M. Mehrad, G. Ning, E. Y. Chen, K. Mehra, and C. Crum, "A pathologist’s road map to Benign, precancerous, and malignant intraepithelial proliferations in the fallopian tube," Adv. Anat. Pathol., vol. 17, pp. 293–302, 2010.
T. Herzog and H. Dinkelspiel, "Fallopian tube removal: Stic-ing it to ovarian cancer: What is the utility of prophylactic tubal removal," Curr. Oncol., vol. 20, pp. 148-151, 2013.
C. Crum, R. Drapkin, D. Kindelberger, F. Medeiros, A. Miron, and Y. Lee, "Lessons from BRCA: The tubal fimbria emerges as an origin for pelvic serous cancer," Clin. Med. Res., vol. 5, pp. 35-44, 2007.
C. Crum, "Intercepting pelvic cancer in the distal fallopian tube: Theories and realities," Mol. Oncol., vol. 3, pp. 165-170, 2009.
Y. Lee, A. Miron, R. Drapkin, M. Nucci, F. Medeiros, A. Saleemuddin, J. Garber, C. Birch, H. Mou, and R. Gordon, "A candidate precursor to serous carcinoma that originates in the distal fallopian tube," J. Pathol., vol. 211, pp. 26-35, 2007.
E. Chen, K. Mehra, M. Mehrad, G. Ning, A. Miron, G. Mutter, N. Monte, B. Quade, F. McKeon, and Y. Yassin, "Secretory cell outgrowth, PAX2 and serous carcinogenesis in the fallopian tube," J. Pathol., vol. 222, pp. 110-116, 2010.
J. Rabban, K. Garg, B. Crawford, L. Chen, and C. Zaloudek, "Early detection of high-grade tubal serous carcinoma in women at low risk for hereditary breast and ovarian cancer syndrome by systematic examination of fallopian tubes incidentally removed during benign surgery," Am. J. Surg. Pathol., vol. 38, pp. 729–742, 2014.
J. Seidman, A. Yemelyanova, R. Zaino, and R. Kurman, "The fallopian tube-peritoneal junction: A potential site of carcinogenesis," Int. J. Gynecol. Pathol., vol. 30, pp. 4–11, 2011.
J. Rabban, B. Crawford, L. Chen, C. Powell, and C. Zaloudek, "Transitional cell metaplasia of fallopian tube fimbriae. A potential mimic of early tubal carcinoma in risk reduction salpingo-oophorectomies from women with BRCA mutations," Am J Surg Pathol., vol. 33, pp. 111–119, 2009.
A. Folkins, E. Jarboe, A. Saleemuddin, Y. Lee, M. Callahan, and R. Drapkin, "A candidate precursor to pelvic serous cancer (p53 Signature) and its prevalence in ovaries and fallopian tubes from women with heterozygous BRCA mutations," Gynecol. Oncol., vol. 109, pp. 168–173, 2008.
Finch, "Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 mutation," JAMA, vol. 296, pp. 185–192 2006.
M. Callahan, C. Crum, and F. Medeiros, "Primary fallopian tube malignancies in BRCA-positive women undergoing surgery for ovarian cancer risk reduction," J. Clin. Oncol., vol. 25, pp. 3985–3990, 2007.
F. Medeiros, M. Muto, and Y. Lee, "The tubal fimbria is a preferred site for early adenocarcinoma in women with familial ovarian cancer syndrome," Am. J. Surg. Pathol., vol. 30, pp. 230–236, 2006.
R. Vang, K. Visvanathan, A. Gross, E. Maambo, and M. Gupta, "Validation of an algorithm for the diagnosis of serous tubal intraepithelial carcinoma," Int. J. Gynecol. Pathol., vol. 31, pp. 243–253, 2012.
A. Yemelyanova, R. Vang, M. Kshirsagar, D. Lu, M. Marks, I.-M. Shih, and R. Kurman, "Immunohistochemical staining patterns of p53 can serve as a surrogate marker forTP53 mutation in ovarian carcinoma: An immunohistochemical and nucleotide sequencing analysis," Mod. Pathol., vol. 24, pp. 1248–1253, 2011.
S. Lauchlan, "The secondary mullerian system," Obstet. Gynecol. Surv., vol. 27, pp. 133-146, 1972.
R. Kurman and I.-M. Shih, "The origin and pathogenesis of epithelial ovarian cancer: A proposed unifying theory," Am. J. Surg. Pathol., vol. 34, pp. 433–443, 2010.
Przybycin, R. Kurman, B. Ronnett, M. Shih Ie, and R. Vang, "Are all pelvic (Nonuterine) serous carcinomas of tubal origin," Am. J. Surg. Pathol., vol. 34, pp. 1407-1416, 2010.
J. Hunt and A. Lynn, "Histologic features of surgically removed fallopian tubes," Arch. Pathol. Lab. Med., vol. 126, pp. 951–955, 2002.
Gayatri Ravikumar , Julian Crasta (2015). Spectrum of Morphological Changes and Prevalence of “P53 Signatures” In Tubal Fimbrial Epithelium in General Population and In Patients with Pelvic Serous Carcinomas. Cancers Review, 2(1): 1-10. DOI: 10.18488/journal.95/2015.2.1/184.108.40.206
Aim: Pelvic serous carcinomas (PSCs) are very aggressive malignancies and present at advanced stage. A paradigm shift in the origin and pathogenesis of PSCs occurred when precursor lesions were found in the Fallopian tube fimbria in the prophylactic bilateral salphingo-ophorectomy (PBSO) specimens from BRCA positive patients. The knowledge of various benign and reactive alterations in the Fallopian tube is mandatory to distinguish these lesions from the true neoplastic changes. The study therefore aims to see the spectrum of morphological changes in the Fallopian tube epithelium (FTE) and to know the incidence of the various precursor lesions and p53 signatures in the tubal fimbria. Method: The study included 102 Fallopian tubes from patients undergoing salphingo – oophorectomies for gynaecological indications. The fimbrial end along with one cross section was embedded and examined for stromal and architectural changes, epithelial features and inflammatory infiltrates. IHC for p53 and Ki67 was done to assess the presence of precursor lesions. Results: The mean age of patients’ was 49.9yrs. Family history of breast/ovarian cancer was present in 5 cases. Histopathology showed fibrosis (30%), Walthard nest (36%) , Wolfian duct remnants(14.7%), pigmentosis tubae(1%) , infiltration by metastatic carcinoma(7%),reactive atypia(6%), metaplasia(16%), tufting(46%),lymphocytes (9%) and plasma cells (2%). SCOUTS were seen in 12%, p53 signature and STIC in 6% and 4% respectively. Tuboperitoneal junction was identified in 15 cases and showed transitional metaplasia. Conclusion: The study describes the different morphological changes in the Fallopian tube in our population. The prevalence of cytological and molecular alterations leading to malignancy was low in general population.
The paper’s primary contribution is finding that completely sampling the tubal fimbria with one cross section is a good practice to identify early precursor lesions which may otherwise go undetected. Knowledge of reactive /benign cellular proliferations is mandatory to help distinguish them from these precursor lesions.