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Hsu I, Lee LH, Hsu L, Chen SU, Hsu CC. Disordered hypothalamus-pituitary-ovary axis in heterotopic extraovarian sex cord-stromal proliferation: a case report of fallopian tube serous adenofibroma. BMC Womens Health 2023; 23:243. [PMID: 37161407 PMCID: PMC10170719 DOI: 10.1186/s12905-023-02407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/03/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Fallopian tube serous adenofibromas are uncommon tumors of the female genital tract, only dozens of cases have ever been reported. Earlier study indicated that they might be derived from embryonic remnants of the Müllerian duct. Clinical presentation of these tumors is usually asymptomatic. Small cysts of 0.5-3 cm in diameter are mostly incidentally found at the fimbriae end, with coarse papillary excrescences lined by epithelial cells and connective tissue stroma without nuclear pleomorphism or mitosis. CASE PRESENTATION A 23-year-old woman with normal secondary sexual characters and 46, XX karyotype, presented to the gynecology clinic complaining of irregular menstrual cycles. Laboratory studies reported unique discrepancy of hormone levels; anti-Müllerian hormone (AMH): 6.05 ng/mL (The normal range of AMH is 1.70-5.63 ng/mL in women aged under 35 years old), follicle stimulating hormone (FSH): 31.9 mIU/mL (reference range: 3.85-8.78, follicular phase; 4.54-22.51, ovulatory phase; 1.79-5.12, luteal phase; 16.74-113.59, menopause), and luteinizing hormone (LH): 52.0 mIU/mL (reference range: 2.12-10.89, follicular phase; 19.18-103.03, ovulatory phase; 1.20-12.86, luteal phase; 10.87-58.64, menopause), mimicking gonadotropin-resistant ovary syndrome. The ultrasound reported a right adnexal cyst of 10.4 × 7.87 × 6.7 cm. Laparoscopic evaluation was performed; pathology revealed serous adenofibroma of the fallopian tube with ovarian stroma contents. Heterotopic extraovarian sex cord-stromal proliferations was most probable. The patient's hormone levels returned to the reproductive status two weeks after surgery; FSH: 7.9 mIU/mL, LH: 3.59 mIU/mL,and AMH: 4.32 ng/mL. The patient's menstrual cycles have resumed to normal for over two years after removal of the fallopian tube cyst. CONCLUSIONS This case of fallopian tube serous adenofibromas presented a discrepancy of serum AMH and FSH mimicking gonadotropin-resistant ovary syndrome. The clinical picture derived from heterotopic extraovarian sex cord-stromal proliferation indicated a disordered hypothalamus-pituitary-ovary axis.
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Affiliation(s)
- Isabel Hsu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Leonard Hsu
- Douglass Hanly Moir Pathology, Sydney, NSW, Australia
| | - Shee-Uan Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Chin Hsu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, Tainan, Taiwan.
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.
