Metabolic syndrome and risk of ovarian and fallopian tube cancer in the United States: An analysis of linked SEER-Medicare data

OBJECTIVE

To clarify associations between metabolic syndrome, its components, and ovarian cancer risk.

METHODS

Using a case-control study within the U.S.-based Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, we examined metabolic syndrome, its components (obesity, impaired fasting glucose, hypertension, HDL cholesterol, triglycerides), and ovarian/fallopian tube cancer risk. Cases (n = 16,850) were diagnosed with cancer between age 68-89 from 1994 through 2013. Controls (n = 281,878) were Medicare enrollees without these cancers living in registry areas. We estimated adjusted odds ratios (OR) and 95% confidence intervals (CI) with logistic regression.

RESULTS

Women with metabolic syndrome had reduced ovarian cancer risk compared to women not meeting the diagnostic criteria (OR 0.86, CI 0.82-0.89). Having one or two syndrome components was associated with increased risk, but having ≥3 was not, when compared to women without any components. Impaired fasting glucose, which was highly prevalent among those with metabolic syndrome, was associated with reduced risk (OR 0.90, CI 0.87-0.93). Hypertension and high triglycerides, the most prevalent components among women without metabolic syndrome, were associated with increased risks (OR 1.08, CI 1.04-1.12; OR 1.05, CI 1.01-1.08, respectively).

CONCLUSIONS

Specific metabolic syndrome components may have modest associations with ovarian cancer. These associations varied in direction and the prevalence of the components influenced the overall association between metabolic syndrome and ovarian cancer. Evaluating metabolic syndrome as a composite exposure could be misleading in ovarian cancer research, but further study of the syndrome components is warranted.

Tubal ligation and incidence of 26 site-specific cancers in the Million Women Study

BACKGROUND

Tubal ligation is known to be associated with a reduction in ovarian cancer risk. Associations with breast, endometrial and cervical cancers have been suggested. We investigated associations for 26 site-specific cancers in a large UK cohort.

METHODS

Study participants completed a questionnaire on reproductive and lifestyle factors in 1996-2001, and were followed for cancer and death via national registries. Using Cox regression models, we estimated adjusted relative risks (RRs) for 26 site-specific cancers among women with vs without tubal ligation.

RESULTS

In 1 278 783 women without previous cancer, 167 430 incident cancers accrued during 13.8 years' follow-up. Significantly reduced risks were found in women with tubal ligation for cancers of the ovary (RR=0.80, 95% CI: 0.76-0.85; P<0.001; n=8035), peritoneum (RR=0.81, 0.66-0.98; P=0.03; n=730), and fallopian tube (RR=0.60, 0.37-0.96; P=0.04; n=168). No significant associations were found for endometrial, breast, or cervical cancers.

CONCLUSIONS

The reduced risks of ovarian, peritoneal and fallopian tube cancers are consistent with hypotheses of a common origin for many tumours at these sites, and with the suggestion that tubal ligation blocks cells, carcinogens or other agents from reaching the ovary, fallopian tubes and peritoneal cavity.

Serous tubal intraepithelial carcinoma arising from the intrauterine portion of the fallopian tube after bilateral salpingo-oophorectomy

Serous tubal intraepithelial carcinoma (STIC) is considered the precursor of pelvic serous carcinomas and the earliest malignant alteration in BRCA mutation-positive women. Recently, risk-reducing salpingo-oophorectomy (RRSO) is being performed in BRCA mutation-positive women and STIC is often discovered incidentally in the fallopian tubes. A 62-year-old woman underwent bilateral salpingo-oophorectomy (BSO) for ovarian cysts. Ten months later, cytological screening for the endometrium revealed adenocarcinoma. No atypical tissue was detected by the endometrial curettage. Imaging tests and hysteroscopy found no abnormal findings. She underwent hysterectomy and was diagnosed with STIC originating from the intrauterine portion of the residual fallopian tube. Here, the authors report the first case of STIC being detected during an endometrial cytological examination after BSO. Although STIC associated with the BRCA mutation usually involves the distal fallopian tube, the present case suggests that the intrauterine portion of the fallopian tube should be removed or cauterized during RRSO.

Serous ovarian, fallopian tube and primary peritoneal cancers: a common disease or separate entities - a systematic review

OBJECTIVE

The aim of this systematic review is to analyze data on risk factors, epidemiology, clinicopathology and molecular biology from studies comparing primary peritoneal cancer, fallopian tube cancer and ovarian cancer of serous histology, in order to achieve a greater understanding of whether or not these disorders should be considered as separate entities.

