Observed Tubal Fimbria Pathological Lesions Of92Cases Pelvic Serous Carcinoma

Objective: In past years, the conventional wisdom holds that ovarianserous carcinoma originate from ovarian surface epithelium.However moreand more evidences suggest that presence of dominant mass of ovarianserous carcinoma originate from fimbria of fallopian tube. In recent years,scholars have proposed that the diagnosis of term “pelvic serous carcinoma”instead of instead of “ovarian serous carcinoma”.Up to date, the new theoryabout mechanism of ovarian serous carcinoma is not complete andpathological grade of ovarian serous carcinoma lack of uniformstandards.More patients need to be confirmed. In view of this, the studysummarized pathological features of92cases of pelvic serous carcinoma,combined with immunohistochemical methods to explore the expression offimbria lesions of ovarian serous carcinoma in the p53pathway(Mdm2-p53-p21). Further observation to investigate the pathogenesis offimbria lesions on ovarian serous carcinoma even in order to verify the theorythat tubal fimbria is the origin of pelvic serous carcinoma. Providing moretheoretical basis for this new theory of the origin of pelvic serous carcinoma.Methods:1Specimen sourceSelected92cases ovarian serous carcinoma specimens of the SecondHospital of Hebei Medical University from the2009to2013with ovariantumor cytoreductive resection of double accessories,hysterectomy,greateromentum,other cleaning tissue.Also using the SEE-FIM method on the wholefallopian tube.2Screening routine HE sections under the microscopeReview92cases of biopsy mentioned above,summarized its pathologicalfeature and histological grade according to University of Texas MD Anderson Cancer Center (MDACC)3Immunohistochemical method3.1ReagentUsing ElivisionTMimmunohistochemical plus two step method to observethe expression of Mdm2protein,p21protein and p53protein on fimbria offallopian tube whith epithelial hyperplasia.3.2Source of caseImmunohistochemistry cases are59cases of tubal distal epithelialhyperplasia which first screen from92cases of ovarian serous carcinoma, p53staining. The results showed that there are24cases in which present of. Thisfurther observation Mdm2protein and P21protein expression on24caseswhich mendtionde above to observe expression of p53signature cells on thefallopian tube fimbria epithelial of ovarian serous carcinoma in p53pathway(Mdm2-p53-p21).4StatisticsThe experimental datas were anlyzed with Chi-square test, Fisher’s exacttest and correlation with stastics software of SPSS13.0edition.Results:1Pathorphological observation1.1Histological grading92cases of ovarian serous carcinoma were graded according to gradingsystem which is divided into high-grade ovarian serous carcinoma63cases(68.5%), low-grade serous carcinoma in29cases (31.5%) according totwo-tier grading system which the University of Texas M.D. Anderson CancerCenter(MDACC) pointed.Age range of the low-grade of serous ovarian cancer between39-63yearsold, the organizational structure of the nipple structure and violated mostcommon ovarian parenchyma, mild to moderate tumor shaped nuclei, giantcell tumor, but the tumor area can be rare common gravel body.High levels of ovarian serous carcinoma, mainly in the age range between52-78years of age, mainly in the organizational structure of solid or glandular structures common tumor nuclei severe atypia, giant cell tumor is morecommon and Gravel rare.1.2Pelvic organ involvementPelvic organs of92case of ovarian serous carcinoma had beeninvolved.There were63case pelvic organs involved of high-grade ovarianserous carcinoma and29case pelvic organs involved of low-grade ovarianserous carcinoma.However the number of pelvic organs involved are differentbetween high-grade ovarian serous carcinoma and low-grade ovarian serouscarcinoma.The results showed that there the number of pelvic organs whichinvolved in high-grade and low-grade serous carcinoma serous presentdifferences, Z=-4.261; P <0.001.The ratio of one involvement organ of high-grade serous carcinoma is4.76%(3/63), the ratio of two organ Involvement is7.93%(5/63), three organinvolvement ratio is11.1%(7/63), the probability of the four organinvolvement is23.80%(15/63); probability of five organ involvement is22.22%(14/63), the probability in six organ involvement is23.80%(15/63),seven organ involvement is6.34%(4/63).However the ratio of one involvement organ of low-grade serouscarcinoma is10.34%(3/29), the ratio of two organ involvement is31.03%(9/29), the ratio of three organ involvement is31.03%(9/29), the probabilityof the four organ involvement is20.69%(6/29); probability of five organinvolvement is6.89%(2/29).Combining statistical results and the above ratio: the involvement of thepelvic organs of high-grade serous are more than the low-grade serouscarcinoma,indicating that high-grade serous carcinoma spread widely.1.3The normal substance of the remaining of ovarian of two groupsIn the92cases of ovarian serous carcinoma,there are69case of ovarianserous carcinoma remaining the substance of ovarian. There are52cases(82.5%)of the high-grade group which had residual ovarian essence and17cases (58.6%) had residual ovarian essence in the low-grade group.Theproportion of high-level group was higher than the low-level group,and the differences of the two groups are statistically significant (P <0.05).These results show that the degree of the low-grade serous carcinomawhich invade ovarian is much higher than high-grade serous carcinoma.1.4Tubal fimbria with serous carcinomaIn the92cases of ovarian serous