The fallopian tube as the origin of non-uterine pelvic high-grade serous carcinoma.

Key content:

• Advances in histopathology, immunohistochemistry and molecular genetics have led to evidence that the fimbrial end of the fallopian tube may be the source of origin of non-uterine high-grade pelvic serous carcinoma (HGPSC).
• Most of the evidence comes from studies in risk-reducing salpingo-oophorectomy in BRCA carriers.
• A proportion of these high-grade tumours have been proven to develop from specific precursor lesions, such as serous tubal intraepithelial carcinoma (STIC), before transformation into invasive high-grade pelvic serous carcinoma.
• Detailed sectioning of the fallopian tube is suggested using the SEE-FIM protocol (Sectioning and Extensively Examining the Fimbriated end of the fallopian tube).
• Clinical management of STIC in the absence of malignancy is not yet clearly defined.

Learning objectives:

• To review the various theories of pathogenesis of non-uterine HGPSC.
• To discuss the clinical management of STIC.
• Preventative strategies for HGPSC.

Ethical issues:

• Role for salpingectomy as a mode of sterilisation in women with completed family and salpingectomy during hysterectomy for benign cases.
• Could risk-reducing salpingectomy be recommended instead of risk-reducing salpingo-oophorectomy in young women, to avoid menopausal side effects?

© 2016 Royal College of Obstetricians and Gynaecologists.

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Related:

1. The Distal Fallopian Tube as the Origin of Non-Uterine Pelvic High-Grade Serous Carcinomas. Scientific Impact Paper No. 44. November 2014. © Royal College of Obstetricians and Gynaecologists. (Artículo completo de libre descarga en formato PDF).