101
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Martínková J, Bláha M, Kubeček O, Maláková J, Špaček J, Bezouška J, Krulichová IS, Filip S. Plasmafiltration as a possible contributor to kinetic targeting of pegylated liposomal doxorubicin (PLD) in order to prevent organ toxicity and immunosuppression. Cancer Chemother Pharmacol 2015; 77:429-37. [PMID: 26678853 DOI: 10.1007/s00280-015-2936-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/30/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the removal of pegylated liposomal doxorubicin (PLD) during plasmafiltration (PF) and determine whether the drug could be withheld prior to its organ distribution responsible for mucocutaneous toxicity. METHODS Six patients suffering from platinum-resistant ovarian cancer were treated with a 1-h IV infusion 50 mg/m(2) of PLD/cycle-for three cycles q4w. Over 44 (46)-47(49) h postinfusion, five patients (14 cycles in total) underwent PF using a cascade PF method consisted of plasma separation by centrifugation and plasma treatment using filtration based one volume of plasma treatment, i.e., 3.18 L (±0.6 L) and plasma flow 1.0 L/h (0.91-1.48 L/h). Doxorubicin concentration in blood was monitored by a high-performance liquid chromatography method for 116 h postinfusion. Pharmacokinetic parameters determined from plasma concentration included volume of distribution, total body clearance, half-life of elimination, and area under the plasma concentration versus time. The amount of doxorubicin in the body eliminated by the patient and via extracorporeal treatment was evaluated. Toxicity was tested using CTCAE v4.0. RESULTS The efficacy of PF and early responses to PLD/PF combination strategy were as follows: over 44(46) h postinfusion considered necessary for target distribution of PLD to tumor, patients eliminated 46 % (35-56 %) of the dose administered. Over 44(46)-47(49) h postinfusion, a single one-volume plasma filtration removed 40 % (22-45 %) (Mi5) of the remaining doxorubicin amount in the body. Total fraction eliminated attained 81 % (75-86 %). The most common treatment-related adverse events (grade 1-2) such as nausea (4/14 cycles-28 %) and vomiting (3/14 cycles-21 %) appeared during 44 h postinfusion. Hematological toxicity-anemia (5/14 cycles-35 %) was reported after cycle II termination. Symptoms of PPE-like syndrome (grade 1-2) appeared in one patient concomitantly with thrombophlebitis and malignant effusion. In this study, only one adverse reaction (1/14-7 %) as short-term malaise and nausea was reported by the investigator as probably related to PF. CONCLUSION A single one-volume PF does remove a clinically important amount of doxorubicin in a kinetic targeting approach. There were no serious signs of drug toxicity and/or PF-related adverse events. Kinetically guided therapy with pegylated liposomal doxorubicin combined with PF may be a useful tool to the higher efficacy and tolerability of therapy with PLD.
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Affiliation(s)
- Jiřina Martínková
- Department of Oncology and Radiotherapy, Charles University in Prague, Medical Faculty and University Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Milan Bláha
- 4th Department of Internal Medicine - Hematology, Charles University in Prague, Medical Faculty and University Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Ondřej Kubeček
- Department of Oncology and Radiotherapy, Charles University in Prague, Medical Faculty and University Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Jana Maláková
- Department of Medical Biochemistry, Charles University in Prague, Medical Faculty and University Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Jiří Špaček
- Department of Gynecology, Charles University in Prague, Medical Faculty and University Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Jan Bezouška
- Department of Surgery, Charles University in Prague, Medical Faculty and University Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Iva Selke Krulichová
- Department of Biophysics, Charles University in Prague, Medical Faculty and University Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Stanislav Filip
- Department of Oncology and Radiotherapy, Charles University in Prague, Medical Faculty and University Hospital in Hradec Králové, Hradec Králové, Czech Republic.
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Agrawal R. Malignancy of fallopian tube. INDIAN J PATHOL MICR 2015; 58:519-520. [PMID: 26549081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- Ranjan Agrawal
- Department of Pathology, Rohilkhand Medical College Hospital, Bareilly, Uttar Pradesh, India
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103
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Mu T, Li H, Wang J, Yao Y, Shen D. [Pathologic features of fallopian tubal fimbriae in patients with endometrial serous carcinoma]. Zhonghua Fu Chan Ke Za Zhi 2015; 50:757-761. [PMID: 26675575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To discuss the potential relationship between endometrial serous carcinoma (ESC) and tubal epithelial lesions by pathologic examination of fallopian tubes with ESC. METHODS A total of 30 cases of typical ESC were reexamined and chosen by the pathologist. In each case, bilateral fallopian tubes were submitted to examination of pathologic morphology and immunostaining for p53, annexin IV (ANX-IV), human epidermal growth factor receptor 2 (HER2)/neu, and high-mobility group protein A2 (HMGA2). RESULTS Fallopian tubal epithelial lesions were found in 15 cases, including 9 cases tubal serous carcinoma, 2 cases serous tubal intraepithelial carcinoma (STIC) and 2 cases epithelial hyperplasia. Both sides of tubal serous carcinoma and STIC were found in 1 case. The results showed the positive expression for p53 in 26 (87%) out of 30 endometrial malignant specimens tissues and 9 (30%) tubal tissues samples (P > 0.05). Twenty-five (83%) endometrial malignant specimens tissues and 6 (20%) tubal tissues samples showed the positive expression of ANX-IV. Twenty-one (70%) endometrial malignant tissues and 7 (23%) tubal tissues showed the positive expression of HER2/neu. Twenty-five (83%) endometrial malignant tissues and 6 (20%) tubal tissues showed the positive expression of HMGA2. While, there were significant differences among the expression of three proteins between endometrium and the fallopian tube site (all P < 0.05). CONCLUSIONS STIC may be associated with the occurrence of ESC. The expression of p53 was positively correlated between the fallopian tube and the endometrium. ANX-IV, HER2/neu and HMGA2 were extensively expressed in ESC.
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Affiliation(s)
- Tian Mu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
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104
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Venturella R, Morelli M, Zullo F. The Fallopian Tube in the 21st Century: When, Why, and How to Consider Removal. Oncologist 2015; 20:1227-9. [PMID: 26382741 DOI: 10.1634/theoncologist.2015-0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/24/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Roberta Venturella
- Department of Obstetrics and Gynaecology, Magna Graecia University, Catanzaro, Italy
| | - Michele Morelli
- Department of Obstetrics and Gynaecology, Magna Graecia University, Catanzaro, Italy
| | - Fulvio Zullo
- Department of Obstetrics and Gynaecology, Magna Graecia University, Catanzaro, Italy
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105
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Duska LR, Java JJ, Cohn DE, Burger RA. Risk factors for readmission in patients with ovarian, fallopian tube, and primary peritoneal carcinoma who are receiving front-line chemotherapy on a clinical trial (GOG 218): an NRG oncology/gynecologic oncology group study (ADS-1236). Gynecol Oncol 2015; 139:221-7. [PMID: 26335594 DOI: 10.1016/j.ygyno.2015.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Readmission within 30days is a measure of care quality. Ovarian cancer patients are at high risk for readmission, but specific risk factors are not defined. This study was designed to determine risk factors in patients with ovarian cancer receiving upfront surgery and chemotherapy. METHODS The study population was enrolled to GOG 0218. Factors predictive of admission within 30days of a previous admission or 40days of cytoreductive surgery were investigated. Categorical variables were compared by Pearson chi-square test, continuous variables by Wilcoxon-Mann-Whitney test. A logistic regression model was used to evaluate independent prognostic factors and to estimate covariate-adjusted odds. All tests were two-tailed, α=0.05. RESULTS Of 1873 patients, 197 (10.5%) were readmitted, with 59 experiencing >1 readmission. One-hundred-forty-four (73%) readmissions were post-operative (readmission rate 7.7%). Significant risk factors include: disease stage (stage 3 vs 4, p=0.008), suboptimal cytoreduction (36% vs 64%, p=0.001), ascites, (p=0.018), BMI (25.4 vs 27.6, p<0.001), poor PS (p<0.001), and higher baseline CA 125 (p=0.017). Patients readmitted within 40days of surgery had a significantly shorter interval from surgery to chemotherapy initiation (22 versus 32days, p<0.0001). Patients treated with bevacizumab had higher readmission rates in the case of patients with >1 readmission. On multivariate analysis, the odds of re-hospitalization increased with doubling of BMI (OR=1.81, 95% CI: 1.07-3.07) and PS of 2 (OR=2.05, 95% CI 1.21-3.48). CONCLUSION Significant risk factors for readmission in ovarian cancer patients undergoing primary surgery and chemotherapy include stage, residual disease, ascites, high BMI and poor PS. Readmissions are most likely after the initial surgical procedure, a discrete period to target with a prospective intervention.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Ascites/etiology
- Bevacizumab/administration & dosage
- Body Mass Index
- CA-125 Antigen/blood
- Carboplatin/administration & dosage
- Carcinoma/blood
- Carcinoma/complications
- Carcinoma/drug therapy
- Carcinoma/pathology
- Chemotherapy, Adjuvant
- Cytoreduction Surgical Procedures
- Double-Blind Method
- Fallopian Tube Neoplasms/blood
- Fallopian Tube Neoplasms/complications
- Fallopian Tube Neoplasms/drug therapy
- Fallopian Tube Neoplasms/pathology
- Female
- Humans
- Middle Aged
- Multivariate Analysis
- Neoplasm Staging
- Neoplasm, Residual
- Neoplasms, Cystic, Mucinous, and Serous/blood
- Neoplasms, Cystic, Mucinous, and Serous/complications
- Neoplasms, Cystic, Mucinous, and Serous/drug therapy
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Obesity/complications
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/complications
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/pathology
- Paclitaxel/administration & dosage
- Patient Readmission/statistics & numerical data
- Peritoneal Neoplasms/blood
- Peritoneal Neoplasms/complications
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/pathology
- Risk Factors
- Time Factors
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Affiliation(s)
- Linda R Duska
- University of Virginia Health Systems, Division of Gynecology Oncology, P.O. Box 800712, Charlottesville, VA 22908, United States.
| | - James J Java
- NRG Oncology/Gynecologic Oncology Group, Statistics & Data Center, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, United States.
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, 320 West 10th Avenue, M210 Starling Loving Hall, Columbus OH 43210, United States.
| | - Robert A Burger
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, 3400 Civic Center Boulevard, SCTR 8-104 Philadelphia PA, United States.
