Tubal Precursor Lesions for High-Grade Serous Ovarian Carcinoma

Background Ovarian cancer is the most common fatal cancer of the female reproductive tract in industrialized countries; it is diagnosed annually in more than 200,000 women worldwide, with the greatest incidence in the USA and Northern Europe, and lowest incidence in Africa and Asia. Aim of the work To show whether the fallopian tube could be the site of origin of pelvic carcinomas. Patients This study included 36 patients with high-grade serous ovarian carcinoma. The patients were selected from the Gynecology Clinic in El-shatby University Maternity Hospital. All patients underwent laparotomy for cytoreduction and staging in Gynecology Department, and all biopsies were sent for histopathology, and patients diagnosed to be high-grade serous ovarian carcinoma were included in our study. Inclusion criteria were high-grade serous-type ovarian cancer selected after laparotomy and histopathological examination. Exclusion criteria were benign adnexal mass, low-grade tumor and other types of ovarian tumors. Methods All patients were subjected to preoperative analysis (history taking, clinical evaluation, ultrasound abdomen and pelvis, for estimation of morphological index, CT scan, assessment of CT peritoneal cancer index PCI and Serum CA125 assessment). Intraoperative peritoneal wash or ascites fluid aspiration, total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy, either supra-or infra-colonic and lymphadenectomy (pelvic, para-aortic) if suspicious were done, and pathological examination (gross examination and histopathological examination) and immunostaining were done. Results Histopathological diagnosis of the tubal lesions through examination of the H& E sections of the distal part of the tube in the studied groups revealed either normal tube with no remarkable changes, hyperplastic changes or tubal intraepithelial neoplasia. In the serous group, 21.4 % of the cases were normal, 69.6 % showed hyperplastic changes, and 9 % were TIN. The non-serous group showed 30.8 % of the cases were normal, 69.2 % showed hyperplastic changes, and no one showed TIN. While the control group showed 83.3 % were normal, 16.7 % showed hyperplastic changes and no one showed TIN. There was a significant difference between serous and control as well as between non-serous and control. In the low-grade group, about 11.1 % of the cases showed no pathological changes, 89.9 % showed hyperplastic changes, and no one showed TIN. While in the high-grade group, 26.3 % of the cases showed no pathological changes, 60.5 % showed hyperplastic changes, and 13.2 % showed TIN. The difference between high-and low-grade serous tumors was statistically significant. Results of immunohistochemical staining for P53 in tubal sections revealed that in the serous group, 5 cases (8.9 %) showed negative staining, 22 cases (39.3 %) showed focal positive staining, and 29 cases (51.8 %) showed diffuse positive staining. In the non-serous group, 8 cases (30.8 %) showed negative staining and 18 cases (69.2 %) showed positive focal. No cases showed diffuse positive staining. In control group, 15 cases (83.3 %) showed negative staining and 3 cases (16.7 %) showed focal positive staining. No cases showed diffuse positive staining. There was significant difference between serous and non-serous, serous and control as well as nonserous and control. In the low-grade group, 1 case (10.6 %) showed negative staining, 17 cases (89.4 %) showed positive focal staining, and no cases showed diffuse positive staining. In high-grade group, 4 cases (5.5 %) showed negative staining, 5 cases (18.2 %) showed focal positive staining, and 29 cases (76.3 %) showed diffuse positive staining. Conclusion and recommendations We concluded that fallopian tube could be a site of origin of pelvic carcinoma. We recommend that risky females after completion of their family size should undergo prophylactic salpingectomy to reduce risk of pelvic cancers.