Persistence of Serous Tubal Intraepithelial Carcinoma after Neo-Adjuvant Chemotherapy: Evidence Based Recommendations for Gross Evaluation of Interval Surgery Cases.
Eugenia Colon, Radmila Ehrsson, Joseph W Carlson. Karolinska University Hospital, Stockholm, Sweden
Background: The origin of pelvic serous carcinomas is a source of continuing controversy. Several recent studies of patients undergoing primary surgery for ovarian, primary peritoneal, and even uterine serous cancer have indicated the value of complete fimbrial sampling in order to detect occult serous tubal intraepithelial carcinoma (STIC). The presence or absence of STIC in specimens from interval surgery after neoadjuvant treatment has not yet, to our knowledge, been addressed.
Design: Fourteen consecutive cases of interval surgery after neoadjuvant chemotherapy were reviewed, using both H&E and, as needed diagnostically, immunohistochemistry for p53 and MIB-1, for the presence or absence of serous tubal intraepithelial carcinoma. Tubal sampling varied among the fifteen cases. Nine archived cases had non-standard sampling of the tubal fimbriae while 5 cases had complete evaluation of the tubal fimbria using a protocol for sectioning and extensively examining the fimbriated end (SEE-FIM).
Results: Residual tumor involved the endosalpinx in five out of nine (55%) cases with non-standard tubal sampling and STIC was identified in one of these. STIC was identified in four out of five (80%) cases with complete fimbrial sampling. Interestingly, p53 positive in situ tubal lesions included both proliferative regions with histologically bizarre cells consistent with chemotherapy effect, and non proliferative regions with minimal to no histologic evidence of chemotherapy effect.
Conclusions: The origin of pelvic serous carcinoma is an area of current controversy. Several lines of evidence indicate that a significant proportion of pelvic serous carcinomas may arise from in situ lesions on the distal fallopian tube. These results are expected to improve the quality of pathologic evaluation by providing data driven recommendations for sampling in interval surgery cases. These results indicate that serous tubal intraepithelial carcinomas can persist through neoadjuvant chemotherapy and can be readily identified during microscopic examination. These results also show the value of a systematic approach to grossing of the fallopian tube.
Category: Gynecologic & Obstetrics
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 132, Wednesday Morning