1
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Han S, Chen X, Li Z. Innate Immune Program in Formation of Tumor-Initiating Cells from Cells-of-Origin of Breast, Prostate, and Ovarian Cancers. Cancers (Basel) 2023; 15:cancers15030757. [PMID: 36765715 PMCID: PMC9913549 DOI: 10.3390/cancers15030757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Tumor-initiating cells (TICs), also known as cancer stem cells (CSCs), are cancer cells that can initiate a tumor, possess self-renewal capacity, and can contribute to tumor heterogeneity. TICs/CSCs are developed from their cells-of-origin. In breast, prostate, and ovarian cancers, progenitor cells for mammary alveolar cells, prostate luminal (secretory) cells, and fallopian tube secretory cells are the preferred cellular origins for their corresponding cancer types. These luminal progenitors (LPs) express common innate immune program (e.g., Toll-like receptor (TLR) signaling)-related genes. Microbes such as bacteria are now found in breast, prostate, and fallopian tube tissues and their corresponding cancer types, raising the possibility that their LPs may sense the presence of microbes and trigger their innate immune/TLR pathways, leading to an inflammatory microenvironment. Crosstalk between immune cells (e.g., macrophages) and affected epithelial cells (e.g., LPs) may eventually contribute to formation of TICs/CSCs from their corresponding LPs, in part via STAT3 and/or NFκB pathways. As such, TICs/CSCs can inherit expression of innate-immunity/TLR-pathway-related genes from their cells-of-origin; the innate immune program may also represent their unique vulnerability, which can be explored therapeutically (e.g., by enhancing immunotherapy via augmenting TLR signaling).
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Affiliation(s)
- Sen Han
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Xueqing Chen
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Zhe Li
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-617-525-4740
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2
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Prophylactic Salpingectomy during Hysterectomy for Benign Disease: A Prospective Study to Evaluate High-Grade Serous Ovarian Carcinoma Precursors. J Clin Med 2022; 12:jcm12010296. [PMID: 36615096 PMCID: PMC9821201 DOI: 10.3390/jcm12010296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Recent findings suggest that high-grade serous ovarian cancer can originate in the fallopian tube. Not only has that made the identification of precursor lesions pivotal in early detection and prevention of these cancers, prophylactic salpingectomy alongside hysterectomy for benign indications has been increasingly proposed as well. The present prospective single-center study included 273 women who underwent opportunistic salpingectomy alongside laparoscopic supracervical hysterectomy. Uterine and tubal histopathological results as well as intra- and postoperative complications were evaluated. The complication rate was 3.3%, of which none were caused by salpingectomy. Uterine histopathology diagnosed 181 patients (66.8%) with uterine myomas, 60 patients (22.1%) with adenomyosis, 29 patients (10.7%) with adenomyomatosis, and, 1 patient (0.4%) without pathological abnormality. p53 signatures were detected in 221 right fallopian tubes (80.9%) and in 229 left tubes (83.9%). In total, 8 patients showed bilateral STIL (2.9%), whereas in 1 patient (0.4%) STIL was detected in the left tube only. No STIC were detected. Laparoscopic opportunistic salpingectomy is demonstrated to be both safe and feasible. It appears to be promising to reduce the risk for ovarian cancer, yet more studies are needed to undoubtedly confirm this.
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Qin G, Park ES, Chen X, Han S, Xiang D, Ren F, Liu G, Chen H, Yuan GC, Li Z. Distinct niche structures and intrinsic programs of fallopian tube and ovarian surface epithelial cells. iScience 2022; 26:105861. [PMID: 36624845 PMCID: PMC9823228 DOI: 10.1016/j.isci.2022.105861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
Epithelial ovarian cancer (EOC) can originate from either fallopian tube epithelial (FTE) or ovarian surface epithelial (OSE) cells, but with different latencies and disease outcomes. To address the basis of these differences, we performed single cell RNA-sequencing of mouse cells isolated from the distal half of fallopian tube (FT) and surface layer of ovary. We find at the molecular level, FTE secretory stem/progenitor cells and OSE cells resemble mammary luminal progenitors and basal cells, respectively. An FT stromal subpopulation, enriched with Pdgfra + and Esr1 + cells, expresses multiple secreted factor (e.g., IGF1) and Hedgehog pathway genes and may serve as a niche for FTE cells. In contrast, Lgr5 + OSE cells express similar genes largely by themselves, raising a possibility that they serve as their own niche. The differences in intrinsic expression programs and niche organizations of FTE and OSE cells may contribute to their different courses toward the development of EOCs.
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Affiliation(s)
- Guyu Qin
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Eun-Sil Park
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Xueqing Chen
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Sen Han
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Dongxi Xiang
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Fang Ren
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Gang Liu
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Huidong Chen
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard School of Public Health, Boston, MA 02215, USA
| | - Guo-Cheng Yuan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard School of Public Health, Boston, MA 02215, USA
| | - Zhe Li
- Division of Genetics, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Medicine, Harvard Medical School, Boston, MA 02115, USA,Corresponding author
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Kinson MS, Rush DS, Santamaria Flores E, Cardenas-Goicoechea SJ, Moawad NS. Occult Synchronous Bilateral Fallopian Tube Cancers: Hysterectomy and Bilateral Salpingectomy for a Benign Indication. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael S. Kinson
- Department of Obstetrics & Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Demaretta S. Rush
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Estefania Santamaria Flores
- Department of Obstetrics & Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Segundo Joel Cardenas-Goicoechea
- Division of Gynecologic Oncology and University of Florida, Gainesville, Florida, USA
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Nash S. Moawad
- Division of Minimally-Invasive Gynecologic Surgery, University of Florida, Gainesville, Florida, USA
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, USA
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Oncogenic Events Dictate the Types and Locations of Gynecological Malignancies Originating from Krt8+ Mesothelial and Müllerian-Derived Epithelial Cells. Cancers (Basel) 2022; 14:cancers14030841. [PMID: 35159108 PMCID: PMC8834519 DOI: 10.3390/cancers14030841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/02/2022] [Accepted: 02/05/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Ovarian and uterine cancers are the most common gynecological malignancies in women. The early detection, prevention, and treatment of these gynecological cancers can benefit from a better understanding of how tumor-initiating cells in them are formed from their corresponding target cell populations in the female reproductive system. To study this, we utilized a genetic approach in mice to introduce driver mutations commonly found in these cancers to Keratin 8 positive (K8+) mesothelial and epithelial cells in the ovary, fallopian tube, and uterus. We found that p53-loss appears to preferentially affect K8+ epithelial cells, leading to the development of uterine and ovarian malignancies, whereas PTEN-loss may preferentially affect mesothelial cells, leading to the development of ovarian endometrioid malignancies or adenoma on the fallopian tube surface. Collectively, our data suggest that oncogenic driver mutations may dominantly determine the locations and types of gynecological malignancies developed from K8+ mesothelial and epithelial cells in the female reproductive system. Abstract Ovarian and uterine cancers are the most prevalent types of gynecological malignancies originating from mesothelial and/or Müllerian-derived epithelial cells. Recent genomic studies have identified common mutations in them that affect signaling pathways such as p53, PTEN/PI3K, RAS, and WNT pathways. However, how these mutations and their corresponding deregulated pathways affect gynecological cancer development from their cells-of-origin remains largely elusive. To address this, we performed the intrabursal injection of Cre-expressing adenovirus under the control of Krt8 promoter (Ad-K8-Cre) to mice carrying combinations of various conditional alleles for cancer genes. We found that Ad-K8-Cre specifically targeted mesothelial cells, including ovarian surface epithelial (OSE) cells (mainly the LGR5+ subset of OSE cells) and mesothelial cells lining the fallopian tube (FT) serosa; the injected Ad-K8-Cre also targeted Müllerian-derived epithelial cells, including FT epithelial cells and uterine endometrial epithelial cells. The loss of p53 may preferentially affect Müllerian-derived epithelial cells, leading to the development of uterine and ovarian malignancies, whereas PTEN-loss may preferentially affect mesothelial cells, leading to the development of ovarian endometrioid malignancies (upon KRAS-activation or APC-loss) or adenoma on the FT surface (upon DICER-loss). Overall, our data suggest that different Krt8+ mesothelial and epithelial cell types in the female reproductive system may have different sensitivities toward oncogenic mutations and, as a result, oncogenic events may dominantly determine the locations and types of the gynecological malignancies developed from them.
