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abstract & correction
Am J Surg Pathol. 2015 Jan;
Mucosal
alterations of the fallopian tube are generally thought to represent
alterations of the native tubal mucosal epithelium, whether benign or
malignant. The current paradigm implicating the fallopian tube fimbriae
as the origin of most pelvic high-grade serous carcinomas (HGSCs) is
based on the premise that HGSC growing within the tubal mucosa
originated there. This has fueled proposals to redefine classification
rules for assigning the primary site of origin on the basis of the
presence or absence of HGSC in the tubal mucosa. The corollary is that
it is unlikely for metastatic carcinoma to grow within fallopian tube
mucosa. Evidence to support or refute this corollary is minimal, in part
because the fallopian tubes historically have been ignored. This study
reports the pattern and topography of 100 nongynecologic cancers that
metastasized to the fallopian tubes. Most tumors were adenocarcinoma
(87%), and the remainder included lymphomas, neuroendocrine tumors, and
mesotheliomas. The most common primary origins of tumor were the colon
(35%) and breast (15%). Gross evidence of a tubal nodule or mass was
only seen in 35% of cases. Ovarian metastases were present in 95% of
cases, although 23% did not exhibit gross evidence of metastasis. Tumor
involved the fimbriae in 49% of cases, including 10% of cases in which
the tumor was restricted to the fimbriae without involving the
nonfimbriated portion of the tube. The anatomic distribution of
metastases included the tubal mucosa (29%), submucosa (43%), muscularis
(54%), serosa (76%), lymphovascular spaces (38%), intraluminal space
(16%), and mesonephric remnants (39%). The most common architectural
pattern of mucosal growth was a flat layer (22/29 cases), followed by
varying degrees of stratification, tufting, and papillary growth.
High-grade atypia was present in 18/29 cases of mucosal growth,
resulting in patterns that resembled primary tubal HGSC. Accompanying
growth in the tubal submucosa frequently produced a pseudoinvasive
pattern mimicking invasive tubal HGSC. Immunohistochemical expression of
p53 by 8/18 high-grade mucosal metastases further contributed to the
resemblance to primary tubal HGSC. Bland cytology was present in 11/29
cases of mucosal growth, some of which also exhibited mucinous features,
resulting in patterns that resembled either tubal mucinous metaplasia
or nonmucinous tubal hyperplasia. Although uncommon, it is possible for
metastases of nongynecologic cancers to grow within the mucosa of the
fallopian tube and create a potential diagnostic pitfall. Intramucosal
growth of a tumor in the fallopian tube is not pathognomonic of a
primary tubal origin of the tumor. These findings may carry implications
for proposed criteria using the status of the fallopian tube mucosa to
assign primary origin of a gynecologic cancer.
In the article that appeared on page 39 of the January
2015 issue of the American Journal of Surgical Pathology, there were
numerical errors in two sample sizes that were described in the left
column of page 39. The corrected statements are below.
“At least 1 slide containing a section of fimbriae was present in 41/53 (77%) specimens that were representatively sampled.”
“The fimbriae were involved by tumor in 49/87 (56%) patients with specimens that contained fimbriae.”
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