Fallopian Tube Carcinoma Research Articles

Hereditary breast and ovarian cancer triggered by occult fallopian tube cancer: a case report

BackgroundAt the time of benign gynecological surgery, a prophylactic salpingo-oophorectomy or salpingectomy is increasingly being performed concurrently to reduce the risk of future ovarian and fallopian tube cancer. We herein describe a case of hereditary breast and ovarian cancer syndrome in which a hysterectomy and bilateral adnexectomy were performed with a preoperative diagnosis of benign tumor. A detailed pathological examination revealed occult fallopian tube cancer, and additional staging surgery provided an accurate pathology diagnosis.Case presentationA 72-year-old Japanese woman with a past history of breast cancer underwent a hysterectomy and bilateral oophoro-salpingectomy for the preoperative diagnosis of uterine myoma and a right para-ovarian cyst. In the detailed pathological examination, high-grade serous carcinoma of the right fallopian tube was detected incidentally, and a subsequent staging laparotomy confirmed single para-aortic lymph node metastasis. Furthermore, a mutation in germline BRCA2 was detected postoperatively, and the patient was finally diagnosed with hereditary breast and ovarian cancer syndrome. She was diagnosed with fallopian tube cancer International Federation of Gynecology and Obstetrics Stage IIIA1(i) and started on adjuvant therapy (six courses of paclitaxel and carboplatin followed by maintenance therapy with olaparib), and 18 months after surgery, she was free of disease.ConclusionThis is a case of fallopian tube cancer that was diagnosed incidentally and then accurately staged with additional advanced staging surgery. Even in the absence of grossly malignant findings, a detailed pathological search of the fallopian tubes and accurate staging surgery are important to make the necessary treatment decisions for the patient.

Apendektomi sonrası tesadüfen teşhis edilen tubal yüksek dereceli seröz karsinom olgu sunumu

Primary tubal carcinoma is a uncommon tumor of female ganitale system. The clinical approach of primary tubal cancers is similar to primary ovarian cancers. Fallopian tube carcinoma is hard to diagnosed preoperatively because of its uncertain symptoms. Providing optimal cytoreductive surgery is the most important treatment step in ovarian, tubal and peritoneal carcinomas.
 We report a case of serous tubal intraepithelial carcinoma and appendix metastasis. A 65 years old post-menopausal woman (gravida 4, para 3) submitted to an external hospital with lower abdominal pain and acute abdominal symptoms. Appendectomy was performed on the patient with preliminary diagnosis of appenditis. The pathology result was reported as high grade serous carcinoma infiltration. Staging surgery was performed with the diagnosis of carcinoma. Until the final pathology result, the diagnosis was considered as appendiceal metastasis of serous tubal cancer. Our clinical and surgical approach to the case, which was diagnosed incidentally with an appendectomy specimen and reported as high grade tubal serous carcinoma, is presented as a case study.

A rare case of primary high-grade serous carcinoma arising in left fallopian tube

Primary fallopian tube carcinoma is a rare gynaecological tumour that has an incidence of 3.6 per million women per annum.1 There is likely an underestimation of true incidence due to late stage presentations and the histopathologic similarity to epithelial ovarian cancer.2

Intrathoracic surgery as part of primary cytoreduction for advanced ovarian cancer: Going to the next level – A Memorial Sloan Kettering Cancer Center study

ObjectiveWe investigated the feasibility, safety, and survival outcomes of intrathoracic cytoreduction during primary debulking surgery (PDS) for advanced ovarian cancer. MethodsWe conducted a database review of patients with stage IIIB-IV ovarian (including fallopian tube and primary peritoneal) carcinoma who underwent PDS at our institution from 01/01/2006–9/30/2021. Patients who underwent intrathoracic cytoreduction as part of primary treatment were included. Patients who received neoadjuvant chemotherapy or surgery for reasons other than cytoreduction were excluded. ResultsAmong 178 patients identified for inclusion, complete gross resection (CGR) in the abdomen and thorax was achieved in 131 (74%); 45 (25%) had optimal cytoreduction, and 2 (1%) had suboptimal cytoreduction. Thirty-one patients (17%) had at least one grade ≥ 3 complication; 8 were possibly related to intrathoracic cytoreduction. There were no deaths within 30 days following surgery. Median length of follow-up among survivors was 53.4 months. Among all patients, the median PFS was 33.6 months (95% CI: 24.7–61.9) and the 3-year PFS rate was 48.9% (95% CI: 41.2%–56.2%). Median OS was 81.3 months (95% CI: 68.9–103). When stratified by residual disease status, median PFS was 51.8 months when CGR was achieved versus 16.7 months with residual disease (HR: 2.17; P < .001) and median OS was 97.6 months when CGR was achieved versus 65.9 months with residual disease (HR: 2.05; P = .003). ConclusionsIntrathoracic cytoreduction during PDS for advanced ovarian cancer is both safe and feasible. CGR can be achieved in patients with intrathoracic disease if properly selected, and could significantly improve both PFS and OS.