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Rudaitis V, Mikliusas V, Januska G, Jukna P, Mickys U, Janavicius R. The incidence of occult ovarian neoplasia and cancer in BRCA1/2 mutation carriers after the bilateral prophylactic salpingo-oophorectomy (PBSO): A single-center prospective study. Eur J Obstet Gynecol Reprod Biol 2020; 247:26-31. [PMID: 32059136 DOI: 10.1016/j.ejogrb.2020.01.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Due to ineffective ovarian cancer (OC) screening programs, prophylactic bilateral salpingo-oophorectomy (PBSO) is suggested for BRCA1/2 genes mutation carriers. The reported incidence of clinically occult neoplasia and OC detected during PBSO varies widely (2-17 %), reflecting differences in studies design. OBJECTIVE We aimed to prospectively evaluate the incidence of occult neoplasia in specimens collected during PBSO performed in a single tertiary center and to determine the effectiveness of this procedure in BRCA1/2 mutation carriers. STUDY DESIGN Between January 2010 and October 2016 a total of 564 new germline BRCA1/2 mutation positive women were identified and 71 carriers underwent laparoscopic PBSO. Patients were prospectively followed-up after the surgery and data on operation, age, complications, histological reports and BRCA1/2 gene mutation types were collected and analyzed. RESULTS Serous tubal intraepithelial carcinoma (STIC) was diagnosed in 7 (9.85 %) and OC in 4 (5.6 %) women (one advanced (FIGO IIIC) and 3 early (FIGO IA/C) stages); total incidence 15.5 %. Women's mean age at the time of surgery was 46.5 years. The mean age of women diagnosed with STIC and OC was 45.9 years (42-64). The mean follow up time for women being diagnosed with OC/STIC was 3.72 years; no recurrence was observed. The median time to perform laparoscopic PBSO was 43 min. (ranging from 25 to 65 min.), no surgical complications occurred during this operation. Interestingly, we found statistically significant (P = 0.0105) enrichment of STIC lesions in BRCA1 c.4035delA (an established Baltic founder mutation) carriers group. CONCLUSION The incidence of pathological findings in BRCA1/2 mutation carries after PBSO is sufficiently high and our prospective study data supports PBSO as the most effective measure for reducing the risk of OC in BRCA1/2 mutation carriers. A novel finding of the enrichment of STIC lesions in BRCA1 c.4035delA carriers may show important biological differences in OC tumorigenesis between different BRCA1 mutations, which warrant further investigations.
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Affiliation(s)
- Vilius Rudaitis
- Vilnius University Hospital Santaros Clinics, Department of Gynecology, Santariskiu st. 2, Vilnius, Lithuania; Vilnius University, Faculty of Medicine, Clinic of Obstetrics and Gynaecology, Ciurlionio st. 21, Vilnius, Lithuania; Vilnius University Hospital Santaros Clinics, Centre of Pathology, P.Baublio st. 5, Vilnius, Lithuania
| | - Vismantas Mikliusas
- Vilnius University Hospital Santaros Clinics, Department of Gynecology, Santariskiu st. 2, Vilnius, Lithuania; Spital STS AG, Frauenklinik, Krankenhausstrasse 12, Thun, Switzerland
| | - Gediminas Januska
- Vilnius University Hospital Santaros Clinics, Department of Gynecology, Santariskiu st. 2, Vilnius, Lithuania
| | - Povilas Jukna
- Vilnius University, Faculty of Medicine, Clinic of Obstetrics and Gynaecology, Ciurlionio st. 21, Vilnius, Lithuania
| | - Ugnius Mickys
- Vilnius University Hospital Santaros Clinics, Centre of Pathology, P.Baublio st. 5, Vilnius, Lithuania
| | - Ramunas Janavicius
- Vilnius University Hospital Santaros Clinics, Hematology, Oncology and Transfusion Medicine Center, Hereditary Cancer Center, Santariskiu st. 2, Vilnius, Lithuania; State Research Institute Innovative Medicine Center, Santariskiu st. 5, Vilnius, Lithuania.
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7
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Stanciu PI, Ind TEJ, Barton DPJ, Butler JB, Vroobel KM, Attygalle AD, Nobbenhuis MAE. Development of Peritoneal Carcinoma in women diagnosed with Serous Tubal Intraepithelial Carcinoma (STIC) following Risk-Reducing Salpingo-Oophorectomy (RRSO). J Ovarian Res 2019; 12:50. [PMID: 31128592 PMCID: PMC6535186 DOI: 10.1186/s13048-019-0525-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/17/2019] [Indexed: 01/29/2023] Open
Abstract
Introduction The management of Serous Tubal Intraepithelial Carcinoma (STIC) found at the time of Risk-Reducing Salpingo-Oophorectomy (RRSO) remains unclear. We set out to analyse the incidence of peritoneal carcinomas developed after prophylactic surgery and to formulate further guidance for these patients. Methods This is a retrospective study of 300 consecutive RRSO performed at the Royal Marsden Hospital between January 2008 and January 2017. Results The median age at RRSO was 47.8 years (range 34 to 60 years) and median BMI was 26.2 kg/m2 (range 16 to 51 kg/m2). A total of 273 patients (91%) were tested for BRCA mutations. Of these, 124 (45.4%) had a BRCA 1 mutation, 118 (43.2%) had a BRCA 2 mutation, 2 (0.7%) had both a BRCA 1 and a BRCA 2 mutation and 29 (10.6%) had no BRCA mutation detected. Isolated STIC lesions were identified in 7 cases (2.3%) and p53 signatures in 75 cases (25%). There were five (1.6%) incidental tubal carcinomas and one (0.3%) ovarian carcinoma at the time of surgery. Two (28.6%) of the 7 patients with STIC identified following RRSO had high grade serous peritoneal carcinoma diagnosed at 53 and 75 months. One (0.3%) patient from the other 287 patients from our series with no STIC diagnosis or incidental carcinomas at RRSO developed high grade serous carcinoma of peritoneal origin after 92 months. Conclusion This study demonstrates that when a STIC lesion is identified following RRSO there is a significantly higher risk of a subsequent peritoneal cancer. Although there is no published consensus in literature, we recommend that consideration should be given for long term follow-up if a STIC lesion is identified at RRSO.
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Affiliation(s)
- P I Stanciu
- Gynaecological Oncology Department, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
| | - T E J Ind
- Gynaecological Oncology Department, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - D P J Barton
- Gynaecological Oncology Department, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - J B Butler
- Gynaecological Oncology Department, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - K M Vroobel
- Pathology Department, The Royal Marsden Hospital, London, UK
| | - A D Attygalle
- Pathology Department, The Royal Marsden Hospital, London, UK
| | - M A E Nobbenhuis
- Gynaecological Oncology Department, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
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Klymenko Y, Nephew KP. Epigenetic Crosstalk between the Tumor Microenvironment and Ovarian Cancer Cells: A Therapeutic Road Less Traveled. Cancers (Basel) 2018; 10:E295. [PMID: 30200265 PMCID: PMC6162502 DOI: 10.3390/cancers10090295] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 12/11/2022] Open
Abstract
Metastatic dissemination of epithelial ovarian cancer (EOC) predominantly occurs through direct cell shedding from the primary tumor into the intra-abdominal cavity that is filled with malignant ascitic effusions. Facilitated by the fluid flow, cells distribute throughout the cavity, broadly seed and invade through peritoneal lining, and resume secondary tumor growth in abdominal and pelvic organs. At all steps of this unique metastatic process, cancer cells exist within a multidimensional tumor microenvironment consisting of intraperitoneally residing cancer-reprogramed fibroblasts, adipose, immune, mesenchymal stem, mesothelial, and vascular cells that exert miscellaneous bioactive molecules into malignant ascites and contribute to EOC progression and metastasis via distinct molecular mechanisms and epigenetic dysregulation. This review outlines basic epigenetic mechanisms, including DNA methylation, histone modifications, chromatin remodeling, and non-coding RNA regulators, and summarizes current knowledge on reciprocal interactions between each participant of the EOC cellular milieu and tumor cells in the context of aberrant epigenetic crosstalk. Promising research directions and potential therapeutic strategies that may encompass epigenetic tailoring as a component of complex EOC treatment are discussed.
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Affiliation(s)
- Yuliya Klymenko
- Cell, Molecular and Cancer Biology Program, Medical Sciences, Indiana University School of Medicine, Bloomington, IN 47405, USA.
- Department of Chemistry and Biochemistry, Harper Cancer Research Institute, University of Notre Dame, South Bend, IN 46617, USA.
| | - Kenneth P Nephew
- Cell, Molecular and Cancer Biology Program, Medical Sciences, Indiana University School of Medicine, Bloomington, IN 47405, USA.
- Department of Cellular and Integrative Physiology and Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
- Indiana University Simon Cancer Center, Indianapolis, IN 46202, USA.
