Fallopian Tube Lesions Research Articles

Histomorphological Pattern of Fallopian Tube Lesions in a Tertiary Care Hospital

Histomorphological Pattern of Fallopian Tube Lesions in a Tertiary Care Hospital

Primary mucinous gland lesions of fallopian tube: a clinicopathological analysis of fourteen cases

Objective: To investigate the clinical and pathological characteristics of primary mucinous gland lesions of the fallopian tubes. Methods: The clinical data, pathomorphological characteristics and immunophenotype of 14 cases of primary mucinous gland lesions of the fallopian tube diagnosed at Obstetrics and Gynecology Hospital of Fudan University from 2015 to 2023 were analyzed retrospectively. In addition, a comprehensive review of relevant literature was conducted. Results: The age of 14 patients ranged from 53 to 83 years, with an average of 65 years. Among them, 13 cases exhibited unilateral involvement while one case showed bilateral presentation. Nine cases were mucinous metaplasia of the fallopian tube, four cases were invasive mucinous adenocarcinoma and one case was mucinous carcinoma in situ. Morphologically, mucinous metaplasia of the fallopian tube was focal, with or without inflammation. The cells of mucinous adenocarcinoma or mucinous carcinoma in situ exhibited characteristics indicative of gastrointestinal differentiation. Immunohistochemical analysis revealed diffuse positive expression of CK7, and negative expression of SATB2. CDX2 demonstrated positive staining in two cases. One case exhibited diffuse and strongly positive mutant expression of p53, whereas the remaining cases displayed wild-type expression. MUC6 showed diffuse or focally positive staining in mucinous gland lesions characterized by gastric differentiation. Some cases of mucinous adenocarcinoma of fallopian tube were subject to AB-PAS staining, resulting in red to purple cytoplasmic staining. Conclusions: Primary mucinous lesions of the fallopian tube are exceedingly uncommon. All cases of mucinous adenocarcinoma of fallopian tubes in this study exhibit the morphology and immunohistochemical characteristics of gastrointestinal differentiation. Mucinous metaplasia of the fallopian tube is a benign lesion of incidental finding, which is closely related to inflammation or gastric differentiation. Mucinous lesions of cervix, ovary and digestive tract are excluded in all patients, confirming the independent existence of mucinous lesions within fallopian tubes.

A HISTOMORPHOLOGICAL STUDY OF FALLOPIAN TUBES IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA

Introduction: Fallopian tubes are complex structures 1. Fallopian tubes are part of female genital tract named after Italian physician Gabriele Fallopias in 16thcentury 2,16. Fallopian tube lesions are non-neoplastic and neoplastic. Non neoplastic lesions are the major cause of sterility13. Present study was under taken with objectives of study all histomorphological lesions of fallopian tubes in bilateral salphigoophorectomised patients. Material and methods: A total number of 249 specimens of hysterectomy with bilateral salpingectomy. Histosalphingooophorectomy cause were studied in the department of pathology SDM College of medical sciences and Hospital Dharwad over a period of 7 years form July 2012 to June 2019. The clinical data, gross and microscopic findings were studied. Incidence and prevalence were calculated. Results: In our study Hydrosalphinx (20.1%) is the commonest finding, Tubal atypia 14.9%, Tubal metaplasia 14%, acute salphingitis 9.2%, Metastatic lesions 6%, Hematosalphinx 6.8%, fallopian tube showing STIC lesions 3.6%, TuberculousSalphingitis 3.2% Conclusion: Fallopian tube lesions present with different pathological findings. Precursors of malignancy in fallopian tube has to be thoroughly examined.

Pattern and Frequency of Fallopian Tube Lesions in Resected Hysterectomy Specimens

Introduction: The fallopian tube or salpinx has been named after scientist Gabrielis Fallopus, who was the first to describe the fallopian tube precisely. Fallopian tubes are though very common surgical specimens but are rarely studied. Inflammatory diseases of fallopian tubes and infertility due to various tubal factors are one most common disease observed in females. Aims and Objectives: To evaluate the spectrum of fallopian tube lesions in surgically resected hysterectomy specimens grossly and on histopathology. To study the frequency of various histopathological lesions of fallopian tubes. Material and Methods: The prospective study was conducted over one year, and 316 Right fallopian tubes and 314 left fallopian tube specimens’ histopathology were analysed. Results: In this study, it was observed that 96.52% of right fallopian tubes and 95.86% of left fallopian tubes were normal on histology. The most common histopathological lesions observed were salpingitis and Para tubal cysts. Conclusion: Various histopathological lesions can be observed in fallopian tubes. Although Malignancies of fallopian tubes are rare, they must be subjected to histopathological examination to evaluate various pathological lesions. Keywords: fallopian tube, salpinx, resected hysterectomy

