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The Fallopian Tube-Peritoneal Junction: A Potential Site of Carcinogenesis

Seidman, Jeffrey D. M.D.; Yemelyanova, Anna M.D.; Zaino, Richard J. M.D.; Kurman, Robert J. M.D.

International Journal of Gynecological Pathology: January 2011 - Volume 30 - Issue 1 - p 4–11
doi: 10.1097/PGP.0b013e3181f29d2a
PATHOLOGY OF THE UPPER GENITAL TRACT: ORIGINAL ARTICLES
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Junctions between different types of epithelia are hot spots for carcinogenesis, but the junction of the peritoneal mesothelium with the fallopian tubal epithelium, the tubal-peritoneal junction, has not been characterized earlier. A total of 613 junctional foci in 228 fallopian tube specimens from 182 patients who underwent surgery for a variety of indications, including 27 risk-reducing salpingo-oophorectomy specimens, were studied. Edema, congestion, and dilated lymphatic channels were commonly present. Transitional metaplasia was found at the junction in 20% of patients and mesothelial hyperplasia in 17%. Inflammation at the junction was seen predominantly in patients with salpingitis, torsion, or tubal pregnancy. Ovarian-type stroma was found at the junction in 5% of patients, and was found elsewhere in the tubal lamina propria in an additional 27% of patients. Findings in risk-reducing salpingo-oophorectomy specimens in women with BRCA mutations, a personal history of breast cancer, and/or a family history of breast/ovarian cancer were similar to those in controls. Transitional metaplasia specifically localizes to this junction, and is the probable source of Walthard cell nests. The recently highlighted significance of fimbrial tubal epithelium in the origin of serous ovarian carcinomas and a study suggesting that mucinous and Brenner tumors may arise from transitional-type epithelium in this location suggest that the tubal-peritoneal junction may play a role in the development of these tumors. This is the first comprehensive description of a hitherto unrecognized transitional zone in the adnexa.

Department of Pathology and Laboratory Medicine (J.D.S.), Washington Hospital Center, Washington, DC

Department of Pathology (A.Y.,R.J.K.), Johns Hopkins University School of Medicine, Baltimore, MD

Department of Pathology (R.J.Z.), the Milton S. Hershey Medical Center, Hershey, PA

Address correspondence and reprint requests to Jeffrey D. Seidman, MD, Department of Pathology and Laboratory Medicine, Washington Hospital Center, 110 Irving Street, North West, Washington, DC 20010. e-mail: Jeffrey.d.seidman@medstar.net

©2011International Society of Gynecological Pathologists