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Coan M, Rampioni Vinciguerra GL, Cesaratto L, Gardenal E, Bianchet R, Dassi E, Vecchione A, Baldassarre G, Spizzo R, Nicoloso MS. Exploring the Role of Fallopian Ciliated Cells in the Pathogenesis of High-Grade Serous Ovarian Cancer. Int J Mol Sci 2018; 19:ijms19092512. [PMID: 30149579 PMCID: PMC6163198 DOI: 10.3390/ijms19092512] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022] Open
Abstract
High-grade serous epithelial ovarian cancer (HGSOC) is the fifth leading cause of cancer death in women and the first among gynecological malignancies. Despite an initial response to standard chemotherapy, most HGSOC patients relapse. To improve treatment options, we must continue investigating tumor biology. Tumor characteristics (e.g., risk factors and epidemiology) are valuable clues to accomplish this task. The two most frequent risk factors for HGSOC are the lifetime number of ovulations, which is associated with increased oxidative stress in the pelvic area caused by ovulation fluid, and a positive family history due to genetic factors. In the attempt to identify novel genetic factors (i.e., genes) associated with HGSOC, we observed that several genes in linkage with HGSOC are expressed in the ciliated cells of the fallopian tube. This finding made us hypothesize that ciliated cells, despite not being the cell of origin for HGSOC, may take part in HGSOC tumor initiation. Specifically, malfunction of the ciliary beat impairs the laminar fluid flow above the fallopian tube epithelia, thus likely reducing the clearance of oxidative stress caused by follicular fluid. Herein, we review the up-to-date findings dealing with HGSOC predisposition with the hypothesis that fallopian ciliated cells take part in HGSOC onset. Finally, we review the up-to-date literature concerning genes that are located in genomic loci associated with epithelial ovarian cancer (EOC) predisposition that are expressed by the fallopian ciliated cells.
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Affiliation(s)
- Michela Coan
- Division of Molecular Oncology, Department of Translational Research, IRCCS CRO Aviano-National Cancer Institute, Via Franco Gallini, 2 33081 Aviano PN, Italy.
| | - Gian Luca Rampioni Vinciguerra
- Division of Molecular Oncology, Department of Translational Research, IRCCS CRO Aviano-National Cancer Institute, Via Franco Gallini, 2 33081 Aviano PN, Italy.
| | - Laura Cesaratto
- Division of Molecular Oncology, Department of Translational Research, IRCCS CRO Aviano-National Cancer Institute, Via Franco Gallini, 2 33081 Aviano PN, Italy.
| | - Emanuela Gardenal
- Azienda Ospedaliera Universitaria Integrata, University of Verona, 37129 Verona, Italy.
| | - Riccardo Bianchet
- Scientific Direction, CRO Aviano Italy, Via Franco Gallini, 2 33081 Aviano, Italy.
| | - Erik Dassi
- Centre for Integrative Biology, University of Trento, 38122 Trento, Italy.
| | - Andrea Vecchione
- Department of clinical and molecular medicine, university of Rome "Sapienza", c/o sant andrea hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
| | - Gustavo Baldassarre
- Division of Molecular Oncology, Department of Translational Research, IRCCS CRO Aviano-National Cancer Institute, Via Franco Gallini, 2 33081 Aviano PN, Italy.
| | - Riccardo Spizzo
- Division of Molecular Oncology, Department of Translational Research, IRCCS CRO Aviano-National Cancer Institute, Via Franco Gallini, 2 33081 Aviano PN, Italy.
| | - Milena Sabrina Nicoloso
- Division of Molecular Oncology, Department of Translational Research, IRCCS CRO Aviano-National Cancer Institute, Via Franco Gallini, 2 33081 Aviano PN, Italy.
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Chene G, Urvoas S, Moret S, Nadaud B, Buenerd A, Chabert P, Mellier G, Lamblin G. Opportunistic Salpingectomy at the Time of Benign Laparoscopic Hysterectomy: Assessment of Possible Complications and Histopathological p53-Signatures. Geburtshilfe Frauenheilkd 2018; 78:605-611. [PMID: 29962519 PMCID: PMC6018067 DOI: 10.1055/a-0611-5167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 04/15/2018] [Accepted: 04/15/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction
The aim of this study is to assess the prevalence of tubal histopathological abnormalities (serous tubal intraepithelial carcinoma STIC and p53 signatures) and the prevalence of perioperative and postoperative complications related to opportunistic laparoscopic salpingectomy in a low risk population.
Materials and Methods
In this observational prospective cohort, prophylactic bilateral salpingectomy during benign laparoscopic hysterectomy was systematically performed in 100 consecutive women. Peri- and postoperative complications were registered. Duration of salpingectomy and post-salpingectomy blood loss were also measured. Histopathological and immunohistochemical analysis with anti-p53 antibody were performed on the whole fallopian tubes according to a specific and validated protocol.
Results
Laparoscopic salpingectomy was always possible without any peri- or postoperative complication attributable to the salpingectomy itself. The mean duration was 428 seconds (354 – 596) and the blood loss was 9 cm
3
(2 – 15). Using histopathological and immunohistochemical assessment with anti-p53 antibody on 199 fallopian tubes (99 bilateral salpingectomies and one unilateral salpingectomy because of previous salpingectomy for ectopic pregnancy), there was a prevalence of 5.52% (11/199) of p53 signatures. No STIC were observed and no associated cancer.
Conclusions
Laparoscopic salpingectomy is both feasible and innocuous during benign hysterectomy. Meticulous histopathologic examination of the tubes may reveal specific abnormalities.
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Affiliation(s)
- Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, Lyon CHU, Lyon, France.,University of Claude Bernard Lyon 1, EMR 3738, Lyon, France
| | - Sarah Urvoas
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, Lyon CHU, Lyon, France
| | - Stéphanie Moret
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, Lyon CHU, Lyon, France
| | - Béatrice Nadaud
- Department of Pathology, Centre Hospitalier Est, Hospices civils de Lyon, Lyon, France
| | - Annie Buenerd
- Department of Pathology, Centre Hospitalier Est, Hospices civils de Lyon, Lyon, France
| | - Philippe Chabert
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, Lyon CHU, Lyon, France
| | - Georges Mellier
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, Lyon CHU, Lyon, France
| | - Gery Lamblin
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, Lyon CHU, Lyon, France
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Klymenko Y, Kim O, Stack MS. Complex Determinants of Epithelial: Mesenchymal Phenotypic Plasticity in Ovarian Cancer. Cancers (Basel) 2017; 9:cancers9080104. [PMID: 28792442 PMCID: PMC5575607 DOI: 10.3390/cancers9080104] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/02/2017] [Accepted: 08/06/2017] [Indexed: 02/07/2023] Open
Abstract
Unlike most epithelial malignancies which metastasize hematogenously, metastasis of epithelial ovarian cancer (EOC) occurs primarily via transcoelomic dissemination, characterized by exfoliation of cells from the primary tumor, avoidance of detachment-induced cell death (anoikis), movement throughout the peritoneal cavity as individual cells and multi-cellular aggregates (MCAs), adhesion to and disruption of the mesothelial lining of the peritoneum, and submesothelial matrix anchoring and proliferation to generate widely disseminated metastases. This exceptional microenvironment is highly permissive for phenotypic plasticity, enabling mesenchymal-to-epithelial (MET) and epithelial-to-mesenchymal (EMT) transitions. In this review, we summarize current knowledge on EOC heterogeneity in an EMT context, outline major regulators of EMT in ovarian cancer, address controversies in EMT and EOC chemoresistance, and highlight computational modeling approaches toward understanding EMT/MET in EOC.
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Affiliation(s)
- Yuliya Klymenko
- Department of Chemistry and Biochemistry, Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN 46617, USA.
- Medical Sciences Program, Indiana University School of Medicine, Bloomington, IN 47405, USA.
| | - Oleg Kim
- Department of Applied and Computational Mathematics and Statistics, Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN 46617, USA.
- Department of Mathematics, University of California Riverside, Riverside, CA 92521, USA.
| | - M Sharon Stack
- Department of Chemistry and Biochemistry, Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN 46617, USA.
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Lamblin G, Thiberville G, Bansac Lamblin A, Moret S, Du-Mesnildot P, Rannou C, Ploton I, Chabert P, Chene G. [What haemostatic technique should we use for opportunistic salpingectomy during benign laparoscopic hysterectomy?]. ACTA ACUST UNITED AC 2017; 45:453-459. [PMID: 28757104 DOI: 10.1016/j.gofs.2017.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare ovarian function before and after laparoscopic hysterectomy with bilateral salpingectomy for benign lesions with two different systems of haemostasis. METHODS In this prospective randomized study comparing two types of energy used for coagulation in bilateral salpingectomy (group A: bipolar electric energy, versus group B: ultrasonic advanced energy [Harmonic®]), forty consecutive non-menopausal patients undergoing laparoscopic hysterectomy for benign lesions were included. Values of anti-Müllerian hormone (AMH), LH and FSH, antral follicle count (AFC) and ovarian vascularization on bilateral Doppler ultrasound, quality of life (questionnaire) were assessed preoperatively and at 1 and 3 months postoperatively. RESULTS Preliminary analysis showed shorter salpingectomy operating time (P<0.0001) and less bleeding (P<0.005) in group B. In group A, there was no statistical difference except a decrease in AFC at 1 and 3 months on the right ovary (P=0.04). In group B, AMH levels were significantly lower postoperatively at 3 months and LH levels were increased at 3 months (respectively P=0.02 et P=0.04). There was no statistical difference in the ultrasonographic data. Quality of life did not significantly differ in both groups. CONCLUSION Preliminary findings showed reduced AMH levels at 3months postoperatively in ultrasonic energy group whereas there was no significative menopausal symptoms. It seems important to continue this study in order to know the real effects of both energy systems on the ovarian function.