Fallopian tube lesions as potential precursors of early ovarian cancer: a comprehensive proteomic analysis

Ovarian cancer is the leading cause of death from gynecologic cancer worldwide. High-grade serous carcinoma (HGSC) is the most common and deadliest subtype of ovarian cancer. While the origin of ovarian tumors is still debated, it has been suggested that HGSC originates from cells in the fallopian tube epithelium (FTE), specifically the epithelial cells in the region of the tubal-peritoneal junction. Three main lesions, p53 signatures, STILs, and STICs, have been defined based on the immunohistochemistry (IHC) pattern of p53 and Ki67 markers and the architectural alterations of the cells, using the Sectioning and Extensively Examining the Fimbriated End Protocol. In this study, we performed an in-depth proteomic analysis of these pre-neoplastic epithelial lesions guided by mass spectrometry imaging and IHC. We evaluated specific markers related to each preneoplastic lesion. The study identified specific lesion markers, such as CAVIN1, Emilin2, and FBLN5. We also used SpiderMass technology to perform a lipidomic analysis and identified the specific presence of specific lipids signature including dietary Fatty acids precursors in lesions. Our study provides new insights into the molecular mechanisms underlying the progression of ovarian cancer and confirms the fimbria origin of HGSC.

Histopathological gamut of fallopian tube lesions: A 5-year retrospective descriptive study in a tertiary care teaching hospital in South India

Histopathological gamut of fallopian tube lesions: A 5-year retrospective descriptive study in a tertiary care teaching hospital in South India

Histopathological Findings in Corresponding Salpingectomy Specimens of Various Ovarian Neoplasms

Aim: The aim of this study is to evaluate salpingectomy specimens of all types of ovarian tumors by opting SEE-FIM grossing protocol. Methods: A total of 79 samples of fallopian tubes were grossed following SEE-FIM protocol, as mentioned by CAP. This study was conducted in Pathology department at Niazi Medical and Dental College Sargodha. Results: One third ovarian tumors (n = 26, 33.8%) were bilateral and two fifth tumors (n = 31, 40.3%) were on the right side. More than ninety percent samples (n = 71, 92.2%) had non-precursor lesions. Lastly, most common cases of ovarian tumors were of mature cystic teratoma (n = 16, 20.8%), dysgerminoma (n = 13, 16.9%) and mucinous cystadenoma (n = 12, 15.6%). The results of chi-square tests showed significant association of both histopathological changes in fallopian tube (χ2 (6) = 31.05, p < .001) and histopathological findings (χ2 (2) = 7.81, p < .05) with types of ovarian neoplasm. Conclusion: The routine following of SEE-FIM is an easily adoptable and valuable protocol in terms of finding unexpected / incidental lesions and their correlation with different ovarian neoplasms. Keyword: SEE-FIM protocol, Salpingectomy specimen, precursor fallopian tube lesions.

“SPECTRUM OF HISTOPATHOLOGICAL CHANGES OF FALLOPIAN TUBES AND ITS POSSIBLE RELATION TO THE STATE OF UTERUS AND OVARIES IN SURGICALLY REMOVED SPECIMENS” – A TWO YEAR STUDY IN A TERTIARY CARE HOSPITAL.