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Ferriss JS, Java JJ, Bookman MA, Fleming GF, Monk BJ, Walker JL, Homesley HD, Fowler J, Greer BE, Boente MP, Burger RA. Ascites predicts treatment benefit of bevacizumab in front-line therapy of advanced epithelial ovarian, fallopian tube and peritoneal cancers: an NRG Oncology/GOG study. Gynecol Oncol 2015. [PMID: 26216729 DOI: 10.1016/j.ygyno.2015.07.103] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Predictive factors for efficacy of bevacizumab in advanced ovarian cancer have remained elusive. We investigated ascites both as a prognostic factor and as a predictor of efficacy for bevacizumab. METHODS Using data from GOG 0218, patients receiving cytotoxic therapy plus concurrent and maintenance bevacizumab were compared to those receiving cytotoxic therapy plus placebo. The presence of ascites was determined prospectively. Chi-square and Wilcoxon-Mann-Whitney tests compared baseline variables between subgroups. Survival was estimated by Kaplan-Meier method, and Cox proportional hazard models were used to evaluate independent prognostic factors and estimate their covariate-adjusted effects on survival. RESULTS Treatment arms were balanced with respect to ascites and other prognostic factors. Overall, 886 (80%) women had ascites, 221 (20%) did not. Those with ascites were more likely to have: poorer performance status (p<0.001); serous histology (p=0.012); higher baseline CA125 (p<0.001); and suboptimal cytoreduction (p=0.004). In multivariate survival analysis, ascites was prognostic of poor OS (Adjusted HR 1.22, 95% CI 1.00-1.48, p=0.045), but not PFS. In predictive analysis, patients without ascites treated with bevacizumab had no significant improvement in either PFS (AHR 0.81, 95% CI 0.59-1.10, p=0.18) or OS (AHR 0.94, 95% CI 0.65-1.36, p=0.76). Patients with ascites treated with bevacizumab had significantly improved PFS (AHR 0.71, 95% CI 0.62-0.81, p<0.001) and OS (AHR 0.82, 95% CI 0.70-0.96, p=0.014). CONCLUSIONS Ascites in women with advanced ovarian cancer is prognostic of poor overall survival. Ascites may predict the population of women more likely to derive long-term benefit from bevacizumab.
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Affiliation(s)
- James S Ferriss
- Temple University School of Medicine & Fox Chase Cancer Center, Philadelphia, PA, United States
| | - James J Java
- Gynecologic Oncology Group Statistical & Data Center, Buffalo, NY, United States
| | | | - Gini F Fleming
- University of Chicago Medical Center, Chicago, IL, United States
| | - Bradley J Monk
- St Joseph's Hospital, Creighton School of Medicine, Phoenix, AZ, United States
| | - Joan L Walker
- University of Oklahoma, Oklahoma City, OK, United States
| | | | | | | | | | - Robert A Burger
- University of Pennsylvania, Philadelphia, PA, United States.
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107
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Rauh-Hain JA, Foley OW, Winograd D, Andrade C, Clark RM, Vargas RJ, Hinchcliff EM, Esselen KM, Horowitz NS, del Carmen MG. Clinical characteristics and outcomes of patients with stage I epithelial ovarian cancer compared with fallopian tube cancer. Am J Obstet Gynecol 2015; 212:600.e1-8. [PMID: 25514761 DOI: 10.1016/j.ajog.2014.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/07/2014] [Accepted: 12/11/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare clinical characteristics and survival between patients with stage I epithelial ovarian cancer and fallopian tube cancer. STUDY DESIGN We identified women with stage I epithelial ovarian cancer and fallopian tube cancer who underwent treatment from 2000-2010. Correlation between categoric variables was assessed with χ2 test. The Kaplan-Meier survival analysis was used to generate overall survival data. Factors predictive of outcome were compared with the use of the log-rank test and Cox proportional hazards model. RESULTS The study group consisted of 385 women with epithelial ovarian cancer and 43 women with fallopian tube cancer. Patients with fallopian tube cancer had a higher rate of stage IA disease (65% vs 48%; P=.02) and grade 3 tumors (60.4% vs 30.9%; P<.001). Patients with fallopian tube cancer had a significantly higher rate of breast cancer (25.6% vs 5.7%; P<.001) and BRCA 1 mutations (45.8% vs 9.1%; P<.001). There was no difference in the rates of platinum-based and paclitaxel chemotherapy between the groups. Women with fallopian tube cancer were more likely to have received ≥6 cycles of chemotherapy (58.1% vs 44.1%; P=.02). The 5-year disease-free survival rates were 100% in women with fallopian tube cancer and 93% in patients with epithelial ovarian cancer (P=.04). The 5-year overall survival rates were 100% and 95% for fallopian tube cancer and epithelial ovarian cancer, respectively (P=.7). CONCLUSION We found a higher rate of stage IA, grade 3, and serous carcinoma in fallopian tube cancer. Women with fallopian tube cancer had a higher rate of breast cancer. There was no difference in overall survival between the groups.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/epidemiology
- Carcinoma, Endometrioid/genetics
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/therapy
- Carcinoma, Ovarian Epithelial
- Chemotherapy, Adjuvant/statistics & numerical data
- Disease-Free Survival
- Fallopian Tube Neoplasms/epidemiology
- Fallopian Tube Neoplasms/pathology
- Fallopian Tube Neoplasms/therapy
- Female
- Genes, BRCA1
- Humans
- Kaplan-Meier Estimate
- Middle Aged
- Neoplasm Staging
- Neoplasms, Cystic, Mucinous, and Serous/genetics
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/therapy
- Neoplasms, Glandular and Epithelial/epidemiology
- Neoplasms, Glandular and Epithelial/pathology
- Neoplasms, Glandular and Epithelial/therapy
- Ovarian Neoplasms/epidemiology
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/therapy
- Paclitaxel/administration & dosage
- Platinum Compounds/administration & dosage
- Prognosis
- Proportional Hazards Models
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Affiliation(s)
- Jose Alejandro Rauh-Hain
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Olivia Wysong Foley
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Dina Winograd
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Carolina Andrade
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rachel Marie Clark
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Roberto Javier Vargas
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Emily Moss Hinchcliff
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Katherine McKinley Esselen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Neil Stuart Horowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marcela Guadalupe del Carmen
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Borley J, Wilhelm-Benartzi C, Yazbek J, Williamson R, Bharwani N, Stewart V, Carson I, Hird E, McIndoe A, Farthing A, Blagden S, Ghaem-Maghami S. Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer. BJOG 2015; 122:843-849. [PMID: 25132394 DOI: 10.1111/1471-0528.12992] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess site of disease on preoperative computed tomography (CT) to predict surgical debulking in patients with ovarian cancer. DESIGN Two-phase retrospective cohort study. SETTING West London Gynaecological Cancer Centre, UK. POPULATION Women with stage 3 or 4, ovarian, fallopian or primary peritoneal cancer undergoing cytoreductive surgery. METHODS Preoperative CT images were reviewed by experienced radiologists to assess the presence or absence of disease at predetermined sites. Multivariable stepwise logistic regression models determined sites of disease which were significantly associated with surgical outcomes in the test (n = 111) and validation (n = 70) sets. MAIN OUTCOME MEASURES Sensitivity and specificity of CT in predicting surgical outcome. RESULTS Stepwise logistic regression identified that the presence of lung metastasis, pleural effusion, deposits on the large-bowel mesentery and small-bowel mesentery, and infrarenal para-aortic nodes were associated with debulking status. Logistic regression determined a surgical predictive score which was able to significantly predict suboptimal debulking (n = 94, P = 0.0001) with an area under the curve (AUC) of 0.749 (95% confidence interval [95% CI]: 0.652, 0.846) and a sensitivity of 69.2%, specificity of 71.4%, positive predictive value of 75.0% and negative predictive value of 65.2%. These results remained significant in a recent validation set. There was a significant difference in residual disease volume in the test and validation sets (P < 0.001) in keeping with improved optimal debulking rates. CONCLUSIONS The presence of disease at some sites on preoperative CT scan is significantly associated with suboptimal debulking and may be an indication for a change in surgical planning.
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Affiliation(s)
- J Borley
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - J Yazbek
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - R Williamson
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - N Bharwani
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - V Stewart
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - I Carson
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - E Hird
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - A McIndoe
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - A Farthing
- Department of Surgery and Cancer, Imperial College London, London, UK
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - S Blagden
- Department of Surgery and Cancer, Imperial College London, London, UK
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
| | - S Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College London, London, UK
- West London Gynaecology Cancer Centre, Imperial College NHS Trust, London, UK
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Rizzuto I, Stavraka C, Chatterjee J, Borley J, Hopkins TG, Gabra H, Ghaem-Maghami S, Huson L, Blagden SP. Risk of Ovarian Cancer Relapse score: a prognostic algorithm to predict relapse following treatment for advanced ovarian cancer. Int J Gynecol Cancer 2015; 25:416-22. [PMID: 25647256 PMCID: PMC4340599 DOI: 10.1097/igc.0000000000000361] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/23/2014] [Accepted: 12/07/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of this study was to construct a prognostic index that predicts risk of relapse in women who have completed first-line treatment for ovarian cancer (OC). METHODS A database of OC cases from 2000 to 2010 was interrogated for International Federation of Gynecology and Obstetrics stage, grade and histological subtype of cancer, preoperative and posttreatment CA-125 level, presence or absence of residual disease after cytoreductive surgery and on postchemotherapy computed tomography scan, and time to progression and death. The strongest predictors of relapse were included into an algorithm, the Risk of Ovarian Cancer Relapse (ROVAR) score. RESULTS Three hundred fifty-four cases of OC were analyzed to generate the ROVAR score. Factors selected were preoperative serum CA-125, International Federation of Gynecology and Obstetrics stage and grade of cancer, and presence of residual disease at posttreatment computed tomography scan. In the validation data set, the ROVAR score had a sensitivity and specificity of 94% and 61%, respectively. The concordance index for the validation data set was 0.91 (95% confidence interval, 0.85-0.96). The score allows patient stratification into low (<0.33), intermediate (0.34-0.67), and high (>0.67) probability of relapse. CONCLUSIONS The ROVAR score stratifies patients according to their risk of relapse following first-line treatment for OC. This can broadly facilitate the appropriate tailoring of posttreatment care and support.
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Affiliation(s)
- Ivana Rizzuto
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Chara Stavraka
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Jayanta Chatterjee
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Jane Borley
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Thomas Glass Hopkins
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Hani Gabra
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Sadaf Ghaem-Maghami
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Les Huson
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Sarah P. Blagden
- *Imperial College Healthcare NHS Trust, Garry Weston Cancer Centre, and †Ovarian Cancer Action Research Centre, Hammersmith Hospital; and ‡Division of Experimental Medicine, Imperial College London, Hammersmith Campus, London, United Kingdom
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Wahner Hendrickson AE, Hawthorne KM, Goode EL, Kalli KR, Goergen KM, Bakkum-Gamez JN, Cliby WA, Keeney GL, Visscher DW, Tarabishy Y, Oberg AL, Hartmann LC, Maurer MJ. Assessment of published models and prognostic variables in epithelial ovarian cancer at Mayo Clinic. Gynecol Oncol 2015; 137:77-85. [PMID: 25620544 PMCID: PMC4380608 DOI: 10.1016/j.ygyno.2015.01.539] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/19/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Epithelial ovarian cancer (EOC) is an aggressive disease in which first line therapy consists of a surgical staging/debulking procedure and platinum based chemotherapy. There is significant interest in clinically applicable, easy to use prognostic tools to estimate risk of recurrence and overall survival. In this study we used a large prospectively collected cohort of women with EOC to validate currently published models and assess prognostic variables. METHODS Women with invasive ovarian, peritoneal, or fallopian tube cancer diagnosed between 2000 and 2011 and prospectively enrolled into the Mayo Clinic Ovarian Cancer registry were identified. Demographics and known prognostic markers as well as epidemiologic exposure variables were abstracted from the medical record and collected via questionnaire. Six previously published models of overall and recurrence-free survival were assessed for external validity. In addition, predictors of outcome were assessed in our dataset. RESULTS Previously published models validated with a range of c-statistics (0.587-0.827), though application of models containing variables which are not part of routine practice were somewhat limited by missing data; utilization of all applicable models and comparison of results are suggested. Examination of prognostic variables identified only the presence of ascites and ASA score to be independent predictors of prognosis in our dataset, albeit with marginal gain in prognostic information, after accounting for stage and debulking. CONCLUSIONS Existing prognostic models for newly diagnosed EOC showed acceptable calibration in our cohort for clinical application. However, modeling of prospective variables in our dataset reiterates that stage and debulking remains the most important predictors of prognosis in this setting.
