| Abstract [eng] |
Ovarian cancer is the second most common malignant disease of the female genital organs, while its mortality from is the highest compared with other malignant tumor diseases of the female reproductive system. Over the last decade, great progress has been made in the science of gynecology, which has changed the approach to this disease. It was believed that ovarian cancer most often arises from the surface epithelium of the ovary; however, advances in genetic and pathology studies it is suspected that the true site of origin of this disease is in the fallopian tubes, more precisely in the distal fimbrial part of the fallopian tubes. The aim of this work is to review the newest scientific literature on serous tubal intraepithelial lesion (STIL), serous tubal intraepithelial carcinoma (STIC), and the p53 protein “signature” in the fallopian tubes. The main objectives of the work are to describe the clinical significance of STIL, STIC, and the p53 protein “signature”, to discuss their detection method, and to present conclusions and recommendations for specialists. The literature review was carried out using the PubMed (MEDLINE) database. Based on keywords and inclusion criteria, the titles and abstracts of articles were reviewed, and in this way 74 articles suitable for the literature review of this work were selected. The topic is relevant because, effective preventive diagnostic measures and programs for detecting this disease have not been developed, and mortality from this disease remains high, despite the use of all diagnostic methods to prevent this disease. Based on literature data, STIC, STIL, and the p53 “signature” indicate early changes in the fallopian tubes, which allow the origin, risk, and progression of the disease to be newly evaluated before invasive disease. SEE-FIM protocol is recommended for the diagnosis of intraepithelial lesions. In patients who have undergone cancer risk-reducing salpingoophorectomy due to BRCA1/2 gene mutations or other hereditary breast and ovarian cancer risk, the specimens obtained during surgical intervention must be examined using the SEE-FIM protocol. According to current guidelines, the application of the SEE-FIM protocol to all patients operated on for benign reasons is not mandatory; however, the use of the protocol should be considered in selected clinical cases. It is stated that the p53 “signature” in the fallopian tubes is considered a possible beginning of high-grade serous carcinogenesis, but the frequency of expression and the relationship with the development of the neoplastic process remain insufficiently defined. In certain cases, when operating for benign indications and when the fallopian tube epithelium is morphologically suspicious, the authors of scientific studies recommend performing immunohistochemical examination of the specimen as an additional method that would help to differentiate or diagnose intraepithelial lesions. Serous tubal intraepithelial lesion, or STIL, is considered a possible intermediate lesion between the p53 “signature” and serous intraepithelial carcinoma, but the biological, clinical, and prognostic significance of this lesion is still not defined. The diagnosis of STIL is based on a combination of morphological features, p53 expression, and Ki-67 immunohistochemical assessment. At present, there are no clear recommendations regarding further treatment or follow-up after STIL is detected, because scientific literature is lacking. STIC is the main precursor of high-grade serous carcinoma. The diagnosis of serous intraepithelial carcinoma is based on morphology and immunohistochemical assessment of p53 and Ki-67. The risk of developing high-grade invasive serous carcinoma after STIC is detected over five or ten years is approximately 10.5% and 21.6%, respectively; therefore, clinical guidelines recommend performing staging of the abdominal cavity and peritoneum by a minimally invasive method. |