Background: The fallopian tube functions as an anatomic and physiologic link between the ovary and the uterus in reproduction by ensuring efcient and orderly ovum transport and providing a proper environment in which fertilization occurs. Not much studies has been done about the lesions of fallopian tube and its relation to the lesions of uterus and ovaries Objectives: To study the various histopathological lesions of uterus, ovaries and fallopian tubes. To correlate the possible relation of the lesions in the uterus and the ovaries to the changes in the fallopian tubes. Materials And Methods: This study was carried out in the department of Pathology, Regional Institute of Medical Sciences, Imphal, Manipur, India . A total of 80(Eighty) specimens of total abdominal hysterectomy with bilateral salpingoophorectomy from patients who underwent surgery in the Obstetrics and Gynecology department of Regional Institute of Medical Sciences Hospital were obtained for study for a duration of 2 years starting from May 2015 to April 2017. Majority of cases were with a clinical Results: diagnosis of uterine broid followed by chronic cervicitis and DUB. The incidence of tubal lesion was 18.75% and tubes with normal ndings comprised 88.75%. It is well appreciated that the Conclusion conditions involving the fallopian tube are frequently non neoplastic pathologic conditions like ectopic pregnancy, acute and chronic salpingitis in contrast to the neoplastic conditions.

Validation of a novel model of ovarian carcinogenesis: Digital spatial profiling of premalignant fallopian tube lesions in the MADM mouse and the potential impact on primary prevention of epithelial ovarian cancer (124)

Validation of a novel model of ovarian carcinogenesis: Digital spatial profiling of premalignant fallopian tube lesions in the MADM mouse and the potential impact on primary prevention of epithelial ovarian cancer (124)

Comparative analysis of the immunohistochemical expression of proliferation-apoptosis, epithelial-mesenchymal and hormone receptor markers in serous ovarian carcinoma and matched fallopian tube

During recent years, there is an accumulating evidence that high grade ovarian carcinoma is developed from the fallopian tube epithelial lesions. However, this subject is not completely understood and still represents the subject of investigation. We investigated the histopathological and immunohistochemical features of fallopian tubes from the patients with serous ovarian carcinoma. The results of our study indicate that in nearly 1/3 of the ovarian serous carcinoma cases, there is the presence of epithelial lesions in fallopian tubes, which might indicate the common origin. In addition, the expression of proliferation-apoptosis, epithelial-mesenchymal and hormone receptor markers are similar in nearly 1/3 of matched fallopian tube lesions and high grade serous ovarian carcinoma. Which represents additional evidence of the origin of high grade serous ovarian cancer from fallopian tube lesions.

Histomorphological Spectrum of Incidentally Detected Fallopian Tube Lesions in Patients Operated for Various Clinical Conditions and Detection of Precursor Lesion by Applying Sectioning and Extensively Examining the Fimbriated End Sampling Protocol

Background: Fallopian tube specimens are studied either in conjunction with ovaries, uterus, and cervix or alone. However, there is less knowledge about the spectrum of histopathological changes in these specimens due to paucity of data. Aim: This study aims to describe the spectrum of histopathological changes with frequency observed in the resected fallopian tube specimens, especially to detect the malignant precursor lesions and malignancy rate. Materials and Methods: Four hundred and ninety-four patients of resected fallopian tubes either separately or along with other female genital tract organs were retrospectively reviewed for histopathological findings. Hematoxylin- and eosin-stained histopathology slides were retrieved and re-examined. The distal fimbriated end was longitudinally sectioned for examination of fimbrial epithelium. The “sectioning and extensively examining the fimbriated end” (SEE-FIM) sampling protocol was used. Results: Out of 494 resected specimens, 247 patients (50%) had some kind of fallopian tube pathology. Fibrosis was the most common lesion observed in 59 cases followed by hematosalpinx (33 cases). Primary neoplasm was seen in 3 (0.6%) of specimens and all were of serous adenocarcinoma histology. Whereas, secondary malignancies were seen in 2 cases (0.4%), with primary being ovary. Four cases of serous tubal intraepithelial carcinoma (STIC) (0.8%) were detected using SEE-FIM protocol. Conclusion: A thorough histopathological examination including SEE-FIM protocols should be followed for detection of various fallopian tube lesions, which will eventually help in appropriate patient workup and treatment. Early detection of precursor lesions such as STIC and prompt treatment intervention may help in the prevention of ovarian malignancies.