carcinoma,there are64case of ovarianserous carcinoma with tubal fimbria tumors.The proportion of tubal fimbriatumors of high-grade group is77.8%and the proportion of tubal fimbriatumors of low-grade group is51.7%. The proportion of tubal fimbria tumorsof high-grade group is higher than the ratio of the low-grade group.Thedifference between the two groups was statistically significant (P <0.05).These results suggest that the occurrence rate of tubal serous carcinoma ofwhich high-grade grade is higher than low grade group,and also shows thereis a close relationship between high-gade serous carcinoma and tubal fimbria1.5Fallopian tube epithelial hyperplasiaIn the92cases of ovarian serous carcinoma,there are59case of ovarianserous carcinoma with fallopian tube epithelial hyperplasia.The proportion offallopian tube epithelial hyperplasia in the high grade serous carcinoma is63.5%(40/63) and65.5%(19/29) in the low-grade serous carcinoma. There isnot statistically significant between the two groups.(P>0.05)1.6Fallopian tube epithelial hyperplasia with tubal fimbria serous carcinomaThere are59cases of fallopian tube epithelial hyperplasia.52cases(88.1%) accompanied by tubal serous carcinoma, including high-level groupof37patients (92.5%), low-level group of15patients (78.9%); Surplus7cases (8.9%) cases of tubal epithelial hyperplasia seen with tubal serouscarcinoma, including high-level group,3patients (7.5%), low-level group,4patients (21.1%).The results suggest that by the probability of fallopian tube epithelialhyperplasia accompanied cancer of ovarian serous carcinoma is higher thanthe oviduct epithelial hyperplasia is not associated with the probability ofcancer. Whether fallopian tube epithelial hyperplasia of two grade ovarianserous carcinoma with tubal fimbria serous carcinoma or not, the difference is not statistically significant.(P>0.05)1.7Gravel appeared in two casesThere are92cases of ovarian serous carcinoma and26cases have gravelbody.There are12cases (19.0%) appeared gravel body, low-level group of14patients(48.3%) appeared gravel body.The difference is statistically significant(P <0.05) in the two groups.These results suggest that the probability in all observed sections of thelow-grade serous carcinomas of which gravel body appeared is higherthan the high-grade serous carcinomas.1.8lymph node metastasisIn the92cases of ovarian serous carcinoma,there are3cases with lymphnode metastasis (4.7%) in the high-level group, the low-level group had1casewith lymph node metastasis (3.4%), the difference is not statisticallysignificant (P>0.05).Whether the high-level or low-level serous serous carcinoma in these casesonly a few cases occurred in lymph node metastasis, which illustrate the mainlymph node metastasis pathway is not serous cancer.1.9Comparison of the two groups of ageHigh-level age group (62.8±1.11; n=63), low-grade age group (49.7±1.82; n=29), the average age of the high-level group than low-level age group,statistically significant differences exist between the two groups of (P <0.0.5).2Immunohistochemical analysis2.1p53staining cells imprint immunohistochemistryThere are59cases with oviduct epithelial hyperplasia,40cases ofhigh-grade serous ovarian cancer,19cases of low-grade serous ovarian cancer.20cases (50%) are high-grade serous ovarian cancer whith p53signture cellon fimbria mucosa epithelial,4cases (21.1%) are low-grade of ovarianserous carcinoma whith p53signture cell. There are differences between theprobability of high-grade and low-grade groups with tubal epitheliumappeared p53signture cell (P <0.05)These results indicate that: probability of p53signature cells appeared in the high-grade serous carcinoma is significantly higher than the low-grade ofserous carcinoma.So there is close connection between high-grade serouscarcinoma and p53signature cells on tubal fimbria.2.2Immunohistochemical staining of Mdm2proteinThere are24cases of ovarian serous carcinoma with p53signature cells onthe fallopian tube fimbria,20cases of high-grade serous ovarian cancer,4cases of low-grade serous carcinoma. The expression of Mdm2of16high-grade serous ovarian cancer patients (80%) is positive who have p53signature cells on the fallopian tube fimbria and3cases (75%) are positive inlow-grade serous carcinoma.The diffence between the two group have nostatistical significance (P>0.05).2.3P21protein immunohistochemical staining resultsThere are24cases of ovarian serous carcinoma with p53signature cells onthe fallopian tube fimbria,20cases of high-grade serous ovarian cancer,4cases of low-grade serous carcinoma. The expression of p21of16high-gradeserous ovarian cancer patients (80%) is unpositive who have p53signaturecells on the fallopian tube fimbria and3cases (75%) are unpositive inlow-grade serous carcinoma.The diffence between the two group have nostatistical significance (P>0.05).Conclusion:1According to MDACC grading, there are differences between twograde of ovarian serous carcinoma.The high-grade ovarian serous cancerspread wider in pelvic and the probability of associated with serous carcinomaand with the the existence of p53signature cells of fallopian tube fimbria ismuch higher.The degree of high-grade ovarian serous carcinoma which invadein ovarian is lower than low-grade ovarian serous carcinoma.2There is close relationship between fallopian tube fimbria andhigh-grade ovarian serous cancer3The p53signature cells of fallopian tube fimbria existences in bothHigh-grade and low-grade ovarian serous carcinoma which associated withabnormal expression of Mdm2-p53-p21pathway.