Objective: The fallopian tube is now recognized as a primary source of precursor neoplastic lesions for pelvic serous adenocarcinomas. Cytologic features of fallopian tube brushings from low-risk patients have not been well described. Study Design: We describe the cytomorphology of tubal epithelium from prospectively collected experimental in vivo brushings from normal fallopian tubes of 7 low-risk patients. Liquid-based cytology slides and cell blocks were prepared and reviewed on all specimens. Results: Fifteen brush cytology specimens were obtained, ten by laparoscopy, four by hysteroscopy and one following hysterectomy and bilateral salpingo-oophorectomy on an ex vivo specimen. Variable cytologic features were documented for background, cellularity, cellular architecture, cilia, nuclear overlap, mitoses, nuclear pleomorphism, nuclear membrane changes and nucleoli. Negative P53 and Ki-67 stain results were documented in available cell blocks. Histopathologic salpingectomy findings and clinical follow-up were benign. Conclusion: Moderate nuclear pleomorphism and nuclear overlap, prominent single and multiple nucleoli and background granular debris were common challenging cytologic findings in fallopian tube brushings from low-risk patients. With experience, cellular changes can be recognized as benign. Recognition of the range of normal fallopian tube cytology should help to minimize false-positive interpretations of cytology specimens obtained in association with risk-reducing salpingo-oophorectomies.

Keywords:
Brush cytology, Fallopian tube, Female genital tract, Hysteroscopy, Screening cytology, Serous carcinoma
1.
Siegel R, Naishadham D, Jemal A: Cancer statistics, 2012. CA Cancer J Clin 2012;62:10-29.
2.
du Bois A, Herrstedt J, Hardy-Bessard AC, Muller HH, Harter P, Kristensen G, Joly F, Huober J, Avall-Lundqvist E, Weber B, Kurzeder C, Jelic S, Pujade-Lauraine E, Burges A, Pfisterer J, Gropp M, Staehle A, Wimberger P, Jackisch C, Sehouli J: Phase III trial of carboplatin plus paclitaxel with or without gemcitabine in first-line treatment of epithelial ovarian cancer. J Clin Oncol 2010;28:4162-4169.
3.
Seidman JD, Horkayne-Szakaly I, Haiba M, Boice CR, Kurman RJ, Ronnett BM: The histologic type and stage distribution of ovarian carcinomas of surface epithelial origin. Int J Gynecol Pathol 2004;23:41-44.
4.
Jaaback KS, Ludeman L, Clayton NL, Hirschowitz L: Primary peritoneal carcinoma in a UK cancer center: comparison with advanced ovarian carcinoma over a 5-year period. Int J Gynecol Cancer 2006;16(suppl 1):123-128.
5.
Halperin R, Zehavi S, Langer R, Hadas E, Bukovsky I, Schneider D: Primary peritoneal serous papillary carcinoma: a new epidemiologic trend? A matched-case comparison with ovarian serous papillary cancer. Int J Gynecol Cancer 2001;11:403-408.
6.
Zheng W, Fadare O: Fallopian tube as main source for ovarian and pelvic (non-endometrial) serous carcinomas. Int J Clin Exp Pathol 2012;5:182-186.
7.
Kindelberger DW, Lee Y, Miron A, Hirsch MS, Feltmate C, Medeiros F, Callahan MJ, Garner EO, Gordon RW, Birch C, Berkowitz RS, Muto MG, Crum CP: Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: evidence for a causal relationship. Am J Surg Pathol 2007;31:161-169.
8.
Carlson JW, Miron A, Jarboe EA, Parast MM, Hirsch MS, Lee Y, Muto MG, Kindelberger D, Crum CP: Serous tubal intraepithelial carcinoma: its potential role in primary peritoneal serous carcinoma and serous cancer prevention. J Clin Oncol 2008;26:4160-4165.
9.
Crum CP, Drapkin R, Miron A, Ince TA, Muto M, Kindelberger DW, Lee Y: The distal fallopian tube: a new model for pelvic serous carcinogenesis. Curr Opin Obstet Gynecol 2007;19:3-9.
10.
Kurman RJ, Shih Ie M: Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer - shifting the paradigm. Hum Pathol 2011;42:918-931.
11.
Levanon K, Crum C, Drapkin R: New insights into the pathogenesis of serous ovarian cancer and its clinical impact. J Clin Oncol 2008;26:5284-5293.
12.
Piek JM, Kenemans P, Verheijen RH: Intraperitoneal serous adenocarcinoma: a critical appraisal of three hypotheses on its cause. Am J Obstet Gynecol 2004;191:718-732.
