Tubal and ovarian pathways to pelvic epithelial cancer: a pathological perspective

Histopathology. 2008 Aug;53(2):127-38. doi: 10.1111/j.1365-2559.2007.02938.x. Epub 2008 Feb 22.


Prolongation of ovarian epithelial cancer survival depends on early detection or improved responses to chemotherapy. Gains in either have been modest at best. Understanding the diverse pathogenesis of this disease is critical to early intervention or prevention. This review addresses six important variables, including (i) cell of origin, (ii) site of origin, (iii) initial genotoxic events, (iv) risks imposed by hereditary and other promoting conditions, (v) subsequent factors that promote different patterns of metastatic spread, and (vi) prospects for intervention. This review proposes two distinct pathways to pelvic epithelial cancer. The first initiates in ovarian surface epithelium (OSE), Mullerian inclusions or endometriosis in the ovary. The second arises from the endosalpinx and encompasses a subset of serous carcinomas. The serous carcinogenic sequence in the distal fallopian tube is described and contrasted with lower grade serous tumors based on tumour location, earliest genetic change and ability (or lack of) to undergo terminal (ciliated) differentiation. Ultimately, a clear understanding of tumour origin and the mechanism(s) leading to the earliest phases of the serous and endometrioid carcinogenic sequences may hold the greatest promise for designing prevention strategies and/or developing new therapies.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Fallopian Tube Neoplasms / classification
  • Fallopian Tube Neoplasms / etiology*
  • Fallopian Tube Neoplasms / pathology*
  • Female
  • Humans
  • Neoplasms, Glandular and Epithelial / classification
  • Neoplasms, Glandular and Epithelial / etiology*
  • Neoplasms, Glandular and Epithelial / pathology*
  • Ovarian Neoplasms / classification
  • Ovarian Neoplasms / etiology*
  • Ovarian Neoplasms / pathology*
  • Pelvic Neoplasms / classification
  • Pelvic Neoplasms / etiology*
  • Pelvic Neoplasms / pathology*