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Affiliation(s)
| | - Kieran M Hawthorne
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Ellen L Goode
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Kimberly R Kalli
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Krista M Goergen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Jamie N Bakkum-Gamez
- Department of Obstetrics of Gynecology, Mayo Clinic, Rochester, MN, United States
| | - William A Cliby
- Department of Obstetrics of Gynecology, Mayo Clinic, Rochester, MN, United States
| | - Gary L Keeney
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, United States
| | - Daniel W Visscher
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, United States
| | | | - Ann L Oberg
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Lynn C Hartmann
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States.
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111
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Sørensen RD, Schnack TH, Karlsen MA, Høgdall CK. Serous ovarian, fallopian tube and primary peritoneal cancers: a common disease or separate entities - a systematic review. Gynecol Oncol 2015; 136:571-81. [PMID: 25615934 DOI: 10.1016/j.ygyno.2015.01.534] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/06/2015] [Accepted: 01/13/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this systematic review is to analyze data on risk factors, epidemiology, clinicopathology and molecular biology from studies comparing primary peritoneal cancer, fallopian tube cancer and ovarian cancer of serous histology, in order to achieve a greater understanding of whether or not these disorders should be considered as separate entities. METHODS A systematic literature search was conducted in PubMed and MEDLINE. Case-control studies comparing primary serous peritoneal or fallopian tube carcinomas with primary serous ovarian carcinomas or a control group were included. RESULTS Twenty-eight studies were found eligible. Primary peritoneal cancer patients were older, had higher parity, were more often obese and had poorer survival compared to ovarian cancer patients. Differences in protein expression patterns of Her2/neu, estrogen and progestin receptors and frequency of loss of heterozygosity differed between primary peritoneal cancer and primary ovarian cancer patients. No major differences were found between primary fallopian tube cancer and primary ovarian cancer. The proportion of serous tubal intraepithelial carcinomas (STIC) was lower in primary peritoneal cancer and primary ovarian cancer compared to primary fallopian tube cancer. CONCLUSION Except from differences in the proportion of STIC only few differences between primary fallopian tube cancer and primary ovarian cancer have been found. In contrast, observed differences in risk factor profile, clinicopathologic and prognostic factors, as well as in the molecular patterns, indicate that peritoneal cancer and ovarian cancer may be linked to different carcinogenic pathways.
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Affiliation(s)
- Rie D Sørensen
- Gynaecological Clinic, The Juliane Marie Center, Rigshospitalet University Hospital of Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark.
| | - Tine H Schnack
- Gynaecologic and Obstetric Clinic, Roskilde Sygehus, Køgevej 7-13, 4000 Roskilde, Denmark.
| | - Mona A Karlsen
- Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Claus K Høgdall
- Gynaecological Clinic, The Juliane Marie Center, Rigshospitalet University Hospital of Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark.
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Ose J, Fortner RT, Rinaldi S, Schock H, Overvad K, Tjonneland A, Hansen L, Dossus L, Fournier A, Baglietto L, Romieu I, Kuhn E, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Masala G, Sieri S, Tumino R, Sacerdote C, Mattiello A, Ramon Quiros J, Obón-Santacana M, Larrañaga N, Chirlaque MD, Sánchez MJ, Barricarte A, Peeters PH, Bueno-de-Mesquita HB, Onland-Moret NC, Brändstedt J, Lundin E, Idahl A, Weiderpass E, Gram IT, Lund E, Kaw KT, Travis RC, Merritt MA, Gunther MJ, Riboli E, Kaaks R. Endogenous androgens and risk of epithelial invasive ovarian cancer by tumor characteristics in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2015; 136:399-410. [PMID: 24890047 DOI: 10.1002/ijc.29000] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/05/2014] [Indexed: 11/09/2022]
Abstract
The role of endogenous androgens and sex hormone-binding globulin (SHBG) in ovarian carcinogenesis is poorly understood. Epithelial invasive ovarian cancer (EOC) is a heterogeneous disease and there are no prospective data on endogenous androgens and EOC risk by tumor characteristics (histology, grade, stage) or the dualistic model of ovarian carcinogenesis (i.e. type I vs. type II, leading to less or more aggressive tumors). We conducted a nested case-control study in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort evaluating androgens and SHBG and invasive EOC risk by tumor characteristics. Female participants who provided a blood sample and were not using exogenous hormones at blood donation were eligible (n = 183,257). A total of 565 eligible women developed EOC; two controls (n = 1,097) were matched per case. We used multivariable conditional logistic regression models. We observed no association between androgens, SHBG and EOC overall. A doubling of androstenedione reduced risk of serous carcinomas by 21% (odds ratio (OR)log2 = 0.79, 95% confidence interval [CI] = [0.64-0.97]). Moreover, associations differed for low-grade and high-grade carcinomas, with positive associations for low-grade and inverse associations for high-grade carcinomas (e.g. androstenedione: low grade: ORlog2 = 1.99 [0.98-4.06]; high grade: ORlog2 = 0.75 [0.61-0.93], phet ≤ 0.01), similar associations were observed for type I/II tumors. This is the first prospective study to evaluate androgens, SHBG and EOC risk by tumor characteristics and type I/II status. Our findings support a possible role of androgens in ovarian carcinogenesis. Additional studies exploring this association are needed.
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Affiliation(s)
- Jennifer Ose
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
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Liu L, Xu X, Jia L, Wei M, Qian B, Wu Y, Shen Y, Wang X, Pei H, Chen X. Primary fallopian tube carcinoma--a retrospective analysis of 66 cases. EUR J GYNAECOL ONCOL 2015; 36:161-167. [PMID: 26050354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Primary fallopian tube carcinoma (PFTC) is a rare malignant gynecologic oncology. There was no consensus on the outcome related clinicopathological characteristics. Present study aims to determine the prognosis associate factors in PFTC. MATERIALS AND METHODS In this retrospective study, the authors identified 50 PFTC patients in Jiangsu Institute of Cancer Research and 16 cases in the Affiliated People's Hospital of Inner Mongolia Medical College between 1988 and 2013. Disease surveillance was conducted based on the follow-up protocol of MD Anderson Cancer Center. Cox proportional hazards model and log-rank test were used to assess the associations between potential clinicpathologic characteristics and the survival durations. RESULTS The median progression free survival (PFS) and overall survival (OS) of PFTC were 36.9 and 62.7 months, respectively. FIGO Stage (p < 0.01, 0.01), grade (p = 0.02, 0.03), tumor residual after initial debulking surgery (p = 0.05, 0.01), nadir CA-125 (p = 0.01, 0.01) were independently related with PFS and OS. The PFS and OS of patients with Stage II PFTC were similar as those with Stage III-IV (30.7 vs 28.3 and 61.9 vs 49.2 months, respectively) but poorer than those of Stage I cases (N/A). The PFS of patients with paclitaxel-based chemotherapy was longer than those with other regime (51.3 vs 33.1 months), but not OS (62.7 vs 42.6 months). The outcome of patients underwent optimal initial cytoreduction surgery was better than those of suboptimal ones (PFS 56.4 vs 21.2 months and OS 65.3 vs 47.9 months, respectively). CONCLUSIOn: PFTC patients with FIGO Stage II disease should be regarded as advanced disease. Paclitaxel based chemotherapy was associated with longer PFS but not OS in PFTC.
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114
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Prat J, Belhadj H, Berek J, Bermudez A, Bhatla N, Cain J, Denny L, Fujiwara K, Hacker N, Avall-Lundqvist E, Mutch D, Odicino F, Pecorelli S, Quinn M, Seoud MAF, Shrivastava SK. Abridged republication of FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum. EUR J GYNAECOL ONCOL 2015; 36:367-369. [PMID: 26390684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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115
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Ganovska A, Kovachev S. [The primary cancer of fallopian tube--a clinical case]. Akush Ginekol (Sofiia) 2015; 54:42-46. [PMID: 27032234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The primary cancer of the fallopian tube is only 1% of all malignant diseases affecting the female genital tract. The etiology is unknown and is assessed with untypical symptomatic. It often affects women at age over 50 years old. Recently in literature are described about 1200 clinical cases. The primary carcinomaof fallopian tube resembles the epithelial ovarian cancers, which defines the similarity in the diagnosis, treatment and follow up of the patients with such type of pathology. We describe a clinical case of 66 year old woman with primary serous low graded cancer of a fallopian tube. The symptoms were presented of dull pains in the lower part of the abdomen and a little quantity of free fluid in the pelvis. The diagnosis is set after a surgical intervention, based on pathoanatomic results. After the radical hysterectomy with bilateral salpingo-oophorectomy, lymphadenectomy and omentectomy, the patient is treated with adjuvant chemotherapy with platinum and taxane.
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116
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Makunike-Mutasa R, Phiri K. Bilharzioma of the fallopian tube - A case report. Cent Afr J Med 2015; 61:21-23. [PMID: 29144094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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117
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Rhymes JM, Gorman T, Sasso RA. Mature cystic teratoma of both the fallopian tube and contralateral ovary: a case report. CLIN EXP OBSTET GYN 2015; 42:812-813. [PMID: 26753493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Intratubal teratoma is a very rare condition. The authors believe to present the first case of a completely intratubal mature cystic teratoma with a contralateral intraovarian teratoma. Preoperative ultrasound examination allowed the intraoperative diagnosis of this rare condition, hence allowing appropriate surgical management. MATERIALS AND METHODS A 19-year-old woman presented with a history of pelvic pain and severe dysmenorrhea. Ultrasound examination initially suggested bilateral ovarian dermoids. Upon laparoscopy, the distal left fallopian tube was obstructed and contained an inflammatory mass adhered to the rectosigmoid. The left ovary was entirely normal. A contralateral intraovarian dermoid was also identified. CONCLUSION Although rare, when an intratubal mass is identified, consideration of intratubal dermoid should be given. Preoperative ultrasound can be of critical importance to the intraoperative diagnosis.
