Fallopian Tube Correlates of Serous Borderline Tumors.
Anna R Laury, Gang Ning, Charles M Quick, Marisa R Nucci, Mana M Parast, Frank D McKeon, Wa Xian, Christopher P Crum. Brigham & Women's Hospital, Boston; UCSD, La Jolla; Harvard Medical School, Boston; A-Star, Philippines, Philippines
Background: Ovarian serous borderline tumors (SBT) are clonal neoplasms exhibiting secretory and ciliated cell differentiation (Sieben 2006), presumed to arise within mullerian epithelium in the ovarian cortex or peritoneal surface.Epithelial hyperplasia has been reported in fallopian tubes (FT) of patients with SBT (Robey 1989) but its significance is unknown.This study explored 4 parameters possibly linking FTs and SBTs: 1) differentiation characteristics of SBTs, 2) frequency of candidate precursors (secretory cell outgrowths in the FT (SCOUT)) relative to controls, 3) existence of SCOUTs exhibiting ciliated differentiation, and 4) a shared immunophenotype between SCOUTs and SBTs.
Design: 48 SBTs were culled from department files and stained for evidence of ciliated (p73) and secretory (HMFG2 or PAX8) differentiation and PAX2 expression.FTs from 34 SBTs and 65 benign controls were examined for PAX2 (-) SCOUTs.
Results: All SBTs stained for p73 and HMFG2 or PAX8, consistent with origin from a cell capable of secretory and ciliated differentiation.SCOUTs were seen in 110/398 (27%) FT cross-sections from SBTs vs 18/161 (11%) in controls (p=<0.001).SCOUTs were heterogenous, ranging from largely secretory (84/110) to mixed ciliated and secretory (26/110). Some SCOUTs had papillary architecture and in two cases, multiple foci of papillary SCOUTs with mixed ciliated and secretory differentiation. All SBTs had heterogeneous PAX2 staining; 35% were >80% positive, 56% were 20-80% positive, and in 9% of SBTs, less than 20% of the cells stained for PAX2.
Conclusions: This study shows for the first time that the FT hosts discrete epithelial alterations that are more frequently associated with SBT, have the capacity for both ciliated and secretory cell differentiation, frequently lack PAX2 expression, and share disturbances in PAX2 expression with SBTs.These findings suggest a precursor condition originating in the FT in a field of multifocal gene dysregulation, a subset of which might gain a growth advantage over pelvic/ovarian surface mesothelium, leading to SBT. If confirmed, this model could explain the origins of both low and high grade pelvic serous neoplasms.
Category: Gynecologic & Obstetrics
Tuesday, March 1, 2011 9:15 AM
Platform Session: Section D, Tuesday Morning