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van Lieshout LAM, Steenbeek MP, De Hullu JA, Vos MC, Houterman S, Wilkinson J, Piek JMJ. Hysterectomy with opportunistic salpingectomy versus hysterectomy alone. Cochrane Database Syst Rev 2019; 8:CD012858. [PMID: 31456223 PMCID: PMC6712369 DOI: 10.1002/14651858.cd012858.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ovarian cancer has the highest mortality rate of all gynaecological malignancies with an overall five-year survival rate of 30% to 40%. In the past two decades it has become apparent and more commonly accepted that a majority of ovarian cancers originate in the fallopian tube epithelium and not from the ovary itself. This paradigm shift introduced new possibilities for ovarian cancer prevention. Salpingectomy during a hysterectomy for benign gynaecological indications (also known as opportunistic salpingectomy) might reduce the overall incidence of ovarian cancer. Aside from efficacy, safety is of utmost importance, especially due to the preventive nature of opportunistic salpingectomy. Most important are safety in the form of surgical adverse events and postoperative hormonal status. Therefore, we compared the benefits and risks of hysterectomy with opportunistic salpingectomy to hysterectomy without opportunistic salpingectomy. OBJECTIVES To assess the effect and safety of hysterectomy with opportunistic salpingectomy versus hysterectomy without salpingectomy for ovarian cancer prevention in women undergoing hysterectomy for benign gynaecological indications; outcomes of interest include the incidence of epithelial ovarian cancer, surgery-related adverse events and postoperative ovarian reserve. SEARCH METHODS The Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two clinical trial registers were searched in January 2019 together with reference checking and contact with study authors. SELECTION CRITERIA We intended to include both randomised controlled trials (RCTs) and non-RCTs that compared ovarian cancer incidence after hysterectomy with opportunistic salpingectomy to hysterectomy without opportunistic salpingectomy in women undergoing hysterectomy for benign gynaecological indications. For assessment of surgical and hormonal safety, we included RCTs that compared hysterectomy with opportunistic salpingectomy to hysterectomy without opportunistic salpingectomy in women undergoing hysterectomy for benign gynaecological indications. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The primary review outcomes were ovarian cancer incidence, intraoperative and short-term postoperative complication rate and postoperative hormonal status. Secondary outcomes were total surgical time, estimated blood loss, conversion rate to open surgery (applicable only to laparoscopic and vaginal approaches), duration of hospital admission, menopause-related symptoms and quality of life. MAIN RESULTS We included seven RCTs (350 women analysed). The evidence was of very low to low quality: the main limitations being a low number of included women and surgery-related adverse events, substantial loss to follow-up and a large variety in outcome measures and timing of measurements.No studies reported ovarian cancer incidence after hysterectomy with opportunistic salpingectomy compared to hysterectomy without opportunistic salpingectomy in women undergoing hysterectomy for benign gynaecological indications. For surgery-related adverse events, there were insufficient data to assess whether there was any difference in both intraoperative (odds ratio (OR) 0.66, 95% confidence interval (CI) 0.11 to 3.94; 5 studies, 286 participants; very low-quality evidence) and short-term postoperative (OR 0.13, 95% CI 0.01 to 2.14; 3 studies, 152 participants; very low-quality evidence) complication rates between hysterectomy with opportunistic salpingectomy and hysterectomy without opportunistic salpingectomy because the number of surgery-related adverse events was very low. For postoperative hormonal status, the results were compatible with no difference, or with a reduction in anti-Müllerian hormone (AMH) that would not be clinically relevant (mean difference (MD) -0.94, 95% CI -1.89 to 0.01; I2 = 0%; 5 studies, 283 participants; low-quality evidence). A reduction in AMH would be unfavourable, but due to wide CIs, the postoperative change in AMH can still vary from a substantial decrease to even a slight increase. AUTHORS' CONCLUSIONS There were no eligible studies reporting on one of our primary outcomes - the incidence of ovarian cancer specifically after hysterectomy with or without opportunistic salpingectomy. However, outside the scope of this review there is a growing body of evidence for the effectiveness of opportunistic salpingectomy itself during other interventions or as a sterilisation technique, strongly suggesting a protective effect. In our meta-analyses, we found insufficient data to assess whether there was any difference in surgical adverse events, with a very low number of events in women undergoing hysterectomy with and without opportunistic salpingectomy. For postoperative hormonal status we found no evidence of a difference between the groups. The maximum difference in time to menopause, calculated from the lower limit of the 95% CI and the natural average AMH decline, would be approximately 20 months, which we consider to be not clinically relevant. However, the results should be interpreted with caution and even more so in very young women for whom a difference in postoperative hormonal status is potentially more clinically relevant. Therefore, there is a need for research on the long-term effects of opportunistic salpingectomy during hysterectomy, particularly in younger women, as results are currently limited to six months postoperatively. This limit is especially important as AMH, the most frequently used marker for ovarian reserve, recovers over the course of several months following an initial sharp decline after surgery. In light of the available evidence, addition of opportunistic salpingectomy should be discussed with each woman undergoing a hysterectomy for benign indication, with provision of a clear overview of benefits and risks.