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118
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Takemoto Y, Ota T, Aoki Y, Ogura K, Ogishima D, Matsumoto T. Carcinosarcoma of the fallopian tube with disappearance of carcinoma cells by neoadjuvant chemotherapy: case study. EUR J GYNAECOL ONCOL 2015; 36:618-622. [PMID: 26513897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The authors report a case of carcinosarcoma (CS) of the fimbria of the fallopian tube in which carcinoma cells disappeared with neoadjuvant chemotherapy (NAC). A 74-year-old woman visited the present hospital with a large pelvic mass and pleural effusion. A magnetic resonance image of the tumor was highly suggestive of ovarian carcinoma. Due to the presence of both serous.adenocarcinoma cells in pleural effusion and pulmonary thrombosis, the patient was given NAC consisting of carboplatin plus paclitaxel (TC) and anticoagulant therapy with warfarin potassium. With six courses of NAC, the pleural effusion and pulmonary thrombosis disappeared, and the tumor decreased 36.2% in greatest diameter. Maximum debulking surgery was then performed. The tumor was found to be located in the fimbria of the right fallopian tube. Hysterectomy and bilateral salpingo-oophorectomy were performed, and histologic examination revealed chondrosarcoma with the presence of necrotic epithelial cells. The necrotic areas were interspersed with papillary structures, and immunohistochemical study showed positivity for CK7 and negativity for CK20, p53, and estrogen receptor (ER), indicating serous adenocarcinoma. Thus, heterologous CS with disappearance of viable carcinoma cells by NAC was diagnosed. The patient was given adjuvant chemotherapy consisting of three courses of TC, and there has been no evidence of disease for 20 months. The authors' experience in this case of gynecologic CS indicates that a serous adenocarcinomatous component of tubal CS can be well cured by TC-based NAC.
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119
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Căpîlna ME, Rusu SC, Laczko C, Szabo B, Marian C. Three synchronous primary pelvic cancers--a case report. EUR J GYNAECOL ONCOL 2015; 36:216-218. [PMID: 26050365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The occurrence of synchronous primary gynaecologic malignancies is a relatively common event. However, the occurrence of three different pelvic cancers is very rare. In this report, the authors describe the clinical, surgical, and pathological findings of a patient with synchronous primary malignancies of the fallopian tube, endometrium, and sigmoid colon. To the authors' knowledge, it is the first case described in the literature with such an association of primary synchronous cancers.
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120
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Petre I, Bernad E, Mureşan A, Bordianu A, Bernad SI, Băcean O, Folescu R, Milulescu A, Pantea S. Choriocarcinoma developed in a tubal pregnancy - a case report. Rom J Morphol Embryol 2015; 56:871-874. [PMID: 26429189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Carcinoma of the Fallopian tube is the least frequent tumor of the female genital tract. The diagnosis is difficult but could be made more frequently if the causes of abnormal bleeding were thoroughly investigated by means of cytology and endometrial curettage. Treatment is by resection of the tumor, total hysterectomy, and bilateral salpingo-oophorectomy followed by chemotherapy. A 25-year-old patient, presented herself at the emergency room, accusing intense lower abdominal pains, accompanied by vaginal bleeding. The histological aspect corroborated with the Ki-67 index is strongly suggestive for a choriocarcinoma developed in a tubal ectopic pregnancy.
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Affiliation(s)
- Izabella Petre
- Department of Obstetrics and Gynecology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania;
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121
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McNeish IA, Ledermann JA, Webber L, James L, Kaye SB, Hall M, Hall G, Clamp A, Earl H, Banerjee S, Kristeleit R, Raja F, Feeney A, Lawrence C, Dawson-Athey L, Persic M, Khan I. A randomised, placebo-controlled trial of weekly paclitaxel and saracatinib (AZD0530) in platinum-resistant ovarian, fallopian tube or primary peritoneal cancer†. Ann Oncol 2014; 25:1988-1995. [PMID: 25070546 DOI: 10.1093/annonc/mdu363] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We investigated whether the Src inhibitor saracatinib (AZD0530) improved efficacy of weekly paclitaxel in platinum-resistant ovarian cancer. PATIENTS AND METHODS Patients with platinum-resistant ovarian, fallopian tube or primary peritoneal cancer were randomised 2 : 1 to receive 8-week cycles of weekly paclitaxel (wPxl; 80 mg/m(2)/week ×6 with 2-week break) plus saracatinib (S; 175 mg o.d.) or placebo (P) continuously, starting 1 week before wPxl, until disease progression. Patients were stratified by taxane-free interval (<6 versus ≥6 months/no prior taxane). The primary end point was progression-free survival (PFS) rate at 6 months. Secondary end points included overall survival (OS) and response rate (RR). RESULTS A total of 107 patients, median age 63 years, were randomised. Forty-three (40%) had received >2 lines of prior chemotherapy. The 6-month PFS rate was 29% (wPxl + S) versus 34% (wPxl + P) (P = 0.582). Median PFS was 4.7 versus 5.3 months (hazard ratio 1.00, 95% confidence interval 0.65-1.54; P = 0.99). RR (complete + partial) was 29% (wPxl + S) versus 43% (wPxl + P), P value = 0.158. Grade 3/4 adverse events were 36% versus 31% (P = 0.624); the most frequent G3/4 toxicities were vomiting (5.8% saracatinib versus 8.6% placebo), abdominal pain (5.8% versus 0%) and diarrhoea (4.3% versus 5.7%). Febrile neutropenia was more common in the saracatinib arm (4.3%) than placebo (0%). Response, PFS and OS were all significantly (P < 0.05) better in patients with taxane interval ≥6 months/no prior taxane (n = 85) than those <6 months (n = 22), regardless of randomisation. CONCLUSIONS Saracatinib does not improve activity of weekly paclitaxel in platinum-resistant ovarian cancer. Taxane-free interval of ≥6 months/no prior taxane was associated with better outcome in both groups. TRIALS REGISTRATION Clinicaltrials.gov NCT01196741; ISRCTN 32163062.
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Affiliation(s)
- I A McNeish
- Institute of Cancer Sciences, University of Glasgow, Glasgow; Department of Medical Oncology, St Bartholomew's Hospital, London.
| | - J A Ledermann
- CR UK and UCL Cancer Trials Centre, University College London, London
| | - L Webber
- CR UK and UCL Cancer Trials Centre, University College London, London
| | - L James
- CR UK and UCL Cancer Trials Centre, University College London, London
| | - S B Kaye
- Department of Medical Oncology, Royal Marsden Hospital, Sutton
| | - M Hall
- Division of Cancer Services, Mount Vernon Hospital, Northwood
| | - G Hall
- Leeds Cancer Centre, St James's University Hospital, Leeds
| | - A Clamp
- Department of Medical Oncology, The Christie Hospital, Manchester
| | - H Earl
- Department of Oncology, Addenbrooke's Hospital, Cambridge
| | - S Banerjee
- Department of Medical Oncology, Royal Marsden Hospital, Sutton
| | - R Kristeleit
- Department of Medical Oncology, University College Hospital, London
| | - F Raja
- CR UK and UCL Cancer Trials Centre, University College London, London
| | - A Feeney
- CR UK and UCL Cancer Trials Centre, University College London, London
| | - C Lawrence
- Department of Medical Oncology, St Bartholomew's Hospital, London
| | - L Dawson-Athey
- Department of Medical Oncology, St Bartholomew's Hospital, London
| | - M Persic
- Department of Oncology, Queen's Hospital, Burton upon Trent, UK
| | - I Khan
- CR UK and UCL Cancer Trials Centre, University College London, London
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Gruessner C, Gruessner A, Glaser K, AbuShahin N, Zhou Y, Laughren C, Wright H, Pinkerton S, Yi X, Stoffer J, Azodi M, Zheng W, Chambers SK. Flutamide and biomarkers in women at high risk for ovarian cancer: preclinical and clinical evidence. Cancer Prev Res (Phila) 2014; 7:896-905. [PMID: 24950779 PMCID: PMC4154987 DOI: 10.1158/1940-6207.capr-13-0408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We hypothesized that (i) preclinical biologic evidence exists for the role of androgens in ovarian cancer development and (ii) flutamide treatment of women at high risk for ovarian cancer may identify meaningful tissue biomarkers of androgen action and of ovarian cancer initiation. We showed that androgen ablation of male mice led to a 24-fold decrease in tumor burden from serous ovarian cells. In a phase II study, we studied the effect of preoperative flutamide treatment (125 mg/day × 6 weeks) in 12 women versus 47 controls, 47% with BRCA mutation. We analyzed immunohistochemical scores of candidate proteins CSF-1, CSF-1R, and ErbB4 in the epithelium and stroma of fallopian tube, ovary, and ovarian endosalpingiosis. Flutamide decreased the levels, notably, of CSF-1 and ErbB4 in ovarian stroma (P ≤ 0.0006) and ovarian endosalpingiosis (P ≤ 0.01), ErbB4 in ovarian epithelium (P = 0.006), and CSF-1R in ovarian endosalpingiosis (P = 0.009). Our logistic regression model clearly distinguished the flutamide patients from controls (P ≤ 0.0001). Our analysis of the precision of this model of CSF-1 and ErbB4 expression in ovarian stroma achieved 100% sensitivity and 97% specificity (AUC = 0.99). Thus, our data suggest that a short 6-week exposure of flutamide reversed elevated levels of CSF-1 and ErbB4 (both of which we had previously found correlated with high risk status). CSF-1 and ErbB4 in ovarian stroma led to a model with high predictive value for flutamide sensitivity. The effect of flutamide on marker expression in ovarian endosalpingiosis, previously associated with BRCA carrier status, suggests that ovarian endosalpingiosis may be a latent precursor to pelvic serous cancers.
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Affiliation(s)
- Christine Gruessner
- College of Medicine, University of Arizona, Tucson, Arizona. Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Angelika Gruessner
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Katherine Glaser
- College of Medicine, University of Arizona, Tucson, Arizona. Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona
| | | | - Yi Zhou
- University of Arizona Cancer Center, Tucson, Arizona
| | | | | | | | - Xiaofang Yi
- University of Arizona Cancer Center, Tucson, Arizona
| | | | - Masoud Azodi
- Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut
| | - Wenxin Zheng
- College of Medicine, University of Arizona, Tucson, Arizona. University of Arizona Cancer Center, Tucson, Arizona. Department of Pathology, University of Arizona, Tucson, Arizona
| | - Setsuko K Chambers
- College of Medicine, University of Arizona, Tucson, Arizona. Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona. University of Arizona Cancer Center, Tucson, Arizona.
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Arko D, Žegura B, Virag M, Fokter Dovnik N, Takač I. Preoperative diagnosis of fallopian tube malignancy with transvaginal color doppler ultrasonography and magnetic resonance imaging after negative hysteroscopy for postmenopausal bleeding. Coll Antropol 2014; 38:1047-1050. [PMID: 25420393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Primary fallopian tube carcinoma is a rare malignancy and is not often diagnosed preoperatively. We present a case of a 67-year-old woman who complained of postmenopausal vaginal bleeding. After a negative hysteroscopy, transvaginal ultrasound showed a well vascularized solid-cystic tumor in the adnexal region separate from the ovary. The presence of an adnexal mass was confirmed by MR imaging. Total abdominal hysterectomy with bilateral salpingoophorectomy, omentectomy and appendectomy, as well as pelvic and paraaortic lymphadenectomy was performed. The pathohistological diagnosis was poorly differentiated serous adenocarcinoma of the fallopian tube, FIGO stage IA. The patient was subsequently treated with platinum based adjuvant chemotherapy.
