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Ritch SJ, Telleria CM. The Transcoelomic Ecosystem and Epithelial Ovarian Cancer Dissemination. Front Endocrinol (Lausanne) 2022; 13:886533. [PMID: 35574025 PMCID: PMC9096207 DOI: 10.3389/fendo.2022.886533] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Epithelial ovarian cancer (EOC) is considered the deadliest gynecological disease and is normally diagnosed at late stages, at which point metastasis has already occurred. Throughout disease progression, EOC will encounter various ecosystems and the communication between cancer cells and these microenvironments will promote the survival and dissemination of EOC. The primary tumor is thought to develop within the ovaries or the fallopian tubes, both of which provide a microenvironment with high risk of causing DNA damage and enhanced proliferation. EOC disseminates by direct extension from the primary tumors, as single cells or multicellular aggregates. Under the influence of cellular and non-cellular factors, EOC spheroids use the natural flow of peritoneal fluid to reach distant organs within the peritoneal cavity. These cells can then implant and seed distant organs or tissues, which develop rapidly into secondary tumor nodules. The peritoneal tissue and the omentum are two common sites of EOC metastasis, providing a microenvironment that supports EOC invasion and survival. Current treatment for EOC involves debulking surgery followed by platinum-taxane combination chemotherapy; however, most patients will relapse with a chemoresistant disease with tumors developed within the peritoneum. Therefore, understanding the role of the unique microenvironments that promote EOC transcoelomic dissemination is important in improving patient outcomes from this disease. In this review article, we address the process of ovarian cancer cellular fate at the site of its origin in the secretory cells of the fallopian tube or in the ovarian surface epithelial cells, their detachment process, how the cells survive in the peritoneal fluid avoiding cell death triggers, and how cancer- associated cells help them in the process. Finally, we report the mechanisms used by the ovarian cancer cells to adhere and migrate through the mesothelial monolayer lining the peritoneum. We also discuss the involvement of the transcoelomic ecosystem on the development of chemoresistance of EOC.
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Affiliation(s)
- Sabrina J. Ritch
- Experimental Pathology Unit, Department of Pathology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Carlos M. Telleria
- Experimental Pathology Unit, Department of Pathology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Cancer Research Program, Research Institute, McGill University Health Centre, Montreal, QC, Canada
- *Correspondence: Carlos M. Telleria, ; orcid.org/0000-0003-1070-3538
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Mutated p53 in HGSC-From a Common Mutation to a Target for Therapy. Cancers (Basel) 2021; 13:cancers13143465. [PMID: 34298679 PMCID: PMC8304959 DOI: 10.3390/cancers13143465] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Ovarian high-grade serous cancer (HGSC), the most common and the deadliest subtype of epithelial ovarian cancer, is characterized by frequent mutations in the TP53 tumor suppressor gene, encoding for the p53 protein in nearly 100% of cases. This makes p53 the focus of many studies trying to understand its role in HGSC. The aim of our review paper is to provide updates on the latest findings related to the role of mutant p53 in HGSC. This includes the clinical outcomes of TP53 mutations in HGSC, upstream regulators and downstream effectors of p53, its function in the earliest stages of HGSC development and in the interplay between the tumor cells and their microenvironment. We summarize with the likelihood of p53 mutants to serve as biomarkers for early diagnosis and as targets for therapy in HGSC. Abstract Mutations in tumor suppressor gene TP53, encoding for the p53 protein, are the most ubiquitous genetic variation in human ovarian HGSC, the most prevalent and lethal histologic subtype of epithelial ovarian cancer (EOC). The majority of TP53 mutations are missense mutations, leading to loss of tumor suppressive function of p53 and gain of new oncogenic functions. This review presents the clinical relevance of TP53 mutations in HGSC, elaborating on several recently identified upstream regulators of mutant p53 that control its expression and downstream target genes that mediate its roles in the disease. TP53 mutations are the earliest genetic alterations during HGSC pathogenesis, and we summarize current information related to p53 function in the pathogenesis of HGSC. The role of p53 is cell autonomous, and in the interaction between cancer cells and its microenvironment. We discuss the reduction in p53 expression levels in tumor associated fibroblasts that promotes cancer progression, and the role of mutated p53 in the interaction between the tumor and its microenvironment. Lastly, we discuss the potential of TP53 mutations to serve as diagnostic biomarkers and detail some more advanced efforts to use mutated p53 as a therapeutic target in HGSC.
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Ovarian BDNF promotes survival, migration, and attachment of tumor precursors originated from p53 mutant fallopian tube epithelial cells. Oncogenesis 2020; 9:55. [PMID: 32471985 PMCID: PMC7260207 DOI: 10.1038/s41389-020-0243-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 02/08/2023] Open
Abstract
High-grade serous ovarian carcinoma (HGSOC) is the most lethal gynecological malignancy. New evidence supports a hypothesis that HGSOC can originate from fallopian tube epithelium (FTE). It is unclear how genetic alterations and pathophysiological processes drive the progression of FTE tumor precursors into widespread HGSOCs. In this study, we uncovered that brain-derived neurotrophic factor (BDNF) in the follicular fluid stimulates the tropomyosin receptor kinase B (TrkB)-expressing FTE cells to promote their survival, migration, and attachment. Using in vitro and in vivo models, we further identified that the acquisition of common TP53 gain-of-function (GOF) mutations in FTE cells led to enhanced BDNF/TrkB signaling compared to that of FTE cells with TP53 loss-of-function (LOF) mutations. Different mutant p53 proteins can either increase TrkB transcription or enhance TrkB endocytic recycling. Our findings have demonstrated possible interplays between genetic alterations in FTE tumor precursors (i.e., p53 GOF mutations) and pathophysiological processes (i.e., the release of follicular fluid upon ovulation) during the initiation of HGSOC from the fallopian tube. Our data revealed molecular events underlying the link between HGSOC tumorigenesis and ovulation, a physiological process that has been associated with risk factors of HGSOC.
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Mara JN, Zhou LT, Larmore M, Johnson B, Ayiku R, Amargant F, Pritchard MT, Duncan FE. Ovulation and ovarian wound healing are impaired with advanced reproductive age. Aging (Albany NY) 2020; 12:9686-9713. [PMID: 32407290 PMCID: PMC7288922 DOI: 10.18632/aging.103237] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/31/2020] [Indexed: 12/14/2022]
Abstract
Aging is associated with reduced tissue remodeling efficiency and increased fibrosis, characterized by excess collagen accumulation and altered matrix degradation. Ovulation, the process by which an egg is released from the ovary, is one of the most dynamic cycles of tissue wounding and repair. Because the ovary is one of the first organs to age, ovulation and ovarian wound healing is impaired with advanced reproductive age. To test this hypothesis, we induced superovulation in reproductively young and old mice and determined the numbers of eggs ovulated and corpora lutea (CLs), the progesterone producing glands formed post-ovulation. Reproductively old mice ovulated fewer eggs and had fewer CLs relative to young controls. Moreover, reproductively old mice exhibited a greater number of oocytes trapped within CLs and expanded cumulus oocyte complexes within unruptured antral follicles, indicative of failed ovulation. In addition, post-ovulatory tissue remodeling was compromised with age as evidenced by reduced CL vasculature, increased collagen, decreased hyaluronan, decreased cell proliferation and apoptosis, impaired wound healing capacity, and aberrant morphology of the ovarian surface epithelium (OSE). These findings demonstrate that ovulatory dysfunction is an additional mechanism underlying the age-related loss of fertility beyond the reduction of egg quantity and quality.
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Affiliation(s)
- Jamie N. Mara
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Luhan T. Zhou
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Megan Larmore
- Department of Comparative Medicine, University of Washington, Seattle, WA 98195, USA
| | - Brian Johnson
- Department of Comparative Medicine, University of Washington, Seattle, WA 98195, USA
| | - Rebecca Ayiku
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Farners Amargant
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Michele T. Pritchard
- Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Francesca E. Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Bajwa P, Nagendra PB, Nielsen S, Sahoo SS, Bielanowicz A, Lombard JM, Wilkinson JE, Miller RA, Tanwar PS. Age related increase in mTOR activity contributes to the pathological changes in ovarian surface epithelium. Oncotarget 2017; 7:19214-27. [PMID: 27036037 PMCID: PMC4991377 DOI: 10.18632/oncotarget.8468] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/23/2016] [Indexed: 12/13/2022] Open
Abstract
Ovarian cancer is a disease of older women. However, the molecular mechanisms of ovarian aging and their contribution to the pathogenesis of ovarian cancer are currently unclear. mTOR signalling is a major regulator of aging as suppression of this pathway extends lifespan in model organisms. Overactive mTOR signalling is present in up to 80% of ovarian cancer samples and is associated with poor prognosis. This study examined the role of mTOR signalling in age-associated changes in ovarian surface epithelium (OSE). Histological examination of ovaries from both aged mice and women revealed OSE cell hyperplasia, papillary growth and inclusion cysts. These pathological lesions expressed bonafide markers of ovarian cancer precursor lesions, Pax8 and Stathmin 1, and were presented with elevated mTOR signalling. To understand whether overactive mTOR signalling is responsible for the development of these pathological changes, we analysed ovaries of the Pten trangenic mice and found significant reduction in OSE lesions compared to controls. Furthermore, pharmacological suppression of mTOR signalling significantly decreased OSE hyperplasia in aged mice. Treatment with mTOR inhibitors reduced human ovarian cancer cell viability, proliferation and colony forming ability. Collectively, we have established the role of mTOR signalling in age-related OSE pathologies and initiation of ovarian cancer.
