries and genetically stable. In contrast, type II is highly aggressive and includes often undifferentiated serous and mixed mesodermal tumors (5). It is often disseminated, with involvement of organs close to the ovaries. During the last decade, increasing data have indicating that the type II tumors originate from the Fallopian tube, and it has been hypothesized that the serous type II tumors arise from implantation of epithelium from the Fallopian tube (6), while endometroid and clear cell cancer may be related to retrograde menstruation by endometroid tissue (6). The type II tumors constitute approximately 75% of all ovarian cancer and are responsible for 90% of ovarian cancer-related deaths (2–5). This so-called tubal hypothesis is based on several observations pointing in the same direction. The gene expressions of early stage tubal lesions have similarities with more severe lesions of the Fallopian tube and type II ovarian cancer (6,7). Tubal intraepithelial carcinoma is present in many women with ovarian cancer or peritoneal serous cancer. Protocols examining fimbrial tissue in BRCA-positive women have revealed a high rate of tubal cancer, the so-called tubal intraepithelial carcinoma (8). Furthermore, the hypothesis is supported by indirect evidence suggesting a reduced risk for serous ovarian cancer after tubal ligation in the general population [HR (hazard ratio) 0.73, 95% confidence interval (CI) 0.63–0.85; 9) and in BRCA mutation carriers (HR 0.43, 95% CI 0.22–0.80; 10). Interestingly, as early as 1982 Tobacman et al. reported on 28 female members of 16 families at high risk for ovarian cancer treated with prophylactic oophorectomy and showed that three of the women developed disseminated intra-abdominal cancer indistinguishable histopathologically from ovarian cancer (11). Although these results are compelling, caution is needed when evaluating these data, but if true this provides a strong rationale for new preventive strategies. The concept is already considered and tried in the management of patients with a strong family history of ovarian cancer and/or those carrying the BRCA1/2 mutation (12–13). The traditional way to handle these patients was to perform bilateral ooperocetomy. There are ongoing studies comparing the traditional method with bilateral salpingectomy (BSE) (13). Whether BSE affects ovarian function is controversial. Animal data in rabbits and monkeys indicate that BSE does not impair ovarian function (14,15). Studies on ovarian response in in vitro fertilization patients after salpingectomy have shown differing results, but there are reports suggesting an influence of baseline endocrine function and impaired ovarian blood flow a period of time after the salpingectomy (16). Furthermore, some recent epidemiological data indicate that surgical sterilization is associated with an earlier menopause (odds ratio 1.38, 95% CI 1.07–1.78; 17). However, these studies are difficult to evaluate owing to the retrospective design and uncertainty about the surgical technique used for sterilization (destructive or salpingetomy). It is likely that the degree of influence on ovarian function is related to the blood supply of the ovarian tissue. Thus, methods such as selective fimbriectomy may minimize the risk for causing harm to the ovaries. This will be increasingly important with declining age of the patient. The concept of BSE for ovarian cancer prevention also has implications for the general female population. If BSE is sufficient to reduce the risk for ovarian cancer significantly, and taking into account the limited means we have today to diagnose and treat this disease successfully, it might be that BSE should be offered to the female population on a completely different scale. Some authorities advocate BSE as method of choice for women over 35 years old as a means of sterilization (18). To study the preventive efficiency of BSE for ovarian cancer in a traditional comparative study is complicated, and alternative ways need to be considered. One way would be to consider changing routines at repeat cesarean section in populations with good national registers on ovarian cancer. Today, the number of repeat cesarean sections is increasing, and women often have their children later in life and are strict about the number of children. If we informed women about the possibility of performing BSE (or fimbriectomy) at repeat cesarean section for ovarian cancer prevention, it is likely that many women would opt for this procedure. Thus, if we assume that 2000 BSEs are performed in Sweden each year in connection with cesarean section, that the average age of the mothers was 42 years at their last delivery, and the reduction of risk could be 50%, it is likely that we could detect a significant reduction of ovarian cancer compared with the general population after approximately 15 years. If different countries joined forces and pooled national data, the process could be significantly faster; more than doubled if all the Nordic countries were involved. We have to ask ourselves if it is ethically justified not to counsel our patients about this possibility and to take the professional discussion to a level where a decision on a change of policy or for setting up a randomized study could be taken. Magnus Westgren 1 1 Department of Obstetics and Gynecology, Karolinska Institute, Karolinska University Hospital Huddinge, Huddinge, Stockholm, Sweden. E-mail: [email protected]
Fallopian tube
Serous carcinoma
Fallopian tube cancer
Cite
Citations (7)
Fallopian tube cancer
Fallopian tube
Cite
Citations (5)