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124
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Radosa MP, Vorwergk J, Fitzgerald J, Kaehler C, Schneider U, Camara O, Runnebaum IB, Schleußner E. Sonographic discrimination between benign and malignant adnexal masses in premenopause. Ultraschall Med 2014; 35:339-344. [PMID: 23775448 DOI: 10.1055/s-0033-1335728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The aim of this study was to assess the diagnostic value of sonographic pattern recognition by experts, a standardized morphological scoring system, the risk malignancy index (RMI) and CA 125 assay for the preoperative assessment of ovarian lesions in premenopausal patients. MATERIAL AND METHODS Diagnostic work-up of 1320 patients who underwent surgical exploration due to an adnexal mass at a tertiary referral center were included. We assessed the discriminative value of pattern recognition, a sonographic morphological scoring system, RMI and CA 125 by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Cohen's kappa for each diagnostic approach while using histopathology as the reference standard. RESULTS Pattern recognition showed the highest discriminative power with an observed kappa of 0.53. Sensitivity and specificity yielded 0.76 and 0.97 respectively. Combining pattern recognition with CA 125 serum measurement in the context of a triage system diminished the diagnostic value (kappa: 0.24; sensitivity: 0.29 specificity: 0.97). For the RMI we observed a sensitivity of 0.54 and a specificity of 0.96 and estimated kappa value yielded 0.37. Omitting the CA 125 assay and using a morphological sonographic assessment system increased the kappa value to 0.45 with sensitivity and specificity observed at 0.61 and 0.97 respectively. CONCLUSION Expert pattern recognition was found to be the method with the highest discriminative power in assessing an adnexal mass during premenopause. Additional assessment of serum CA 125 diminished the diagnostic accuracy. Standardized morphological sonographic assessment resulted in a moderate diagnostic accuracy. Supplementing the morphological sonographic assessment with CA 125 by using the RMI algorithm did not improve the diagnostic value.
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Affiliation(s)
- M P Radosa
- Gynecology and Obstetrics, Jena Universtiy Hospital, Jena
| | - J Vorwergk
- Gynecology and Obstetrics, Jena Universtiy Hospital, Jena
| | - J Fitzgerald
- Gynecology and Obstetrics, Jena Universtiy Hospital, Jena
| | - C Kaehler
- Praxis Prof. Dr. Kaehler, Praenatologische Schwerpunktpraxis Erfurt
| | - U Schneider
- Gynecology and Obstetrics, Jena Universtiy Hospital, Jena
| | - O Camara
- Gynecology and Obstetrics, Jena Universtiy Hospital, Jena
| | - I B Runnebaum
- Gynecology and Obstetrics, Jena Universtiy Hospital, Jena
| | - E Schleußner
- Abteilung Geburtshilfe, Universitätsfrauenklinik, Jena
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125
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Horng HC, Teng SW, Lai CR, Chang WH, Chang YH, Yen MS, Wang PHP. Prognostic factors of primary fallopian tube cancer in a single institute in Taiwan. Int J Gynaecol Obstet 2014; 127:77-81. [PMID: 24997471 DOI: 10.1016/j.ijgo.2014.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/09/2014] [Accepted: 06/04/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To improve the understanding of primary fallopian tube carcinoma (PFTC) through an analysis of possible clinical and pathologic determinants of prognosis. METHODS A retrospective review of the database of a tertiary hospital in Taiwan for 1978-2007 was conducted to identify patients with a diagnosis of PFTC and to evaluate the clinicopathologic features associated with PFTC outcome. RESULTS Fifty-eight patients (mean age 62.5 years) had a diagnosis of PFTC. Stage III/IV disease (55%) and poorly differentiated tumors (52%) were most common. The median follow-up was 93 months (range, 11-333 months). The 5-year disease-free survival rate was 59%, and the overall survival rate was 64%. Factors important in disease-free and overall survival in univariate analysis included the presence of pelvic and/or para-aortic lymph node metastases, International Federation of Gynecology and Obstetrics stage, high preoperative carbohydrate antigen 125 serum level, completion of optimal debulking surgery, and the use of paclitaxel-based chemotherapy; however, only patients with optimal cytoreduction had a decreased hazard of recurrence (hazard ratio [HR] 0.06; 95% confidence interval [CI] 0.01-0.23) and mortality (HR 0.08; 95% CI, 0.02-0.31) in multivariate analysis. CONCLUSION Advanced tumor stage, in particular the presence of lymph node metastases, worsened the prognosis of patients with PFTC. However, optimal debulking surgery significantly improved the prognosis, emphasizing the importance of the treatment strategy.
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Affiliation(s)
- Huann-Cheng Horng
- Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Sen-Wen Teng
- Department of Obstetrics and Gynecology, Cardinal Tien Hospital-Hsintien, New Taipei City, Taiwan; Department of Obstetrics and Gynecology, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chiung-Ru Lai
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pathology, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Hsu Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, National Yang-Ming University School of Nursing, Taipei, Taiwan
| | - Yen-Hou Chang
- Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ming-Shyen Yen
- Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Peng-Hui Peter Wang
- Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Infection and Immunity Research, National Yang-Ming University, Taipei, Taiwan.
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Ludovisi M, De Blasis I, Virgilio B, Fischerova D, Franchi D, Pascual MA, Savelli L, Epstein E, Van Holsbeke C, Guerriero S, Czekierdowski A, Zannoni G, Scambia G, Jurkovic D, Rossi A, Timmerman D, Valentin L, Testa AC. Imaging in gynecological disease (9): clinical and ultrasound characteristics of tubal cancer. Ultrasound Obstet Gynecol 2014; 43:328-335. [PMID: 23893713 DOI: 10.1002/uog.12570] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To describe clinical history and ultrasound findings in patients with tubal carcinoma. METHODS Patients with a histological diagnosis of tubal cancer who had undergone preoperative ultrasound examination were identified from the databases of 13 ultrasound centers. The tumors were described by the principal investigator at each contributing center on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, three authors reviewed together all available digital ultrasound images and described them using subjective evaluation of gray-scale and color Doppler ultrasound findings. RESULTS We identified 79 women with a histological diagnosis of primary tubal cancer, 70 of whom (89%) had serous carcinomas and 46 (58%) of whom presented at FIGO stage III. Forty-nine (62%) women were asymptomatic (incidental finding), whilst the remaining 30 complained of abdominal bloating or pain. Fifty-three (67%) tumors were described as solid at ultrasound examination, 14 (18%) as multilocular solid, 10 (13%) as unilocular solid and two (3%) as unilocular. No tumor was described as a multilocular mass. Most tumors (70/79, 89%) were moderately or very well vascularized on color or power Doppler ultrasound. Normal ovarian tissue was identified adjacent to the tumor in 51% (39/77) of cases. Three types of ultrasound appearance were identified as being typical of tubal carcinoma using pattern recognition: a sausage-shaped cystic structure with solid tissue protruding into it like a papillary projection (11/62, 18%); a sausage-shaped cystic structure with a large solid component filling part of the cyst cavity (13/62, 21%); an ovoid or oblong completely solid mass (36/62, 58%). CONCLUSIONS A well vascularized ovoid or sausage-shaped structure, either completely solid or with large solid component(s) in the pelvis, should raise the suspicion of tubal cancer, especially if normal ovarian tissue is seen adjacent to it.
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Affiliation(s)
- M Ludovisi
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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Li HX, Lu ZH, Shen K, Cheng WJ, Malpica A, Zhang J, Wei JJ, Zhang ZH, Liu J. Advances in serous tubal intraepithelial carcinoma: correlation with high grade serous carcinoma and ovarian carcinogenesis. Int J Clin Exp Pathol 2014; 7:848-57. [PMID: 24696706 PMCID: PMC3971287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 01/23/2014] [Indexed: 06/03/2023]
Abstract
Early serous carcinoma in fallopian tube or serous tubal intraepithelial carcinoma (STIC), an early lesion limited to the epithelium of the fallopian tube and firstly identified from specimen obtained by prophylactic salpingo-oophorectomy, has provided insight into pelvic high grade serous carcinoma (HGSC). Increasing evidence indicates that STIC is a likely precursor for HGSC and several studies have focused on this lesion and its clinical significance. This review addresses recent advances in recognizing STIC and its correlation with HGSC and ovarian carcinogenesis. It also describes evidence regarding the fallopian tube as a source of some HGSCs, the protocol for optimizing histological evaluation of the tubes, the spectrum of tubal lesions from benign to noninvasive carcinoma, changes in diagnostic criteria from purely morphologic characteristics to a combination of morphologic features and molecular biomarkers, and new studies about potential biomarkers. However, the direct evidence regarding STIC as the precursor of HGSC is still tantalizing due to other possibilities that may also explain the origin of pelvic HGSC. Further molecular genetic studies are required to address this important question.
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Affiliation(s)
- Hong-Xia Li
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, P. R. China
- Department of Pathology, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Zhao-Hui Lu
- Department of Pathology, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, P. R. China
| | - Keng Shen
- Department of Obstetric and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, P. R. China
| | - Wen-Jun Cheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, P. R. China
| | - Anais Malpica
- Department of Pathology, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Jing Zhang
- Department of Pathology, Forth Military Medical UniversityXi’an, Shanaxi, P. R. China
| | - Jian-Jun Wei
- Department of Pathology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Zhi-Hong Zhang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, P. R. China
| | - Jinsong Liu
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical UniversityNanjing, Jiangsu, P. R. China
- Department of Pathology, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
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128
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Seton-Rogers S. Ovarian cancer: A better mimic. Nat Rev Cancer 2014; 14:74-5. [PMID: 24457414 DOI: 10.1038/nrc3674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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129
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Herzog TJ, Monk BJ, Rose PG, Braly P, Hines JF, Bell MC, Wenham RM, Secord AA, Roman LD, Einstein MH, Drake RD, Childs BH. A phase II trial of oxaliplatin, docetaxel, and bevacizumab as first-line therapy of advanced cancer of the ovary, peritoneum, and fallopian tube. Gynecol Oncol 2014; 132:517-25. [PMID: 24476788 DOI: 10.1016/j.ygyno.2014.01.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 01/07/2014] [Accepted: 01/18/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the safety and efficacy of the novel combination of docetaxel, oxaliplatin, and bevacizumab as first-line treatment of advanced cancer of the ovary, peritoneum or fallopian tube after initial debulking surgery. METHODS Eligible patients (stage IB-IV) were treated with 6 cycles of oxaliplatin (85 mg/m(2)), docetaxel (75 mg/m(2)), and bevacizumab (15 mg/kg) every 3 weeks, followed by single-agent bevacizumab 15 mg/kg every 3 weeks to complete one year of therapy. The primary endpoint was 12-month progression-free survival (PFS). RESULTS A total of 132 patients (80 with measurable disease at baseline; 52 with non-measurable, evaluable disease at baseline) enrolled and received study treatment. At diagnosis, 76.5% of patients had stage III disease and 20% had stage IV. 62.9% were optimally cytoreduced. The most common grade 3/4 adverse events were neutropenia (42.4%), leukopenia (13.6%), hypertension (8.3%), fatigue (6.1%), and nausea (6.1%). One patient (0.8%) had a fatal gastrointestinal perforation. The best overall confirmed response rate (complete response+partial response [measurable disease subgroup]) was 58.6% (95% CI 49%, 67%). CA-125 response rates for the measurable and non-measurable disease subgroups were 83.0% and 81.5%, respectively. The 12-month PFS rate for the measurable disease subgroup was 65.7% (95% CI 53.4%, 76.7%); median PFS was 16.3 (95% CI 12.6, 19.6) months. Median overall survival was 47.3 (95% CI 34.1, upper limit not applicable) months. CONCLUSIONS This novel treatment regimen may provide a promising therapeutic approach for women with ovarian, primary peritoneal, or fallopian tube carcinoma. No unanticipated safety concerns were identified.