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Affiliation(s)
- Preety Bajwa
- Gynaecology Oncology Group, School of Biomedical Sciences and Pharmacy, New South Wales, Australia
| | - Prathima B Nagendra
- Gynaecology Oncology Group, School of Biomedical Sciences and Pharmacy, New South Wales, Australia
| | | | - Subhransu S Sahoo
- Gynaecology Oncology Group, School of Biomedical Sciences and Pharmacy, New South Wales, Australia
| | - Amanda Bielanowicz
- Gynaecology Oncology Group, School of Biomedical Sciences and Pharmacy, New South Wales, Australia
| | - Janine M Lombard
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Division of Gynaecology Oncology, Department of Medical Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - J Erby Wilkinson
- Unit for Laboratory Animal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Richard A Miller
- Department of Pathology and Geriatrics Center, University of Michigan, Ann Arbor, MI, USA
| | - Pradeep S Tanwar
- Gynaecology Oncology Group, School of Biomedical Sciences and Pharmacy, New South Wales, Australia
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6
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Molecular analysis of high-grade serous ovarian carcinoma with and without associated serous tubal intra-epithelial carcinoma. Nat Commun 2017; 8:990. [PMID: 29042553 PMCID: PMC5645359 DOI: 10.1038/s41467-017-01217-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 08/30/2017] [Indexed: 01/04/2023] Open
Abstract
Many high-grade serous carcinomas (HGSCs) of the pelvis are thought to originate in the distal portion of the fallopian tube. Serous tubal intra-epithelial carcinoma (STIC) lesions are the putative precursor to HGSC and identifiable in ~ 50% of advanced stage cases. To better understand the molecular etiology of HGSCs, we report a multi-center integrated genomic analysis of advanced stage tumors with and without STIC lesions and normal tissues. The most significant focal DNA SCNAs were shared between cases with and without STIC lesions. The RNA sequence and the miRNA data did not identify any clear separation between cases with and without STIC lesions. HGSCs had molecular profiles more similar to normal fallopian tube epithelium than ovarian surface epithelium or peritoneum. The data suggest that the molecular features of HGSCs with and without associated STIC lesions are mostly shared, indicating a common biologic origin, likely to be the distal fallopian tube among all cases.High-grade serous carcinomas (HGSCs) are associated with precursor lesions (STICs) in the fallopian epithelium in only half of the cases. Here the authors report the molecular analysis of HGSCs with and without associated STICs and show similar profiles supporting a common origin for all HGSCs.
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Wang Y, Wang Y, Wei L, Hong S, Zhao M, Zhang X, Zheng W. BRCA1 expression, proliferative and apoptotic activities in ovarian epithelial inclusions. J Ovarian Res 2017; 10:12. [PMID: 28270171 PMCID: PMC5341199 DOI: 10.1186/s13048-017-0307-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine proliferative and apoptotic activity in relation with BRCA1 expression in ovarian epithelial inclusions (OEIs), the putative precursor lesions of ovarian epithelial cancer (OEC). METHODS Benign ovaries from 95 patients were examined. Dual immunohistochemical staining for both BRCA1 and MIB-1 were performed to examine the relationship between BRCA1 and MIB-1 in OEI cells. Apoptotic activity was assessed on the parallel tissue sections by using TUNEL assay. Patients' age, menstrual phase and menopausal status were analyzed. RESULTS OEIs were present in the ovaries of 53% of the patients. OEIs were less frequently found in premenopausal (45%) than postmenopausal women (58%). BRCA1 and MIB-1 were found in 27 and 47% of the OEI-containing ovaries, respectively. All BRCA1 positive OEI cells are MIB-1 positive with dual staining method, although overall the percentage of positive cells was small. No significant difference was found for BRCA1 and MIB-1 expression in OEIs between menopausal status and menstrual phases. Apoptosis containing OEIs were seen in 70% of the ovaries. Compared to OEIs in proliferative menstrual phase and premenopausal status, significantly more apoptosis was found in OEIs from secretory phase and postmenopausal women. A small fraction of the epithelial cells within OEIs are proliferating or dying. CONCLUSIONS Low estrogen and/or high progesterone levels may promote OEI cell turnover via induction of apoptosis. Imbalance between cell proliferation and death within OEIs under influence of hormones may play a role in the ovarian epithelial tumorigenesis.
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Affiliation(s)
- Yiying Wang
- Department of Obstetrics and Gynecology, Henan Province People’s Hospital, Zhengzhou, China
- Department of Obstetrics and Gynecology, Zhengzhou University People’s Hospital, Zhengzhou, China
| | - Yue Wang
- Department of Obstetrics and Gynecology, Henan Province People’s Hospital, Zhengzhou, China
- Department of Obstetrics and Gynecology, Zhengzhou University People’s Hospital, Zhengzhou, China
| | - Li Wei
- Department of Obstetrics and Gynecology, Henan Province People’s Hospital, Zhengzhou, China
- Department of Obstetrics and Gynecology, Zhengzhou University People’s Hospital, Zhengzhou, China
| | - Shuhui Hong
- Department of Gynecology, Qianfoshan Hospital of Shandong University, Ji’nan, China
- Department of Pathology, University of Texas Southwestern Medical Center, 6000 Harry Hines Blvd, NB6.408, Dallas, 75390-9072 TX USA
| | - Miaoqing Zhao
- Department of Pathology, Provincial Hospital Affiliated to Shandong University, Ji’nan, China
- Department of Pathology, University of Texas Southwestern Medical Center, 6000 Harry Hines Blvd, NB6.408, Dallas, 75390-9072 TX USA
| | - Xi Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji’nan, China
| | - Wenxin Zheng
- Department of Pathology, University of Texas Southwestern Medical Center, 6000 Harry Hines Blvd, NB6.408, Dallas, 75390-9072 TX USA
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 6000 Harry Hines Blvd, NB6.408, Dallas, 75390-9072 TX USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX USA
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Salpingectomy and prevention of ovarian carcinoma. Gynecol Minim Invasive Ther 2016. [DOI: 10.1016/j.gmit.2015.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Serous Tubal Intraepithelial Carcinoma Localizes to the Tubal-peritoneal Junction. Int J Gynecol Pathol 2015; 34:112-20. [DOI: 10.1097/pgp.0000000000000123] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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10
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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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12
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Dubeau L, Drapkin R. Coming into focus: the nonovarian origins of ovarian cancer. Ann Oncol 2014; 24 Suppl 8:viii28-viii35. [PMID: 24131966 DOI: 10.1093/annonc/mdt308] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The traditional view of epithelial ovarian cancer asserts that all tumor subtypes share a common origin in the ovarian surface epithelium (OSE) DESIGN: A literature review was carried out to summarize the emerging understanding of extraovarian sources of epithelial ovarian carcinomas. RESULTS Historically, there were no diagnostic criteria for documenting the origin of ovarian epithelial carcinomas. Moreover, there are no normal epithelial tissues in the ovary with morphologic similarities to these tumors. In fact, no precursor lesions have ever been reproducibly identified in the ovary. However, there is a strong correlation between extrauterine Müllerian tissue and the development of ovarian carcinomas, tumors of low malignant potential, and cystadenomas. The most recent support for this hypothesis comes from the careful analysis of risk-reducing bilateral salpingo-oopherectomy specimens from BRCA1 or BRCA2 mutation carriers. These studies showed that a significant majority of high-grade serous ovarian carcinomas, the most common subtype, arise from the fallopian tube fimbriae rather than the OSE. CONCLUSIONS Mounting evidence indicates that the vast majority of epithelial ovarian carcinomas are not ovarian in origin. Extrauterine Müllerian epithelium from various sites in the reproductive tract likely accounts for the diverse morphology and behavior of these tumors.
