Bilateral serous tubal intraepithelial carcinoma associated with high-grade serous carcinoma of the peritoneum

Hermann Brustmann

doi:10.17077/2154-4751.1413

Abstract

Serous tubal intraepithelial carcinoma (STIC) is now considered a putative precursor lesion of most extrauterine high-grade serous carcinomas (HGSC). It is frequently reported in high-risk women and women with advanced-stage serous carcinoma. This case study reports a serous high-grade carcinoma (HGSC) consisting of a bilateral STIC with a focus of stromal invasion in the left tube, and a peritoneal HGSC. The grossly normal-appearing tubes including the fimbriated ends were sectioned following the SEE-FIM protocol. In both tubes, tumor aggregates were exfoliated extensively to the tubal lumens. The neoplastic epithelia in any location were diffusely positive for p53 in strong nuclear patterns. Pelvic lymph nodes were negative for tumor on serial sections and keratin 7 immunohistochemistry, and there was no evidence of lymphatic vessel involvement. The lack of any evidence of lymphovascular invasion and regional lymph node metastases supports the interpretation of intraluminal and transcoelomic spread, and may be taken as evidence of dissemination of tubal neoplastic cells by exfoliation in this case. The biology of transcoelomic spread is reviewed in this manuscript.

Highlights

Attention has been drawn to the junction between the fimbrial mucosa and the tubal serosa as well as to the junction between the fimbrial mucosa and the ovarian surface epithelium as the location of origin of some forms of epithelial ovarian cancer.[1,2,3] Serous tubal intraepithelial carcinoma (STIC) has been identified in the fallopian tubes of prophylactic salpingo-oophorectomies of BRCA mutation carriers with a predilection for the fimbriae in about 90% of cases.[2,4] STIC is considered a putative precursor lesion of most extrauterine high-grade serous carcinomas (HGSC)
Bilateral serous tubal intraepithelial carcinoma associated with high-grade serous carcinoma of the peritoneum: evidence for transcoelomic tumor spread by extended lymph node evaluation
Examined pelvic lymph nodes were negative for tumor, and there was no evidence of lymphatic vessel involvement

Summary

Introduction

Attention has been drawn to the junction between the fimbrial mucosa and the tubal serosa as well as to the junction between the fimbrial mucosa and the ovarian surface epithelium as the location of origin of some forms of epithelial ovarian cancer.[1,2,3] Serous tubal intraepithelial carcinoma (STIC) has been identified in the fallopian tubes of prophylactic salpingo-oophorectomies of BRCA mutation carriers with a predilection for the fimbriae in about 90% of cases.[2,4] STIC is considered a putative precursor lesion of most extrauterine high-grade serous carcinomas (HGSC). Bilateral salpingo-oophorectomy, and resection of the omentum majus and the peritoneal tumor deposits as well as pelvic lymphadenectomy The latter was done for optimal staging since the site of the primary tumor was uncertain prior to surgery, and there was no evidence of suspicious lymph nodes from either surgery or imaging. Neoplastic proliferations were observed at the infundibular regions and the fimbrial ends of both tubes These epithelia were characterized by marked nuclear atypia with hyperchromasia, irregular outlines, increased size, exhibited stratification and crowding, loss of polarity, tufting, papillary growth patterns, and high nuclear-tocytoplasmic ratios (Figures 2,3). A final diagnosis of a bilateral STIC associated with a unilateral focus of invasive tubal HGSC and peritoneal HGSC was rendered The author interpreted these findings as consistent with a primary lesion in the fallopian tubes, and a stage of FIGO IIIC was assigned.

Discussion

Conclusion