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Affiliation(s)
- Thomas J Herzog
- Columbia University, NY Presbyterian Medical Center, New York, NY, USA.
| | - Bradley J Monk
- Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | | | | | - Maria C Bell
- Sioux Valley University Hospital, Sioux Falls, SD, USA
| | - Robert M Wenham
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Lynda D Roman
- University of Southern California-Norris Comprehensive Cancer Center and Hospital, Los Angeles, CA, USA
| | - Mark H Einstein
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
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130
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Lacorre A, Gauthier T, Gardet E, Berger J, Loum O, Monteil J, Tubiana N, Aubard Y. [Resection of iliac vessels and adnexial cancer: report of 2 cases]. ACTA ACUST UNITED AC 2014; 42:265-8. [PMID: 24411338 DOI: 10.1016/j.gyobfe.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Indexed: 11/20/2022]
Abstract
Aim of no residual macroscopic disease has to be the objective of the gynecologist oncologist surgeon. It can require extensive surgical procedures in all the abdomen area. We report 2 rare cases of cytoreductive surgery with iliac vessels resection and use of vascular prosthesis. We discuss the opportunity of this surgery with high morbidity.
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Affiliation(s)
- A Lacorre
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU Dupuytren, avenue Larrey, 87000 Limoges, France
| | - T Gauthier
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU Dupuytren, avenue Larrey, 87000 Limoges, France.
| | - E Gardet
- Service de chirurgie vasculaire, CHU Dupuytren, avenue Luther-King, 87000 Limoges, France
| | - J Berger
- Service d'urologie, CHU Dupuytren, avenue Luther-King, 87000 Limoges, France
| | - O Loum
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU Dupuytren, avenue Larrey, 87000 Limoges, France
| | - J Monteil
- Service de médecine nucléaire, CHU Dupuytren, avenue Luther-King, 87000 Limoges, France
| | - N Tubiana
- Service d'oncologie médicale, CHU Dupuytren, avenue Luther-King, 87000 Limoges, France
| | - Y Aubard
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU Dupuytren, avenue Larrey, 87000 Limoges, France
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131
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Murta EFC. Tumour markers, ultrasonography, and ovarian cancer diagnosis. EUR J GYNAECOL ONCOL 2014; 35:111. [PMID: 24772908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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132
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Kalampokas E, Sofoudis C, Boutas I, Kalampokas T, Tourountous I. Primary fallopian tube carcinoma: a case report and mini-review of the literature. EUR J GYNAECOL ONCOL 2014; 35:595-596. [PMID: 25423713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Primary fallopian tube carcinoma (PFTC) is an uncommon gynecologic tumor, responsible for 0.14% to 1.8% of genital malignancies, with a mean incidence of 3.6 per million women per annum. The factors that contribute to its appearance are not well-known. Overall survival percentages for patients with PFTC are generally low. Although the preoperative diagnosis rarely occurs and it is usually first confirmed by the pathologist, an earlier diagnosis occurs with early clinical manifestation and prompt investigation leading to better prognosis. Both PFTC and epithelial ovarian cancer (EOC) are treated with similar surgical and chemotherapy methods. The authors report a case of a patient with bilateral high grade serous carcinoma of the fallopian tube, whose initial presentation was bilateral cystic adnexal masses and serosanguinous discharge, with no other pelvic involvement. This article also reviews in brief and presents updates of this rare gynecological malignancy.
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133
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Ryu KJ, Kim IS, Bae HS, Lee JK, Lee NW, Song JY. Paratubal cancer found at the time of laparoscopic surgery for adnexal torsion: a case report and literature review. EUR J GYNAECOL ONCOL 2014; 35:741-744. [PMID: 25556286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Paratubal cysts are common incidental finding, but malignant paratubal cancers have rare occurrence and have not been sufficiently described and discussed in previous studies. CASE REPORT This report describes a case of a 70-year-old female who underwent emergent laparoscopy for adnexal torsion. A serous cystadenocarcinoma arising in a paratubal cyst and accompanied by tubal torsion was revealed by frozen section and successfully treated with laparoscopic cytoreductive surgery and adjuvant chemotherapy. CONCLUSION This report is the first case of paratubal cancer with bilateral tubal torsion which was diagnosed and treated with laparoscopic surgery, and the third report describing serous cystadenocarcinoma arising in a paratubal cyst. In the laparoscopic surgery for the paratubal cyst clinically presumed as accompanied with tubal torsion, surgeons should not ignore the possibility of malignancy in spite of the rare incidence of paratubal cancers and the preconception that adnexal malignancies are seldom accompanied by tubal torsion.
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Affiliation(s)
- K J Ryu
- Department of Obstetrics and Gynecology, Korea Universit Medical Center, Seoul, Korea
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134
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Ul'rikh EA, Papunidi MD, Urmancheeva AF, Matsko DE. [Fallopian tube carcinoma: clinical and morphological features, analysis of 69 cases]. Vopr Onkol 2014; 60:375-378. [PMID: 25033694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Primary fallopian tube carcinoma (PFTC) is a rare gynecological malignancy accounting 0.14-1.8% cases. The purpose of the study was to assess clinical, morphological and immunohistochemical features of PFTC. All the cases of PFTC were detected during 1980-2005. 31 cases of PFTC were analyzed as to Ki-67, HER-2 expression, estrogen receptors (ER), progesterone receptors (PR), grade and stage. 69 cases of PFTC were detected with an average age of 55, 6 years (range 21-73 years). Stage I detected in 34.2% cases, Stages II and III--32.8%, Ca in situ--10%. Among 31 patients ER were positive in 75% (n = 23), PR were positive in 46% (n = 14): ER+PR+ in 12 (38%) cases, ER+PR- in 11 (36%) cases, ER-PR+ in 2 (6%) cases, ER-PR- in 6 (19.4%) cases. Only 2 cases were HER-2 positive with ER+PR+ and ER-PR- status. Ki-67 labeling index (LI, %) values ranged from 15 to 95% (median 60) with average rate 58.03% +/- 4.08. Ki-67 LI values > or = 60% were graded as high and < 60% as low. We did not find any significant differences in Ki-67 LI values among tumors of various Receptor Status. However Ki-67 L1 > 60% was associated with poor 5-year survival (14%), vs 75% in Ki-67 L1 < 60%. Primary fallopian tube carcinoma is mainly HER-2 negative, receptor positive in 79.6%. Ki-67 rate is irrespective of ER PR status. However the level of Ki-67 (> 60%) was a significant survival prognostic factor.
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Bozkurt M. Reply from M. Bozkurt, A E. Yumru1, I. Aral. EUR J GYNAECOL ONCOL 2014; 35:111-112. [PMID: 24772909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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136
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Wan J, Li XM, Gu J. Primary choriocarcinoma of the fallopian tube: a case report and literature review. EUR J GYNAECOL ONCOL 2014; 35:604-607. [PMID: 25423716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Choriocarcinoma is a highly malignant tumor of trophoblastic origin. Primary fallopian tube choriocarcinoma is an extremely rare occurrence, especially in women over 50 years of age. This article concerns a case of tubal choriocarcinoma developing in a 54-year-old woman, which the authors present together with a brief review of the literature. The woman presented with irregular vaginal bleeding for two months, following three months of amenorrhea. Transvaginal dopolar and pelvic computed tomography (CT) scan showed an adnexal cystomic-solid mass. Her serum human chorionic gonadotropin (hCG) levels were 29,1116 mIU/ml. The patient underwent hysterectomy and bisalpingo-oophorectomy. Histology was suggestive of tubal choriocarcinoma. Immunohistochemistry tests were positive for the hCG, Ki 67, CK, PLAP, and negative for CD30, supporting the diagnosis of choriocarcinoma. A combination of 5-Fu and KSM was administrated postoperatively. After four cycles of chemotherapy, her serum hCG level fell to the normal range. The patient remains disease-free 14 months after disease diagnosis.
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137
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Nasser S, Arsenic R, Lohneis P, Kosian P, Sehouli J. A case of primary peritoneal carcinoma: evidence for a precursor in the fallopian tube. Anticancer Res 2014; 34:407-412. [PMID: 24403495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Primary high-grade serous peritoneal carcinoma (PPSC) is a rare malignancy with an ambiguous pathogenesis. CASE REPORT We report on a 51-year-old woman presenting with a routine smear test cytology suspicious of adenocarcinoma. She underwent hysteroscopy, laparsocopy with multiple biopsies and bilateral salpingoophorectomy. She was diagnosed with a serous tubal intraepithelial carcinoma in situ (STIC) in the right fallopian tube. Subsequently, she underwent radical surgery and was diagnosed with peritoneal high-grade serous carcinoma. Interestingly, both ovaries remained histologically tumour-free. DISCUSSION High-grade serous carcinomas that arise on the peritoneum with tumour-free ovaries are rare. The findings in this case, coupled with current evidence, strongly suggest a precursor lesion in the fallopian tube (STIC lesions). The clinical implications of this theory reside in the potential for improving early detection strategies. Nonetheless, more data on precursor lesions in the fallopian tubes and their transformation to serous carcinoma are required to plan for future screening methods.
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Affiliation(s)
- Sara Nasser
- Charite' Universitätsmedizin Berlin, Campus Virchow Klinikum Augustenburger platz 1, 13353 Berlin, Germany.