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Affiliation(s)
- L Dubeau
- Department of Pathology, USC Norris Comprehensive Cancer Center and Hospital, University of Southern California, Los Angeles
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13
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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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14
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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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15
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Smith ER, Wang Y, Xu XX. Development of a mouse model of menopausal ovarian cancer. Front Oncol 2014; 4:36. [PMID: 24616881 PMCID: PMC3935315 DOI: 10.3389/fonc.2014.00036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/12/2014] [Indexed: 01/08/2023] Open
Abstract
Despite significant understanding of the genetic mutations involved in ovarian epithelial cancer and advances in genomic approaches for expression and mutation profiling of tumor tissues, several key questions in ovarian cancer biology remain enigmatic: the mechanism for the well-established impact of reproductive factors on ovarian cancer risk remains obscure; cell of origin of ovarian cancer continue to be debated; and the precursor lesion, sequence, or events in progression remain to be defined. Suitable mouse models should complement the analysis of human tumor tissues and may provide clues to these questions currently perplexing ovarian cancer biology. A potentially useful model is the germ cell-deficient Wv (white spotting variant) mutant mouse line, which may be used to study the impact of menopausal physiology on the increased risk of ovarian cancer. The Wv mice harbor a point mutation in c-Kit that reduces the receptor tyrosine kinase activity to about 1–5% (it is not a null mutation). Homozygous Wv mutant females have a reduced ovarian germ cell reservoir at birth and the follicles are rapidly depleted upon reaching reproductive maturity, but other biological phenotypes are minimal and the mice have a normal life span. The loss of ovarian function precipitates changes in hormonal and metabolic activity that model features of menopause in humans. As a consequence of follicle depletion, the Wv ovaries develop ovarian tubular adenomas, a benign epithelial tumor corresponding to surface epithelial invaginations and papillomatosis that mark human ovarian aging. Ongoing work will test the possibility of converting the benign epithelial tubular adenomas into neoplastic tumors by addition of an oncogenic mutation, such as of Tp53, to model the genotype and biology of serous ovarian cancer. Model based on the Wv mice may have the potential to gain biological and etiological insights into ovarian cancer development and prevention.
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Affiliation(s)
- Elizabeth R Smith
- Department of Cell Biology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine , Miami, FL , USA
| | - Ying Wang
- Department of Cell Biology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine , Miami, FL , USA
| | - Xiang-Xi Xu
- Department of Cell Biology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine , Miami, FL , USA ; Department of Obstetrics and Gynecology, University of Miami School of Medicine , Miami, FL , USA
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16
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Chene G, Dauplat J, Radosevic-Robin N, Cayre A, Penault-Llorca F. Tu-be or not tu-be: that is the question… about serous ovarian carcinogenesis. Crit Rev Oncol Hematol 2013; 88:134-43. [PMID: 23523591 DOI: 10.1016/j.critrevonc.2013.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 01/01/2013] [Accepted: 03/06/2013] [Indexed: 12/31/2022] Open
Abstract
Our understanding of the early natural history of epithelial ovarian carcinoma is limited by the access to early lesions as the disease is very often diagnosed at advanced stages. The incessant ovulation theory from the last century that indicated the ovary as the site for the initiation of high-grade serous cancers is contrary to the newly emerging idea that ovarian cancer could arise from the distal fallopian tube. In view of the recent pathological and molecular studies, we propose to discuss the genesis of high-grade serous ovarian cancer.
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Affiliation(s)
- G Chene
- Department of Histopathology, Centre Jean Perrin, Clermont-Ferrand, France; Department of Surgery, Centre Jean Perrin, Clermont-Ferrand, France; Department of Obstetrics and Gynecology, CHU St Etienne, France.
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17
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Lacoste CR, Clemenson A, Lima S, Lecointre R, Peoc'h M, Chene G. Tubo-ovarian dysplasia in relationship with ovulation induction in rats. Fertil Steril 2013; 99:1768-73. [PMID: 23433516 DOI: 10.1016/j.fertnstert.2013.01.127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 01/17/2013] [Accepted: 01/18/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess tubo-ovarian dysplasia via morphologic and immunohistochemical study of rats exposed to ovulation stimulation protocols. DESIGN Animal experimental study. SETTING Academic research hospital. ANIMAL(S) 72 female Wistar rats divided into three groups. INTERVENTION(S) Stimulation protocols using follicle-stimulating hormone (FSH) or clomiphene citrate for 3, 6, or 12 cycles, after which the animals were killed. MAIN OUTCOME MEASURE(S) Ovarian and tubal dysplasia score and immunohistochemical assessment using p53 and Ki67. RESULT(S) The ovarian dysplasia score was statistically significantly higher after 12 stimulation cycles in the groups receiving FSH (group B) or clomiphene citrate (group C) compared with control (group A). The tubal dysplasia score was statistically significantly increased after only three stimulation cycles in groups B and C. The Ki67 proliferation marker was statistically significantly expressed in the ovaries from group C, and in the fallopian tubes from groups B and C. P53 was constantly low in all three groups. CONCLUSION(S) Ovulation stimulation may induce tubal and ovarian histopathologic and immunohistochemical abnormalities with a dose effect. The role of the fallopian tubes and their interaction with the ovaries require further study.
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Affiliation(s)
- Claude Régis Lacoste
- Department of Obstetrics, Gynecology, and Reproductive Medicine, CHU Nord, St. Etienne, France
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18
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Chene G, Penault-Llorca F, Robin N, Cayre A, Provencher D, Dauplat J. Vers un dépistage possible du cancer de l’ovaire ? ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jgyn.2012.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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19
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Chene G, Rahimi K, Mes-Masson AM, Provencher D. Surgical implications of the potential new tubal pathway for ovarian carcinogenesis. J Minim Invasive Gynecol 2013; 20:153-9. [PMID: 23332575 DOI: 10.1016/j.jmig.2012.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/21/2012] [Accepted: 11/30/2012] [Indexed: 12/14/2022]
Abstract
Since 2001, many studies by different investigators have demonstrated that the fallopian tube might be at the origin of most high-grade ovarian and peritoneal serous carcinomas. Simple changes in surgical practice (ie, prophylactic bilateral salpingectomy instead of salpingo-oophorectomy) could have significant implications for death from ovarian cancer and, on the other hand, for the morbidity caused by ovariectomy (surgical menopause). In this review, we describe the new tubal carcinogenic sequence, the advantages and disadvantages of exclusive use of salpingectomy in the general population, and in cases of hereditary predisposition to ovarian cancer such as for carriers of BRCA mutation.
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Affiliation(s)
- Gautier Chene
- Research Centre of the University of Montreal Hospital Centre (CRCHUM), Montreal Cancer Institute, Montreal, Quebec, Canada.
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20
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Hatzi VI, Terzoudi GI, Spiliopoulou CA, Stefanidou ME. Toxicogenomic evaluation of chemically induced chromosomal imbalance using DNA image analysis. Toxicol Mech Methods 2012; 23:303-7. [PMID: 23215871 DOI: 10.3109/15376516.2012.756091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study of carcinogenic potential of a variety of chemical agents such as food additives and drugs of abuse via the application of various in vitro methodologies constitutes the first step for the evaluation of their toxicogenomic profile. Considering the chromosomal theories of carcinogenesis, where it is stated that aneuploidy and chromosomal imbalance (instability) are among the main causes of carcinogenesis, chemicals capable to induce such changes in the cells could be considered as potential carcinogens. Chromosomal imbalance and aneuploidy directly affect the overall DNA content of the exposed cell as well as other cellular morpho- and densitometric features. These features can be measured by means of computerized DNA image analysis technologies and include DNA content (DNA Index), Proliferation Index, Ploidy Balance, Degree of Aneuploidy, Skewness and Kurtosis. Considering the enormous number of untested chemicals and drugs of abuse that follow non-genotoxic mechanisms of carcinogenesis, the establishment of a reliable technology for the estimation of chemically induced chromosomal imbalance is of particular importance in toxicogenomic studies. In the present article and based on our previously published work, we highlight the advantages of the applications of DNA image analysis technology in an easy-to-use experimental model for the evaluation of the potential risk of various chemicals. The use of this technology for the detection of chemically induced chromosomal instability will contribute to the development of safer regulatory directives concerning the use of chemicals in food and pharmaceutical industry, as well as in the clarification of mechanisms of action of drugs of abuse.
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Affiliation(s)
- Vasiliki I Hatzi
- Institute of Nuclear & Radiological Sciences & Technology, Energy & Safety, National Centre for Scientific Research, NCSR Demokritos , Athens , Greece.
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21
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Sherman ME, Guido R, Wentzensen N, Yang HP, Mai PL, Greene MH. New views on the pathogenesis of high-grade pelvic serous carcinoma with suggestions for advancing future research. Gynecol Oncol 2012; 127:645-50. [PMID: 22940485 DOI: 10.1016/j.ygyno.2012.08.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 08/17/2012] [Accepted: 08/22/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Mark E Sherman
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Hormonal and Reproductive Epidemiology Branch, Rockville, MD, USA.