English

BACKGROUND Among all the disorders of female reproductive system, adnexal masses are one of the most common disorders. The main purpose of the study was to evaluate an adnexal mass and to differentiate the mass as benign or malignant and facilitate selection of appropriate treatment algorithm. For few benign lesions, radiological follow-up is very suitable for further management and additional follow-up may not be useful when an imaging abnormality is not found. METHODS Our study was conducted in Osmania General Hospital and its allied hospital named Government Maternity Hospital, Hyderabad, on about 150 patients. This is an institution-based, multicentric, cross-sectional, prospective, analytical study. All clinically suspected female patients with adnexal masses referred to the Department of Radiodiagnosis were evaluated. These patients were first subjected to ultrasonography, followed by magnetic resonance imaging (MRI) (plain and contrast wherever required). MRI findings were compared with ultrasonography. These findings were compared with operative findings and histopathological findings, wherever performed. RESULTS In the present study, females in the age group of 21 – 40 years showed majority of pelvic lesions - 81 (54 %). Most of the pelvic masses were arising from the ovary - 102 (68 %). Majority of the adnexal lesions on MRI were benign in nature - 132 (88 %). MRI showed a sensitivity of 100 %, specificity of 97.7 %, and a positive predictive value of 83 %, & a negative predictive value of 100 %. CONCLUSIONS In practice, ultrasonography (USG) is the primary modality for diagnosing the pelvic mass. MRI is superior to ultrasound and can be used as problem solving technique in the assessment of pelvic mass. The multiplanar imaging capability allows accurate identification of origin of mass and characterisation of mass. This is helpful to the preoperative planning of sonographically detected mass and avoids surgery in possible cases. MRI is the technique of choice for staging, treatment planning and post treatment follow-up of pelvic malignancies. KEYWORDS MRI, USG, Adnexal Masses, Ovarian Masses, Board Ligament Lesions, Fallopian Tube Lesions, Cysts

Immunohistochemical Expression Status of p53, CD44v9, and Ki-67 in a Series of Fallopian Tube Lesions of High-grade Serous Carcinoma.

Pelvic high-grade serous carcinoma (HGSC) has been postulated to arise via a stepwise accumulation of (epi)genetic alterations from normal epithelium to secretory cell outgrowth (SCOUT), p53 signature, and serous tubal intraepithelial carcinoma (STIC) to invasive HGSC. The aim of this study is to investigate alterations in p53 and CD44v9 expression and the status of Ki-67 labeling index in a series of fallopian tube lesions of HGSC patients. A total of 45 specimens were analyzed in 16 patients with HGSC, and their lesions were categorized as follows: morphologically normal fallopian tube epithelium (FTE, n=6 samples), SCOUT (n=5), p53 signature (n=4), dormant STIC (n=8), active STIC (n=6), and HGSC (n=16). Morphologic features and immunohistochemical expression patterns of the p53 protein, CD44v9 protein, and Ki-67 antigen were blindly evaluated by 2 pathologists. Increased nuclear p53 protein accumulation was observed in p53 signature, dormant STIC, active STIC and HGSC compared with normal FTE and SCOUT (P<0.001). Immunohistochemistry scores of CD44v9 protein expression were significantly higher in normal FTE, SCOUT, and p53 signature than in dormant STIC, active STIC, and HGSC (P<0.001). Both active STIC and HGSC had significantly higher Ki-67 labeling indices than normal FTE, SCOUT, p53 signature and dormant STIC (P<0.001). CD44v9 loss contributes to the stepwise progression of p53 signature to dormant STIC. In conclusion, p53 mutation followed by CD44v9 loss may be involved in the evolution of STIC, which may confer positive clonal selection with a growth and survival advantage.

Serous tubal intraepithelial carcinoma (STIC) at the time of primary debulking surgery (PDS) of high-grade serous ovarian cancer (HGSOC): Does it matter?

Objective: The aim of this study was to evaluate the clinical significance and genomic associations of concurrent serous tubal intraepithelial carcinoma (STIC) fallopian tube lesions identified in women with high-grade serous carcinoma (HGSC) undergoing primary debulking surgery (PDS).