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Affiliation(s)
- G Lamblin
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - G Thiberville
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - A Bansac Lamblin
- Département de radiologie, Centre lyonnais imagerie féminine, 69000 Lyon, France
| | - S Moret
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - P Du-Mesnildot
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - C Rannou
- Département de radiologie, groupement hospitalier Est, 69000 Lyon-Bron, France
| | - I Ploton
- Département de biochimie, groupement hospitalier Est, 69000 Lyon-Bron, France
| | - P Chabert
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - G Chene
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France; Université Claude-Bernard Lyon-1, EMR 3738, 69000 Lyon, France.
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13
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Wang J, Liu Q, Zhou X, He Y, Guo Q, Shi Q, Eriksson S, Zhou J, He E, Skog S. Thymidine kinase 1 expression in ovarian serous adenocarcinoma is superior to Ki-67: A new prognostic biomarker. Tumour Biol 2017. [PMID: 28651488 DOI: 10.1177/1010428317706479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cancer is a disease with abnormally proliferating cells and therefore proliferation rate is an important index for assessing tumour growth. Ki-67 is a commonly used proliferation marker considered to be an unfavourable prognostic marker in some tumors, while Thymidine kinase 1 (TK1) is an interesting proliferation marker because its levels are highly dependent on the growth stage of cells. To define the immunohistochemistry (IHC) expression of the TK1 in patients with ovarian serous adenocarcinoma and establish its potential role as a new biomarker for progressive disease, we analyzed the expression patterns of TK1 and Ki-67 in 109 patients with ovarian serous adenocarcinoma. TK1 and Ki-67 expression both showed a statistically significant correlation to MD Anderson Cancer Center (MDACC) grade, but not to age, tumour size, lymph node metastasis or pathological TNM (pTNM) stages. TK1 expression, MDACC grades, pathological stages and lymph node metastasis correlate to relapse incident rate and overall survival, but Ki-67 does not. Although TK1 expression, MDACC grade, pTNM stage and lymph node metastasis significantly correlate to relapse in the Cox univariate analysis, in the multivariate Cox analysis only TK1 expression and lymph node metastasis were independent prognostic factors. The overall survival also correlated significantly to TK1 expression, MDACC grade, pTNM stage and lymph node metastasis in the Cox univariate analysis. However, only the pTNM stage was found to be an independent prognostic factor for survival in the Cox multivariate analysis. Therefore, though TK1 expression was an independent prognostic factor for relapse, but not for survival, TK1 is a more informative expression than Ki-67 for LI, relapse and overall survival rates. Thus, when TK1 is combined with MDACC grading, pTNM staging and lymph node metastasis, IHC determination of TK1 expression may improve the overall prediction of prognosis in patients with ovarian cancer.
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Affiliation(s)
- Jianjun Wang
- 1 Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qi Liu
- 2 Department of Gynaecology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaodie Zhou
- 1 Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yan He
- 1 Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qing Guo
- 1 Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qunli Shi
- 1 Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Staffan Eriksson
- 3 Department of Anatomy, Physiology and Biochemistry, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ji Zhou
- 4 Sino-Swed Molecular Bio-Medicine Research Institute, Shanghai, China
| | - Ellen He
- 4 Sino-Swed Molecular Bio-Medicine Research Institute, Shanghai, China
| | - Sven Skog
- 4 Sino-Swed Molecular Bio-Medicine Research Institute, Shanghai, China
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14
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Dynamic real-time in vivo confocal laser endomicroscopy of the fallopian tube during laparoscopy in the prevention of ovarian cancer. Eur J Obstet Gynecol Reprod Biol 2017; 216:18-23. [PMID: 28692889 DOI: 10.1016/j.ejogrb.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 06/07/2017] [Accepted: 07/04/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Recently it has been postulated that most ovarian cancers have a tubal origin. The identification of preinvasive tubal lesions would be of great interest in the early diagnosis of ovarian cancer. Optical biopsy has been developed and validated in the detection of precancerous lesions (such as Barrett's oesophagus). The first objective of this study was to assess the feasibility of optical biopsy in the study of fallopian tubes during laparoscopy. The second objective was to describe the images in benign premalignant and malignant tubes with a histopathological and immunohistochemical (p53 and Ki67 expressions) correlation. STUDY DESIGN In this prospective study, 40 patients undergoing laparoscopic salpingectomy for benign conditions (benign hysterectomy), prophylactic conditions (BRCA mutation) or in case of pelvic cancers were included after obtaining informed and signed consent prior to surgery. The optical biopsy was performed on the fimbria of each tube in and ex vivo. A correlation was made with the histopathological and immunohistochemical analysis. RESULTS The feasibility of optical biopsy was always confirmed during laparoscopy. The optical biopsy iconography revealed different images in benign tubal epithelium (well-defined black and grey structure), in adenomatoid tumour (tortuous architectural organization), in STIC precancerous lesion (enlarged, irregular and pleomorphic cells, dilated and distorted vessels) and in tubal metastasis of high grade serous ovarian cancer (dark neoplastic cells irregular in size and shape) CONCLUSIONS: Optical biopsy may be the first emerging mini-invasive technology that could detect tubal lesions and may be considered as a promising tool in the early detection of ovarian cancer.
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Rottmann M, Burges A, Mahner S, Anthuber C, Beck T, Grab D, Schnelzer A, Kiechle M, Mayr D, Pölcher M, Schubert-Fritschle G, Engel J. Cancer of the ovary, fallopian tube, and peritoneum: a population-based comparison of the prognostic factors and outcomes. J Cancer Res Clin Oncol 2017; 143:1833-1844. [DOI: 10.1007/s00432-017-2422-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/11/2017] [Indexed: 12/26/2022]
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16
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Eken MK, Kaygusuz EI, Temizkan O, İlhan G, Çöğendez E, Karateke A. Occult serous carcinoma of fallopian tube presenting as supraclavicular lymphadenopathy. Taiwan J Obstet Gynecol 2017; 55:450-2. [PMID: 27343337 DOI: 10.1016/j.tjog.2016.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 10/21/2022] Open
Affiliation(s)
- Meryem Kurek Eken
- Department of Obstetrics and Gynecology, Zeynep Kamil Education and Research Hospital, Istanbul, Turkey.
| | - Ecmel Işık Kaygusuz
- Department of Pathology, Zeynep Kamil Education and Research Hospital, Istanbul, Turkey
| | - Osman Temizkan
- Department of Obstetrics and Gynecology, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Gülşah İlhan
- Department of Obstetrics and Gynecology, Süleymaniye Education and Research Hospital, Istanbul, Turkey
| | - Ebru Çöğendez
- Department of Obstetrics and Gynecology, Zeynep Kamil Education and Research Hospital, Istanbul, Turkey
| | - Ateş Karateke
- Department of Obstetrics and Gynecology, Zeynep Kamil Education and Research Hospital, Istanbul, Turkey
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17
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Chene G, Lamblin G. Response to Dr Nohuz's letter: Could prophylactic salpingectomy replace tubal ligation? J Gynecol Obstet Hum Reprod 2017; 46:305-306. [PMID: 28403932 DOI: 10.1016/j.jogoh.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 12/28/2016] [Indexed: 11/26/2022]
Affiliation(s)
- G Chene
- Department of Gynecology, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France; Université Claude-Bernard-Lyon 1, EMR 3738, 69000 Lyon, France.
| | - G Lamblin
- Department of Gynecology, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France
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18
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Chene G, de Rochambeau B, Le Bail-Carval K, Beaufils E, Chabert P, Mellier G, Lamblin G. [Current surgical practice of prophylactic and opportunistic salpingectomy in France]. ACTA ACUST UNITED AC 2016; 44:377-84. [PMID: 27363615 DOI: 10.1016/j.gyobfe.2016.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/09/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Since the recent evidence of a tubal origin of most ovarian cancers, opportunistic salpingectomy could be discussed as a prophylactic strategy in the general population and with hereditary predisposition. We aimed to survey French gynecological surgeons about their current surgical practice of prophylactic salpingectomy. METHODS An anonymous online survey was sent to French obstetrician-gynaecologists and gynecological surgeons. There were 13 questions about their current clinical practice and techniques of salpingectomy during a benign hysterectomy or as a tubal sterilization method, salpingectomy versus salpingo-oophorectomy in the population with genetic risk, salpingectomy in relationship with endometriosis and questions including histopathological considerations. RESULTS Among the 569 respondents, opportunistic salpingectomy was always performed between 42.48% and 43.44% during laparoscopic, laparoscopic-assisted vaginal or laparotomic hysterectomy and only 12.26% in case of vaginal route. In the genetic population, salpingo-oophorectomy was mainly performed. Tubal sterilization was often practiced by the hysteroscopic route. More than 90% of respondents didn't perform salpingectomy in case of endometriosis. There was not any specific tubal histopathological protocol in 71.54% of cases. CONCLUSIONS Salpingectomy may be a preventing strategy in the low- and high-risk population. The survey's responses show that salpingectomy seems to be a current practice during benign hysterectomy for more than 40% doctors. However, there is not any change with no more salpingectomy in the population with genetic risk, or in case of endometriosis or tubal sterilization.