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22
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Fadiel A, Chen Z, Ulukus E, Ohtani K, Hatami M, Naftolin F. Ezrin Overexpression by Transformed Human Ovarian Surface Epithelial Cells, Ovarian Cleft Cells, and Serous Ovarian Adenocarcinoma Cells. Reprod Sci 2012; 19:797-805. [DOI: 10.1177/1933719111433884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ahmed Fadiel
- Department of Obstetrics and Gynecology, New York University, New York City, NY, USA
- Departments of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT, USA
| | - Zhaocong Chen
- Departments of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT, USA
- Current Address: Department of Molecular Biology, Tongji University Medical School, Wuhan, China
| | - Emine Ulukus
- Pathology, Yale University School of Medicine, New Haven, CT, USA
- Current Address: Department of Pathology, Eylul University, School of Medicine, Inciralti, Izmir, 35340, Turkey
| | - Kaori Ohtani
- Departments of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT, USA
- Current Address: Department of Obstetrics and Gynecology, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi, Tokyo, Japan
| | - Mehrangiz Hatami
- Department of Obstetrics and Gynecology, New York University, New York City, NY, USA
| | - Frederick Naftolin
- Department of Obstetrics and Gynecology, New York University, New York City, NY, USA
- Departments of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT, USA
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23
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Is There a Relationship between Ovarian Epithelial Dysplasia and Infertility? Obstet Gynecol Int 2012; 2012:429085. [PMID: 22496700 PMCID: PMC3306969 DOI: 10.1155/2012/429085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 10/18/2011] [Accepted: 11/06/2011] [Indexed: 11/17/2022] Open
Abstract
Aim. Ovarian epithelial dysplasia was initially described in material from prophylactic oophorectomies performed in patients at genetic risk of ovarian cancer. Similar histopathological abnormalities have been revealed after ovulation stimulation. Since infertility is also a risk factor for ovarian neoplasia, the aim of this study was to study the relationship between infertility and ovarian dysplasia. Methods. We blindly reviewed 127 histopathological slides of adnexectomies or ovarian cystectomies according to three groups-an exposed group to ovulation induction (n = 30), an infertile group without stimulation (n = 35), and a spontaneously fertile control group (n = 62)-in order to design an eleven histopathological criteria scoring system. Results. The ovarian dysplasia score was significantly higher in exposed group whereas dysplasia score was low in infertile and control groups (resp., 8.21 in exposed group, 3.69 for infertile patients, and 3.62 for the controls). In the subgroup with refractory infertility there was a trend towards a more severe dysplasia score (8.53 in ovulation induction group and 5.1 in infertile group). Conclusion. These results raise questions as to the responsibility of drugs used to induce ovulation and/or infertility itself in the genesis of ovarian epithelial dysplasia.
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24
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Kuhn E, Kurman RJ, Shih IM. Ovarian Cancer Is an Imported Disease: Fact or Fiction? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2012; 1:1-9. [PMID: 22506137 DOI: 10.1007/s13669-011-0004-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The cell of origin of ovarian cancer has been long debated. The current paradigm is that epithelial ovarian cancer (EOC) arises from the ovarian surface epithelium (OSE). OSE is composed of flat, nondescript cells more closely resembling the mesothelium lining the peritoneal cavity, with which it is continuous, rather than the various histologic types of ovarian carcinoma (serous, endometrioid, and clear cell carcinoma), which have a Müllerian phenotype. Accordingly, it has been argued that the OSE undergoes a process termed "metaplasia" to account for this profound morphologic transformation. Recent molecular and clinicopathologic studies not only have failed to support this hypothesis but also have provided evidence that EOC stems from Müllerian-derived extraovarian cells that involve the ovary secondarily, thereby calling into question the very existence of primary EOC. This new model of ovarian carcinogenesis proposes that fallopian tube epithelium (benign or malignant) implants on the ovary to give rise to both high-grade and low-grade serous carcinomas, and that endometrial tissue implants on the ovary and produces endometriosis, which can undergo malignant transformation into endometrioid and clear cell carcinoma. Thus, ultimately EOC is not ovarian in origin but rather is secondary, and it is logical to conclude that the only true primary ovarian neoplasms are germ cell and gonadal stromal tumors analogous to tumors in the testis. If this new model is confirmed, it has profound implications for the early detection and treatment of "ovarian cancer."
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Affiliation(s)
- Elisabetta Kuhn
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA
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25
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Kurman RJ, Shih IM. Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer--shifting the paradigm. Hum Pathol 2011; 42:918-31. [PMID: 21683865 DOI: 10.1016/j.humpath.2011.03.003] [Citation(s) in RCA: 767] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/23/2011] [Accepted: 03/23/2011] [Indexed: 12/13/2022]
Abstract
Recent morphologic, immunohistochemical, and molecular genetic studies have led to the development of a new paradigm for the pathogenesis and origin of epithelial ovarian cancer based on a dualistic model of carcinogenesis that divides epithelial ovarian cancer into 2 broad categories designated types I and II. Type I tumors comprise low-grade serous, low-grade endometrioid, clear cell and mucinous carcinomas, and Brenner tumors. They are generally indolent, present in stage I (tumor confined to the ovary), and are characterized by specific mutations, including KRAS, BRAF, ERBB2, CTNNB1, PTEN, PIK3CA, ARID1A, and PPP2R1A, which target specific cell signaling pathways. Type I tumors rarely harbor TP53 mutations and are relatively stable genetically. Type II tumors comprise high-grade serous, high-grade endometrioid, malignant mixed mesodermal tumors (carcinosarcomas), and undifferentiated carcinomas. They are aggressive, present in advanced stage, and have a very high frequency of TP53 mutations but rarely harbor the mutations detected in type I tumors. In addition, type II tumors have molecular alterations that perturb expression of BRCA either by mutation of the gene or by promoter methylation. A hallmark of these tumors is that they are genetically highly unstable. Recent studies strongly suggest that fallopian tube epithelium (benign or malignant) that implants on the ovary is the source of low-grade and high-grade serous carcinoma rather than the ovarian surface epithelium as previously believed. Similarly, it is widely accepted that endometriosis is the precursor of endometrioid and clear cell carcinomas and, as endometriosis, is thought to develop from retrograde menstruation; these tumors can also be regarded as involving the ovary secondarily. The origin of mucinous and transitional cell (Brenner) tumors is still not well established, although recent data suggest a possible origin from transitional epithelial nests located in paraovarian locations at the tuboperitoneal junction. Thus, it now appears that type I and type II ovarian tumors develop independently along different molecular pathways and that both types develop outside the ovary and involve it secondarily. If this concept is confirmed, it leads to the conclusion that the only true primary ovarian neoplasms are gonadal stromal and germ cell tumors analogous to testicular tumors. This new paradigm of ovarian carcinogenesis has important clinical implications. By shifting the early events of ovarian carcinogenesis to the fallopian tube and endometrium instead of the ovary, prevention approaches, for example, salpingectomy with ovarian conservation, may play an important role in reducing the burden of ovarian cancer while preserving hormonal function and fertility.
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Affiliation(s)
- Robert J Kurman
- Division of Gynecologic Pathology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
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26
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[Ovarian epithelial dysplasia: Description of a dysplasia scoring scheme]. Ann Pathol 2011; 31:3-10. [PMID: 21349382 DOI: 10.1016/j.annpat.2010.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Revised: 06/29/2010] [Accepted: 10/11/2010] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Precancerous ovarian epithelial dysplasia was first described after prophylactic oophorectomy (OP) for genetic risk (BRCA mutation) or because of a strong family history of ovarian and/or breast cancer. The objective of this study was to describe histopathological features of ovarian dysplasia and to propose a dysplasia scoring sheme with a cut-off. PATIENTS AND METHOD One hundred and twenty-five bilateral oophorectomies (genetic predisposition: n=35 and control group: n=90) were reviewed by two pathologists blinded to clinical data. Eleven epithelial cytological and architectural features were studied and an ovarian dysplasia score was defined to compare the degree of ovarian epithelial abnormalities between the two groups. RESULTS Mean ovarian dysplasia score was significantly higher in prophylactic oophorectomy group than in control group (9.0 versus 3.5, P<0.001). Dysplasia was more severe in OP with BRCA mutation than in OP without (11.6 in BRCA 1; 7.6 in BCRA 2; 7.1 in family history). The cut off for dysplasia was 8 with a sensitivity of 60% and a specificity of 93.3%. CONCLUSION The increased dysplasia score in OP and the gradation in dysplastic severity in OP with proven BRCA mutations may suggest that ovarian dysplasia could be a pre-malignant non invasive histopathological lesion. The 11 cytological and architectural features in the dysplasia scoring sheme could be a useful tool to study ovarian dysplasia.
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27
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Stefanidou ME, Hatzi VI, Terzoudi GI, Loutsidou AC, Maravelias CP. Effect of cocaine and crack on the ploidy status of Tetrahymena pyriformis: a study using DNA image analysis. Cytotechnology 2010; 63:35-40. [PMID: 21057873 DOI: 10.1007/s10616-010-9318-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 10/20/2010] [Indexed: 11/30/2022] Open
Abstract
The effect of cocaine and crack on the ploidy status of Feulgen-stained Tetrahymena pyriformis macronuclei using computerized DNA image analysis system was tested. For this purpose, selected doses of 5, 10 and 20 μg (per mL culture) of both drugs were administered for 2, 5 and 20 h to protozoa cultures and DNA image analysis of T. pyriformis nuclei was performed. The analysis was based on the measurement of the following parameters: Ploidy Balance (PB), Degree of Aneuploidy (DA), skewness and kurtosis. The results have shown a positive effect of both cocaine and crack on PB and on DA of T. pyriformis macronuclei. In particular, our results reveal that the aneugenic effect (which is expressed as a decrease in PB and an increase in DA) of cocaine on T. pyriformis macronuclei follows a dose-dependent manner, while crack induces aneuploidy in a dose-independent manner. Changes in the PB and DA values would induce a disturbance in the cellular density and heterogeneity of chromatin and the increase in skewness and kurtosis values after exposure of T. pyriformis to both drugs, did confirm this hypothesis. These observations were further correlated with alterations in the chromosomal segregation and with damage in mitotic spindle microtubules observed previously. In this study the impact of cocaine and crack on genomic instability and carcinogenesis was further supported and T. pyriformis can be proposed as a model organism to test the nuclear ploidy status after exposure to harmful chemicals and drugs.
