Carlson Joseph W, Miron Alexander, Jarboe Elke A, Parast Mana M, Hirsch Michelle S, Lee Yonghee, Muto Michael G, Kindelberger David, Crum Christopher P
Department of Pathology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
J Clin Oncol. 2008 Sep 1;26(25):4160-5. doi: 10.1200/JCO.2008.16.4814.
A diagnosis of primary peritoneal serous carcinoma (PPSC) requires exclusion of a source in other reproductive organs. Serous tubal intraepithelial carcinoma (STIC; stage 0) has been described in asymptomatic women with BRCA mutations and linked to a serous cancer precursor in the fimbria. This study examined the frequency of STIC in PPSC and its clinical outcome in BRCA-positive women.
Presence or absence of STIC was recorded in consecutive cases meeting the 2001 WHO criteria for PPSC, including 26 patients with nonuniform sampling of the fallopian tubes (group 1) and 19 patients with complete tubal examination (group 2; sectioning and extensively examining the fimbriated end, or SEE-FIM protocol). In selected cases, STIC or its putative precursor and the peritoneal tumor were analyzed for p53 mutations (exons 1 to 11). Outcome of STIC was ascertained by literature review.
Thirteen (50%) of 26 PPSCs in group 1 involved the endosalpinx, with nine STICs (35%). Fifteen (79%) of 19 cases in group 2 contained endosalpingeal involvement, with nine STICs (47%). STIC was typically fimbrial and unifocal, with variable invasion of the tubal wall. In five of five cases, the peritoneal and tubal lesion shared an identical p53 mutation. Of 10 reported STICs in BRCA-positive women, all patients were without disease on follow-up.
The fimbria is the source of nearly one half of PPSCs, suggesting serous malignancy originates in the tubal mucosa but grows preferentially at a remote peritoneal site. The generally low risk of recurrence in stage 0 (STIC) disease further underscores STIC as a possible target for early serous cancer detection and prevention.
原发性腹膜浆液性癌（PPSC）的诊断需要排除其他生殖器官的原发灶。浆液性输卵管上皮内癌（STIC；0期）已在无症状的BRCA突变女性中被描述，并与输卵管伞端的浆液性癌前体相关。本研究调查了PPSC中STIC的发生率及其在BRCA阳性女性中的临床结局。
记录连续符合2001年WHO PPSC标准的病例中STIC的有无，包括26例输卵管取样不完整的患者（第1组）和19例输卵管完整检查的患者（第2组；切片并广泛检查伞端，即SEE-FIM方案）。在选定病例中，分析STIC或其假定前体以及腹膜肿瘤的p53突变（外显子1至11）。通过文献回顾确定STIC的结局。
第1组26例PPSC中有13例（50%）累及输卵管内膜，其中9例为STIC（35%）。第2组19例中有15例（79%）累及输卵管内膜，其中9例为STIC（47%）。STIC通常位于伞端且为单灶性，输卵管壁侵犯程度不一。5例中的5例，腹膜和输卵管病变共享相同的p53突变。在BRCA阳性女性中报告的10例STIC中，所有患者随访时均无疾病。
输卵管伞端是近一半PPSC的来源，提示浆液性恶性肿瘤起源于输卵管黏膜，但优先在远处腹膜部位生长。0期（STIC）疾病通常较低的复发风险进一步强调STIC作为早期浆液性癌检测和预防的可能靶点。
