Development of Peritoneal Carcinoma in women diagnosed with Serous Tubal Intraepithelial Carcinoma (STIC) following Risk-Reducing Salpingo-Oophorectomy (RRSO)

P I Stanciu,J B Butler,M A E Nobbenhuis,T E J Ind,A D Attygalle,K M Vroobel,D P J Barton

doi:10.1186/s13048-019-0525-1

Abstract

IntroductionThe management of Serous Tubal Intraepithelial Carcinoma (STIC) found at the time of Risk-Reducing Salpingo-Oophorectomy (RRSO) remains unclear. We set out to analyse the incidence of peritoneal carcinomas developed after prophylactic surgery and to formulate further guidance for these patients.MethodsThis is a retrospective study of 300 consecutive RRSO performed at the Royal Marsden Hospital between January 2008 and January 2017.ResultsThe median age at RRSO was 47.8 years (range 34 to 60 years) and median BMI was 26.2 kg/m2 (range 16 to 51 kg/m2). A total of 273 patients (91%) were tested for BRCA mutations. Of these, 124 (45.4%) had a BRCA 1 mutation, 118 (43.2%) had a BRCA 2 mutation, 2 (0.7%) had both a BRCA 1 and a BRCA 2 mutation and 29 (10.6%) had no BRCA mutation detected. Isolated STIC lesions were identified in 7 cases (2.3%) and p53 signatures in 75 cases (25%). There were five (1.6%) incidental tubal carcinomas and one (0.3%) ovarian carcinoma at the time of surgery. Two (28.6%) of the 7 patients with STIC identified following RRSO had high grade serous peritoneal carcinoma diagnosed at 53 and 75 months. One (0.3%) patient from the other 287 patients from our series with no STIC diagnosis or incidental carcinomas at RRSO developed high grade serous carcinoma of peritoneal origin after 92 months.ConclusionThis study demonstrates that when a STIC lesion is identified following RRSO there is a significantly higher risk of a subsequent peritoneal cancer. Although there is no published consensus in literature, we recommend that consideration should be given for long term follow-up if a STIC lesion is identified at RRSO.

Highlights

The management of Serous Tubal Intraepithelial Carcinoma (STIC) found at the time of Risk-Reducing Salpingo-Oophorectomy (RRSO) remains unclear
A large spectrum of fallopian tube lesions have been described ranging from p53 signatures with normal-appearing tubal epithelium, no atypia and low proliferation index based on Ki-67 immunostaining but with mutant p53 expression pattern [6] to serous tubal intraepithelial lesions (STIL) with cytological atypia but falling short of STIC [7]. p53 immunohistochemistry is one of the most efficient markers for STICs and a predictor for TP53 mutation
The aim of this study is to review the histological findings of 300 consecutive RRSOs, to analyse the association of STIC with subsequent diagnosed peritoneal carcinomas and to discuss the possible change in the management and follow up of these patients

Summary

Introduction

The management of Serous Tubal Intraepithelial Carcinoma (STIC) found at the time of Risk-Reducing Salpingo-Oophorectomy (RRSO) remains unclear. More than 90% of STICs have p53 signatures and share identical TP53 mutations with invasive ovarian or peritoneal cancers suggesting that STICs are the site of origin for high grade serous carcinomas [8]. Germline TP53 mutations are considered to have a significant role in the oncogenesis of several human cancers [9] and are found in more than 95% of ovarian high grade serous carcinomas [10]. These mutations represent the initial event in the development of high grade serous carcinomas and are documented in the majority of STICs [11, 12]

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