A prospective randomized multicenter trial for lymphadenectomy in early-stage ovarian cancer: LOVE study.

The Lymphadenectomy in Ovarian Neoplasms (LION) study revealed that systemic lymphadenectomy did not bring survival benefit for advanced ovarian cancer patients with clinically normal lymph nodes and was associated with a higher incidence of operative complications. However, there is no consensus on whether lymphadenectomy has survival benefit or not in early epithelial ovarian cancer (EOC). We designed the LOVE study, a multicenter, randomized controlled, phase III trial to compare the efficacy and safety of comprehensive staging surgery with or without lymphadenectomy in stages IA-IIB EOC and fallopian tube carcinomas (FTC). The hypothesis is that the oncological outcomes provided by comprehensive staging surgery without lymphadenectomy are non-inferior to those of conventional completion staging surgery in early-stage EOC and FTC patients who have indications for post-operative adjuvant chemotherapy. Patients assigned to experimental group will undergo comprehensive staging surgery, but lymphadenectomy. Patients assigned to comparative group will undergo completion staging surgery including systematic pelvic and para-aortic lymphadenectomy. All subjects will receive 3-6 cycles of standard adjuvant chemotherapy. Major inclusion criteria are pathologic confirmed stage IA-IIB EOC or FTC, and patients have indications for adjuvant chemotherapy either confirmed by intraoperative fast frozen section or previous pathology after an incomplete staging surgery. Major exclusion criteria are non-epithelial tumors and low-grade serous carcinoma. Patients with severe rectum involvement which lead to partial rectum resection will be excluded. The sample size is 656 subjects. Primary endpoint is disease-free survival. ClinicalTrials.gov Identifier: NCT04710797.

Bilateral primary papillary serous carcinoma of the fallopian tube – A rare case scenario

Bilateral primary fallopian tube carcinoma is a very rare case scenario. Approximately, its incidence is 0.02% of all the gynecological malignancy. A 40-year-old female patient visited the hospital with complaints of lower abdominal pain for 3 months. Ultrasound of the pelvis shows complex bilateral adnexal lesions with ORADS score 4 – intermediate risk. The serum CA-125 is elevated. The provisional diagnosis of bilateral pyosalpinx was made. The uterus with bilateral ovaries and fallopian tubes was removed. On histopathology, thus, the final diagnosis of primary bilateral papillary serous carcinoma of the fallopian tube was made. Bilateral primary fallopian tube carcinoma is a very rare case scenario. Intraoperative frozen study is to be done to diagnose this entity. The high degree of suspicion is required to diagnose a case of bilateral fallopian tube carcinoma as it is a very rare case scenario and usually confused for pyosalpinx.