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Affiliation(s)
- Maria E Stefanidou
- Department of Forensic Medicine and Toxicology, Medical School, University of Athens, 75 M. Asias str., Goudi 115.27, Athens, Greece,
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Pérez-López FR, Chedraui P, Troyano-Luque JM. Peri- and post-menopausal incidental adnexal masses and the risk of sporadic ovarian malignancy: new insights and clinical management. Gynecol Endocrinol 2010; 26:631-43. [PMID: 20500106 DOI: 10.3109/09513590.2010.487611] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Adnexal masses are common among peri- and post-menopausal women. Although ovarian cancer is a significant cause of mortality in menopausal women, large population-based studies demonstrate that the majority of adnexal masses are benign. Despite this, the appearance of an adnexal mass is a concern for the patient and an insight exercise for physicians. In most cases, an adnexal enlargement is an incidental finding, generally corresponding to a benign cyst and easily diagnosed by conventional ultrasound. Exceptionally an ovarian tumour may be malignant and should be treated as early as possible. When conventional ultrasound renders complex morphology other diagnostic tools must be used such as: colour Doppler and functional tumour vessel properties, serum CA 125 levels, nuclear magnetic resonance imaging and in some cases laparoscopy. Several new tumour markers are being studied for clinical application, although there are presently no clear recommendations. Adnexal masses with benign morphological and functional properties must be periodically monitored as an alternative to surgery since malignant transformation is exceptional.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynaecology, Facultad de Medicina, Universidad de Zaragoza, Hospital Clínico de Zaragoza, Zaragoza 50009, Spain.
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Linger RJ, Kruk PA. BRCA1 16 years later: risk-associated BRCA1 mutations and their functional implications. FEBS J 2010; 277:3086-96. [PMID: 20608970 DOI: 10.1111/j.1742-4658.2010.07735.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mutations in the tumor suppressor breast cancer susceptibility gene 1 (BRCA1), an important player in the DNA damage response, apoptosis, cell cycle regulation and transcription, confer a significantly elevated lifetime risk for breast and ovarian cancer. Although the loss of wild-type BRCA1 function is an important mechanism by which mutations confer increased cancer risk, multiple studies suggest mutant BRCA1 proteins may confer functions independent of the loss of wild-type BRCA1 through dominant negative inhibition of remaining wild-type BRCA1, or through novel interactions and pathways. These functions impact various cellular processes and have the potential to significantly influence cancer initiation and progression. In this review, we discuss the functional classifications of risk-associated BRCA1 mutations and their molecular, cellular and clinical impact for mutation carriers.
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Affiliation(s)
- Rebecca J Linger
- Department of Pathology and Cell Biology, University of South Florida, Tampa, FL 33612, USA
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30
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Precursor lesions of high-grade serous ovarian carcinoma: morphological and molecular characteristics. JOURNAL OF ONCOLOGY 2010; 2010:126295. [PMID: 20445756 PMCID: PMC2860809 DOI: 10.1155/2010/126295] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 02/14/2010] [Indexed: 11/18/2022]
Abstract
The lack of proven screening tools for early detection and the high mortality of ovarian serous carcinoma (OSC), particularly high grade, have focused attention on identifying putative precursor lesions with distinct morphological and molecular characteristics. The finding of occult invasive and intraepithelial fallopian tube carcinomas in prophylactically removed specimens from asymptomatic high-risk BRCA 1/2-mutation carriers supports the notion of an origin for OSC in the fallopian tube. The intraepithelial carcinomas have been referred to as serous intraepithelial carcinomas (STICs) but our own findings (unpublished data) and recent reports have drawn attention to a spectrum of changes that fall short of STICs that we have designated serous tubal intraepithelial lesions (STILs).
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Pothuri B, Leitao MM, Levine DA, Viale A, Olshen AB, Arroyo C, Bogomolniy F, Olvera N, Lin O, Soslow RA, Robson ME, Offit K, Barakat RR, Boyd J. Genetic analysis of the early natural history of epithelial ovarian carcinoma. PLoS One 2010; 5:e10358. [PMID: 20436685 PMCID: PMC2859950 DOI: 10.1371/journal.pone.0010358] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 03/31/2010] [Indexed: 11/19/2022] Open
Abstract
Background The high mortality rate associated with epithelial ovarian carcinoma (EOC) reflects diagnosis commonly at an advanced stage, but improved early detection is hindered by uncertainty as to the histologic origin and early natural history of this malignancy. Methodology/Principal Findings Here we report combined molecular genetic and morphologic analyses of normal human ovarian tissues and early stage cancers, from both BRCA mutation carriers and the general population, indicating that EOCs frequently arise from dysplastic precursor lesions within epithelial inclusion cysts. In pathologically normal ovaries, molecular evidence of oncogenic stress was observed specifically within epithelial inclusion cysts. To further explore potential very early events in ovarian tumorigenesis, ovarian tissues from women not known to be at high risk for ovarian cancer were subjected to laser catapult microdissection and gene expression profiling. These studies revealed a quasi-neoplastic expression signature in benign ovarian cystic inclusion epithelium compared to surface epithelium, specifically with respect to genes affecting signal transduction, cell cycle control, and mitotic spindle formation. Consistent with this gene expression profile, a significantly higher cell proliferation index (increased cell proliferation and decreased apoptosis) was observed in histopathologically normal ovarian cystic compared to surface epithelium. Furthermore, aneuploidy was frequently identified in normal ovarian cystic epithelium but not in surface epithelium. Conclusions/Significance Together, these data indicate that EOC frequently arises in ovarian cystic inclusions, is preceded by an identifiable dysplastic precursor lesion, and that increased cell proliferation, decreased apoptosis, and aneuploidy are likely to represent very early aberrations in ovarian tumorigenesis.
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Affiliation(s)
- Bhavana Pothuri
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Mario M. Leitao
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Douglas A. Levine
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Agnès Viale
- Molecular Biology Program, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Adam B. Olshen
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Crispinita Arroyo
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Faina Bogomolniy
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Narciso Olvera
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Oscar Lin
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Robert A. Soslow
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Mark E. Robson
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Richard R. Barakat
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Jeff Boyd
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Gene Mutations in Animal Models: Do Tumor Suppressor Genes, brca1 and brca2, Play a Role in Ovarian Carcinogenesis? Lab Anim Res 2010. [DOI: 10.5625/lar.2010.26.4.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Conditional inactivation of Brca1, p53 and Rb in mouse ovaries results in the development of leiomyosarcomas. PLoS One 2009; 4:e8534. [PMID: 20046869 PMCID: PMC2795167 DOI: 10.1371/journal.pone.0008534] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 12/10/2009] [Indexed: 12/29/2022] Open
Abstract
Epithelial ovarian cancer (EOC) is thought to arise in part from the ovarian surface epithelium (OSE); however, the molecular events underlying this transformation are poorly understood. Germline mutations in the BRCA1 tumor suppressor gene result in a significantly increased risk of developing EOC and a large proportion of sporadic EOCs display some sort of BRCA1 dysfunction. To generate a model in which Brca1-mediated transformation can be studied, we previously inactivated Brca1 alone in murine OSE, which resulted in an increased accumulation of premalignant changes, but no tumor formation. In this study, we examined tumor formation in mice with conditionally expressed alleles of Brca1, p53 and Rb, alone or in combination. Intrabursal injection of adenovirus expressing Cre recombinase to inactivate p53 resulted in tumors in 100% of mice. Tumor progression was accelerated in mice with concomitant inactivation of Brca1 and p53, but not Rb and p53. Immunohistologic analyses classified the tumors as leiomyosarcomas that may be arising from the ovarian bursa. Brca1 inactivation in primary cultures of murine OSE cells led to a suppression of proliferation that could be rescued by concomitant inactivation of p53 and/or Rb. Brca1-deficient OSE cells displayed an increased sensitivity to the DNA damaging agent cisplatin, and this effect could be modulated by inactivation of p53 and/or Rb. These results indicate that Brca1 deficiency can accelerate tumor development and alter the sensitivity of OSE cells to chemotherapeutic agents. Intrabursal delivery of adenovirus intended to alter gene expression in the ovarian surface epithelium may, in some strains of mice, result in more rapid transformation of adjacent cells, resulting in leiomyosarcomas.
