Estudio macro y microscópico de salpingectomías profilácticas en mujeres BRCA positivo

Serous ovarian cancer is a type of ovarian carcinoma. Two subtypes of serous carcinoma can be distinguished: Type 1 (frequent mutation of PTEN, KRAS and BRAF), corresponding to low-grade serous carcinoma, and Type 2 (frequent mutation of p53), corresponding to high-grade serous carcinoma. Its origin is not clear; classically causative factors included continuous ovulation, damage to the ovarian surface during ovulation and subsequent metaplasia. However, recently it has been proposed that the fallopian tube may be the origin of high-grade serous carcinoma. In order to test this hypothesis, we analyzed samples from 20 patients with known mutations in BRCA1-2 who had undergone bilateral salpingo-oophorectomy. The fallopian tube was studied macroscopically following the SEE-FIM protocol and Kurman's algorithm for the diagnosis of serous tubal intraepithelial carcinoma. All the sections were tested immunohistochemically with Ki-67 and p53 and the fallopian tubes were classified into 4 categories: normal, STIC (intraepithelial carcinoma), STIL (intraepithelial tubal lesion in transition) and p53 signature. In the series studied, 7 cases (35%) were diagnosed as abnormal: 2 STIL (10%) and 5 p53 signature (25%). The rest of the fallopian tubes showed no cytological atypia or immunostaining with the antibodies used. A study of the ovaries found no lesions in any of the cases. These findings agree with the results of other authors, and point to an initial lesion in the tube, reflecting a mutation of a tumour-suppressing gene (p53), which might play an important role in the development of high grade ovarian serous carcinoma.