Primary fallopian tube carcinoma: Preoperative diagnostic dilemma

Primary fallopian tube carcinoma: Preoperative diagnostic dilemma

Uterine tube cancer in the practice of an obstetrician-gynecologist

Fallopian tube cancer (FTC) is an actual problem in oncology. Despite the low frequency of FTC, it is quite easy to confuse it with other malignant diseases of the female genital organs, namely, ovarian and endometrial cancer. It is quite difficult to diagnose FTC in time, since the absence of specific symptoms determines the detection of malignant tumors of fallopian tubes only during surgical interventions for benign gynecological pathology or in case of suspicion of ovarian or endometrial cancer. The final diagnosis and primary origin of the tumor can be established only by postoperative histological study.The article presents a review of the literature of scientometric databases on the etiology, diagnosis, and treatment of FTC. Based on the analysis of data from the scientific literature, the problem of FTC as a rare and deceptive malignant disease with a rather aggressive course is highlighted, which causes the formation of oncological awareness among obstetricians-gynecologists regarding this type of cancer.According to the literature, it is established that FTC is diagnosed very rarely. Among all cases of malignant tumors of the female genital organs, the frequency of FTC is only 0.14–1.8 %. It was also established that it is possible to diagnose FTC in a time only in 0–21 % of cases, according to other data– up to 10 %.Due to the aggressive course of tubal cancer, the five-year survival rate ranges from 22 till 57 %. Intraoperatively, it is possible to detect malignant tumors of the fallopian tubes only in 50 % of cases. The article provides data on the possible causes of development, clinical symptoms that can be manifested by FTC, as well as methods of diagnosis and treatment of this cancer.FTC is a very deceptive oncological pathology, which can be caused by chronic inflammatory changes in the fallopian tubes, infertility, fallopian tube endometriosis, and BRCA1 and BRCA2 mutations. First of all, obstetrician-gynecologists should pay attention on abnormal uterine bleeding in the patient, purulent-bloody discharge, pain in the lower abdomen, the phenomenon of “watery tubal discharge”, since these pathological manifestations are typical for FTC. The tumor marker CA-125 and β-subunit of hCG have important meaning, the levels of which are increased by FTC.Significant similarity of clinical symptoms with ovarian and endometrial cancer leads to significant errors in establishing the correct diagnosis. Since malignant tumors of the fallopian tubes can metastasize to groups of lymphatic lymph nodes that are completely atypical for them, it is also necessary to carry out a differential diagnosis with breast cancer, because FTC can manifest itself in the form of axillary lymphadenopathy, and with stomach cancer, in which an isolated increase of the left supraclavicular lymph node (Virchow’s metastasis) can also be observed, which is also characteristic of fallopian tube carcinomas.

Immunohistochemical phenotype of fallopian tubes in patients with different grades of serous ovarian carcinoma

During recent years, there is an accumulating evidence that high grade ovarian carcinoma is developed from the fallopian tube epithelial lesions. However, is not yet completely understood and still represents the subject of investigation. We investigated the immunohistochemical phenotype of matched fallopian tubes from the patients with different types and malignancy grades of ovarian carcinoma. Matched fallopian tubes from ovarian cancer patients were available in 260 cases, including mucinous borderline tumor (n=25), mucinous carcinoma (n=15), serous borderline tumor (n=90), low grade serous carcinoma (n=72) and high grade serous carcinoma (n=48). Immunohistochemical investigation included markers of proliferation (Ki67), apoptosis (Bcl2, p53), hormone receptors (ER, PR), epithelial differentiation (CK7), mesenchymal differentiation (vimentin, calretinin) and stem cells (CD44). The results indicate that the presence of fallopian tube carcinoma in situ is significantly correlated with the presence of high grade ovarian serous carcinoma (r=0.44, p&amp;#60;0.001), whilst there was no significant association with low grade and borderline serous tumors or mucinous tumors.

L1CAM is required for early dissemination of fallopian tube carcinoma precursors to the ovary

Most ovarian high-grade serous carcinomas (HGSC) arise from Serous Tubal Intraepithelial Carcinoma (STIC) lesions in the distal end of the fallopian tube (FT). Formation of STIC lesions from FT secretory cells leads to seeding of the ovarian surface, with rapid tumor dissemination to other abdominal structures thereafter. It remains unclear how nascent malignant cells leave the FT to colonize the ovary. This report provides evidence that the L1 cell adhesion molecule (L1CAM) contributes to the ability of transformed FT secretory cells (FTSEC) to detach from the tube, survive under anchorage-independent conditions, and seed the ovarian surface. L1CAM was highly expressed on the apical cells of STIC lesions and contributed to ovarian colonization by upregulating integrins and fibronectin in malignant cells and activating the AKT and ERK pathways. These changes increased cell survival under ultra-low attachment conditions that mimic transit from the FT to the ovary. To study dissemination to the ovary, we developed a tumor-ovary co-culture model. We showed that L1CAM expression was important for FT cells to invade the ovary as a cohesive group. Our results indicate that in the early stages of HGSC development, transformed FTSECs disseminate from the FT to the ovary in a L1CAM-dependent manner.

