Introduction In recent studies of the origin(s) of pelvic serous carcinoma, two concepts have emerged: the fallopian tube as a major source for these tumors and a carcinogenic sequence in the distal fallopian tube. The first has immediate implications for both the early detection and classification of this disease. The second impacts on the pathogenesis of tubal malignancies and has important implications for the histologic diagnosis. In particular, the discovery of benign-appearing secretory cell outgrowths (SCOUTs) in the fallopian tube that contain functional gene perturbations shared with cancer requires a reassessment of the concept of intra-epithelial neoplasia. This exercise requires the separation of innocuous clonal expansions or outgrowths of no clinical significance from those with the potential, albeit low, to metastasize. In this chapter, we introduce the term "intra-epithelial neoplasia" to denote the latter, preferring to relegate epithelial processes of lesser degree to a descriptive category that although linked to cancer, do not belong in the diagnostic lexicon. In this spectrum may lie the genetic changes that mark the acquisition of the metastatic phenotype. We emphasize that, while this progression is most closely linked to serous carcinomas, it can occur with other phenotypes, including endometrioid and, rarely, mucinous neoplasia. Finally it is important to superimpose this new information on the existing concept of ovarian and peritoneal carcinoma. In both instances, it is useful to look at both low- and high-grade serous neoplasms and the potential contribution of the fallopian tube in their pathogenesis.
|Original language||English (US)|
|Title of host publication||Altchek's Diagnosis and Management of Ovarian Disorders, Third Edition|
|Publisher||Cambridge University Press|
|Number of pages||10|
|State||Published - Jan 1 2010|
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