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Affiliation(s)
- G Chene
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France; EMR 3738, université Claude-Bernard Lyon 1, 69000 Lyon, France.
| | - B de Rochambeau
- Département de gynécologie-obstétrique, hôpital privé Marne-Chantereine, 77177 Brou-sur-Chantereine, France
| | - K Le Bail-Carval
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France
| | - E Beaufils
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France
| | - P Chabert
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France
| | - G Mellier
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France
| | - G Lamblin
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, 69000 Lyon, France
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19
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Chene G, Meysonnier C, Buenerd A, Moret S, Nadaud B, Beaufils E, Le Bail-Carval K, Chabert P, Mellier G, Lamblin G. Faisabilité de la salpingectomie prophylactique lors d’une hystérectomie d’indication bénigne par voie vaginale et évaluation de la prévalence des lésions tubaires occultes : étude préliminaire. ACTA ACUST UNITED AC 2016; 45:549-58. [DOI: 10.1016/j.jgyn.2015.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/21/2015] [Accepted: 07/13/2015] [Indexed: 11/28/2022]
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20
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Hysterectomy for benign disease: clinical practice guidelines from the French College of Obstetrics and Gynecology. Eur J Obstet Gynecol Reprod Biol 2016; 202:83-91. [PMID: 27196085 DOI: 10.1016/j.ejogrb.2016.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of the study was to draw up French College of Obstetrics and Gynecology (CNGOF) clinical practice guidelines based on the best available evidence concerning hysterectomy for benign disease. METHODS Each recommendation for practice was allocated a grade, which depends on the level of evidence (clinical practice guidelines). RESULTS Hysterectomy should be performed by a high-volume surgeon (>10 hysterectomy procedures per year) (gradeC). Stimulant laxatives taken as a rectal enema are not recommended prior to hysterectomy (gradeC). It is recommended to carry out vaginal disinfection using povidone-iodine solution prior to hysterectomy (grade B). Antibiotic prophylaxis is recommended during hysterectomy, regardless of the surgical approach (grade B). The vaginal or laparoscopic approach is recommended for hysterectomy for benign disease (grade B), even if the uterus is large and/or the patient is obese (gradeC). The choice between these two surgical approaches depends on other parameters, such as the surgeon's experience, the mode of anesthesia, and organizational constraints (duration of surgery and medical economic factors). Vaginal hysterectomy is not contraindicated in nulliparous women (gradeC) or in women with previous cesarean section (gradeC). No specific hemostatic technique is recommended with a view to avoiding urinary tract injury (gradeC). In the absence of ovarian disease and a personal or family history of breast/ovarian carcinoma, the ovaries should be preserved in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended with a view to reducing the risk of peri- or postoperative complications (grade B). CONCLUSION The application of these recommendations should minimize risks associated with hysterectomy.
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21
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Chene G. [Endometriosis and ovarian cancer: An old story...]. ACTA ACUST UNITED AC 2016; 44:77-8. [PMID: 26853482 DOI: 10.1016/j.gyobfe.2016.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Indexed: 11/30/2022]
Affiliation(s)
- G Chene
- Département de gynécologie, hôpital Femme-Mère-Enfants, HCL, CHU Lyon Est, 59, boulevard Pinel, 69677 Bron, France; Université Claude-Bernard Lyon 1, EMR 3738, 69000 Lyon, France.
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22
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Chene G, Caloone J, Moret S, Le Bail-Carval K, Chabert P, Beaufils E, Mellier G, Lamblin G. [Is endometriosis a precancerous lesion? Perspectives and clinical implications]. ACTA ACUST UNITED AC 2016; 44:106-12. [PMID: 26850282 DOI: 10.1016/j.gyobfe.2016.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/21/2015] [Indexed: 01/17/2023]
Abstract
Epidemiological studies have shown a relationship between endometriosis and clear cell/endometrioid ovarian cancers (named "Endometriosis Associated Ovarian Cancer" or EAOC). The recent discovery of signaling pathways (especially the SWI/SNF and PI3K/AKT/mTOR pathways) that linked endometriosis and EAOC could lead to the development of specific biomarkers as ARID1A to screen benign to premalignant endometriosis and to new targeted treatment. Moreover, the better understanding of the pathogenesis of the epithelial ovarian cancer arising from the Fallopian tube could allow new early prevention strategies that will be described in this review.
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Affiliation(s)
- G Chene
- Département de Gynécologie, Hôpital Femme Mère Enfants, HCL, CHU Lyon Est, 59, boulevard Pinel, 69677 Bron, France; Université Claude Bernard Lyon 1, EMR 3738, 69000 Lyon, France.
| | - J Caloone
- Département de Gynécologie, Hôpital Femme Mère Enfants, HCL, CHU Lyon Est, 59, boulevard Pinel, 69677 Bron, France
| | - S Moret
- Département de Gynécologie, Hôpital Femme Mère Enfants, HCL, CHU Lyon Est, 59, boulevard Pinel, 69677 Bron, France
| | - K Le Bail-Carval
- Département de Gynécologie, Hôpital Femme Mère Enfants, HCL, CHU Lyon Est, 59, boulevard Pinel, 69677 Bron, France
| | - P Chabert
- Département de Gynécologie, Hôpital Femme Mère Enfants, HCL, CHU Lyon Est, 59, boulevard Pinel, 69677 Bron, France
| | - E Beaufils
- Département de Gynécologie, Hôpital Femme Mère Enfants, HCL, CHU Lyon Est, 59, boulevard Pinel, 69677 Bron, France
| | - G Mellier
- Département de Gynécologie, Hôpital Femme Mère Enfants, HCL, CHU Lyon Est, 59, boulevard Pinel, 69677 Bron, France
| | - G Lamblin
- Département de Gynécologie, Hôpital Femme Mère Enfants, HCL, CHU Lyon Est, 59, boulevard Pinel, 69677 Bron, France
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23
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Iavazzo C, Gkegkes ID, Vrachnis N. Primary peritoneal cancer in BRCA carriers after prophylactic bilateral salpingo-oophorectomy. J Turk Ger Gynecol Assoc 2016; 17:73-6. [PMID: 27403072 DOI: 10.5152/jtgga.2016.15223] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/05/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The presence of deleterious mutations in breast cancer (BRCA)-1 or BRCA-2 gene has a decisive influence on the development of various types of neoplasms, such as breast, ovarian, tubal, and peritoneal cancers. Primary peritoneal cancer is an aggressive malignancy which, due to the absence of a specific screening test, cannot be diagnosed in its early stages. As a risk-reducing option, prophylactic bilateral salpingo-oophorectomy and mastectomy are often proposed in BRCA gene carriers. The effectiveness of a preventive surgical treatment is, however, unclear in the development of peritoneal cancer. MATERIAL AND METHODS An extensive electronic search was performed in PubMed, Scopus, and Cochrane databases. RESULTS The total number of patients who underwent prophylactic bilateral salpingo-oophorectomy was 1,830, of whom 28 presented with peritoneal cancer (1.53%). The age of the included patients ranged from 48 to 61 years. BRCA-1 was present in 9 out of 28 patients and BRCA-2 in 2 patients, while the type of BRCA was unclear in 17 patients. Salpingo-oophorectomy was performed in 23 out of 28 patients, while oophorectomy was carried out in 5 patients. The interval from initial risk-reducing surgical treatment to the presentation of peritoneal cancer ranged from 12 to 84 months. CONCLUSION Modification of the follow-up guidelines and increase in healthcare providers' awareness may reduce the risk of peritoneal cancer.