A rare case of paraneoplastic cerebellar ataxia secondary to Gynaecological malignancy

We report on a rare case of paraneoplastic syndrome (PS) that was discovered on completion of diagnostic work up to be a fallopian tube carcinoma. A 65year old female, presented with 1 month history of imbalance, gait instability, incoordination of right upper limb, vertigo and vomiting. Cerebrovascular accident and drug intoxication was excluded. Indicative of further diagnosis of paraneoplastic syndrome was presence of adnexal mass in pelvis with identification of onconeural anti-Yo antibodies, detection of which leads to the confirmation of diagnosis. The anti- Yo (Anti-Purkinje cell) antibodies that specifically damage Purkinje cells of the cerebellum. Anti- Yo related paraneoplastic cerebellar degeneration is most commonly found in women with gynecological and breast cancers.

Data Set for the Reporting of Ovarian, Fallopian Tube and Primary Peritoneal Carcinoma: Recommendations From the International Collaboration on Cancer Reporting (ICCR).

The move toward consistent and comprehensive surgical pathology reports for cancer resection specimens has been a key development in supporting evidence-based patient management and consistent cancer staging. The International Collaboration on Cancer Reporting (ICCR) previously developed a data set for reporting of the ovarian, fallopian tube and primary peritoneal carcinomas which was published in 2015. In this paper, we provide an update on this data set, as a second edition, that reflects changes in the 2020 World Health Organization (WHO) Classification of Female Genital Tumours as well as some other minor modifications. The data set has been developed by a panel of internationally recognized expert pathologists and a clinician and consists of "core" and "noncore" elements to be included in surgical pathology reports, with detailed commentary to guide users, including references. This data set replaces the widely used first edition, and will facilitate consistent and accurate case reporting, data collection for quality assurance and research, and allow for comparison of epidemiological and pathologic parameters between different populations.

HISTOMORPHOLOGICAL EVALUATION OF TUMOURS OF FEMALE GENITAL TRACT AND ITS CHANGE IN TUMOUR PROFILE OVER A PERIOD OF 12YRS IN A TERTIARY CARE REFERRAL HOSPITAL IN CHENNAI.

Background: The most common cause of morbidity &amp; mortality among females are due to cancers arising from female reproductive organs next to breast cancers. The most common sites include uterine cervix, corpus uteri &amp; ovary followed by least common sites like vulva, vagina, fallopian tubes and gestational trophoblastic diseases. Aim of the study: 1. To evaluate the trend in the prole of benign, premalignant &amp; malignant lesions of female genital tract (FGT) tumours at primary tertiary care hospital in Chennai. 2. To study frequency, age distribution &amp; diverse histomorphological spectrum of tumours of female genital tract. 3. To compare and analyze our data with other published studies in the literature. Materials &amp; Methods: This cross sectional retrospective observational study was conducted at tertiary care gynaecological center at Chennai over a period of 12 years from Jan 2008 to Dec 2019. The medical records were retrieved, data analyzed and the results were expressed in descriptive statistics. Results: During the study period we received 44752 histopathological specimens out of which 12477 cases were gynaecological malignancies. Cervix uteri (66.38%) was the most common site followed by ovary (16.65%), corpus uteri (10.71%), gestational trophoblastic disease (4.13%), vulva (0.82%), vagina (0.36%), fallopian tube (0.02%), and vault carcinoma (0.93%). Squamous cell carcinomas were most common type of malignancy in cervix (93.15%), vulva (91%), vagina (82%) &amp; vault (78%). Endometrial adenocarcinomas (81%) were more frequent tumour in corpus uteri while surface epithelial tumours constitute 78.72% of cases in ovary. For gestational trophoblastic disease, 78.25% of cases had complete molar pregnancy. 41-50yrs of age groups were commonly affected for cervical, ovarian &amp; endometrial malignancies where as in vulval lesions the most common age group was 61-70yrs. In case of gestational trophoblastic disease the majority of patients were presented at 21-30yrs of age. Conclusion: This is one of the largest studies conducted with more than 10000 cases being reported in female genital tract. Cervical carcinomas are the leading gynecological malignancy followed by ovary &amp; corpus uteri at our institute. There is a declining trend in the distribution of cases among cervical cancers were as there is an increasing trend in distribution of cases in other site like ovary &amp; corpus uteri.

