Division of Breast, Institute of Pathology, Gynecologic and Perinatal Pathology, University of Leipzig, Liebigstrasse 26, Leipzig, Germany.
Int J Gynecol Pathol. 2011 Sep;30(5):417-24. doi: 10.1097/PGP.0b013e318216d447.
The objective of this study was to evaluate the role of the fimbriated end and nonfimbriated epithelium of fallopian tubes with regard to p53 signature, tubal intraepithelial lesions in transition (TILT), and serous tubal in-situ carcinoma (STIC) in cases of different kinds of serous pelvic cancer. This study immunohistochemically evaluated (by Ki-67 and p53 staining) the presence of p53 signature, TILT lesions, and STIC in 14 consecutive cases of prophylactic salpingo-oophorectomy in women with BRCA-1/2 mutation (bilateral salpingo-oophorectomy), 11 cases of macroscopically inconspicuous adnexae of patients with primary contralateral tubal cancer (TC), 9 cases of primary peritoneal cancer (PPC), and 10 cases of serous ovarian borderline tumors, evaluating the fallopian tubes (using the Sectioning and Extensively Examining the FIMbria protocol), ovarian surface epithelium, and ovarian cortical inclusion cysts. The frequencies of p53 signature, TILT, and STIC were 35.7%, 7.1%, and 0% in cases of prophylactic surgery, 18.2%, 9.1%, and 18.2% in TC, and 11.1%, 0%, and 33.3% in PPC. These precursor lesions were missed during the initial routine screening and were found in the fimbriated end of the fallopian tubes in 94%. In 1 case of PPC, staining for p53 was negative in STIC. The studied adnexal tissue of serous ovarian borderline tumor and ovarian cortical inclusion cysts of all cases showed no alterations according to p53 signature, TILT, or STIC. STIC and p53 signature as precursor lesions of pelvic serous cancer were seen in macroscopically inconspicuous contralateral fallopian tubes in unilateral TC, in patients with elective bilateral salpingo-oophorectomy, and in patients affected by PPC. Therefore, we propose the complete processing of adnexal tissue and the use of step sectioning to establish the correct diagnosis. Immunohistochemistry for p53 and ki-67 may aid in the diagnosis, but is not necessary for routine investigation.
本研究旨在评估输卵管有纤毛端和无纤毛上皮在不同类型浆液性盆腔癌病例中与 p53 特征、管内上皮内病变（TILT）和输卵管原位浆液性癌（STIC）之间的关系。本研究通过 Ki-67 和 p53 染色对 14 例 BRCA-1/2 突变（双侧输卵管卵巢切除术）预防性输卵管卵巢切除术妇女、11 例原发性对侧输卵管癌（TC）患者大体上无明显附件、9 例原发性腹膜癌（PPC）和 10 例浆液性卵巢交界性肿瘤患者的输卵管（采用 Sectioning 和 Extensively Examining the FIMbria 方案）、卵巢表面上皮和卵巢皮质包涵囊肿中 p53 特征、TILT 病变和 STIC 的存在进行了免疫组织化学评估。预防性手术、TC 中 p53 特征、TILT 和 STIC 的频率分别为 35.7%、7.1%和 0%、18.2%、9.1%和 18.2%、11.1%、0%和 33.3%。这些前体病变在初始常规筛查中被遗漏，在输卵管的纤毛端发现了 94%。在 1 例 PPC 中，STIC 中 p53 的染色为阴性。所有病例的浆液性卵巢交界性肿瘤和卵巢皮质包涵囊肿的研究附件组织均未显示 p53 特征、TILT 或 STIC 改变。STIC 和 p53 特征作为盆腔浆液性癌的前体病变，在单侧 TC 中大体上无明显异常的对侧输卵管、在接受双侧输卵管卵巢切除术的患者以及在患有 PPC 的患者中均可见。因此，我们建议对附件组织进行完整处理，并采用分步切片来确立正确的诊断。p53 和 ki-67 的免疫组织化学可能有助于诊断，但并非常规检查所必需。