Study of spectrum of neoplastic and non-neoplastic lesions in fallopian tube in a tertiary care hospital

Background: Fallopian tubes are affected by a wide spectrum of diseases varying from salpingitis to carcinoma. Most pathological processes involving the fallopian tube are inflammatory and are of clinical significance because they interfere with the function of the fallopian tube and result in infertility. Although fallopian tube is affected by a wide spectrum of diseases, a literature search reveals that there are only occasional studies, documenting histologic changes in the fallopian tube removed for all reasons. This prompts the present study. The aim is to study the gross and microscopic features of the excised fallopian tubes and to study the common and unusual lesions in them and to study the frequency of histological findings and relative frequencies of different findings. Materials and methods: Four hundred and forty-five cases of fallopian tubes that were removed were studied retrospectively, and their histopathological findings documented. Results: The majority of the fallopian tubes had inflammatory changes comprised of acute and chronic salpingitis, salpingitis isthmica nodosa, tuberculous salpingitis, xanthogranulomatous salpingitis, hematosalpinx, and hydrosalpinx. Sixteen cases comprised of ectopic pregnancy. One case of primary fallopian tube adenocarcinoma and two cases of metastatic adenocarcinoma. Conclusion: The majority of the fallopian tubes remain unremarkable in a majority of the surgical pathology specimens, yet the fallopian tube must be subjected to a thorough histopathological examination to evaluate the various pathological lesions.

An Alternate Diagnostic Algorithm for the Diagnosis of Intraepithelial Fallopian Tube Lesions.

Intraepithelial fallopian tube neoplasia is thought to be a precursor lesion to high-grade serous carcinoma of the Müllerian adnexae, particularly in women with BRCA1 or BRCA2 mutations. This association has led to recommendations to assess fallopian tubes for intraepithelial atypia. However, the diagnostic reproducibility of a diagnosis of intraepithelial neoplasia is unclear. In this study, 2 gynecologic pathologists independently evaluated sections of fallopian tubes from a sample of women (N=198, 623 slides) undergoing salpingectomy. A total of 101 (54%) women were undergoing risk-reducing salpingo-oophorectomy. Pathologists were blinded to patient histories and prior diagnoses. Pathologists rendered one of three diagnoses for each slide: "negative for fallopian tube intraepithelial neoplasia (FTIN)," "indeterminate for FTIN," or "definite for FTIN." Cases that were considered by histology definite for FTIN or suspicious for FTIN were stained with p53 and Ki67. Pathologists agreed on the diagnosis of "definite for FTIN" 61.5% of the time. There was no agreement on any cases for the diagnosis of "indeterminate for FTIN." Fifteen "indeterminate for FTIN" and 12 "definite for FTIN" cases were stained with p53 and Ki67. Two of the "indeterminate" cases (13%) had p53-positive foci. Five of the "definite" cases had p53-positive foci. In 3 of the other 8 "definite" cases, there was obvious carcinoma present, but the carcinoma did not stain with p53, suggesting a possible null phenotype. We propose that immunostains should only be used to aid in the diagnosis of FTIN in cases with indeterminate histology. The use of p53 immunohistochemistry in cases that were considered "definite for FTIN" by histology was minimally helpful, and in fact often served to further confuse the diagnosis.

A Histopathological Study of Fallopian Tube Lesions - in a Tertiary Care Centre

A Histopathological Study of Fallopian Tube Lesions - in a Tertiary Care Centre

Histopathological study of surgically resected specimens of fallopian tube

Background: Fallopian Tubes are very common surgical specimen received in the pathological laboratory. It is affected by wide spectrum of both non neoplastic and neoplastic lesions. But there is very few studies described the frequency of various histopathological spectrums of lesions of fallopian tube. Aims & Objectives: To study the various histopathological lesions seen in surgically resected specimens of fallopian tube and their age distributions.Material and Method: A total of 200 surgically resected specimen of fallopian tube of all age group of patients which are received for one and half year duration, are processed with routine histopathological techniques. Histopathological features were studied on Haematoxylin and Eosin stain.Results: In our studies majority of the cases are belongs to 40 to 60 years of age out of 200 specimens. In this study, most of the patients were undergone total abdominal hysterectomy with salpingo-oophorectomy (60%). In our study out of 200 cases 63 (31.50%) specimens show unremarkable histology. Only 1(0.50%) case shows neoplastic pathology. Most common histopathological findings observed are paratubal cyst, ectopic tubal gestation and Walthard Cell Nests.Conclusion: Present study shows broad spectrum of pathological lesions in fallopian tube. Majority of the lesions are non neoplastic in nature. Thorough histopathological examination of fallopian tube specimens is necessary to document many lesions including rare primary intraepithelial malignancy which can be missed clinically and found incidentally on histopathological examination.