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Affiliation(s)
- Christos Iavazzo
- Gynaecological Oncology Department, Christie Hospital, Manchester, United Kingdom
| | - Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
| | - Nikolaos Vrachnis
- Second Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio Hospital, Athens, Greece
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Coosemans A, Decoene J, Baert T, Laenen A, Kasran A, Verschuere T, Seys S, Vergote I. Immunosuppressive parameters in serum of ovarian cancer patients change during the disease course. Oncoimmunology 2015; 5:e1111505. [PMID: 27141394 DOI: 10.1080/2162402x.2015.1111505] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/15/2015] [Accepted: 10/17/2015] [Indexed: 12/30/2022] Open
Abstract
Neoplastic cells can escape immune control leading to cancer growth. Regulatory T cells (Treg), myeloid-derived suppressor cells (MDSC) and tumor-associated macrophages (TAM) are crucial in immune escape. TAM are divided based on their immune profile, M1 are immunostimulatory while M2 are immunosuppressive. Research so far has mainly focused on the intratumoral behavior of these cells. This study, on the other hand, explored the systemic changes of the key metabolites [IL-4 (interleukin), IL-13, arginase, IL-10, VEGF-A (vascular endothelial growth factor), CCL-2 (chemokine (C-C) motif ligand 2) and TGF-β (transforming growth factor)] linked to Treg, MDSC and TAM during the course of the disease in ovarian and fallopian tube cancer patients. Serum samples were therefore analyzed at diagnosis, after (interval)-debulking surgery and after chemotherapy (paclitaxel-carboplatin). We also determined galectin-1 (gal-1), involved in angiogenesis and tumor-mediated immune evasion. We found significantly lower levels of IL-10, VEGF-A, TGF-β and arginase and higher levels of gal-1 after chemotherapy compared to diagnosis. After debulking surgery, a decrease in IL-10 was significant. Gal-1 and CCL-2 appeared independent prognostic factors for progression-free and overall survival (OS) (multivariate analysis). These results will help us in the decision making of future therapies in order to further modulate the immune system in a positive way.
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Affiliation(s)
- An Coosemans
- Department of Gynecology and Obstetrics, UZ Leuven, Leuven, Belgium; Department of Oncology, Laboratory of Gynecologic Oncology, ImmunOvar Research Group, KU Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Judit Decoene
- Department of Gynecology and Obstetrics, UZ Leuven , Leuven, Belgium
| | - Thaïs Baert
- Department of Gynecology and Obstetrics, UZ Leuven, Leuven, Belgium; Department of Oncology, Laboratory of Gynecologic Oncology, ImmunOvar Research Group, KU Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Annouschka Laenen
- Biostatistics and Statistical Bioinformatics Center of Leuven, KU Leuven , Leuven, Belgium
| | - Ahmad Kasran
- Department of Microbiology and Immunology, Laboratory of Clinical Immunology, KU Leuven , Leuven, Belgium
| | - Tina Verschuere
- Department of Neuroscience, Laboratory of Experimental Neurosurgery, KU Leuven , Leuven, Belgium
| | - Sven Seys
- Department of Microbiology and Immunology, Laboratory of Clinical Immunology, KU Leuven , Leuven, Belgium
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, UZ Leuven, Leuven, Belgium; Department of Oncology, Laboratory of Gynecologic Oncology, ImmunOvar Research Group, KU Leuven, Leuven Cancer Institute, Leuven, Belgium
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25
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Chêne G, Lamblin G, Marcelli M, Huet S, Gauthier T. [Urinary, infectious and digestive adverse events related to benign hysterectomy and the associated surgery on the Fallopian tube: Guidelines]. ACTA ACUST UNITED AC 2015; 44:1183-205. [PMID: 26527024 DOI: 10.1016/j.jgyn.2015.09.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 09/18/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To provide clinical practice guidelines from the French College of Obstetrics and Gynecology (CNGOF) based on the best evidence available, concerning the urinary, infectious and digestive adverse events related to benign hysterectomy and the associated surgery including opportunistic salpingectomy and adnexectomy. MATERIAL AND METHOD Review of literature using following keywords: benign hysterectomy; urinary injury; bladder injury; ureteral injury; vesicovaginal fistula; infection; bowel injury; salpingectomy. RESULTS Urinary catheter should be removed before 24h following uncomplicated hysterectomy (grade B). In case of urinary catheter during hysterectomy, immediate postoperative removal is possible (grade C). No hemostasis technics can be recommended to avoid urinary injury (grade C). There is not any evidence to recommend to perform a window in the broad ligament or an ureterolysis, to put ureteral stent or a uterine manipulator in order to avoid ureteral injury. An antibiotic prophylaxis by a cephalosporin is always recommended (grade B). Mechanical bowel preparation before hysterectomy is not recommended (grade B). If there is no ovarian cyst/disease and no familial or personal history of ovarian/breast cancer, ovarian conservation is recommended in premenopausal women (grade B). In postmenopausal women, informed consent and surgical approach should be taken in account to perform a salpingo-oophorectomy. Since the association salpingectomy and hysterectomy is not assessed in the prevention of ovarian cancer, systematic bilateral salpingectomy is not recommended (expert consensus). CONCLUSIONS Practical application of these guidelines should decrease the prevalence of visceral complications associated with benign hysterectomy.
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Affiliation(s)
- G Chêne
- Département de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 69002 Lyon, France; Université Claude-Bernard Lyon 1, EMR 3738, 69100 Villeurbanne, France.
| | - G Lamblin
- Département de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 69002 Lyon, France
| | - M Marcelli
- Département de gynécologie-obstétrique, hôpital La Conception, Aix-Marseille université, 13005 Marseille, France
| | - S Huet
- Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Larrey, 87000 Limoges, France
| | - T Gauthier
- Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Larrey, 87000 Limoges, France
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Expression of Stem Cell Markers in Preinvasive Tubal Lesions of Ovarian Carcinoma. BIOMED RESEARCH INTERNATIONAL 2015; 2015:808531. [PMID: 26504831 PMCID: PMC4609379 DOI: 10.1155/2015/808531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/28/2015] [Indexed: 01/14/2023]
Abstract
In order to better understand the ovarian serous carcinogenic process with tubal origin, we investigated the expression of stem cell markers in premalignant tubal lesions (serous tubal intraepithelial carcinoma or STIC). We found an increased stem cell marker density in the normal fallopian tube followed by a high CD117 and a low ALDH and CD44 expression in STICs raising the question of the role of the stem cell markers in the serous carcinogenic process.
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Selmes G, Ferron G, Filleron T, Querleu D, Mery E. Lésions épithéliales précoces dans les annexectomies prophylactiques chez des patientes à haut risque de cancer de l’ovaire : à propos d’une série de 93 cas. ACTA ACUST UNITED AC 2015; 43:659-64. [DOI: 10.1016/j.gyobfe.2015.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/08/2015] [Indexed: 12/31/2022]
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DNA Damage Signaling and Apoptosis in Preinvasive Tubal Lesions of Ovarian Carcinoma. Int J Gynecol Cancer 2015; 25:761-9. [DOI: 10.1097/igc.0000000000000196] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Eken M, Temizkan O, Kaygusuz EI, Herkiloğlu D, Çöğendez E, Karateke A. Primary carcinoma of the fallopian tubes: Analysis of sixteen patients. Turk J Obstet Gynecol 2015; 12:83-88. [PMID: 28913049 PMCID: PMC5558382 DOI: 10.4274/tjod.67355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/07/2015] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of this study was to review patients with tubal carcinoma who underwent surgery in our clinic due to primary carcinoma of the fallopian tubes, a very rare gynecologic malignancy. MATERIALS AND METHODS Sixteen patients who were diagnosed as having primary carcinoma of the fallopian tubes and underwent surgery in Zeynep Kamil Research and Training Hospital between January 2007 and December 2014 were included in the study. Demographic data such as age, gravidity, parity, menopausal condition, symptoms, adjuvant therapy, recurrence of tumor, as well as time and type of operation were extracted from patient epicrisis reports and oncology files. Patient information was extracted from the patients' current files and phone calls were made with patients and their relatives. RESULTS The mean age of patients was 59.6 (range, 43-78) years. Seventy-five percent of the women were menopausal at admission; the mean menopause duration was 10 years (range, 1-20 years). None of the patients were nulliparous and mean parity was 4.3 (2-8). The most common presenting symptom was abdominopelvic pain, followed by abnormal uterine bleeding. The most common histopathologic type was high-grade serous carcinoma. The mean follow-up duration was 23.7 months (range, 2-53 months). During follow-up, recurrence was seen in 4 (25%) patients. One patient left the study during follow-up. The mean disease-free survival was 48 months. No relation was found between disease-free survival, age, stage, grade, and histologic type in univariate logistic regression analysis. CONCLUSION Primary carcinoma of the fallopian tubes is a rare gynecologic tumor that is seen in older patients, has no specific signs, and usually cannot be diagnosed before surgery. Therefore, we think that large-series, multi-centered studies with long-term follow-up duration are needed to define its etiopathogenesis and treatment strategies for the disease.