METHODS

A systematic literature search was conducted in PubMed and MEDLINE. Case-control studies comparing primary serous peritoneal or fallopian tube carcinomas with primary serous ovarian carcinomas or a control group were included.

RESULTS

Twenty-eight studies were found eligible. Primary peritoneal cancer patients were older, had higher parity, were more often obese and had poorer survival compared to ovarian cancer patients. Differences in protein expression patterns of Her2/neu, estrogen and progestin receptors and frequency of loss of heterozygosity differed between primary peritoneal cancer and primary ovarian cancer patients. No major differences were found between primary fallopian tube cancer and primary ovarian cancer. The proportion of serous tubal intraepithelial carcinomas (STIC) was lower in primary peritoneal cancer and primary ovarian cancer compared to primary fallopian tube cancer.

CONCLUSION

Except from differences in the proportion of STIC only few differences between primary fallopian tube cancer and primary ovarian cancer have been found. In contrast, observed differences in risk factor profile, clinicopathologic and prognostic factors, as well as in the molecular patterns, indicate that peritoneal cancer and ovarian cancer may be linked to different carcinogenic pathways.

The role of the fallopian tube in ovarian cancer

High-grade serous carcinoma (HGSC) is the most common and lethal subtype of ovarian cancer. Research over the past decade has strongly suggested that "ovarian" HGSC arises in the epithelium of the distal fallopian tube, with serous tubal intraepithelial carcinomas (STICs) being detected in 5-10% of BRCA1/2 mutation carriers undergoing risk-reducing surgery and up to 60% of unselected women with pelvic HGSC. The natural history, clinical significance, and prevalence of STICs in the general population (ie, women without cancer and not at an increased genetic risk) are incompletely understood, but anecdotal evidence suggests that these lesions have the ability to shed cells with metastatic potential into the peritoneal cavity very early on. Removal of the fallopian tube (salpingectomy) in both the average and high-risk populations could therefore prevent HGSC, by eliminating the site of initiation and interrupting spread of potentially cancerous cells to the ovarian/peritoneal surfaces. Salpingectomy may also reduce the incidence of the 2 next most common subtypes, endometrioid and clear cell carcinoma, by blocking the passageway linking the lower genital tract to the peritoneal cavity that enables ascension of endometrium and factors that induce local inflammation. The implementation of salpingectomy therefore promises to significantly impact ovarian cancer incidence and outcomes.

Fallopian tube origin of supposed ovarian high-grade serous carcinomas

INTRODUCTION

Serous carcinomas are the most frequent histologic type of ovarian and peritoneal cancers, and can also be detected in the endometrium and fallopian tubes. Serous carcinomas are usually high-grade neoplasms when diagnosed, yet the identification of an associated precursor lesion remains challenging. Pathological examination of specimens obtained from prophylactic bilateral salpingo-oophorectomies that were performed for patients harboring BRCA1/2 mutations suggests that high-grade serous carcinomas may arise in the fallopian tubes rather than in the ovaries.

OBJECTIVE

To investigate the presence and extent of fallopian tube involvement in cases of serous pelvic carcinomas.

METHODS

Thirty-four cases of serous pelvic carcinoma with clinical presentations suggesting an ovarian origin were analyzed retrospectively. Histologic samples of fallopian tube tissues were available for these cases and were analyzed. Probable primary site, type of tubal involvement, tissues involved in the neoplasia and vascular involvement were evaluated.

RESULTS

Fallopian tube involvement was observed in 24/34 (70.6%) cases. In 4 (11.8%) of these cases, an intraepithelial neoplasia was present, and therefore these cases were hypothesized to be primary from fallopian tubes. For an additional 7/34 (20.6%) cases, a fallopian tube origin was considered a possible primary.

CONCLUSIONS

Fallopian tubes can be the primary site for a subset of pelvic high-grade serous carcinomas.

Case report: Occurrence of fallopian tube cancer in a patient with previous history of estrogen receptor positive breast cancer

Fallopian tube cancer is very rare, it accounts less than 1% of all genital tract cancer in women. The annual incidence is 3.6 per million women per year. The vast majority of fallopian tube cancers are papillary serous adenocarcinomas. Most women with fallopian tube cancer are usually diagnosed at age 50s to 60s. Vaginal bleeding or discharge is the most common presentation. We would like to present a case in which fallopian tube cancer was diagnosed in a patient with post menopausal bleeding, abnormal ultrasound finding and history of estrogen receptor (ER) positive breast cancer.