Survival after maximum effort cytoreductive surgery and platinum-based chemotherapy in patients with epithelial ovarian cancer, fallopian tube carcinoma and primary peritoneal carcinomatosis: Experience of a Public University Hospital in Spain

Survival after maximum effort cytoreductive surgery and platinum-based chemotherapy in patients with epithelial ovarian cancer, fallopian tube carcinoma and primary peritoneal carcinomatosis: Experience of a Public University Hospital in Spain

A randomized phase 3 trial of intraperitoneal versus intravenous carboplatin with dose-dense weekly paclitaxel in patients with ovarian, fallopian tube, or primary peritoneal carcinoma (a GOTIC-001/JGOG-3019/GCIG, iPocc Trial) (LBA 3)

<b>Objectives:</b> Traditionally, the target of intraperitoneal (IP) chemotherapy for ovarian cancer was patients with minimal residual disease after debulking surgery. However, our pharmacological study suggested that IP carboplatin therapy should also be feasible for patients with larger size residual disease, and our previous phase 2 study demonstrated a satisfactory response rate of IP carboplatin plus dose-dense paclitaxel (ddTCip) regimen in patients with macroscopic residual disease after initial surgery for ovarian (OV), fallopian tube (FT), and primary peritoneal (PP) carcinoma. The purpose of this study is to assess whether IP administration of carboplatin is superior to intravenous (IV) administration of carboplatin (ddTCiv regimen) in OV, FT, and PP carcinoma patients with either minimal or macroscopic residual disease. <b>Methods:</b> Eligible patients were those with newly diagnosed stages II-IV disease. All patients were to undergo an initial laparotomy or laparoscopy with primary debulking surgery if possible. Before abdomen was closed, patients were randomized to either IV or IP arm. An IP port and catheter was placed if the patient was assigned to IP arm. Chemotherapy regimen was either IV paclitaxel plus IV carboplatin (IV arm) or IV paclitaxel plus IP carboplatin (IP arm). Dose of paclitaxel was 80 mg/m² Q1W and dose of carboplatin was at an area under the curve (AUC) of 6 Q3W. Each patient was to receive 6 to 8 cycles of chemotherapy. Patients with bulky residual disease were allowed to undergo interval debulking surgery followed by assigned arm regimen up to 8 cycles total. Primary endpoint was PFS, and secondary endpoints included OS, safety, QOL, and cost/benefit. <b>Results:</b> Total of 655 patients were randomized between 2010 and 2016 from Japan, Singapore, Korea, New Zealand, USA, and Hong Kong. Stage distribution was II (n= 88), III (n=448), and IV (n=119). Size of residual disease at randomization was either 0 cm (n=163), < 1 cm (n=97), 1-2 cm (n=33), or >2 cm (n=362). Histological types were serous (n=420), endometrioid (n=61), clear cell (n=74), and others (n=100). Median follow-up was 55.7 months. IP chemotherapy significantly improved PFS in the ITT population (HR=0.83, 95%CI:0.69-0.99, p=.041) and in the 602 eligible patients (HR=0.78, 95%CI:0.65-0.94, p=.009). Median PFS for ITT population was 20.7 (95%CI: 18.1-22.8) months in the IV arm and 23.5 (95%CI: 20.5-26.9) months in the IP arm. Median PFS for eligible patients was 20.0 (95%CI: 18.0-22.2) months in the IV arm and 22.9 (95%CI:19.6-26.9) months in the IP arm. Subset analysis showed that the survival benefit was greater in patients with larger size residual disease. Toxicity profile was essentially equivalent in both arms except for catheter-related toxicities (11.8%). <b>Conclusions:</b> ddTCip chemotherapy improved the PFS over ddTCiv regimen in patients with OV, FT, and PP carcinoma regardless of the residual tumor size after initial surgery.

Clinical and genetic findings of incidental serous tubal intraepithelial carcinoma (145)

