Abstract
Ovarian cancer is the deadliest gynecologic malignancy, accounting for more than 14,000 deaths each year. With no established way to prevent or screen for it, the vast majority of cases are diagnosed as International Federation of Gynecology and Obstetrics (FIGO) stage III or higher. Individuals with germline BRCA mutations are at particularly high risk for epithelial ovarian cancer and have been the subject of many risk-reducing strategies. In the past ten years, studies looking at risk-reducing salpingo-oophorectomy (RRSO) in this population have uncovered an interesting association: up to 8% of women with BRCA1 or BRCA2 mutations who underwent RRSO had an associated serous tubal intraepithelial carcinoma (STIC). The importance of this finding is highlighted by the fact that up to 60% of ovarian cancer patients will also have an associated STIC. These studies have led to a paradigm shift that a subset of epithelial ovarian cancer originates not in the ovarian epithelium, but rather in the distal fallopian tube. In response to this, many providers have changed their practice by expanding the role of routine salpingectomy, hysterectomy, and sterilization procedures. The American College of Obstetricians and Gynecologists (ACOG) has acknowledged opportunistic salpingectomy as a safe strategy to reduce the risk of epithelial ovarian cancer in Committee Opinion #774. It is thus important for pathologists and clinicians to understand the definition of STIC; how it is diagnosed; and, most importantly, its clinical significance.
Highlights
InformationThere are three broad categories of primary ovarian tumors: germ cell tumors, sex cord-stromal tumors, and surface/epithelial tumors
Ovarian serous carcinomas can be further divided into low- and high-grade serous carcinomas (HGSOC), the latter being the focus of this review
From 536 cases grossed by the Sectioning and Extensively Examining the Fimbriated End (SEE-FIM) protocol, 15 serous tubal intraepithelial carcinoma (STIC) were identified in 39 cases of non-uterine pelvic high-grade serous carcinoma
Summary
There are three broad categories of primary ovarian tumors: germ cell tumors, sex cord-stromal tumors, and surface/epithelial tumors. Surface epithelial tumors can be subclassified into five different cell types: Brenner, mucinous, clear cell, endometrioid, and serous. In each of these five cell types, tumors can range from benign to borderline (low-malignant potential) to malignant (carcinoma) [1]. Ovarian serous carcinomas can be further divided into low- and high-grade serous carcinomas (HGSOC), the latter being the focus of this review. Women in the United States have a lifetime risk of 1.38% for developing HGSCs, with a mean age of 63 years at presentation. HGSCs have a strong association with BRCA mutations and almost ubiquitously harbor TP53 mutations [2]. HGSOCs carry a poor prognosis, representing over 70% of all epithelial ovarian cancer deaths [3].
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