title: The presence of mucosal iron in the fallopian tube supports the "incessant menstruation hypothesis" for ovarian carcinoma.
abstract: The incessant ovulation hypothesis for the etiology of ovarian carcinoma has been accepted for decades, but recent evidence strongly implicates the fallopian tube mucosa as the source of most high-grade "ovarian serous carcinomas." Menstrual reflux through the tubes, a normal phenomenon, is a putative source of tubal mucosal exposure to carcinogens. We searched for histologic evidence of deposition of iron, a well-recognized carcinogen, in the fallopian tubes in 196 women with advanced-stage high-grade pelvic serous carcinomas in comparison with 370 controls. Tubal hemosiderin and/or pseudoxanthoma cells were found in 20% of the serous carcinoma cases, and an iron stain was positive in 30% of a sample of pigment-negative cases. Controls displayed pigment in 5% (P<0.001). In both cases and controls, pigment was significantly more frequently present in women with endometriosis as compared with those without. We conclude that tubal mucosal iron is present in a significant proportion of women with advanced-stage high-grade pelvic serous carcinoma. As a carcinogen, iron may play a role in the pathogenesis of these tumors. As compared with the incessant ovulation hypothesis, the recently proposed "incessant menstruation hypothesis" may be a better explanation of the well-recognized association of ovarian carcinoma with the length of the reproductive life uninterrupted by pregnancy.
authors.affiliation: Department of Pathology and Laboratory Medicine, Washington Hospital Center, Washington, DC 20010, USA. jdseidman@hotmail.com
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Seidman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002471:Cell Transformation, Neoplastic; D018284:Cystadenocarcinoma, Serous / Q000378:metabolism / Q000473:pathology*; D004715:Endometriosis / Q000473:pathology; D005185:Fallopian Tube Neoplasms / Q000378:metabolism / Q000473:pathology*; D005187:Fallopian Tubes / Q000378:metabolism / Q000473:pathology; D005260:Female; D006485:Hemosiderin / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000378:metabolism*; D008598:Menstruation; D008875:Middle Aged; D009092:Mucous Membrane / Q000378:metabolism / Q000473:pathology; D010051:Ovarian Neoplasms / Q000378:metabolism / Q000473:pathology*; D010386:Pelvic Neoplasms / Q000378:metabolism / Q000473:pathology*; D010534:Peritoneal Neoplasms / Q000378:metabolism / Q000473:pathology*
chemical_list: D006485:Hemosiderin; D007501:Iron