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Affiliation(s)
- Meryem Eken
- Zeynep Kamil Training and Research Hospital, Clinic of Gynecology and Obstetrics, İstanbul, Turkey
| | - Osman Temizkan
- Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Gynecology and Obstetrics, İstanbul, Turkey
| | - Ecmel Işık Kaygusuz
- Zeynep Kamil Training and Research Hospital, Clinic of Pathology, İstanbul, Turkey
| | - Dilşad Herkiloğlu
- Zeynep Kamil Training and Research Hospital, Clinic of Gynecology and Obstetrics, İstanbul, Turkey
| | - Ebru Çöğendez
- Zeynep Kamil Training and Research Hospital, Clinic of Gynecology and Obstetrics, İstanbul, Turkey
| | - Ateş Karateke
- Zeynep Kamil Training and Research Hospital, Clinic of Gynecology and Obstetrics, İstanbul, Turkey
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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] [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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Chene G, Lamblin G, Le Bail-Carval K, Chabert P, Golfier F, Dauplat J, Deligdisch L, Penault-Llorca F, Mellier G. [Prophylactic salpingectomy or salpingo-oophorectomy as an ovarian cancer prevention?]. Presse Med 2015; 44:317-23. [PMID: 25578546 DOI: 10.1016/j.lpm.2014.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 06/06/2014] [Accepted: 07/03/2014] [Indexed: 10/24/2022] Open
Abstract
A recent hypothesis has stated that many ovarian cancers (especially high-grade serous histotype) could arise from the distal part of the fallopian tube. On one hand we know that risk-reducing salpingo-oophorectomy is the most effective prevention for ovarian cancer among BRCA mutation carriers. On the other, oophorectomy increases the relative risk for cardiovascular, osteoporotic psychosexual and cognitive dysfunctions in premenopausal women. This raises the question whether bilateral salpingectomy could be an effective strategy in the prevention of ovarian cancer in case of hereditary predisposition and in the general population. Here we discuss origin of ovarian cancer in the light of the latest molecular studies and the relative risks and benefits of a strategy of exclusive salpingectomy in comparison with the classical adnexectomy.
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Affiliation(s)
- Gautier Chene
- CHU Lyon Est, hôpital femme mère enfant, département de gynécologie-obstétrique, université Claude-Bernard Lyon 1, 69000 Lyon, France.
| | - Gery Lamblin
- CHU Lyon Est, hôpital femme mère enfant, département de gynécologie-obstétrique, université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - Karine Le Bail-Carval
- CHU Lyon Est, hôpital femme mère enfant, département de gynécologie-obstétrique, université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - Philippe Chabert
- CHU Lyon Est, hôpital femme mère enfant, département de gynécologie-obstétrique, université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - François Golfier
- Université Claude-Bernard Lyon 1, département de gynécologie-obstétrique, centre hospitalier Lyon Sud, 69000 Lyon, France
| | - Jacques Dauplat
- Centre Jean-Perrin, département de chirurgie, 63000 Clermont-Ferrand, France
| | - Liane Deligdisch
- Mount Sinai School of Medicine, département de pathologie, 10029 New York, États-Unis
| | - Frédérique Penault-Llorca
- Centre Jean-Perrin, département d'anatomie et cytologie pathologiques, 63000 Clermont-Ferrand, France
| | - Georges Mellier
- CHU Lyon Est, hôpital femme mère enfant, département de gynécologie-obstétrique, université Claude-Bernard Lyon 1, 69000 Lyon, France
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Morphological and immunohistochemical pattern of tubo-ovarian dysplasia and serous tubal intraepithelial carcinoma. Eur J Obstet Gynecol Reprod Biol 2014; 183:89-95. [PMID: 25461359 DOI: 10.1016/j.ejogrb.2014.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 08/05/2014] [Accepted: 10/03/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Histopathological examination of material from prophylactic salpingo-oophorectomies performed in patients at genetic risk of ovarian cancer can reveal abnormalities interpreted as possible pre-cancerous "ovarian dysplasia" and tubal precursors lesions. We sought to study the morphological features and immunohistochemical expression patterns of neoplasia-associated markers in prophylactically removed ovaries and fallopian tubes (pBSO) in comparison with a group of serous tubal intraepithelial carcinoma (STIC) and non-cancerous controls. STUDY DESIGN Morphological features and immunohistochemical expression patterns of Ki-67 (for proliferation biomarker), p53 (key pathway of mullerian serous tumorogenesis), Bcl2 (anti-apoptotic), γH2AX (a double-strand breaks marker) and ALDH1 (a stem cell marker significantly associated with early-stage ovarian cancer) were blindly evaluated by two pathologists in 111 pBSO, 12 STICs and 116 non-cancerous salpingo-oophorectomies (control group) (nBSO). RESULTS Morphological ovarian and tubal dysplasia scores were significantly higher in the pBSO than in controls (respectively, 8.8 vs 3.12, p<0.0001, for ovaries and 6.54 vs 1.58, p<0.0001 for tubes). Increased γH2AX expression was observed in the pBSO and STICs compared with the controls whereas expression patterns of Ki67, p53 and bcl2 were low to moderate in the pBSO group. STICs overexpressed Ki67 and p53 while bcl2 expression was low; Interestingly, ALDH1 expression was low in non dysplastic epithelium, high in dysplasia and constantly low in STICs. CONCLUSION The morphological and immunohistochemical profile of tubo-ovarian dysplasia and STICs might be consistent with progression toward neoplastic transformation in the Serous Carcinogenesis Sequence. These changes may be pre-malignant and could represent an important phase in early neoplasia. ALDH1 activation in pBSO samples and its extinction in STICs should be considered as a target for prevention.
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Sahai P, Kakkar A, Pathy S, Kumar L, Bhatla N, Chander S. Synchronous malignant mixed Müllerian tumor of the uterus with transitional cell carcinoma of the ovary. J Obstet Gynaecol Res 2014; 41:319-23. [PMID: 25227514 DOI: 10.1111/jog.12510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/28/2014] [Indexed: 11/30/2022]
Abstract
A 55-year-old woman presented with a complaint of post-menopausal bleeding per vaginum. Local examination revealed a mass, protruding from the cervical os, which detached spontaneously. An adnexal mass was felt through the pouch of Douglas on per vaginum examination. Histopathological examination of the avulsed specimen revealed a diagnosis of malignant mixed Müllerian tumor. The patient underwent surgical staging with total abdominal hysterectomy, bilateral salpingo-oophorectomy, left pelvic lymphadenectomy, infracolic omentectomy, and peritoneal wash cytology. Pathological examination revealed a second primary tumor, that is, a transitional cell carcinoma of the ovary. Both the uterine malignant mixed Müllerian tumor and the ovarian transitional cell carcinoma were staged as IA. Subsequently, the patient was treated with adjuvant chemotherapy followed by radiotherapy. The patient is in complete remission at 1 year following the treatment. Synchronous genital tract neoplasms constitute a therapeutic challenge and necessitate an effective multimodality therapeutic approach based on meticulous pathological examination and tumor staging.
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Affiliation(s)
- Puja Sahai
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Koç N, Ayas S, Uygur L. The association of serous tubal intraepithelial carcinoma with gynecologic pathologies and its role in pelvic serous cancer. Gynecol Oncol 2014; 134:486-91. [PMID: 25038287 DOI: 10.1016/j.ygyno.2014.07.089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/08/2014] [Accepted: 07/13/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Possible primary sites of pelvic serous cancers are, fallopian tubes, ovaries or peritoneum. Recent studies have revealed that a portion of these tumors originates from serous tubal intraepithelial carcinoma (STIC) at the distal end of fallopian tubes. In this study, the association of STIC with pelvic serous carcinomas and the pathologic parameters that indicate the tubes as the primary site were assessed. METHODS In total, 495 pairs of fallopian tubes obtained via total abdominal hysterectomy and bilateral salpingo-oophorectomy between 2011 and 2013 were examined according to SEE-FIM protocol. Hematoxylin and eosin-stained slides were examined by pathologists. Suspicious areas were immunostained with p53 and Ki-67 to diagnose STIC precisely. RESULTS Of the 495 cases, 110 cases were malignant. Among 34 cases of non-uterine serous carcinomas, 13 were diagnosed with STIC. STIC was located at the fimbrial end of the fallopian tubes in 12 cases. No STIC was identified in the gynecologic malignancies other than non-uterine serous pelvic carcinomas and benign gynecologic pathologies. Comparison of the ovarian and tubal cancer cases with and without STIC did not reveal a factor that helps to define the primary site. STIC was an important factor associated in a higher portion of the cases with bilateral ovarian cancer. CONCLUSION The role of STIC in carcinogenesis continues to be discussed as it is unknown whether STIC is the precursor lesion or just associates with the malignancies. Discovering the accurate precursor lesions and tumor carcinogenesis is essential to prevent these malignancies and to develop early diagnostic methods.
