Recurrent fallopian tube carcinoma: TP53 mutation and clinical course

HER-2/neu and p27Kip1 in progression of Fallopian tube carcinoma: an immunohistochemical and array comparative genomic hybridization study

AIMS

To determine expression of p53, HER-2/neu and p27(Kip1) in serous Fallopian tube carcinoma (FTC) in relation to stage and grade, and to investigate DNA copy number changes of HER-2 and P27KIP1 as a potential mechanism of altered expression status.

METHODS AND RESULTS

Immunohistochemistry was performed on 28 serous FTCs and 10 normal Fallopian tubes. p53 protein accumulated and p27(Kip1) was down-regulated significantly in early-stage FTCs compared with normal Fallopian tubes. HER-2/neu overexpression was absent in normal Fallopian tubes and in all stage I FTCs (n = 6) but present in 57% (12/21) of advanced-stage FTCs. No differences in expression between grade 2 and 3 tumours were detected. HER-2 gain/amplification was found by array comparative genomic hybridization in 23% (3/13) of analysed FTCs and all showed overexpression. HER-2/neu overexpression also occurred without DNA copy number changes in three other cases. For p27(Kip1), expression and DNA copy number were unrelated.

CONCLUSIONS

p53 accumulation and p27(Kip1) down-regulation seem to be early events in Fallopian tube carcinogenesis. HER-2/neu showed overexpression, caused by gain/amplification in 50%, and may be involved in progression of FTC. These data contribute to a better understanding of the molecular carcinogenesis of FTC and to possible new therapeutic approaches.

Fallopian tube carcinoma: a review

PURPOSE

Primary fallopian tube carcinoma (PFTC) is a rare tumor that histologically and clinically resembles epithelial ovarian cancer (EOC). The purpose of this study is to review the current available literature data on PFTC.

PATIENTS AND RESULTS

Early clinical manifestation and prompt investigation often lead to diagnosis at an early stage of disease. However, the diagnosis of PFTC is rarely considered preoperatively and is usually first appreciated by the pathologist. Surgical staging/management and the use of chemotherapy follow the concepts used in epithelial ovarian cancer (EOC). In contrast to EOC is the importance of early lymphatic spread in this disease. The earlier diagnosis of PFTC leads to an apparent better survival compared with EOC. However, as with EOC, stage and residual tumor are the most important prognostic variables.

CONCLUSION

Until more extensive clinical research has been performed, ovarian carcinoma management principles should be used in clinical practice.

Current management of fallopian tube carcinoma

The management of fallopian tube carcinoma is similar to that of ovarian carcinoma. Surgery should consist of bilateral salpingo-oophorectomy, total abdominal hysterectomy, comprehensive surgical staging also including a systematic pelvic and para-aortic lymphadenectomy, and aggressive debulking in patients with advanced tumour. Patients with apparently early stage low-risk fallopian tube carcinoma, not submitted to complete surgical staging, as well as those with early stage high-risk disease should receive adjuvant single-agent carboplatin. Patients with advanced disease should undergo paclitaxel- plus carboplatin-based chemotherapy. Second-line treatment for persistent/recurrent disease should be mainly based on the platinum-free interval, whereas secondary cytoreduction should be considered only for highly selected patients with localized, late relapse.