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138
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Perets R, Wyant GA, Muto KW, Bijron JG, Poole BB, Chin KT, Chen JYH, Ohman AW, Stepule CD, Kwak S, Karst AM, Hirsch MS, Setlur SR, Crum CP, Dinulescu DM, Drapkin R. Transformation of the fallopian tube secretory epithelium leads to high-grade serous ovarian cancer in Brca;Tp53;Pten models. Cancer Cell 2013; 24:751-65. [PMID: 24332043 PMCID: PMC3917315 DOI: 10.1016/j.ccr.2013.10.013] [Citation(s) in RCA: 419] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 06/17/2013] [Accepted: 10/22/2013] [Indexed: 02/08/2023]
Abstract
High-grade serous ovarian carcinoma presents significant clinical and therapeutic challenges. Although the traditional model of carcinogenesis has focused on the ovary as a tumor initiation site, recent studies suggest that there may be additional sites of origin outside the ovary, namely the secretory cells of the fallopian tube. Our study demonstrates that high-grade serous tumors can originate in fallopian tubal secretory epithelial cells and also establishes serous tubal intraepithelial carcinoma as the precursor lesion to high-grade serous ovarian and peritoneal carcinomas in animal models targeting the Brca, Tp53, and Pten genes. These findings offer an avenue to address clinically important questions that are critical for cancer prevention and early detection in women carrying BRCA1 and BRCA2 mutations.
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Affiliation(s)
- Ruth Perets
- Department of Medical Oncology, Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Gregory A Wyant
- Eugene Braunwald Research Center, Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Katherine W Muto
- Eugene Braunwald Research Center, Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Jonathan G Bijron
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Barish B Poole
- Eugene Braunwald Research Center, Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Kenneth T Chin
- Eugene Braunwald Research Center, Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Jin Yun H Chen
- Eugene Braunwald Research Center, Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Anders W Ohman
- Eugene Braunwald Research Center, Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Corey D Stepule
- Eugene Braunwald Research Center, Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Soongu Kwak
- Department of Medical Oncology, Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Alison M Karst
- Department of Medical Oncology, Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Michelle S Hirsch
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sunita R Setlur
- Eugene Braunwald Research Center, Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Christopher P Crum
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Daniela M Dinulescu
- Eugene Braunwald Research Center, Department of Pathology, Harvard Medical School, Boston, MA 02115, USA; Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Ronny Drapkin
- Department of Medical Oncology, Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA; Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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139
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Crum CP, Herfs M, Ning G, Bijron JG, Howitt BE, Jimenez CA, Hanamornroongruang S, McKeon FD, Xian W. Through the glass darkly: intraepithelial neoplasia, top-down differentiation, and the road to ovarian cancer. J Pathol 2013; 231:402-12. [PMID: 24030860 PMCID: PMC3947463 DOI: 10.1002/path.4263] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/08/2013] [Accepted: 09/09/2013] [Indexed: 12/25/2022]
Abstract
It is currently hoped that deaths from extra-uterine high-grade serous cancer (HGSC) will be reduced via opportunistic salpingectomy in healthy women. Accumulated data implicate the fimbria as a site of origin and descriptive molecular pathology and experimental evidence strongly support a serous carcinogenic sequence in the Fallopian tube. Both direct and indirect ('surrogate') precursors suggest that the benign tube undergoes important biological changes after menopause, acquiring abnormalities in gene expression that are often shared with malignancy, including PAX2, ALDH1, LEF1, RCN1, RUNX2, beta-catenin, EZH2, and others. However, the tube can be linked to only some HGSCs, recharging arguments that nearby peritoneum/ovarian surface epithelium (POSE) also hosts progenitors to this malignancy. A major sticking point is the difference in immunophenotype between POSE and Müllerian epithelium, essentially requiring mesothelial to Müllerian differentiation prior to or during malignant transformation to HGSC. However, emerging evidence implicates an embryonic or progenitor phenotype in the adult female genital tract with the capacity to differentiate, normally or during neoplastic transformation. Recently, a putative cell of origin for cervical cancer has been identified in the squamo-columnar (SC) junction, projecting a model whereby Krt7+ embryonic progenitors give rise to immunophenotypically distinct progeny under stromal influences via 'top down' differentiation. Similar differentiation can be seen in the endometrium with a parallel in juxtaposed mesothelial and Müllerian differentiation in the ovary. Abrupt mesothelial-Müllerian transitions remain to be proven, but would explain the rapid evolution, short asymptomatic interval, and absence of a defined epithelial starting point in many HGSCs. Resolving this question will require accurately distinguishing progenitor from progeny tumour cells in HGSC and pinpointing where initial transformation and trans-differentiation occur, whether in the tube or POSE. Both will be critical to expectations from prophylactic salpingectomy and future approaches to pelvic serous cancer prevention.
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Affiliation(s)
- Christopher P Crum
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
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140
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Erickson BK, Conner MG, Landen CN. The role of the fallopian tube in the origin of ovarian cancer. Am J Obstet Gynecol 2013; 209:409-14. [PMID: 23583217 DOI: 10.1016/j.ajog.2013.04.019] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/02/2013] [Accepted: 04/08/2013] [Indexed: 01/05/2023]
Abstract
Advanced cases of epithelial ovarian, primary peritoneal, and primary tubal malignancies have a relatively poor prognosis and collectively remain the most deadly of all gynecologic malignancies. Although traditionally thought of as one disease process, ongoing research suggests that there is not 1 single site or cell type from which these cancers arise. A majority of the serous tumors appear to originate from dysplastic lesions in the distal fallopian tube. Therefore, what we have traditionally considered "ovarian" cancer may in fact be tubal in origin. In this article, we will review epithelial ovarian cancer classification and genetics, theories regarding cells of origin with a focus on tubal intraepithelial carcinoma, and implications for prevention and screening.
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Affiliation(s)
- Britt K Erickson
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL
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141
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142
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Lau HY, Chen YJ, Yen MS, Chen RF, Yeh SO, Twu NF. Primary fallopian tube carcinoma: a clinicopathologic analysis and literature review. J Chin Med Assoc 2013; 76:583-7. [PMID: 23890835 DOI: 10.1016/j.jcma.2013.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 03/06/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Primary fallopian tube carcinoma (PFTC) is a rare tumor, and it is very difficult to diagnose preoperatively. The aims of this study were to evaluate the clinicopathologic features of primary fallopian tube carcinoma (PFTC) and to review the current available literature on PFTC. METHODS The medical records of 16 patients who were diagnosed with PFTC at Taipei Veterans General Hospital between January 2001 and December 2011 were analyzed retrospectively. RESULTS The mean age at diagnosis was 63 years (range, 41-86 years), and the mean follow-up period was 39.8 months (range, 4.0-102.8 months). Fourteen (87.5%) patients were menopausal women. The most common clinical presentation was nonspecific pelvic pain (37.5%), followed by abnormal vaginal bleeding (31.2%), pelvic mass (18.8%), and gastrointestinal symptoms (12.5%). One patient was diagnosed with PFTC preoperatively; 11 (68.6%) patients were diagnosed as having adnexal mass of unknown origin, but primarily in the ovary. Other diagnoses included endometrial cancer, cervical cancer, colon cancer, and rectum cancer in one patient each. Three (18.8%) patients were in Stage I, two (12.5%) in Stage II, nine (56.2%) in Stage III, and two (12.5%) in Stage IV. The serous type was histologically predominant (75%), and six patients were of a high grade (37.5%). The 5-year disease-free survival rate was 73.3%. CONCLUSION PFTC is infrequently diagnosed preoperatively or intraoperatively due to its rarity, and has a varied and nonspecific presentation. Only 6.3% of the patients had typical symptoms suggestive of tubal carcinoma. This report may benefit surgeons by providing additional information about the clinicopathologic behavior of PFTC so that patients can be appropriately counseled.
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Affiliation(s)
- Hei-Yu Lau
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC
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143
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Hviid MM, Teklay B, Jensen PT. [Atypical debut of symptoms of fallopian tube cancer]. Ugeskr Laeger 2013; 175:2114-2115. [PMID: 24011209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Fallopian tube cancer is rare and accounts for 0.3-1% of all gynaecological cancers. We describe a case of undiagnosed fallopian tube cancer presenting as a swollen inguinal lymph node and later diagnosed with PET-CT. Final histology revealed a serous adenocarcinoma of the fallopian tube with metastases to both ovaries and one inguinal lymph node. Recent studies suggest that serous borderline tumour of the ovaries originate from the fallopian tubes. The present case confirms this hypothesis. PET-CT is an important tool in diagnosing ovarian and fallopian tube cancers.
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144
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Matković V, Haller H, Vrdoljak E, Corusić A, Jelavić TB, Strinić T, Karnjus-Begonja R, Barisic D, Tomić S, Kukura V, Ban M, Ranka SP, Matic M, Skalec SL, Topolovec Z, Mrcela M, Zekan J, Fröbe A, Hajredini A, Babic D, Mamula O, Brncić-Fischer A, Vojnović Z, Sundov D. [Clinical recommendations for diagnosing, treatment and monitoring of patients with ovarian cancer -- Croatian Oncology Society and Croatian Society for Gynecology and Obstetrics as Croatian Medical Association units and Croatian Society of Gynecological Oncology]. Lijec Vjesn 2013; 135:235-241. [PMID: 24364199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various non-epithelial ovarian malignancies. A special group consists of epithelial carcinomas of low malignant potential with clinically indolent flow, good prognosis and no invasion, and primary cancer of the peritoneum and fallopian tube cancer. Clinically, these malignant tumors are generally asymptomatic in early stages, and usually diagnosed in advanced stages. The diagnosis is confirmed by pathological examination, and occasionally, cytological findings after completing diagnostic procedures. Multidisciplinary team makes treatment decisions, taking into account age, general condition and comorbidities of the patient and characteristics of the tumor itself, including disease stage, histological type and grade of the tumor. The principles of treatment of primary peritoneal and fallopian tube cancer are based on the principles of treatment of epithelial ovarian cancer involving surgery, chemotherapy, immune and hormone therapy, and symptomatic-supportive care throughout the treatment. Less common histological types have a different treatment approach being more frequently diagnosed in the early stages of the disease, have more indolent flow, so in these patients conservative surgeries with the goal of preserving fertility are more often employed. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with ovarian carcinoma, fallopian tube and primary peritoneal cancer in the Republic of Croatia.