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Dauplat J, Chene G, Pomel C, Dauplat M, Bouëdec G, Mishellany F, Lagarde N, Bignon Y, Jaffeux P, Aublet-Cuvelier B, Dechelotte P, Pouly J, Penault-Llorca F. Comparison of dysplasia profiles in stimulated ovaries and in those with a genetic risk for ovarian cancer. Eur J Cancer 2009; 45:2977-83. [DOI: 10.1016/j.ejca.2009.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Revised: 06/09/2009] [Accepted: 06/12/2009] [Indexed: 11/24/2022]
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Abstract
Two major functions of the mammalian ovary are the production of germ cells (oocytes), which allow continuation of the species, and the generation of bioactive molecules, primarily steroids (mainly estrogens and progestins) and peptide growth factors, which are critical for ovarian function, regulation of the hypothalamic-pituitary-ovarian axis, and development of secondary sex characteristics. The female germline is created during embryogenesis when the precursors of primordial germ cells differentiate from somatic lineages of the embryo and take a unique route to reach the urogenital ridge. This undifferentiated gonad will differentiate along a female pathway, and the newly formed oocytes will proliferate and subsequently enter meiosis. At this point, the oocyte has two alternative fates: die, a common destiny of millions of oocytes, or be fertilized, a fate of at most approximately 100 oocytes, depending on the species. At every step from germline development and ovary formation to oogenesis and ovarian development and differentiation, there are coordinated interactions of hundreds of proteins and small RNAs. These studies have helped reproductive biologists to understand not only the normal functioning of the ovary but also the pathophysiology and genetics of diseases such as infertility and ovarian cancer. Over the last two decades, parallel progress has been made in the assisted reproductive technology clinic including better hormonal preparations, prenatal genetic testing, and optimal oocyte and embryo analysis and cryopreservation. Clearly, we have learned much about the mammalian ovary and manipulating its most important cargo, the oocyte, since the birth of Louise Brown over 30 yr ago.
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Affiliation(s)
- Mark A Edson
- Department of Pathology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030, USA
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36
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Chêne G, Penault-Llorca F, Le Bouëdec G, Mishellany F, Dauplat MM, Jaffeux P, Aublet-Cuvelier B, Pouly JL, Déchelotte P, Dauplat J. Ovarian epithelial dysplasia and prophylactic oophorectomy for genetic risk. Int J Gynecol Cancer 2009; 19:65-72. [PMID: 19258944 DOI: 10.1111/igc.0b013e3181990127] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
UNLABELLED To make an accurate histopathological description of ovarian dysplasia in a population at genetic risk of ovarian cancer and devise an ovarian dysplasia score. MATERIALS AND METHODS In this retrospective cohort study, 90 patients who had undergone bilateral oophorectomy or ovarian cystectomy between 1992 and 2005 and whose ovaries were reported as normal were divided into two groups: Group A comprising prophylactic oophorectomies for genetic predisposition (N = 28), and Group B or control group, fertile and non-cancerous (N = 62). Eleven epithelial cytological and architectural features were defined. Ovaries were analysed and reviewed by four pathologists blinded to clinical data. An ovarian dysplasia score was devised to quantify extent of ovarian epithelial abnormalities. The degrees of ovarian epithelial abnormalities (dysplasia scores) were compared between the two groups. RESULTS Mean dysplasia score was significantly higher in Group A (prophylactic oophorectomies) than in Group B (control group) (9.67 vs. 4.19, P < 0.001). In Group A, we observed a gradation in the severity of the dysplastic lesions between (i) proven BRCA mutations and prophylactic oophorectomies without mutations (11.26 vs. 8.1), and (ii) according to age (10.27 after age 50 years vs. 8.6 before age 50 years, P = 0.2962). CONCLUSION These results suggest abnormalities in ovaries from high risk women. The ovarian dysplasia may be a pre-malignant, non-invasive histological lesion that could be an important step in early neoplasia.
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Affiliation(s)
- Gautier Chêne
- Department of Surgery, Centre Jean Perrin, rue Montalembert, Clermont-Ferrand, France.
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Cai KQ, Wu H, Klein-Szanto AJ, Xu XX. Acquisition of a second mutation of the Tp53 alleles immediately precedes epithelial morphological transformation in ovarian tumorigenicity. Gynecol Oncol 2009; 114:18-25. [PMID: 19375154 DOI: 10.1016/j.ygyno.2009.03.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/03/2009] [Accepted: 03/17/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Tp53 mutation is frequent and associates with malignant, high-grade ovarian cancer. However, the details about the progression of Tp53 mutation from heterozygous to homozygous, and association between genotypes and morphological transformation are not clear. We further investigated the expression and mutation of Tp53 and associated markers such as p21 and HDM2 in ovarian cancer. METHOD Areas of contiguous ovarian surface epithelia linking morphological normal monolayer to multilayer neoplastic cells were analyzed for the correlation of Tp53 pathway alteration in relation to morphological transformation, by immunostaining and sequencing of Tp53 gene in cells from laser captured microdissection. RESULTS Consistent with previous reports, Tp53 staining is positive in 78% of the tumors. The staining of p21 is positive in about 12%, and HMD2 is positive in only 1% of the tumors. In 9 out of 10 cases of p21-positive tumors, p53 is also positive. In the majority of cases of epithelial histological transitions, overexpression of Tp53 correlates with morphological transformation: Tp53 is negative in monolayered cells and positive in neoplastic lesions. Morphological transformation also closely correlates with cell proliferation as indicated by Ki-67 staining and loss of p21 expression. We detected heterozygous mutation of Tp53 in the monolayers adjacent to neoplastic cells. CONCLUSIONS p21 expression is an indicator of a wild type Tp53 and lack of p21 in the presence of Tp53 expression predicts an inactivated Tp53. Tp53 inactivation immediately precedes morphological transformation of the ovarian surface epithelium in most cases, and the histological transitional epithelia containing a heterozygous Tp53 mutation are thus pre-neoplastic lesions. We propose that the loss of a second allele of Tp53 leading to the loss of p21 expression, and subsequent cell proliferation, compose a sequence of events that lead to morphological transformation and instigation of ovarian epithelial tumor development.
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Affiliation(s)
- Kathy Q Cai
- Ovarian Cancer Programs, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
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Levanon K, Crum C, Drapkin R. New insights into the pathogenesis of serous ovarian cancer and its clinical impact. J Clin Oncol 2008; 26:5284-93. [PMID: 18854563 DOI: 10.1200/jco.2008.18.1107] [Citation(s) in RCA: 294] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
There are only a handful of concepts concerning cancer and carcinogenesis that are currently beyond dispute. One such dogma is the adenoma-carcinoma sequence and that a multistep accumulation of genetic alterations is required for transformation from a benign to a neoplastic tissue. The inevitable derivative of this dogma is that every invasive carcinoma is in fact a missed intraepithelial tumor, and furthermore, a late evolutionary stage in the sequence of development from a precursor lesion. Until fairly recently, high-grade serous ovarian carcinoma seemed to be one of the only known deviants of these concepts. In this article, we discuss the emergence of the fallopian tube fimbria as a field of origin for high-grade serous carcinomas and present a binary model of ovarian cancer pathogenesis that takes into consideration prior epidemiologic, morphologic, and genetic data. With the rise of the fallopian tube secretory epithelial cell as a cell of origin for high-grade pelvic serous carcinomas, the need to develop tools and model systems to characterize the biology and physiology of this cell is recognized.
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Affiliation(s)
- Keren Levanon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
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Chêne G, Penault-Llorca F, Le Bouëdec G, Mishellany F, Dauplat MM, Tardieu AS, Pomel C, Jaffeux P, Aublet-Cuvelier B, Pouly JL, Déchelotte P, Dauplat J. [Ovarian epithelial dysplasia: myth or reality? Review]. ACTA ACUST UNITED AC 2008; 36:800-7. [PMID: 18657463 DOI: 10.1016/j.gyobfe.2008.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 05/27/2008] [Indexed: 10/21/2022]
Abstract
Ovarian epithelial dysplasia has been described in the ovarian surface epithelium by histologic, morphometric and nuclear profile studies. It could represent a potential precursor of ovarian malignancy in patients with genetic risk of ovarian cancer, although its natural history and progression to carcinoma are unpredictable. Diagnosis and identification of ovarian dysplasia would certainly be useful to understand the early steps of ovarian carcinogenesis. However, dysplasia in relation with ovulation induction seems to have a different pattern. We report dysplasia definitions and the current clinical management.
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Affiliation(s)
- G Chêne
- Département de chirurgie, centre Jean-Perrin, rue Montalembert, 63000 Clermont-Ferrand, France.