<b>Objectives:</b> Serous tubal intraepithelial carcinoma (STIC) is thought to represent the precursor lesion to the high-grade serous fallopian tube or ovarian carcinoma. STIC lesions are found 0.6-6% of the time in women undergoing risk-reducing salpingo-oophorectomy (RRSO) in the setting of a known hereditary predisposition. = However, due to the rarity of incidentally identified STIC lesions, there is limited data to guide management. NCCN guidelines suggest consideration of surgical staging and referral for genetic evaluation. In the absence of a known pathogenic variant as the indication for surgery, there is no data on rates of genetic testing or long-term outcomes. The objective of this study was to describe both clinical outcomes as well as genetic information collected for patients with incidentally noted STIC lesions. <b>Methods:</b> Following IRB approval, pathology records were used to identify all patients diagnosed with a STIC lesion on final pathology from 2007-2021 at a single institution. STIC lesions were characterized utilizing immunohistochemistry. Only patients with STIC lesions undergoing surgery for benign indications were included. Demographic, clinical-pathologic, and genetic data were collected. <b>Results:</b> A total of 16 patients were identified. The median age at diagnosis was 65.5 years (39-80). Fifteen patients (93.8%) had unilateral STIC lesions with one patient having bilateral STIC lesions. Most lesions were positive for p53 (94.1%) and had increased Ki67 proliferation, defined as >10% (94.1%). Two patients (12.5%) had a personal history of malignancy prior to their STIC lesion diagnosis. Patients had a wide variety of presentations, including pelvic mass (37.5%), prolapse (31.3%), abnormal uterine bleeding (25%), and pelvic pain (6.3%). Nine patients had additional surgical procedures performed (56.3%), and no cancer diagnosis was identified for any patient. Additional procedures included contralateral salpingo-oophorectomy, omentectomy, pelvic and paraaortic lymph node dissection, and peritoneal biopsies. No patients received adjuvant treatment. Eleven patients were offered a genetic counseling referral (68.8%), with seven patients completing a counseling appointment (63.6%). Five of the seven patients who completed their visit met criteria for testing based on additional personal and/or family history (71.4%), with one patient testing positive for a PALB2 pathogenic variant (20% of tested patients). Three patients, none of whom underwent genetic testing, were subsequently diagnosed with breast cancer during the follow-up period. <b>Conclusions:</b> Incidental STIC lesions are rare. In this cohort, there were no ovarian, fallopian tube, or primary peritoneal cancer diagnoses after additional surgical staging or during follow-up. More data is needed to guide treatment recommendations. However, compared to STIC lesions in patients undergoing RRSO for a known predisposition, it is not clear whether additional surgical procedures are warranted in patients with incidentally noted STIC lesions. Our data support NCCN recommendations for referral for genetic evaluation as 71% qualified for testing. One patient (20% of those who qualified for testing) had a clinically actionable pathogenic variant. Notably, three patients later developed breast cancer; however, without genetic testing, we cannot determine if there may be a genetic link. Further studies of these lesions are warranted.

The impact of neoadjuvant chemotherapy on the tumor microenvironment in advanced high-grade serous carcinoma

High-grade serous ovarian, fallopian tube or peritoneal carcinoma is an aggressive subtype of ovarian cancer that frequently develops resistance to chemotherapy. It remains contested whether the resistance is caused by the acquisition of novel molecular aberrations or alternatively through the selection of rare pre-existing tumor clones. To address this question, we applied single-cell RNA sequencing to depict the tumor landscape of 6 samples from a single case of advanced high-grade serous fallopian tube carcinoma during neoadjuvant chemotherapy (NACT). We analyzed a total of 32,079 single cells, with 17,249 cells derived from the pre-NACT multisite tumor tissue samples and 14,830 cells derived from the post-NACT multisite tumor tissue samples. We identified the diverse properties of the tumor, immune and stromal cell types between the pre-NACT and post-NACT tumors. The malignant epithelial cells displayed a high degree of intratumor heterogeneity in response to NACT. We showed that the primary resistant clone (clone 63) epithelial genotype was already present in the pre-NACT tumors, and was adaptively enriched after NACT. This clone 63 was correlated with a poor clinical prognosis. Furthermore, single-cell analysis of CD4+ T cells demonstrated that IL2RAhi-CCL22+-Tregs were selectively enriched in post-NACT tumors. Interestingly, this Treg subtype could recruit and enrich themselves through secreting the CCL22-CCR1 combination in pre-NACT and post-NACT tumors, and further express CD274 to suppress other CD4 and CD8 T cells through a CD274-PDCD1 axis in the post-NACT tumors, and this predicted an immunosuppressive state after NACT. Overall, our results provide important evidence for the adaptive resistance theory of HGSC, and for the potential development of therapeutic strategies to treat HGSC and improve the survival of patients with HGSC.

Retrospective study of histopathological and prognostic characteristics of primary fallopian tube carcinomas: twenty-year experience (SOCRATE)

ObjectivePrimary fallopian tube carcinoma represents a rare entity, accounting for about 0.75%–1.2% of all gynecological malignancies. The rationale of our study is to describe the prognosis of primary fallopian tube...