13.
Seidman JD, Zhao P, Yemelyanova A: ‘Primary peritoneal' high-grade serous carcinoma is very likely metastatic from serous tubal intraepithelial carcinoma: assessing the new paradigm of ovarian and pelvic serous carcinogenesis and its implications for screening for ovarian cancer. Gynecol Oncol 2011;120:470-473.
14.
Fields MM, Chevlen E: Ovarian cancer screening: a look at the evidence. Clin J Oncol Nurs 2006;10:77-81.
15.
Papanicolaou G: Exfoliative Cytology, ed 1. Cambridge, Harvard University Press, 1954.
16.
Dudkiewicz J: Cytomorphology of epithelial cells of fallopian tubes obtained by aspiration from operative specimens. Am J Obstet Gynecol 1968;102:82-90.
17.
Dudkiewicz J: Quantitative and qualitative changes of epithelial cells of fallopian tubes in women according to the phase of menstrual cycle: a cytologic study. Acta Cytol 1970;14:531-537.
18.
Herzberg AJ, Raso DS, Silverman JF: Color Atlas of Normal Cytology, ed 1. Philadelphia, Churchill Livingstone, 1999.
19.
Aali BS, Malekpour R, Nakheii N, Mehdizadeh A: Utility and diagnostic accuracy of fallopian tube touch imprint cytology. Cytopathology 2005;16:252-255.
20.
Fidler HK Lock DR: Carcinoma of the fallopian tube detected by cervical smear. Am J Obstet Gynecol 1954;67:1103-1111.
21.
De May M: The Pap Test, ed 1. Singapore, ASCP, 2005.
22.
Safret A, Bosch B, Bannwart F, Rinderknecht B, Hafner HU: Carcinoma in situ of the fallopian tube presenting as a positive Pap smear. Acta Cytol 2004;48:462-464.
23.
Jorns JM, Knoepp SM: Occult fallopian tube carcinoma detected in routine pelvic washing specimens submitted for staging: another justification for pelvic washing cytology? Diagn Cytopathol 2009;37:923-929.
24.
Cianci A, Palumbo G, Tempera G, Furneri PM: C trachomatis detection in infertile women by using a tubal cytobrush during laparoscopy. Acta Eur Fertil 1989;20:363-365.
25.
Haeusler G, Tempfer C, Lehner R, Sam C, Kainz C: Fallopian tissue sampling with a cytobrush during hysteroscopy: a new approach for detecting tubal infection. Fertil Steril 1997;67:580-582.
26.
Matsushima T, Kaseki H, Ishihara, K Araki T: Assessment of fallopian tube cytology for the diagnosis of endometriosis and hydrosalpinx. J Nippon Med Sch 2002;69:445-450.
27.
Mulvany NJ, Arnstein M, Ostor AG: Fallopian tube cytology: a histocorrelative study of 150 washings. Diagn Cytopathol 1997;16:483-488.
28.
Landon G, Stewart J, Deavers M, Lu K, Sneige N: Peritoneal washing cytology in patients with BRCA1 or BRCA2 mutations undergoing risk-reducing salpingo-oophorectomies: a 10-year experience and reappraisal of its clinical utility. Gynecol Oncol 2012;125:683-686.
29.
Manchanda R, Drapkin R, Jacobs I, Menon U: The role of peritoneal cytology at risk-reducing salpingo-oophorectomy (RRSO) in women at increased risk of familial ovarian/tubal cancer. Gynecol Oncol 2012;124:185-191.
30.
Sneige N, Dawlett MA, Kologinczak TL, Guo M: Endosalpingiosis in peritoneal washings in women with benign gynecologic conditions. Cancer Cytopathol 2013, E-pub ahead of print.
31.
Crum CP, McKeon FD, Xian W: The oviduct and ovarian cancer: causality, clinical implications, and ‘targeted prevention'. Clin Obstet Gynecol 2012;55:24-35.
32.
Kurman RJ, Vang R, Junge J, Hannibal CG, Kjaer SK, Shih Ie M: Papillary tubal hyperplasia: the putative precursor of ovarian atypical proliferative (borderline) serous tumors, noninvasive implants, and endosalpingiosis. Am J Surg Pathol 2011;35:1605-1614.
33.
Rungruang B, Hood BL, Sun M, Hoskins E, Conrads TP, Zorn KK: Novel surgical approaches for sampling the ovarian surface epithelium and proximal fluid proteome. J Proteome Res 2010;9:6071-6076.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.