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40
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Boyd J. Whence epithelial ovarian carcinoma? Gynecol Oncol 2008; 109:161-3. [PMID: 18455635 DOI: 10.1016/j.ygyno.2008.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 03/28/2008] [Indexed: 10/22/2022]
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Zhang Z, Singh M, Davidson S, Rosen DG, Yang G, Liu J. Activation of BTAK expression in primary ovarian surface epithelial cells of prophylactic ovaries. Mod Pathol 2007; 20:1078-84. [PMID: 17673924 DOI: 10.1038/modpathol.3800945] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The ovarian epithelial cells carrying heterozygous BRCA1 or BRCA2 mutation (we called BRCA1/2 mutation) are known to predispose to the development of ovarian cancer; however, the molecular basis of such predisposition is largely unknown. We hypothesize that BTAK may be a potential target for heterozygous BRCA1/2 mutation. We sought to determine the relationship between the status of BRCA1/2 heterozygous mutation and BTAK expression in prophylactically removed ovaries as compared with normal ovaries and ovarian cancer controls. Western blot analysis of BTAK was performed in a primary cell culture carrying heterozygous BRCA1 mutation and three normal ovarian surface epithelial cell cultures. Immunohistochemical analysis of BTAK expression was also performed by image analysis in ovaries of 21 patients with known BRCA1/2 mutation or very strong family history of breast/ovarian cancer that underwent prophylactic oophorectomy, 38 normal ovaries from patients without any known mutation, and 194 ovarian carcinomas. The BTAK expression was significantly increased in primary culture carrying a heterozygous BRCA1 mutation as compared to those with no known BRCA1/2 mutation. Immunohistochemical staining of BTAK showed increased expression in ovarian epithelial cells carrying BRCA1/2 mutation or strong breast/ovarian family history compared with normal ovaries (P<0.001). Higher BTAK expression was found in ovarian cancer cells compared to ovaries without cancer but with known BRCA1/2 mutation or strong family history (P<0.001), and expression levels of BTAK and p53 were directly correlated (r=0.306; P<0.001). Increased expression of BTAK is directly correlated with mutation status of BRCA1/2 genes, suggesting that mutation in a single allele of either BRCA1 or 2 may be responsible for the activation of BTAK. This activation may be a key early genetic event in the development of hereditary ovarian cancer.
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Affiliation(s)
- Zhihong Zhang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4095, USA
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42
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Evaluation of normal-sized ovaries associated with primary peritoneal serous carcinoma for possible precursors of ovarian serous carcinoma. Gynecol Oncol 2007; 106:201-6. [PMID: 17477958 DOI: 10.1016/j.ygyno.2007.03.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 03/06/2007] [Accepted: 03/09/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Three groups of "high-risk" ovaries have previously been studied for possible precursors of ovarian carcinoma: ovaries removed prophylactically from women at high risk, normal ovaries contralateral to a unilateral ovarian carcinoma, and normal ovarian tissue found adjacent to primary ovarian carcinomas. No data are available for a fourth high-risk group: normal-sized ovaries from women with primary peritoneal serous carcinoma. METHODS Grossly normal-sized ovaries from 26 patients with primary peritoneal serous carcinoma were compared to normal-sized ovaries from 75 controls. Controls were divided at the median age for age matching. Cortical inclusions, surface epithelial invaginations (clefts), surface papillary proliferation, and calcifications were examined. RESULTS Case versus control comparisons showed, respectively, inclusions in 92% and 68% of patients, clefts in 54% and 59%, and papillomatosis in 35% and 16%. For each profile of ovary on one section, cases versus controls, respectively, had a mean number of inclusions of 5.55 and 3.97, size of the largest inclusion of 1.28 and 1.27 mm, and depth of the deepest cleft of 1.04 and 0.9 mm. After controlling for age, correcting for multiple comparisons and using two-sided chi square, there were no significant differences between cases and controls in all the parameters measured. In comparing the two control groups, the only significant finding was that the young group displayed deeper clefts than the older group (2.06 versus 0.9 mm, respectively). CONCLUSION Grossly normal-sized ovaries from women with primary peritoneal serous carcinoma display no significant differences in inclusions, clefts, papillomatosis, and calcifications in comparison to age-matched controls.
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Crum CP, Drapkin R, Miron A, Ince TA, Muto M, Kindelberger DW, Lee Y. The distal fallopian tube: a new model for pelvic serous carcinogenesis. Curr Opin Obstet Gynecol 2007; 19:3-9. [PMID: 17218844 DOI: 10.1097/gco.0b013e328011a21f] [Citation(s) in RCA: 350] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Research over the past 50 years has yielded little concrete information on the source of pelvic serous cancer in women, creating a knowledge gap that has adversely influenced our ability to identify, remove or prevent the earliest stages of the most lethal form of ovarian cancer. RECENT FINDINGS The distal fallopian tube is emerging as an established source of many early serous carcinomas in women with BRCA mutations (BRCA+). Protocols examining the fimbrial (SEE-FIM) end have revealed a noninvasive but potentially lethal form of tubal carcinoma, designated tubal intraepithelial carcinoma. Tubal intraepithelial carcinoma is present in many women with presumed ovarian or peritoneal serous cancer. A candidate precursor to tubal intraepithelial carcinoma, entitled the 'p53 signature', suggests that molecular events associated with serous cancer (p53 mutations) may be detected in benign mucosa. SUMMARY A fully characterized precursor lesion is a first and necessary step to pelvic serous cancer prevention. The emerging data offer compelling evidence for a model of 'fimbrial-ovarian' serous neoplasia, and call attention to the distal fallopian tube as an important source for this disease, the study of which could clarify pathways to cancer in both organs and generate novel strategies for cancer prevention.
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Affiliation(s)
- Christopher P Crum
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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Gaytán M, Morales C, Bellido C, Sánchez-Criado JE, Gaytán F. Macrophages in human fallopian tube and ovarian epithelial inclusion cysts. J Reprod Immunol 2007; 73:66-73. [PMID: 17014913 DOI: 10.1016/j.jri.2006.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 05/08/2006] [Accepted: 06/12/2006] [Indexed: 10/24/2022]
Abstract
Epithelial inclusion cysts (EICs) are considered a preferential site for ovarian carcinogenesis. Local inflammation, associated to ovulatory wound repair and epithelial inflammatory conditions, facilitates EIC formation and involves activation of macrophages. The aim of this study was to analyse the presence and numbers of macrophages in the ovarian surface epithelium (OSE), in EICs, and in the fallopian tubes, as tubal metaplasia is a common finding in EICs. Immunohistochemical analysis of macrophages was performed in 25 fallopian tubes in different phases of the menstrual cycle, and in 30 ovaries showing EICs from cycling and postmenopausal women. In the fallopian tube, macrophages were abundant and underwent cyclic changes during the menstrual cycle, being particularly abundant within the epithelium at early and mid-luteal phases. Macrophages were not found in the normal OSE. However, OSE areas and EICs showing tubal metaplasia were invariably associated with infiltration by abundant macrophages. Macrophages were present among epithelial cells, infiltrating the cyst wall, as well as free in the cyst lumen. No significant differences existed between follicular and luteal phases of the cycle, or between cycling and postmenopausal women. This study has demonstrated that macrophages are associated with metaplastic EICs, and raises the possibility that these cells contribute to the particular microenvironment of EICs through secretion of cytokines and growth factors that may reach bioactive concentrations in the confined space of the EICs.
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Affiliation(s)
- M Gaytán
- Department of Cell Biology, Physiology and Immunology, Faculty of Medicine, University of Córdoba, Córdoba, Spain
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Ahmed N, Thompson EW, Quinn MA. Epithelial–mesenchymal interconversions in normal ovarian surface epithelium and ovarian carcinomas: An exception to the norm. J Cell Physiol 2007; 213:581-8. [PMID: 17708542 DOI: 10.1002/jcp.21240] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cancer that arises from the ovarian surface epithelium (OSE) accounts for approximately 90% of human ovarian cancer, and is the fourth leading cause of cancer-related deaths among women in developed countries. The pathophysiology of epithelial ovarian cancer is still unclear because of the poor understanding of the complex nature of its development and the unusual mechanism(s) of disease progression. Recent studies have reported epithelial-mesenchymal transition (EMT) in cultured OSE and ovarian cancer cell lines in response to various stimuli, but our understanding of the importance of these observations for normal ovarian physiology and cancer progression is not well established. This review highlights the current literature on EMT-associated events in normal OSE and ovarian cancer cell lines, and discusses its implication for normal ovarian function as well as acquisition of neoplastic phenotypes. The pathological changes in OSE in response to EMT during neoplastic transformation and the contribution of hormones, growth factors, and cytokines that initiate and drive EMT to sustain normal ovarian function, as well as cancer development and progression are also discussed. Finally, emphasis is placed on the clinical implications of EMT and potential therapeutic opportunities that may arise from these observations have been proposed.
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Affiliation(s)
- Nuzhat Ahmed
- Women's Cancer Research Centre, Royal Women's Hospital, Melbourne, Victoria, Australia.
