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p53 Signature and Serous Tubal In-situ Carcinoma in Cases of Primary Tubal and Peritoneal Carcinomas and Serous Borderline Tumors of the Ovary

Leonhardt, Karoline M.A.; Einenkel, Jens M.D.; Sohr, Sindy Ph.D.; Engeland, Kurt Ph.D.; Horn, Lars-Christian M.D., Ph.D.

International Journal of Gynecological Pathology: September 2011 - Volume 30 - Issue 5 - p 417–424
doi: 10.1097/PGP.0b013e318216d447

The objective of this study was to evaluate the role of the fimbriated end and nonfimbriated epithelium of fallopian tubes with regard to p53 signature, tubal intraepithelial lesions in transition (TILT), and serous tubal in-situ carcinoma (STIC) in cases of different kinds of serous pelvic cancer. This study immunohistochemically evaluated (by Ki-67 and p53 staining) the presence of p53 signature, TILT lesions, and STIC in 14 consecutive cases of prophylactic salpingo-oophorectomy in women with BRCA-1/2 mutation (bilateral salpingo-oophorectomy), 11 cases of macroscopically inconspicuous adnexae of patients with primary contralateral tubal cancer (TC), 9 cases of primary peritoneal cancer (PPC), and 10 cases of serous ovarian borderline tumors, evaluating the fallopian tubes (using the Sectioning and Extensively Examining the FIMbria protocol), ovarian surface epithelium, and ovarian cortical inclusion cysts. The frequencies of p53 signature, TILT, and STIC were 35.7%, 7.1%, and 0% in cases of prophylactic surgery, 18.2%, 9.1%, and 18.2% in TC, and 11.1%, 0%, and 33.3% in PPC. These precursor lesions were missed during the initial routine screening and were found in the fimbriated end of the fallopian tubes in 94%. In 1 case of PPC, staining for p53 was negative in STIC. The studied adnexal tissue of serous ovarian borderline tumor and ovarian cortical inclusion cysts of all cases showed no alterations according to p53 signature, TILT, or STIC. STIC and p53 signature as precursor lesions of pelvic serous cancer were seen in macroscopically inconspicuous contralateral fallopian tubes in unilateral TC, in patients with elective bilateral salpingo-oophorectomy, and in patients affected by PPC. Therefore, we propose the complete processing of adnexal tissue and the use of step sectioning to establish the correct diagnosis. Immunohistochemistry for p53 and ki-67 may aid in the diagnosis, but is not necessary for routine investigation.

Division of Breast (K.L., L-C.H.), Institute of Pathology, Gynecologic and Perinatal Pathology, University of Leipzig, Leipzig, Germany

Department of Obstetrics and Gynecology (Institute of Trier) (J.E., S.S., K.E.), University of Leipzig, Leipzig, Germany

Address correspondence and reprint requests to Lars-Christian Horn, MD, PhD, Institute of Pathology, University of Leipzig, Liebigstrasse 26, Leipzig D-04103, Germany. e-mail:

©2011International Society of Gynecological Pathologists