Risk reducing surgery with peritoneal staging in BRCA1-2 mutation carriers. A prospective study

IntroductionInternational guidelines recommend risk-reducing salpingo-oophorectomy (RRSO) in BRCA1-2 mutations carriers to decrease ovarian cancer occurrence. In this prospective study, we describe the incidence of occult malignancies and the surgical outcomes in asymptomatic BRCA mutation carriers submitted to RRSO. MethodsData on BRCA1-2 carriers undergoing RRSO with peritoneal washing and peritoneal/omental biopsies (PeS), between January 2019 until March 2021, were prospectively collected. ResultsA total of 132 patients were enrolled: 74 BRCA1 and 58 BRCA2 mutation carriers. 31.1% women underwent RRSO and PeS (16.2% of BRCA1 and 50% of BRCA2 carriers), while 68.9% patients were submitted also to concomitant hysterectomy. Almost all the procedures (99.2%) were performed by minimally invasive surgery. Postoperative complications occurred in twelve patients (9.1%): 10 in the concomitant hysterectomy group and two complications in the RRSO group. At the final pathological examination, 6 (4.5%) occult carcinomas were diagnosed: 3 fallopian tube carcinomas, one ovarian carcinoma and two serous tubal intraepithelial carcinomas (STICs), with negative PeS. Median age of occult carcinomas patients at RRSO was 54 (range: 48–79) years. The mean follow up was 20 (range: 7–34) months. During the follow up, no primary peritoneal cancer has been diagnosed. ConclusionsOccult pathologic findings in RRSO occurred in 4.5% (3% invasive carcinomas, STIC 1.5%) among our patients. The routine use of peritoneal biopsies does not improve the detection of occult malignancies. Our data confirm the importance of timely performing RRSO in BRCA1-2 carriers.

Prolonged Exposition with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) May Provide Survival Benefit after Cytoreductive Surgery (CRS) in Advanced Primary Epithelial Ovarian, Fallopian Tube, and Primary Peritoneal Cancer.

Simple SummaryThe mainstay of therapy for primary advanced ovarian, fallopian tube, and primary peritoneal carcinoma is cytoreductive surgery (CRS) and platinum-containing chemotherapy. Since the primary and recurrent disease is mainly confined to the peritoneal cavity, intraperitoneal chemotherapy with or without hyperthermia has been evolved in order to improve survival. However, the studies to date are mainly retrospective, nonrandomized, and heterogeneous in terms of patient selection. There are currently only a limited number of reliable data on the role of hyperthermic intraperitoneal chemotherapy (HIPEC), its ideal timing of application, and duration. The aim of this study was to report our single-center experience with CRS + HIPEC involving patients with primary FIGO stage ≥ III B epithelial carcinoma. Hereby, multimodal therapy was feasible with acceptable morbidity and mortality, with no difference in overall survival between interval and upfront surgery. However, prolongation of HIPEC was shown to provide survival benefits regardless of previous administration of chemotherapy.Background: The usage of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced gynecological cancers is increasing. Methods: Prospectively collected data of 85 advanced primary ovarian/fallopian tube cancer and peritoneal carcinoma patients of a single center were investigated. Results: A total 48, 37, 62, and 25 patients were enrolled into the HIPEC with/without neoadjuvant chemotherapy (upfront vs. interval) and into the 60 min and 90 min long HIPEC groups, respectively. Better overall survival (OS) was observed in the 90 min HIPEC group (p = 0.0330), compared to the 60 min HIPEC group. Neither OS (p = 0. 2410), disease-specific (p = 0. 3670), nor recurrence-free survival (p = 0.8240) differed between upfront and interval HIPEC. Higher peritoneal carcinomatosis index (PCI) values were associated with worse disease-specific survival (p = 0.0724). Age (p = 0.0416), body mass index (p = 0.0044), PCI (p < 0.0001), the type (p = 0.0016) and duration (p = 0.0012) of HIPEC, and increased perioperative morbidity (p < 0.0041) had the greatest impact on OS. Conclusions: Increasing data support the value of HIPEC in the treatment of advanced ovarian cancer. Ongoing prospective studies will definitively clarify the role and timing of this additional therapeutic approach.