An Early Precursor to Pelvic Serous Carcinoma (p53 Signature): Site Specificity and Impact of Genetic Risk (BRCA)
MC Chang, AK Folkins, EA Jarboe, A Saleemuddin, Y Lee, CP Crum. Brigham & Women's Hospital, Boston, MA
Background: The p53 signature, an entity in the distal fallopian tube, has been linked to early serous carcinoma and is proposed as an early phase of serous carcinogenesis. However, the distribution of the p53 signature in the pelvis has not been systematically determined.
Design: We analyzed cases with benign mllerian epithelium in the ovaries (CIC, 75), endosalpingiosis (ESP, 54), fallopian tubes from BRCA+ women (FTHR, 75), controls (FTLR, 41), women with serous tubal intraepithelial carcinoma (FTSTIC,17), and serous carcinoma (FTSCA, 33) for p53 signatures by p53 immunostaining.
Results: p53 signatures were identified in 0, 0, 38, 32, 53 and 57 percent of CIC, ESP, FTHR, FTLR, FTSTIC, and FTSCA, respectively. With rare exceptions, p53 signatures were identified only in epithelium of the salpinx proper and were significantly more common in fallopian tubes containing STIC or in association with pelvic serous carcinoma (see figure). Genetic risk (BRCA) does not influence frequency of p53 signatures.
Conclusions: p53 signatures are significantly associated with the fallopian tube (p < 0.001) and in that organ, with malignancy (p = 0.037). The evidence strongly suggests that the majority of serous carcinomas that are not directly associated with a pre-existing condition (such as endometriosis) arise either in the fimbria or in salpingeal epithelium that is in continuity with the fimbria (adhesions). The terms fimbrial ovarian or simply pelvic serous carcinoma are more accurate descriptors for this disease.
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 175, Tuesday Afternoon