Tubal and ovarian pathways to pelvic epithelial cancer: a pathological perspective

Prolongation of ovarian epithelial cancer survival depends on early detection or improved responses to chemotherapy. Gains in either have been modest at best. Understanding the diverse pathogenesis of this disease is critical to early intervention or prevention. This review addresses six important variables, including (i) cell of origin, (ii) site of origin, (iii) initial genotoxic events, (iv) risks imposed by hereditary and other promoting conditions, (v) subsequent factors that promote different patterns of metastatic spread, and (vi) prospects for intervention. This review proposes two distinct pathways to pelvic epithelial cancer. The first initiates in ovarian surface epithelium (OSE), Mullerian inclusions or endometriosis in the ovary. The second arises from the endosalpinx and encompasses a subset of serous carcinomas. The serous carcinogenic sequence in the distal fallopian tube is described and contrasted with lower grade serous tumors based on tumour location, earliest genetic change and ability (or lack of) to undergo terminal (ciliated) differentiation. Ultimately, a clear understanding of tumour origin and the mechanism(s) leading to the earliest phases of the serous and endometrioid carcinogenic sequences may hold the greatest promise for designing prevention strategies and/or developing new therapies.

Gestational choriocarcinoma arising from a cornual ectopic pregnancy: a case report and review of the literature

INTRODUCTION

Gestational choriocarcinoma associated with ectopic pregnancy is an extremely rare event. We report a case of a choriocarcinoma arising from a cornual pregnancy.

CASE

The patient is a 35-year-old G8 P2052 who was referred to our department due to failure of treatment for a suspected ectopic pregnancy. The patient had initially been treated with methotrexate injection but her beta-hCG levels reached a plateau 3 weeks later and, despite another two methotrexate injections, started to rise. The patient underwent dilation and curettage that did not reveal any trophoblastic tissue. A diagnostic hysteroscopy that followed demonstrated occluded ostia of the left tube. The patient subsequently underwent diagnostic laparoscopy that revealed a mass in the left cornua, which was removed with wedge-wide resection. Histologic evaluation revealed choriocaricnoma.

DISCUSSION

Appropriate monitoring of beta-hCG titers following conservative management of suspected ectopic pregnancy is important, not only to diagnose persistent ectopic gestation, but also to rule out the presence of malignant trophoblastic disease, albeit the latter is a rare diagnosis.

The clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation

The objective of this study was to determine the clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation registered with the Trophoblastic Disease Screening and Treatment Centre, Weston Park Hospital, Sheffield between 1986 and 2000. From the 5581 women registered, those with a diagnosis of ectopic molar pregnancy were identified from a computer database. Information regarding the relevant history of each patient and the clinical presentation, treatment, and outcomes of gestational trophoblastic disease (GTD) was determined by reviewing referral forms, case notes, and pro formas completed by the referring gynecologist. Histological review of the cases was undertaken where possible. Suspected ectopic molar gestations comprised 31/5581 (0.55%) of registrations. Known risk factors for ectopic pregnancy were identified in 79% of cases. Central histological review confirmed only six cases of GTD: three choriocarcinoma and three early complete moles. Four patients subsequently required chemotherapy. All patients are now in complete remission. We conclude that ectopic GTD is uncommon, with a UK incidence of approximately 1.5 per 1,000,000 births. Initial management is usually surgical removal of the conceptus, pathological suspicion of the diagnosis and registration with a screening center. Chemotherapy may be required and the prognosis is excellent.

Primary fallopian tube carcinoma: a retrospective multicenter study

PURPOSE

This retrospective multicenter study aimed to assess the survival and prognostic factors of primary fallopian tube carcinoma.

METHODS

The medical records of 29 patients with fallopian tube carcinoma from two centers were reviewed for age, stage, surgical intervention, relapse and survival.

RESULTS

The mean age of the patients was 56 years (range, 37-76). Six patients were in Stage I (20.7%), eight cases in Stage II (27.6%), nine cases in Stage III (31%) and two cases in Stage IV (6.9%). Data on stage was not available in four cases (13.8). Fifteen patients underwent lymph node evaluation. The median follow-up was 29 months (range, 3-122). The median survival was 95 months with a 5-year survival rate of 69.7%. The median progression-free survival was 76 months with a 5-year survival rate of 51.8%.

CONCLUSION

Age, stage and lymphadenectomy were found to be significant prognostic factors on overall survival.

Metachronous carcinoma of the vulva and fallopian tube

BACKGROUND

Metachronous carcinoma of the vulva and fallopian tube is an unusual co-occurrence of gynecological malignancies. A report of such a case that developed and recurred over a 7-year period is presented.

