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Women with fallopian tube carcinoma (FTC) are reported to have a higher frequency of inherited BRCA mutations than those with ovarian carcinoma (OC) or primary peritoneal carcinoma (PPC). We hypothesized that routine serial sectioning of fallopian tubes would increase the proportion of cases designated as FTC and change the frequency of inherited mutations between carcinoma types. Eight hundred and sixty-seven women diagnosed from 1998 to 2018 were enrolled at diagnosis into an institutional tissue bank. Germline DNA, available from 700 women with FTC (N = 124), OC (N = 511) and PPC (N = 65), was assessed using targeted capture and massively parallel sequencing for mutations in ovarian carcinoma susceptibility genes. Cases were divided between those prior to routine serial sectioning (1998–2008) and after (2009–2019), and the frequency of FTC and inherited mutations was assessed. The proportion of carcinomas attributed as FTC after 2009 was 28% (128/465), significantly higher than before 2009 [5% (21/402), p <.0001, OR 6.9, 95% CI 4.3–11.2], with subsequent decreases in OC and PPC. In the sequenced group, overall inherited mutation frequency in FTC (24/124, 19%), OC (106/511, 21%, p =.42), and PPC (16/65, 25%, p =.25) were similar. Germline mutation rates in FTC were lower after 2009,16/107 cases (15%), compared to 8/17 cases (47.1%) before 2009 (p =.005, OR 0.20, 95% CI 0.06–0.64). The prevalence of inherited mutations is similar in FTC compared to OC or PPC when using modern pathological assignment. Complete serial sectioning of fallopian tubes has significantly increased the diagnosis of FTC, and subsequently decreased the frequency of inherited mutations within this group. • Routine serial sectioning of fallopian tubes increased the fallopian tube cancer proportion by five-fold. • Routine serial sectioning of fallopian tubes decreased the ovarian and primary peritoneal cancer proportion. • Fallopian tube cancer identified on serial sectioning was associated with a reduced frequency of germline mutations. • Germline mutation frequency is similar for women with fallopian tube, ovarian or primary peritoneal cancer. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the safety and efficacy of the novel combination of docetaxel, oxaliplatin, and bevacizumab as first-line treatment of advanced cancer of the ovary, peritoneum or fallopian tube after initial debulking surgery. Methods: Eligible patients (stage IB-IV) were treated with 6cycles of oxaliplatin (85mg/m2), docetaxel (75mg/m2), and bevacizumab (15mg/kg) every 3weeks, followed by single-agent bevacizumab 15mg/kg every 3weeks to complete one year of therapy. The primary endpoint was 12-month progression-free survival (PFS). Results: A total of 132 patients (80 with measurable disease at baseline; 52 with non-measurable, evaluable disease at baseline) enrolled and received study treatment. At diagnosis, 76.5% of patients had stage III disease and 20% had stage IV. 62.9% were optimally cytoreduced. The most common grade 3/4 adverse events were neutropenia (42.4%), leukopenia (13.6%), hypertension (8.3%), fatigue (6.1%), and nausea (6.1%). One patient (0.8%) had a fatal gastrointestinal perforation. The best overall confirmed response rate (complete response+partial response [measurable disease subgroup]) was 58.6% (95% CI 49%, 67%). CA-125 response rates for the measurable and non-measurable disease subgroups were 83.0% and 81.5%, respectively. The 12-month PFS rate for the measurable disease subgroup was 65.7% (95% CI 53.4%, 76.7%); median PFS was 16.3 (95% CI 12.6, 19.6) months. Median overall survival was 47.3 (95% CI 34.1, upper limit not applicable) months. Conclusions: This novel treatment regimen may provide a promising therapeutic approach for women with ovarian, primary peritoneal, or fallopian tube carcinoma. No unanticipated safety concerns were identified. [Copyright &y& Elsevier]