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Affiliation(s)
- Nermin Koç
- Zeynep Kamil Women and Children Diseases Research and Training Hospital, Department of Pathology, Turkey
| | - Selçuk Ayas
- Zeynep Kamil Women and Children Diseases Research and Training Hospital, Department of Gyneoncology, Turkey
| | - Lütfiye Uygur
- Zeynep Kamil Women and Children Diseases Research and Training Hospital, Department of Obstetrics and Gynecology, Turkey.
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Recent concepts of ovarian carcinogenesis: type I and type II. BIOMED RESEARCH INTERNATIONAL 2014; 2014:934261. [PMID: 24868556 PMCID: PMC4017729 DOI: 10.1155/2014/934261] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/31/2014] [Indexed: 02/06/2023]
Abstract
Type I ovarian tumors, where precursor lesions in the ovary have clearly been described, include endometrioid, clear cell, mucinous, low grade serous, and transitional cell carcinomas, while type II tumors, where such lesions have not been described clearly and tumors may develop de novo from the tubal and/or ovarian surface epithelium, comprise high grade serous carcinomas, undifferentiated carcinomas, and carcinosarcomas. The carcinogenesis of endometrioid and clear cell carcinoma (CCC) arising from endometriotic cysts is significantly influenced by the free iron concentration, which is associated with cancer development through the induction of persistent oxidative stress. A subset of mucinous carcinomas develop in association with ovarian teratomas; however, the majority of these tumors do not harbor any teratomatous component. Other theories of their origin include mucinous metaplasia of surface epithelial inclusions, endometriosis, and Brenner tumors. Low grade serous carcinomas are thought to evolve in a stepwise fashion from benign serous cystadenoma to a serous borderline tumor (SBT). With regard to high grade serous carcinoma, the serous tubal intraepithelial carcinomas (STICs) of the junction of the fallopian tube epithelium with the mesothelium of the tubal serosa, termed the “tubal peritoneal junction” (TPJ), undergo malignant transformation due to their location, and metastasize to the nearby ovary and surrounding pelvic peritoneum. Other theories of their origin include the ovarian hilum cells.
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36
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Chene G, Radosevic-Robin N, Tardieu AS, Cayre A, Raoelfils I, Dechelotte P, Dauplat J, Penault Llorca F. Morphological and immunohistochemical study of ovarian and tubal dysplasia associated with tamoxifen. Eur J Histochem 2014; 58:2251. [PMID: 24998918 PMCID: PMC4083318 DOI: 10.4081/ejh.2014.2251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 02/27/2014] [Accepted: 03/03/2014] [Indexed: 01/16/2023] Open
Abstract
Ovarian epithelial dysplasia was initially described in material from prophylactic oophorectomies for BReast CAncer gene (BRCA) mutation. Similar histopathological abnormalities have been revealed after ovulation stimulation. Given that tamoxifen (TAM) has a clomid-like effect and is sometimes used to induce ovulation, we studied the morphological features and immunohistochemical expression patterns of neoplasia-associated markers in adnexectomies previously exposed to TAM for breast cancer. We blindly reviewed 173 histopathological slides of adnexectomies according to three groups – oophorectomies associated with TAM exposure (n=42), oophorectomies associated with clomiphene exposure (n=15) and a spontaneously fertile non cancerous control group (n=116). Morphological features (with an ovarian and tubal dysplasia scoring system) and immunohistochemical expression patterns of Ki-67, p53 and Aldehyde dehydrogenase 1 (ALDH1 is an enzyme significantly associated with earlystage ovarian cancer) were evaluated and correlated. Mean tubal dysplasia score was significantly higher in the TAM group and clomiphen group than in controls (respectively 7.8 vs 3.5, P<0.007 and 6.8 vs 3.5, P=0.008). There is no statistical difference for the ovarian score in TAM group in comparison with the control group whereas we found a significant score for clomiphen group (6.5, P=0.009). Increased ALDH1 expression was observed in the two exposed group whereas expression patterns of Ki67 and p53 were moderate. Interestingly, ALDH1 expression was low in non-dysplastic epithelium, high in dysplasia, and constantly low in the two carcinoma. Furthemore, we confirm our previous results showing that ALDH1 may be a useful tissue biomarker in the subtle histopathological diagnosis of tubo-ovarian dysplasia.
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Affiliation(s)
- G Chene
- Centre Jean Perrin, ERTICA Research Team.
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37
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Morphological and immunohistochemical analysis in ovaries and fallopian tubes of tamoxifen, letrozole and clomiphene-treated rats. Arch Gynecol Obstet 2014; 290:553-9. [DOI: 10.1007/s00404-014-3234-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
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Early preinvasive lesions in ovarian cancer. BIOMED RESEARCH INTERNATIONAL 2014; 2014:639252. [PMID: 24804229 PMCID: PMC3997076 DOI: 10.1155/2014/639252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/02/2014] [Accepted: 03/03/2014] [Indexed: 01/15/2023]
Abstract
Faced with the catastrophic prognosis for ovarian cancer due to the fact that it is most often diagnosed late at the peritoneal carcinomatosis stage, screening and early detection could probably reduce the mortality rate. A better understanding of the molecular characteristics of the different ovarian cancer subtypes and their specific molecular signatures is indispensable prior to development of new screening strategies. We discuss here the early natural history of ovarian cancer and its origins.
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Sama AR, Schilder RJ. Refractory fallopian tube carcinoma - current perspectives in pathogenesis and management. Int J Womens Health 2014; 6:149-57. [PMID: 24511245 PMCID: PMC3913505 DOI: 10.2147/ijwh.s40889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Fallopian tube carcinoma (FTC) is considered a rare malignancy, but recent evidence shows that its incidence may have been underestimated. Risk-reducing salpingo-oophorectomy (RRSO) in breast cancer susceptibility gene (BRCA)-positive women has provided a unique opportunity to study the pathogenesis of FTC and ovarian carcinomas. Newer data now suggest that most high-grade serous cancers of the ovary originate in the fimbrial end of the fallopian tube. Due to the presumed rarity of FTC, most current and more recent ovarian cancer clinical trials have now included patients with FTC. The treatment guidelines recommend similar overall management and that the same chemotherapy regimens be used for epithelial ovarian cancers and FTC.
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Affiliation(s)
- Ashwin R Sama
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Russell J Schilder
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
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40
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Chene G, Tchirkov A, Pierre-Eymard E, Dauplat J, Raoelfils I, Cayre A, Watkin E, Vago P, Penault-Llorca F. Early telomere shortening and genomic instability in tubo-ovarian preneoplastic lesions. Clin Cancer Res 2013; 19:2873-82. [PMID: 23589176 DOI: 10.1158/1078-0432.ccr-12-3947] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Genetic instability plays an important role in ovarian carcinogenesis. We investigated the level of telomere shortening and genomic instability in early and preinvasive stages of ovarian cancer, serous tubal intraepithelial carcinoma (STIC), and tubo-ovarian dysplasia (TOD). EXPERIMENTAL DESIGN Fifty-one TOD from prophylactic salpingo-oophorectomies with BRCA1 or 2 mutation, 12 STICs, 53 tubo-ovarian high-grade serous carcinoma, and 36 noncancerous controls were laser capture microdissected from formalin-fixed, paraffin-embedded sections, analyzed by comparative genomic hybridization (array CGH) and for telomere length (using quantitative real-time PCR based on the Cawthon's method). TOD and STICs were defined by morphologic scores and immunohistochemical expressions of p53, Ki67, and γH2AX. RESULTS TOD showed marked telomere shortening compared with noncancerous controls (P < 10(-7)). STICs had even shorter telomeres than TOD (P = 0.0008). Ovarian carcinoma had shorter telomeres than controls but longer than STICs and dysplasia. In TOD, telomeres were significantly shorter in those with BRCA1 mutation than in those with BRCA2 mutation (P = 0.005). In addition, γH2AX expression in TOD and STIC groups with short telomeres was significantly increased (P < 10(-7)). In dysplastic epithelium, we found subtle genomic alterations, in contrast to more important genomic imbalances in STICs. The total number of genetic alterations was the highest in ovarian cancers. CONCLUSIONS These findings suggest that genetic instability occurs in early stages of ovarian tumorigenesis. STICs and noninvasive dysplasia are likely an important step in early serous ovarian neoplasia.
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Affiliation(s)
- Gautier Chene
- Department of Histopathology, Centre Jean Perrin, ERTICA Research Team, Clermont-Ferrand, France.
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