CASE

A 53-year-old G3P3 female presented with a verrucous carcinoma of the vulva and a serous papillary adenocarcinoma of the left fallopian tube metachronously. To investigate a possible association between the co-occurrence of the rare neoplasms and factors associated with multiple gynecological malignancies, we analyzed the status of human papillomavirus infection and DNA mismatch repair deficiency as indicated by microsatellite instability. All samples analyzed were negative for these factors.

CONCLUSION

The present results support the possibility that metachronous carcinomas of the vulva and fallopian tube involve unknown etiological factors or arise independently.

[Clinical aspects of primary cancer of the fallopian tube. A retrospective study of 20 cases]

OBJECTIVES

From a review of 20 cases of primary carcinoma of the fallopian tube, we stress the various clinical aspects of the disease and discuss the possibilities of a preoperative diagnosis.

MATERIALS AND METHODS

A retrospective study covering the period between 1982 and 1996. An analysis of the different etiological factors mentioned in the literature, of the physical signs and symptoms of the carcinoma, of the patients' age and hormonal status as well as the role of additional investigations was conducted.

RESULTS

The average age of the patients was 62.3 years, 90% of the women had reached menopause and 15% were nullipara. A history of salpingitis was noted in 5% of the patients and another 5% had infertility problems. 20% of the patients had suffered from another carcinoma. Metrorrhagia was the most frequent clinical finding revealing the disease (55%) followed by abnormal secretions of blood stained liquid (15%). Hydrops Tubae Profluens was not observed in this series. The main complementary investigations performed were pelvic ultrasound scanning and hysterosalpingography, preoperative diagnosis was possible in 15% of cases; diagnosis was made during the operative procedure in 45% of cases and by pathologic examination in the remaining 40% of patients.

CONCLUSION

Primary carcinoma of the fallopian tube is a rare form of cancer of unknown aetiology. Clinical signs are often unrelated and sometimes misleading; however, preoperative diagnosis is possible if one keeps in mind the existence of this carcinoma.

Adenocarcinoma of the bilateral fallopian tube occurring after tubal sterilization

A case of bilateral tubal carcinoma occurring 22 years after tubal sterilization is presented. We believe that this is the first case report of bilateral tubal carcinoma that has arisen in ligated fallopian tubes. The possibility that tubal occlusion is one of the causative factors of tubal carcinoma is discussed.

Laparoscopic evaluation of the onset and progression of endometriosis

OBJECTIVE

To clarify the pathogenesis of endometriosis on the basis of analysis of primary lesion sites, age at onset, rate of progression, and response to drug treatment.

STUDY DESIGN

The clinical records of 690 women with laparoscopically confirmed endometriosis were retrospectively analyzed based on the revised American Fertility Society point system.

RESULTS

The primary site of endometriosis was the uterosacral ligament and pelvic peritoneum/pouch of Douglas in 73% of patients with stage I disease, whereas only 16% had ovarian lesions. However, disease progression was associated with an increasing frequency of ovarian lesions. In terms of the revised American Fertility Society score, endometriosis progressed at a mean rate of 0.3 point per month. Thus the earliest onset of endometriosis was estimated at 3 to 4 years after menarche. Drug therapy improved the revised American Fertility Society score by about 50%. Patients with a low response to an initial cycle of therapy generally showed further improvement after an additional treatment cycle.

CONCLUSIONS

Because endometriosis may occur as early as 3 to 4 years after menarche and gradually progresses, drug therapy, including long-term treatment, should be carried out in women with definitive evidence of endometriosis who must maintain their reproductive potential.

Postsalpingostomy intercornual bridging with hematosalpinx, chronic salpingitis and perisalpingeal endometriosis. A case report

Two years after a left salpingo-oophorectomy for a tuboovarian mass from endometriosis and a right salpingostomy for hydrosalpinx, a 28-year-old, infertile woman underwent pelvic surgery for severe pain and progressive endometriosis. The closed, swollen tube arched over the posterior aspect of the uterus, bridging the two cornua; it was filled with blood and showed severe chronic salpingitis and widespread perisalpingeal endometriosis.

Choriocarcinoma of the fallopian tube associated with induced superovulation in an IVF program; a case report

The authors present a case of choriocarcinoma of the fallopian tube. The patient was enrolled in an IVF program and to our knowledge this is the first report of a choriocarcinoma following treatment with clomiphene citrate and hMG. The possible role of superovulation in inducing the tumour is discussed. The patient was treated by conservative surgery only and is in remission 1.5 years after the event.