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Affiliation(s)
- Laura A M van Lieshout
- Catharina Cancer Institute, Catharina HospitalDepartment of Obstetrics and GynaecologyMichelangelolaan 2EindhovenNetherlands5623EJ
- Radboud University Nijmegen Medical CentreDepartment of Obstetrics and GynaecologyNijmegenNijmegenNetherlands6525 GA
| | - Miranda P Steenbeek
- Radboud University Nijmegen Medical CentreDepartment of Obstetrics and GynaecologyNijmegenNijmegenNetherlands6525 GA
| | - Joanne A De Hullu
- Radboud University Nijmegen Medical CentreDepartment of Obstetrics and GynaecologyNijmegenNijmegenNetherlands6525 GA
| | - M Caroline Vos
- Elisabeth‐TweeSteden HospitalObstetrics and GynaecologyHilvarenbeekseweg 60TilburgNetherlands5000LC
| | - Saskia Houterman
- Catharina HospitalDepartment of Education and ResearchMichelangelolaan 2EindhovenNetherlands5623 EJ
| | - Jack Wilkinson
- Manchester Academic Health Science Centre (MAHSC), University of ManchesterCentre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and HealthClinical Sciences Building Salford Royal NHS Foundation Trust HospitalRoom 1.315, Jean McFarlane Building University Place Oxford RoadManchesterUKM13 9PL
| | - Jurgen MJ Piek
- Catharina Cancer Institute, Catharina HospitalDepartment of Obstetrics and GynaecologyMichelangelolaan 2EindhovenNetherlands5623EJ
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Venturella R, Morelli M, Lico D, Di Cello A, Rocca M, Sacchinelli A, Mocciaro R, D'Alessandro P, Maiorana A, Gizzo S, Zullo F. Wide excision of soft tissues adjacent to the ovary and fallopian tube does not impair the ovarian reserve in women undergoing prophylactic bilateral salpingectomy: results from a randomized, controlled trial. Fertil Steril 2015; 104:1332-9. [DOI: 10.1016/j.fertnstert.2015.08.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/01/2015] [Accepted: 08/05/2015] [Indexed: 11/28/2022]
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Walker JL, Powell CB, Chen LM, Carter J, Bae Jump VL, Parker LP, Borowsky ME, Gibb RK. Society of Gynecologic Oncology recommendations for the prevention of ovarian cancer. Cancer 2015; 121:2108-20. [PMID: 25820366 DOI: 10.1002/cncr.29321] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/22/2014] [Accepted: 01/20/2015] [Indexed: 12/25/2022]
Abstract
Mortality from ovarian cancer may be dramatically reduced with the implementation of attainable prevention strategies. The new understanding of the cells of origin and the molecular etiology of ovarian cancer warrants a strong recommendation to the public and health care providers. This document discusses potential prevention strategies, which include 1) oral contraceptive use, 2) tubal sterilization, 3) risk-reducing salpingo-oophorectomy in women at high hereditary risk of breast and ovarian cancer, 4) genetic counseling and testing for women with ovarian cancer and other high-risk families, and 5) salpingectomy after childbearing is complete (at the time of elective pelvic surgeries, at the time of hysterectomy, and as an alternative to tubal ligation). The Society of Gynecologic Oncology has determined that recent scientific breakthroughs warrant a new summary of the progress toward the prevention of ovarian cancer. This review is intended to emphasize the importance of the fallopian tubes as a potential source of high-grade serous cancer in women with and without known genetic mutations in addition to the use of oral contraceptive pills to reduce the risk of ovarian cancer.