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Affiliation(s)
- Visnja Matković
- Klinika za zenske bolesti i porode Petrova, Medicinski fakultet Sveucilista u Zagrebu, KBC Zagreb
| | - Herman Haller
- Medicinski fakultet Sveucilista u Rijeci, KBC Rijeka
| | | | - Ante Corusić
- Klinika za zenske bolesti i porode Petrova, Medicinski fakultet Sveucilista u Zagrebu, KBC Zagreb
| | | | | | | | - Dubravko Barisic
- Klinika za zenske bolesti i porode Petrova, Medicinski fakultet Sveucilista u Zagrebu, KBC Zagreb
| | | | | | - Marija Ban
- Medicinski fakultet Sveucilista u Splitu, KBC Split
| | - Stern Padovan Ranka
- Klinicki zavod za dijagnosticku i intervencijsku radiologiju, Medicinski fakultet Sveucilista u Zagrebu, KBC Zagreb
| | - Mate Matic
- Medicinski fakultet Sveucilista u Osijeku, KBC Osijek
| | - Suzana Lide Skalec
- Klinika za zenske bolesti i porode Petrova, Medicinski fakultet Sveucilista u Zagrebu, KBC Zagreb
| | | | | | - Josko Zekan
- Klinika za zenske bolesti i porode Petrova, Medicinski fakultet Sveucilista u Zagrebu, KBC Zagreb
| | | | - Adem Hajredini
- Klinika za zenske bolesti i porode Petrova, Medicinski fakultet Sveucilista u Zagrebu, KBC Zagreb
| | - Damir Babic
- Klinicki zavod za patologiju, Medicinski fakultet Sveucilista u Zagrebu, KBC Zagreb
| | - Ozren Mamula
- Medicinski fakultet Sveucilista u Rijeci, KBC Rijeka
| | | | | | - Dinka Sundov
- Medicinski fakultet Sveucilista u Splitu, KBC Split
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Fagotti A, Vizzielli G, Fanfani F, Costantini B, Ferrandina G, Gallotta V, Gueli Alletti S, Tortorella L, Scambia G. Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: impact on prognosis in a single institution experience. Gynecol Oncol 2013; 131:341-6. [PMID: 23938372 DOI: 10.1016/j.ygyno.2013.08.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 07/26/2013] [Accepted: 08/02/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the prognostic impact of routinely use of staging laparoscopy (S-LPS) in patients with primary advanced epithelial ovarian cancer (AEOC). METHODS All women were submitted to S-LPS before receiving primary debulking surgery (PDS) or neoadjuvant treatment (NACT). The surgical and survival outcome were evaluated by univariate and multivariate analysis. RESULTS Among 300 consecutive patients submitted to S-LPS no complications related to the surgical procedure were registered. The laparoscopic evaluation showed that almost half of the patients (46.3%) had a high tumor load. One-hundred forty-eight (49.3%) women were considered suitable for PDS and the remaining 152 (50.7%) were submitted to NACT. The percentages of complete (residual tumor, RT=0) and optimal (RT<1cm) cytoreduction of PDS and interval debulking surgery (IDS) were 62.1% and 57.5%, 22.5% and 27.7%, respectively, p=0.07. The post-operative complications of NACT/IDS group were lower than PDS group (p=0.01). The median progression free survival in women with RT=0 at PDS was 25 months (95% CI, 15.1-34.8), which was statistically significant longer than in all other patients, irrespective of the type of treatment they received (p=0.0001). At multivariate analysis, residual disease (p=0.011) and performance status (p=0.016) maintained an independent association with the PFS. CONCLUSIONS Including S-LPS in a tertiary referral center for the management AEOC does not appear to have a negative impact in terms of survival and it may be helpful to individualize the treatment avoiding unnecessary laparotomies and surgical complications.
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Affiliation(s)
- A Fagotti
- Division of Minimally Invasive Ginecological Surgery - St. Maria Hospital - University of Perugia, Terni, Italy.
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146
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Huang WC, Tsai CC, Wei MC, Kuo KT. Mutation analysis of papillary tubal hyperplasia associated with ovarian atypical proliferative serous tumor and low-grade serous carcinoma. Am J Obstet Gynecol 2013; 209:e6-8. [PMID: 23711666 DOI: 10.1016/j.ajog.2013.05.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/11/2013] [Accepted: 05/21/2013] [Indexed: 01/05/2023]
Abstract
We present a patient with ovarian atypical proliferative serous tumor and low-grade serous carcinoma, related to KRAS mutation. Bilateral fallopian tubes had papillary tubal hyperplasia, providing additional evidence that it is the putative precursor of low-grade serous tumors. Mutation analysis of papillary tubal hyperplasia has not been done in previous literature.
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Affiliation(s)
- Wen-Chih Huang
- Department of Anatomic Pathology, Far Eastern Memorial Hospital, Taipei, Taiwan
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147
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Kato K, Tate S, Nishikimi K, Shozu M. Assessment of intraoperative tube thoracostomy after diaphragmatic resection as part of debulking surgery for primary advanced-stage Müllerian cancer. Gynecol Oncol 2013; 131:32-5. [PMID: 23891788 DOI: 10.1016/j.ygyno.2013.07.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The present study assessed the use of an intraoperative tube thoracostomy for patients with primary advanced-stage ovarian, fallopian tube, or peritoneal cancer who underwent a diaphragmatic resection as part of debulking surgery and to define which patients are more likely to benefit from an intraoperative tube thoracostomy. METHODS All consecutive patients with stage IIIC-IV Müllerian cancer who underwent diaphragmatic resection at our institution between April 2008 and March 2013 were retrospectively reviewed. When a full-thickness resection of the diaphragm was performed and the thoracic cavity was opened, a chest tube was routinely placed during surgery. Patient-, disease-, and surgery-related data were collected from the patients' medical records. The data were evaluated with particular attention directed at pleural effusion after diaphragmatic resection. RESULTS A total of 37 patients were included in this study. No complications associated with the intraoperative tube thoracostomy procedures occurred. An infection of the thoracic cavity occurred in one patient, following the presence of intra-abdominal abscess. The total volume of pleural drainage ranged from 88 to 2826 mL (median, 965 mL). The estimated blood loss, intraoperative blood transfusion, and area of the diaphragmatic opening were significantly associated with the total volume of pleural drainage in univariate analyses. In a multivariate analysis, the estimated blood loss was the only factor to be significantly associated with the total volume of pleural drainage. CONCLUSIONS A prophylactic tube thoracostomy might be considered if the volume of the estimated blood loss is higher than usual.
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Affiliation(s)
- Kazuyoshi Kato
- Department of Gynecology, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
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148
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Jain M, Puri V. Synchronous carcinosarcoma uterus and primary serous carcinoma of bilateral fallopian tubes: a case report. J Reprod Med 2013; 58:361-364. [PMID: 23947091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The coexistence of multiple primary tumors in the female genital tract is very rare. Carcinosarcoma of the uterus is very rarely encountered among multiple genital malignancies. CASE A 63-year-old woman presented with synchronous carcinosarcoma of the uterus and primary serous carcinoma of bilateral fallopian tubes. The diagnosis was confirmed histopathologically and immunohistochemically. CONCLUSION This case is presented for its rarity and unique presentation. To the best of our knowledge, ours is the first reported case of this unique combination of synchronous genital malignancies.
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Affiliation(s)
- Manjula Jain
- Department of Pathology, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi 110001, India
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O’Shannessy DJ, Jackson SM, Twine NC, Hoffman BE, Dezso Z, Agoulnik SI, Somers EB. Gene expression analyses support fallopian tube epithelium as the cell of origin of epithelial ovarian cancer. Int J Mol Sci 2013; 14:13687-703. [PMID: 23880844 PMCID: PMC3742211 DOI: 10.3390/ijms140713687] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/18/2013] [Accepted: 06/20/2013] [Indexed: 02/06/2023] Open
Abstract
Folate receptor alpha (FOLR1/FRA) is reported to be overexpressed in epithelial ovarian cancers (EOC), especially the serous histotype. Further, while dysregulation of the folate-dependent 1-carbon cycle has been implicated in tumorogenesis, little is known relative to the potential mechanism of action of FOLR1 expression in these processes. We therefore investigated the expression of FOLR1, other folate receptors, and genes within the 1-carbon cycle in samples of EOC, normal ovary and fallopian tube on a custom TaqMan Low Density Array. Also included on this array were known markers of EOC such as MSLN, MUC16 and HE4. While few differences were observed in the expression profiles of genes in the 1-carbon cycle, genes previously considered to be overexpressed in EOC (e.g., FOLR1, MSLN, MUC16 and HE4) showed significantly increased expression when comparing EOC to normal ovary. However, when the comparator was changed to normal fallopian tube, these differences were abolished, supporting the hypothesis that EOC derives from fallopian fimbriae and, further, that markers previously considered to be upregulated or overexpressed in EOC are most likely not of ovarian origin, but fallopian in derivation. Our findings therefore support the hypothesis that the cell of origin of EOC is tubal epithelium.
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Affiliation(s)
- Daniel J. O’Shannessy
- Department of Translational Medicine and Diagnostics, Morphotek, Inc., 210 Welsh Pool Rd., Exton, PA 19341, USA; E-Mails: (S.M.J.); (B.E.H.); (E.B.S.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-610-423-6554; Fax: +1-610-423-6199
| | - Stephen M. Jackson
- Department of Translational Medicine and Diagnostics, Morphotek, Inc., 210 Welsh Pool Rd., Exton, PA 19341, USA; E-Mails: (S.M.J.); (B.E.H.); (E.B.S.)
| | - Natalie C. Twine
- Biomarkers and Personalized Medicine Core Functional Unit, Eisai Inc., Four Corporate Drive, Andover, MA 01810,USA; E-Mails: (N.C.T.); (Z.D.); (S.I.A.)
| | - Bryan E. Hoffman
- Department of Translational Medicine and Diagnostics, Morphotek, Inc., 210 Welsh Pool Rd., Exton, PA 19341, USA; E-Mails: (S.M.J.); (B.E.H.); (E.B.S.)
| | - Zoltan Dezso
- Biomarkers and Personalized Medicine Core Functional Unit, Eisai Inc., Four Corporate Drive, Andover, MA 01810,USA; E-Mails: (N.C.T.); (Z.D.); (S.I.A.)
| | - Sergei I. Agoulnik
- Biomarkers and Personalized Medicine Core Functional Unit, Eisai Inc., Four Corporate Drive, Andover, MA 01810,USA; E-Mails: (N.C.T.); (Z.D.); (S.I.A.)
| | - Elizabeth B. Somers
- Department of Translational Medicine and Diagnostics, Morphotek, Inc., 210 Welsh Pool Rd., Exton, PA 19341, USA; E-Mails: (S.M.J.); (B.E.H.); (E.B.S.)
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150
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Liu F, Wei J, Shen D, Liu J. Mucinous borderline tumor involving fallopian tube: case report and review of the literature. Int J Clin Exp Pathol 2013; 6:962-965. [PMID: 23638231 PMCID: PMC3638110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 03/15/2013] [Indexed: 06/02/2023]
Abstract
We report the case of a 74-year-old woman with a primary mucinous borderline tumor of the fallopian tube coexisting with an ovarian mucinous borderline tumor. Data were obtained through histopathologic study of the excised surgical specimen. p53, estrogen receptor (ER) and PAX8 expression were evaluated by immunohistochemistry on the available right fallopian tube and ovary. Both the ovarian and fallopian tube borderline ovarian tumors were negative for p53, ER and PAX8. However, the staining pattern highlighted the transition from a normal ciliated cell to neoplastic epithelia in the fallopian tube fimbria. This is the first report to indicate that mucinous borderline tumors may arise from the ciliated cells at the fallopian tube fimbrial epithelia. ER and PAX8 are useful markers in identifying the transition and origination of these tumors.
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Affiliation(s)
- Fangfang Liu
- Department of Pathology, Peking University People’s HospitalBeijing 100044, China
- Department of Pathology, The University of Texas MD Anderson Cancer CenterHouston, TX 77030, USA
| | - Junjian Wei
- Department of Pathology, Evanston HospitalEvanston, IL 60201
| | - Danhua Shen
- Department of Pathology, Peking University People’s HospitalBeijing 100044, China
| | - Jinsong Liu
- Department of Pathology, The University of Texas MD Anderson Cancer CenterHouston, TX 77030, USA
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