Paratubal cysts: frequency, histogenesis, and associated clinical features

A review of 79 cystic lesions found in the routine study of the fallopian tube and its surrounding areas between the years 1980 and 1982, revealed that the majority of the lesions represented accessory lumina of the fallopian tube. These tubal cysts commonly have been described as hydatids or parovarian cysts, but their relationship to the normal tube has not been identified clearly, their frequency has not been determined, their clinical significance rarely has been considered, and their embryologic origin remains imperfectly understood.

Tubal polyps, epithelial inclusions, and endometriosis after tubal sterilization

Histologic findings in 133 previously ligated fallopian tubes of women who underwent subsequent hysterectomy and bilateral salpingectomy were compared with those of 50 normal fallopian tubes and related to four surgical procedures for sterilization. Dilatation of proximal tubal lumen, flattening of the folds, polyps, and increase of mitotic activity of the epithelium was subsequent to tubal occlusion in any case, regardless of the type of sterilization. After sterilization by ring, ligation, and coagulation, the incidence of epithelial inclusions was significantly different from that observed after sterilization by clips. Focal endometriosis was only found after tubal ligation and coagulation. It is suggested that epithelial inclusions were the result of surviving fragments of tubal epithelium translocated in the tubal wall during the procedure, and that endometriosis was caused by implantation of expelled menstrual products through the open lumen into the healed ligation area.

Endometriosis and the development of tuboperitoneal fistulas after tubal ligation

The present study details gross and histologic findings of 79 previously ligated fallopian tubes from 3 groups of patients. Of 20 oviducts removed after documented sterilization failure (group I), 6 revealed a process compatible with endometriosis. Four of nine previously ligated fallopian tubes removed at the Johns Hopkins Hospital (group II) were successfully injected with India ink. In two patients histologic examination demonstrated the India ink in epithelium-lined spaces that lay beyond the muscle of the tubal wall extending from the tubal lumen to the serosal surface. Fifty oviducts were studied in twenty-five patients requesting reversal of their sterilizations (group III). A higher percentage of fistulas was demonstrated in patients with less than 4 cm of remaining proximal tubal segment. Furthermore, most of these fistulas were demonstrated in patients for whom 3 years had elapsed since the original sterilization procedure. Patients sterilzed by laparoscopic cautery methods were observed to have a higher percentage of fistula formation and histologic documentation of endometriosis at the sterilization site as compared with patients sterilized by other methods. Our observations suggest that ligation of the oviduct within 4 cm of the uterine cornu may predispose to the development of endometriosis and subsequent fistula formation in the tip of the ligated oviduct.

Carcinosarcoma of the fallopian tube: a case report and review of the literature

A patient with a carcinosarcoma of the Fallopian tube is presented. She is the first reported from the United Kingdom and the 23rd in the literature. The clinical and pathological features, pathogenesis and management are discussed.

Nodular salpingitis and tubal endometriosis. I. Comparative clinical study

Nodular salpingitis and tubal endometriosis have been referred to in succession as salpingiosis, diverticulosis, adenomyosis of the oviduct, endometrioid conditions, etc. This varied terminology underscores their etiopathogenetic and morphological substratum which is different from that of non specific tubal inflammation, but at the same time this variety of terms has always created confusion in interpretation and diagnosis. We have considered it necessary to carry out a comparative study of nodular salpingitis and tubal endometriosis in 42 cases of sterility operated during the last two years for tubal obstruction and in which histological examination has yielded evidence for the lesions of nodular salpingitis (NS) or endometriosis (EM) in at least one of the oviducts. As for the etiology of the two diseases, we have discussed the role plaid by inflammatory conditions, uterine trauma (curettage) and dystrophic disorders, as well as the importance of hyperandrogenism in NS. Taking into account the diffuse sclerogenic tendency of the tubal wall in NS and the concomitant inflammatory and dystrophic lesions in the peritubal tissues in EM, the postoperative outlook depends on early surgery, to be performed before tubal anatomy has been completely altered.

Ultrastructure of fallopian tube carcinoma

Fallopian tube carcinoma is one of the rarest of primary gynecologic malignancies. Normal tubal epithelium is composed of secretory, ciliated, and intercalary cells. To determine the cellular composition and ultrastructural details of this rare neoplasm, a moderately well-differentiated tubal carcinoma was studied with the electron microscope. A prominent feature was the formation of numerous ultramicro alveolar spaces lined by cell surface microvilli. The nuclei of the neoplastic cells demonstrated a variety of fine structural abnormalities. Based on cell size and shape criteria, a possible dual tumor cell population was suggested. However, no cilia were seen in any of the tumor cells and almost all were devoid of secretory granules. These latter observations suggest that this tumor was primarily a proliferation of intercalary cells.