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Affiliation(s)
- Joan L Walker
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - C Bethan Powell
- Northern California Gynecologic Cancer Program, Kaiser Permanente San Francisco, San Francisco, California
| | - Lee-May Chen
- Gynecology/Oncology Division, University of California San Francisco/Mt. Zion Cancer Center, San Francisco, California
| | - Jeanne Carter
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Victoria L Bae Jump
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Mark E Borowsky
- Helen F. Graham Cancer Center, Christiana Care Health System, Newark, Delaware
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5
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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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6
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Early Detection of High-grade Tubal Serous Carcinoma in Women at Low Risk for Hereditary Breast and Ovarian Cancer Syndrome by Systematic Examination of Fallopian Tubes Incidentally Removed During Benign Surgery. Am J Surg Pathol 2014; 38:729-42. [DOI: 10.1097/pas.0000000000000199] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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7
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Revisiting the pathogenesis of ovarian cancer: the central role of the fallopian tube. Arch Gynecol Obstet 2013; 289:241-6. [DOI: 10.1007/s00404-013-3041-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/19/2013] [Indexed: 12/15/2022]
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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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Dietl J, Wischhusen J, Geissinger E. The fimbria/ovarian surface junction. Hum Reprod 2011; 26:3494-5; author reply 3495. [PMID: 22016419 DOI: 10.1093/humrep/der337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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10
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Vaughan S, Coward JI, Bast Jr. RC, Berchuck A, Berek JS, Brenton JD, Coukos G, Crum CC, Drapkin R, Etemadmoghadam D, Friedlander M, Gabra H, Kaye SB, Lord CJ, Lengyel E, Levine DA, McNeish IA, Menon U, Mills GB, Nephew KP, Oza AM, Sood AK, Stronach EA, Walczak H, Bowtell DD, Balkwill FR. Rethinking ovarian cancer: recommendations for improving outcomes. Nat Rev Cancer 2011; 11:719-25. [PMID: 21941283 PMCID: PMC3380637 DOI: 10.1038/nrc3144] [Citation(s) in RCA: 969] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There have been major advances in our understanding of the cellular and molecular biology of the human malignancies that are collectively referred to as ovarian cancer. At a recent Helene Harris Memorial Trust meeting, an international group of researchers considered actions that should be taken to improve the outcome for women with ovarian cancer. Nine major recommendations are outlined in this Opinion article.
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Affiliation(s)
- Sebastian Vaughan
- Ovarian Cancer Action Research Centre, Imperial College London Hammersmith Campus, Du Cane Road, London, W12 0NN
| | | | - Robert C. Bast Jr.
- MD Anderson Cancer Center, Ovarian Cancer Research Lab, 1515 Holcombe Blvd, Houston, Texas 77030, USA
| | - Andy Berchuck
- Duke University Medical Center, Division of Gynecologic Oncology, DUMC 3079, Durham, NC 27710
| | - Jonathan S. Berek
- Stanford Women’s Cancer Center, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, 94305, USA
| | - James D. Brenton
- Cancer Research UK, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE
| | - George Coukos
- University of Pennsylvania, Center for Research on Women’s Health, 1315 Rm, BRB II/III, Philadelphia, Pennsylvania 19104, USA
| | - Christopher C. Crum
- Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02445, USA
| | - Ronny Drapkin
- Dana-Farber Cancer Institute, Harvard Medical School, JFB 215D, 450 Brookline Avenue, Boston, Massachusetts 02215, USA
| | | | - Michael Friedlander
- Prince of Wales Cancer Centre, Department of Medical Oncology, Barker Street, Randwick, 2031, Australia
| | - Hani Gabra
- Ovarian Cancer Action Research Centre, Imperial College London Hammersmith Campus, Du Cane Road, London, W12 0NN
| | - Stan B. Kaye
