High-Grade Serous Carcinoma of the Fallopian Tube

Abstract

A woman presented with pelvic pain, increased abdominal girth, and gastrointestinal symptoms. A pelvic adnexal mass was identified by imaging and resected. Pathology diagnosed the mass as high-grade serous carcinoma (HGSC) of the fallopian tube.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Which gene is most commonly altered in high-grade serous carcinoma?a.KRASb.BRAFc.NRASd.TP53 Answer: d. TP53 Some form of TP53 gene alteration is found in nearly all HGSCs.1Kurman R.J. Shih I. The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory.Am J Surg Pathol. 2010; 34: 433-443Crossref PubMed Scopus (1196) Google Scholar,2Kurman R.J. Carcangiu M.L. Herrington C.S. Young R.H. WHO Classification of Tumours of Female Reproductive Organs. IARC, Lyon, France2014Google Scholar In contrast, KRAS and BRAF mutations are more frequent in low-grade serous carcinoma (LGSC).1Kurman R.J. Shih I. The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory.Am J Surg Pathol. 2010; 34: 433-443Crossref PubMed Scopus (1196) Google Scholar,2Kurman R.J. Carcangiu M.L. Herrington C.S. Young R.H. WHO Classification of Tumours of Female Reproductive Organs. IARC, Lyon, France2014Google Scholar Further, a significant percentage of HGSCs arise from intraepithelial carcinoma of the fallopian tube whereas LGSC commonly evolves from a continuum of ovarian neoplastic precursors including serous borderline tumor. Morphologically, HGSC often has an infiltrative mixture of papillae, glandular, and solid structures composed of cells with marked cytologic atypia, and frequent mitotic activity. LGSC also has destructive invasion, but the micropapillae have low-grade nuclear features and a lower frequency of mitotic activity.