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46
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Cai KQ, Klein-Szanto A, Karthik D, Edelson M, Daly MB, Ozols RF, Lynch HT, Godwin AK, Xu XX. Age-dependent morphological alterations of human ovaries from populations with and without BRCA mutations. Gynecol Oncol 2006; 103:719-28. [PMID: 16698071 DOI: 10.1016/j.ygyno.2006.03.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 03/24/2006] [Accepted: 03/31/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE From analysis of pre-cancer ovarian tissues obtained from prophylactic oophorectomies, several studies reported the increased ovarian morphological changes in high-risk ovaries, but whether these morphological changes are associated with BRCA1/BRCA2 genotypes or are cancer precursors is controversial. Here, we have investigated a recent collection of ovaries from prophylactic oophorectomies and control ovaries from surgeries due to other non-ovarian-related cancer or non-neoplastic diseases to determine if ovarian morphological changes relate to BRCA1/2 genotypes or reproductive history. METHODS We assembled a panel of archived ovarian tissues: 52 ovarian tissue blocks were from prophylactic oophorectomies of a high-risk (HR) population; 66 ovaries were from surgeries due to non-ovarian-related diseases, referred to as normal-risk (NR) group. The morphology of ovarian tissues was examined, and morphological changes including papillomatosis, invaginations, inclusion cysts, and epithelial stratification were assessed in a blinded fashion. RESULTS No statistically significant difference in frequency of these histolopathologic features was found between HR and NR groups. However, inclusion cysts and deep invaginations were found much more commonly in women age 45-54 of either HR or NR groups. CONCLUSIONS This study suggests that no significant increase in the presence of non-neoplastic ovarian morphological changes is associated with BRCA1/BRCA2 mutations. Rather, the frequency of these histological features, especially inclusion cysts, may associate with age or menopausal status. We propose that ovulatory and perimenopausal gonadotropin stimulation produces ovarian morphological changes, and these histological features may promote the transformation of genetically compromised epithelial cells in the development of ovarian cancer.
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Affiliation(s)
- Kathy Qi Cai
- Ovarian Cancer Program and Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
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Clark-Knowles KV, Garson K, Jonkers J, Vanderhyden BC. Conditional inactivation of Brca1 in the mouse ovarian surface epithelium results in an increase in preneoplastic changes. Exp Cell Res 2006; 313:133-45. [PMID: 17070800 DOI: 10.1016/j.yexcr.2006.09.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 09/25/2006] [Accepted: 09/25/2006] [Indexed: 12/17/2022]
Abstract
Epithelial ovarian cancer (EOC) is thought to arise from the ovarian surface epithelium (OSE); however, the molecular events underlying this transformation are poorly understood. Germline mutations in the BRCA1 tumor suppressor gene result in a significantly increased risk of developing EOC and a large proportion of sporadic EOCs display some sort of BRCA1 dysfunction. Using mice with conditional expression of Brca1, we inactivated Brca1 in the murine OSE and demonstrate that this inactivation results in the development of preneoplastic changes, such as hyperplasia, epithelial invaginations, and inclusion cysts, which arise earlier and are more numerous than in control ovaries. These changes resemble the premalignant lesions that have been reported in human prophylactic oophorectomy specimens from women with BRCA1 germline mutation. We also report that inactivation of Brca1 in primary cultures of murine OSE cells leads to a suppression of proliferation due to increased apoptosis that can be rescued by concomitant inactivation of p53. These observations, along with our finding that these cells display an increased sensitivity to the DNA-damaging agent cisplatin, indicate that loss of function of Brca1 in OSE cells impacts both cellular growth control and DNA-damage repair which results in altered cell behavior manifested as morphological changes in vivo that arise earlier and are more numerous than what can be attributed to ageing.
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Affiliation(s)
- Katherine V Clark-Knowles
- Department of Cellular and Molecular Medicine, University of Ottawa, 501 Smyth Rd., Box 926, Ottawa, Ontario, Canada K1H 8L6.
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Fleming JS, Beaugié CR, Haviv I, Chenevix-Trench G, Tan OL. Incessant ovulation, inflammation and epithelial ovarian carcinogenesis: revisiting old hypotheses. Mol Cell Endocrinol 2006; 247:4-21. [PMID: 16297528 DOI: 10.1016/j.mce.2005.09.014] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Revised: 09/30/2005] [Accepted: 10/11/2005] [Indexed: 12/11/2022]
Abstract
Epithelial ovarian cancer (EOC) is often a lethal disease because in many cases early symptoms go undetected. Although research proceeds apace, as yet there are few reliable and specific biomarkers for the early stages of the disease. EOC is an umbrella label for a highly heterogeneous collection of cancers, which includes tumours of low malignant potential, serous cystadenomas, mucinous and clear cell carcinomas, all of which are likely to arise from a number of epithelial cell types and a variety of progenitor lesions. Many, but not all types of EOC are thought to arise from the cells lining ovarian inclusion cysts. In this review, we discuss the hypotheses that have driven our ideas on epithelial ovarian carcinogenesis and examine the morphological and genetic evidence for pathways to EOC. The emergence of laser-capture microdissection and expression profiling by microarray technologies offers the promise of defining these pathways more accurately, as well as providing us with the tools for earlier diagnosis.
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Affiliation(s)
- Jean S Fleming
- Eskitis Institute for Cell & Molecular Therapies, School of Biomolecular and Biomedical Sciences, Griffith University Nathan Campus, Nathan, Qld 4111, Australia.
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Okamura H, Katabuchi H, Nitta M, Ohtake H. Structural changes and cell properties of human ovarian surface epithelium in ovarian pathophysiology. Microsc Res Tech 2006; 69:469-81. [PMID: 16718660 DOI: 10.1002/jemt.20306] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The surface epithelial cells of the ovary, which are modified peritoneal cells, form a single, focally pseudostratified layer. The Müllerian ducts differentiate after invagination of the coelomic mesothelium over the gonadal ridges during the 6th week of embryonic life. On the basis of the embryologically putative Müllerian potential of this epithelium, endometriosis can be explained by coelomic metaplasia from the peritoneum, including ovarian surface epithelium. Some pelvic endometriosis specimens have shown that epithelial cells on the ovary or pelvis are serially changed to endometriotic gland cells. Immunohistochemistry as well as scanning electron microscopy also reinforce the light-microscopical findings. A three-dimensional culture system demonstrated that human ovarian surface epithelial cells exhibited a glandular-stromal structure when they were cocultured with endometrial stromal cells in an estrogen-rich environment. Ovarian carcinomas in the epithelial-stromal category are thought to arise from the surface epithelium and its inclusions. The ovarian surface epithelium is physiologically involved in follicular rupture, oocyte release, and the subsequent repair of follicle wall during reproductive age. Simultaneously, ovulation may cause a loss of integrity of the surface epithelium, followed by accumulation of multiple mutations. The cortical invagination, surface stromal proliferation, and Müllerian differentiation of these cells are likely not to be an early step in the cancer development. However, the inclusion cysts are closely related with carcinogenesis because they are significantly more common in ovaries contralateral to those containing epithelial cancers than in control ovaries. As an in vitro study, ovarian carcinoma cell lines were established from simian virus 40 large T antigen-transformed human surface epithelial cells of the ovary. Further investigations of these cell lines may lead to insights into the preneoplastic and early stages of carcinomas. To clarify the pathogenesis of endometriosis and epithelial ovarian cancer, specifically designed studies of ovarian surface epithelium are required.
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Affiliation(s)
- Hitoshi Okamura
- Department of Reproductive Medicine, Kumamoto University, Kumamoto 860-8556, Japan.
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Kerner R, Sabo E, Gershoni-Baruch R, Beck D, Ben-Izhak O. Expression of cell cycle regulatory proteins in ovaries prophylactically removed from Jewish Ashkenazi BRCA1 and BRCA2 mutation carriers: Correlation with histopathology. Gynecol Oncol 2005; 99:367-75. [PMID: 16051332 DOI: 10.1016/j.ygyno.2005.06.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Revised: 06/07/2005] [Accepted: 06/13/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Prophylactic oophorectomy in Ashkenazi Jewish women with BRCA mutations represents a unique opportunity to search for premalignant changes in ovaries. Reports on the presence of dysplastic lesions in these ovaries are contradictory. Our aim was to study the expression of cell cycle regulatory proteins--p53, Skp2, p27, Ki67, Bcl2 and p16--in correlation with histopathological changes. p16(INK4A) was not studied before in prophylactically removed ovaries. METHODS Ninety-four ovaries from 50 Ashkenazi Jewish BRCA carriers were compared with 42 ovaries removed for reasons unrelated to cancer and with 16 ovarian carcinomas. RESULTS Three (6%) patients from the high-risk group had an occult carcinoma. A significant association was found between BRCA-positive expression and the presence of atypical changes in the superficial ovarian epithelium (P = 0.014) as well as the presence of epithelial cortical clefts (P = 0.042). Expression of p53 in cortical inclusions was significantly higher in the BRCA-positive cases than in the benign control group (P = 0.03). The high-risk and the benign control group did not differ significantly by the expression of p16, BCL2, Ki67, p27 and SKP2 (P > 0.05). However, both groups significantly differed from the carcinoma group (P < 0.0001). A significant positive correlation was found between the expression of Ki67, and the grade of atypia in the high-risk group (R = 0.3, P = 0.01) and in the benign control group (R = 0.5, P = 0.02). CONCLUSIONS BRCA mutation carriers had more atypical changes in the superficial epithelium (P = 0.014) and more epithelial cortical clefts (P = 0.042) compared to the benign control group. The histopathology changes were not supported by significantly altered expressions of the proteins used in our study. Additional molecular studies could contribute to the disclosure of precancerous ovarian lesions.
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Affiliation(s)
- Ram Kerner
- Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel.
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