Abstract: Objective: Serial sectioning of the fallopian tube in women undergoing risk reducing surgery has been shown to increase the detection rate of occult malignancy in BRCA mutation carriers. We undertook this study to determine whether this protocol at the time of surgery for ovarian cancer (OV) or primary peritoneal malignancies (PP) changes the detection rate of fallopian tube carcinoma (FT). We secondarily investigated where this difference affects patient outcomes. Methods: A retrospective review of 130 patients treated at the University of Chicago Medical Center for ovarian, peritoneal or fallopian tube carcinoma was conducted. Sixty five patients diagnosed with OV, PP or FT who had serial sectioning of the fallopian tubes at the time of diagnoses (SS) were compared to 65 patients whose fallopian tubes were sectioned in a standard fashion (PSS). Results: Serial sectioning of the fallopian tube at the time of pathologic examination in women with presumed OV or PP led to an increase in the number of women diagnosed with FT as the primary site of origin (p<0.001). Clinical or pathologic risk factors leading to an increased risk of FT were not identified. Survival between the two groups was similar. Conclusion: In women with presumed OV or PP, serial sectioning identifies women with FT. FT may be more common than previously noted; however distinct biologic or clinical behavior to differentiate it from OV or PP could not be identified. Clinical management of FT should continue to be the same as that of OV or PP. [Copyright &y& Elsevier]

Abstract: Objective: Mullerian low grade serous carcinoma (LGSC) and high grade serous carcinoma (HGSC) have distinct molecular profiles, clinical behavior and treatment response. Our objective was to study the biological profiles of these carcinomas. Methods: This study examines publicly available gene expression profiles of LGSC and HGSC to identify differentially expressed genes and key pathways involved in carcinogenesis and chemotherapy response. Results: Our analysis supports the hypothesis that serous mullerian carcinoma develop through two different pathways yielding two distinct malignancies, namely LGSC and HGSC. Furthermore, genes potentially involved in chemotherapeutic resistance of LGSC were identified. Suppressing the levels of these genes/proteins may increase clinical response to standard chemotherapy in patients with LGSC. Conclusion: In summary, this review shows the molecular profile of LGSC and HGSC through multi-center analysis of gene expression profiles of these tumors. The gene signatures of these neoplasms may potentially be used to develop disease-specific, targeted therapy for LGSC and HGSC. [Copyright &y& Elsevier]

Abstract: Objective: The objective of this retrospective study was to determine the clinical outcomes of patients with primary fallopian tube carcinoma (PFTC) treated with paclitaxel and platinum analogue-based combination chemotherapy following primary cytoreductive surgery. Methods: Sixty-four patients with the diagnosis of PFTC were identified through the gynecology service database and the tumor registry of 4 different institutions. The majority of patients (48/64, 75%) were treated with carboplatin AUC (area under curve) 6 and paclitaxel 175 mg/m2 as a 3 h infusion. Results: Among 28 patients with measurable disease, we observed 19 (68%) complete clinical and 7 (25%) partial responses for an overall response rate of 93%. After a median follow-up of 40 months (3+–134+ months), the 5-year survival rate of the entire population was 70% (median overall survival [mOS] not reached) and the median time to tumor progression (mTTP) was 81 months (95% CI: 53–109). Stage and residual disease were of prognostic significance. The mTTP was not reached in patients with stage I/II and was 38 months for patients with stage III/IV (p =0.004). The mOS for patients with stage I/II was not reached, whereas it was 62 months for those with stage III/IV (p =0.057). The mTTP was 86 and 23 months for patients with residual disease <2 cm and >2 cm, respectively (p <0.001). The mOS was not reached for patients with residual disease <2 cm, while it was 36 months for residual disease >2 cm (p <0.001). Conclusion: Optimally cytoreduced patients with PFTC treated with platinum and paclitaxel-based chemotherapy regimen have an excellent possibility of survival. [Copyright &y& Elsevier]