Abstract NT-104: SYNERGISTIC COMBINATION OF MORTALIN-TARGETING AND P53 REACTIVATOR DRUGS FOR OVARIAN CANCER

Abstract PURPOSE: TP53 gene missense mutations represent the most common genetic defect in fallopian tube (FT) lesions and high grade serous ovarian cancer (HGSOC) and cause of drug resistance. We hypothesized that drugs with complementary p53 protein-targeted mechanisms (SHetA2 drug release of p53 from mortalin binding, PRIMA-1MET drug reactivation of p53 transcription activity) synergistically kill ovarian cancer cells without harming normal cells. EXPERIMENTAL DESIGN: SHetA2-mediated cytoplasmic to nuclear/mitochondrial p53 translocation was studied in wildtype and mutant p53 ovarian cancer cell lines using Western blot analysis of subcellular-enriched fractions and fluorescent microscopic imaging of immunocytochemistry. Human FT epithelial cells (hFTSECs) were used as healthy controls. The p53 reactivator drugs PRIMA-1 and PRIMA-1MET were combined with SHetA2 to study drug interactions and mechanisms using Western blot, rtPCR, cytotoxicity, reactive oxygen species (ROS) and ATP assays. RESULTS: SHetA2 induced p53 nuclear and mitochondrial accumulation in ovarian cancer cell lines, but not in hFTSECs. Both mortalin and p53 expression altered SHetA2 cytotoxicity in ovarian cancer cells. Modest effects of PRIMA-1MET on cell lines inversely correlated with SLC7A11 expression, a known biomarker of PRIMA-1MET sensitivity. SHetA2 induced SLC7A11 in the presence of wildtype or missense mutant p53, but inhibited SLC7A11 in the absence of p53. SHetA2 and PRIMA-1MET were synergistic-to-strongly synergistic in ovarian cancer cells with mutant p53, synergistic with wildtype p53, additive with null p53 and antagonistic in hFTSECs. Elevated apoptosis, p53 transcription activity and ROS in combination with reduced ATP were associated with this mutant p53-dependent synergy. CONCLUSION: Altogether, our findings identified the SHetA2 and PRIMA-1MET combination as a promising new therapeutic strategy for the treatment of HGSOCs with missense mutant p53. GRANT SUPPORT: Supported by the US National Cancer Institute grant R01 CA196200 and Foundation for Women's Cancer- Ovarinnovate: Ovarcome Research Excellence Award. Citation Format: Satish Kumar Ramraj, Doris M. Benbrook. SYNERGISTIC COMBINATION OF MORTALIN-TARGETING AND P53 REACTIVATOR DRUGS FOR OVARIAN CANCER [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr NT-104.

Molecular markers derived from ovarian cancer and its correlation with the types of oviductal epithelial lesions

To explore the role of P53, pairing box gene 8 antibody (PAX8), and calcium omentum protein (Calretinin) in the origin of epithelial ovarian cancer. Methods: A total of 63 tissue samples of ovarian tumor and fallopian tubes were collected. Immunohistochemistry methods were used to analyze the expression of P53, PAX8, and Calretinin. The relationship between these protein levels and the classification of ovarian tumors was evaluated. Results: In epithelial ovarian cancer, the P53 or PAX8 was correlated with the occurrence of high-grade carcinoma, while the calretinin was correlated with the occurrence of low-grade carcinoma (P<0.05). The combination of PAX8 with Calretinin was correlated with the grade of ovarian tumor (P<0.05). The combination of P53 with Calretinin was correlated with the grade of tumor (P<0.05). The combination of P53 with PAX8 was correlated with the grade of tumor (P<0.05). The expression of P53 in fallopian tubes was correlated with the malignant degree of epithelial ovarian cancer (P<0.05). The degree of fallopian tube lesions in patients with ovarian cancer was correlated with epithelial ovarian cancer. The malignant lesions of tubal epithelium was correlated with high-grade carcinoma, while the normal or atypical hyperplasia of tubal epithelium was correlated with low-grade carcinoma (P<0.05). Conclusion: P53 and Calretinin combined with PAX8 show a synergistic effect on the differentiation of epithelial ovarian cancer grade. The morphology of HE and the expression of TP53 in the fallopian tube epithelium play an auxiliary role in the diagnosis of epithelial ovarian cancer.