Non-Fimbrial Localization of Early Fallopian Tube Carcinoma: Implications for Prophylactic Surgery Technique in Women with Hereditary Risk for Pelvic Serous Carcinoma.
Sarah M Calkins, Joseph T Rabban. University of California, San Franciso
Background: The fallopian tube fimbriae are the major site of localization of the earliest forms of hereditary pelvic serous cancer. Occult cancers in the fimbriae are also common in women with sporadic ovarian or peritoneal serous carcinoma. Bilateral salpingo-oophorectomy is effective in markedly reducing the risk of hereditary pelvic cancer. However, not all such tubal tumors are localized to the fimbriae. Anatomic distribution of early tubal carcinoma carries implications for technique of risk reducing surgery. This study evaluated the topography of occult tubal carcinoma, emphasizing incidence of cases exclusively involving the non-fimbrial tube.
Design: Bilateral tubes were evaluated with an enhanced dissection protocol in 212 women presenting for a variety of benign and malignant gynecologic indications. Tubes were first formalin-fixed. The fimbriae were amputed from the ampulla and sectioned parallel to the fimbrial length. The ampulla was dissected in cross-section. Slice thickness was 2 to 3 millimeters. All slices were examined microscopically.
Results: Tubal carcinoma was present in 15/212 patients. 3 patients had carcinoma exclusively in the mucosa of the tubal ampulla/isthmus whereas 12 patients had carcinoma involving fimbriae. Among the 3 non-fimbrial tumors, 2 were invasive high grade serous carcinoma and 1 was a non-invasive but exophytic high grade serous carcinoma. None were grossly visible. Size was 0.1 to 1.0 cm. None had lymphovascular invasion. Among the 3 patients with exclusive ampullary involvement of the tube, 2 had primary peritoneal serous carcinoma and 1 had primary ovarian carcinosarcoma.
Conclusions: While grossly occult tubal carcinoma most commonly involves the fimbriae, the more proximal tube may occasionally be the exclusive site of involvement. This suggests that the benefit of risk-reducing surgery is maximized if all of the tube, not just the distal portion, is completely removed. Additionally, attention to thin-sectioning and complete histologic examination should be directed to the entire tube, not just the fimbriae.
Category: Gynecologic & Obstetrics
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 133, Wednesday Morning