Abstract: Objectives: Pelvic serous carcinomas are classified according to the location of greatest mass of tumor as ovarian, peritoneal or fallopian tube. Recent studies suggest these cancers may arise in the fallopian tube. This study explores the relationship between ovarian cancers and fallopian tube mucosal involvement. Methods: Sixteen consecutive cases of epithelial ovarian malignancy were prospectively identified and the fallopian tubes submitted in toto for histopathological examination for tubal mucosal involvement. Immunohistochemical staining for p53 and Ki-67, and fluorescent in situ hybridization (FISH) analysis for chromosomal copy number changes were performed on 10 cases. Three cases of mucosal epithelial abnormalities identified in risk-reducing salpingectomy specimens were similarly characterized. Results: Of sixteen cases, twelve were high-grade serous carcinoma, stage III, and four cases were stage I, two borderline mucinous, one borderline serous, and one low-grade mucinous carcinoma. Ten cases of high-grade serous carcinoma showed either unilateral fallopian tube mucosal involvement (n = 7) or tubal obliteration ipsilateral to the dominant ovarian mass (n = 3), compared to none of the other carcinomas. FISH analysis showed similar copy number changes in the ovarian and fallopian tube mucosal carcinoma in 3 cases, suggesting a unifocal origin; one case had differences suggesting multifocal origin of cancer. One case had equivocal FISH results. From risk-reducing salpingectomy cases, the multiple foci of tubal intraepithelial carcinoma and focus of invasive carcinoma showed similar gene copy number changes within each case, suggesting monclonality. Both cases of epithelial atypia/dysplasia showed gene copy number changes. Conclusions: Fallopian tube mucosal and ovarian tumors have similar genetic abnormalities in most cases, indicating a monoclonal origin that may originate either from the ovary, peritoneum or fallopian tube. In situ epithelial lesions of the fallopian tube from risk-reducing salpingectomies show gene copy abnormalities consistent with these being early lesions of serous carcinoma and suggest that chromosomal instability is a very early event in serous carcinogenesis. [Copyright &y& Elsevier]

Abstract: Background.: Paraneoplastic cerebellar degeneration (PCD) is rarely caused by fallopian tube adenocarcinoma. Case.: We present a patient with PCD and fallopian tube cancer. Anti-Yo antibody, one of an anti-neuronal antibody, was positive in serum and cerebrospinal fluid. She was also positive for HLA A24, which is common in patients with PCD. Radical surgery did not significantly ameliorate her neurological impairment, although the dysarthria improved slightly. Conclusion.: This case highlights the importance of detecting the underlying malignancy in patients with subacute neurological impairment and shows that fallopian tube cancer can potentially cause PCD. [Copyright &y& Elsevier]

Primary adenocarcinoma of the fallopian tube is a rare disease, and cerebral metastasis from this tumor is an extremely rare event.A 61-year-old female, who had been thought to be in a disease-free state after the initial treatment for stage IIIc fallopian tube adenocarcinoma, presented with severe headache, dizziness, nausea, and vomiting. Brain CT and MRI revealed solitary metastatic lesion in the cerebrum, which was the only site of recurrence. It was removed surgically, followed by platinum-based combination chemotherapy, and a clinical remission was achieved for 36 months.Attention should be paid to the possibility of cerebral metastasis in patients who develop neurogenic signs and symptoms. Prolonged survival could be achieved with aggressive treatment containing surgical debulking and adjuvant chemotherapy for solitary cerebral metastasis. [Copyright &y& Elsevier]

Background. Fallopian tube carcinoma is a rare malignancy that commonly recurs after initial surgical resection. New combined instrumentation with co-registered PET and CT is a new technique that combines functional and anatomic imaging to detect metastatic disease that may be difficult to detect with either modality alone.Case. We present two cases of suspected fallopian tube carcinoma recurrence demonstrating the unique potential of combined PET-CT using 18F-fluoro-2-deoxyglucose (FDG). These cases demonstrate the unique capability to detect and localize metastatic disease when serum CA-125, laparoscopy, and CT scan alone were unable to detect recurrence.Conclusion. PET-CT with FDG may prove to be a sensitive and accurate method for detection of metastatic disease and may influence the clinical management of recurrent fallopian tube carcinoma. [Copyright &y& Elsevier]