- Institute of Cancer Research/Royal Marsden Hospital, Section of Medicine, Downs Road, Sutton, SM2 5PT
| | - Chris J. Lord
- Institute of Cancer Research, Breakthrough Toby Robins Breast Cancer Research Institute, 237 Fulham Road, London, SW3 6JB
| | - Ernst Lengyel
- University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 2050, Chicago, Illinois 60637, USA
| | - Douglas A. Levine
- Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA
| | - Iain A. McNeish
- Queen Mary University of London, Barts Cancer Institute, Charterhouse Square, London, EC1M 6BQ
| | - Usha Menon
- University College London Elizabeth Garrett Institute of Women’s Health, Euston Road, London, NW1 2BU
| | - Gordon B. Mills
- University of Texas M.D. Anderson Cancer Center, 1515, Holcombe Boulevard, Houston, Texas 77030, USA
| | - Kenneth P. Nephew
- Indiana University School of Medicine, 1001 E. Third Street, Bloomington, Indiana 47405, USA
| | - Amit M. Oza
- Princess Margaret Hospital, 5th Floor Rm 5-717, 610 University Ave, Toronto, Ontario M5G 2M9, Canada
| | - Anil K. Sood
- University of Texas M. D. Anderson Cancer Center, Departments of Gynecologic Oncology and Cancer Biology, Unit 1362, P.O. BOX 301439, Houston, Texas 77230, USA
| | - Euan A. Stronach
- Ovarian Cancer Action Research Centre, Imperial College London Hammersmith Campus, Du Cane Road, London, W12 0NN
| | - Henning Walczak
- Division of Immunology and Inflammation, Imperial College London, South Kensington Campus, London, SW7 2AZ
| | - David D. Bowtell
- Corressponding author, DAVID BOWTELL, Head, Cancer Genomics and Genetics Program, Principal Investigator Australian Ovarian Cancer Study, Peter MacCallum Cancer Centre, Department of Biochemistry, University of Melbourne, , Lab 61-3-96561287, Office 61-3-96561356, Mail Address: Research Division, Peter MacCallum Cancer Centre, Locked Bag 1 A'Beckett St, Melbourne 8006, VIC. Australia, http://www.petermac-research.org.au
| | - Frances R. Balkwill
- Queen Mary University of London, Centre for Cancer and Inflammation, Charterhouse Square, Barts and the London Medical School, London, EC1M 6BQ
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Dietl J, Wischhusen J, Häusler SFM. The post-reproductive Fallopian tube: better removed? Hum Reprod 2011; 26:2918-24. [PMID: 21849300 DOI: 10.1093/humrep/der274] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recently, the distal Fallopian tube has attracted considerable attention not only as site of origin for serous cancer in women with BRCA mutations, but also as the anatomical location where the majority of serous ovarian cancers apparently develop. Consequently, the Fallopian tube may be the unique location where early 'ovarian' cancers can be found--which would contradict the long-standing impression that the ovaries and the Fallopian tubes are always simultaneously involved. Based on the dismal prognosis associated with ovarian cancer and our inability to screen for early-stage disease, we discuss the rationale for introducing salpinges-hysterectomy as new clinical standard for women in need of hysterectomy and further weigh the arguments for and against bilateral salpingectomy as a sterilization method. There is no known physiological benefit of retaining the post-reproductive Fallopian tube during hysterectomy or sterilization, especially as this does not affect ovarian hormone production. On the other hand, the consequences associated with a surgical menopause provide a rationale for preserving the ovaries in premenopausal women. Prophylactic removal of the Fallopian tubes during hysterectomy or sterilization would rule out any subsequent tubal pathology, such as hydrosalpinx, which is observed in up to 30% of women after hysterectomy. Moreover, this intervention is likely to offer considerable protection against later tumour development, even if the ovaries are retained. Thus, we recommend that any hysterectomy should be combined with salpingectomy. In addition, women over 35 years of age could also be offered bilateral salpingectomy as means of sterilization.
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Affiliation(s)
- J Dietl
- Department of Obstetrics and Gynaecology, University of Würzburg, School of Medicine, Josef-Schneider-Strasse 4, 97080 Würzburg, Germany.
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