Background. Fallopian tube carcinoma is a rare gynecologic cancer. An extensive literature search reveals no previous case report of fallopian tube carcinoma presenting with a brain metastasis.Case. A 63-year-old woman presented with 3 weeks of progressive left-sided weakness. CT scan of the brain revealed a solitary lesion in the right parietal lobe. The patient underwent a complete resection, followed by whole-brain radiation therapy. Pathologic review demonstrated adenocarcinoma with follicular structures. A directed workup revealed a large right adnexal mass. She underwent resection of a large fallopian tube carcinoma with normal ovaries. She recovered from surgery and is receiving combination chemotherapy.Conclusion. This is the first case report of a fallopian tube carcinoma presenting as a brain metastasis. [Copyright &y& Elsevier]

Background. Women with a germline BRCA1 or BRCA2 mutation have a significantly increased risk of developing ovarian cancer compared with women in the general population and may consider bilateral prophylactic oophorectomy as a risk-reducing option.Case. We report a case of occult fallopian tube cancer diagnosed at prophylactic surgery in a patient with a BRCA2 mutation.Conclusions. This report acts as a reminder of the importance of removing as much of the fallopian tube as possible during prophylactic surgery in BRCA1 and BRCA2 carriers and of the need for careful pathological examination of surgical specimens after surgery. [Copyright &y& Elsevier]

Objective: In patients with ovarian/fallopian tube/primary peritoneal cancer, maximum surgical effort is aimed at complete cytoreduction as it results in longer overall survival [1]. In selected patients, achieving this goal with robotic-assisted surgery provides the patient with the benefits of minimally invasive surgery [2,3]. The authors present resection of bulky aorto-caval lymph nodes in a patient with serous fallopian tube cancer. Methods: A 51-year-old underwent robotic hysterectomy and bilateral salpingo-oopherectomy by her gynecologist for bilateral complex adnexal masses and leiomyomatous uterus. The findings were consistent with a high-grade serous carcinoma arising from the right fallopian tube. The tumor size was 7 x 1.7 cm and was metastatic to bilateral ovaries. Pelvic washings and lymphovascular invasion were negative. After the patient was referred to gynecologic oncology with these findings, enhanced computed tomography demonstrated 4.5 x 2 cm lymphadenopathy at the level of aortic bifurcation and 2.5 x 2 cm inter-aortocaval lymphadenopathy extending to the level of the left renal vein. The planned procedure was robotic resection of the aortic lymphadenopathy and completion of staging, including omentectomy, pelvic lymphadenectomy and resection of pelvic sidewalls where the tumor was adherent as described in the initial operative report. The trocars were placed in a sunrise distribution [4] with the camera port placed in the epigastrium. The peritoneum overlying the para-aortic lymphadenopathy was incised and the conglomerate of matted lymph nodes was dissected off the aorta and vena cava. The inferior mesenteric artery was freed and the dissection was carried cephalad behind the third portion of the duodenum which had to be mobilized 5 cm up in order to achieve exposure and resection of the lymphadenopathy. Titanium clips were used for hemostasis where necessary. A sponge was inserted in the abdomen to increase tamponade surface in the event of vascular injury. An accessory renal artery was crossing in front of the vena cava and was incidentally found below the adenopathy. The specimens were deposited in a laparoscopy bag and delivered transvaginally. Results: The hospital stay was overnight and there were no complications. The surgical pathology evaluation revealed stage IIIC2 disease with multiple positive matted aortic lymph nodes, negative bilateral pelvic lymph nodes and negative omentum. The patient has been disease-free for nine months after completion of chemotherapy. Conclusion: Complete tumor debulking can be accomplished in selected patients using minimally invasive approaches by the experienced laparoscopic surgeon. The surgeon has to be aware of the numerous variations in the vascular anatomy of the tributaries to the great vessels since injury or inadvertent ligation of these vessels can have significant consequences. [ABSTRACT FROM AUTHOR]