Hum. Reprod. Advance Access originally published online on June 2, 2009
Human Reproduction 2009 24(9):2238-2243; doi:10.1093/humrep/dep196
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Malignant cells are not found in ovarian cortex from breast cancer patients undergoing ovarian cortex cryopreservation
1 Department of Obstetrics and Gynaecology, Hospital Universitario Dr Peset, Av Gaspar Aguilar 90, 46017 Valencia, Spain 2 Instituto Valenciano de Infertilidad (IVI)-Valencia, Valencia, Spain 3 Department of Pathology, Hospital Universitario Dr Peset, Valencia, Spain 4 IVI-Barcelona, Barcelona, Spain
5 Correspondence address. E-mail: pellicer_ant{at}gva.es
BACKGROUND: Breast cancer is a frequent indication for ovarian cortex cryopreservation due to its high incidence. The main concern of this procedure is the possibility of reintroducing metastatic cells within the implant, an issue that has not been addressed systematically. Thus, a study was designed to analyse the presence of ovarian metastases in breast cancer patients undergoing ovarian tissue cryopreservation.
METHODS: Morphological and immunohistochemical studies following the concept of the sentinel lymph node (SLN) were performed on 100 cortical ovarian biopsies obtained from 63 patients and on six frozen-thawed entire cortex from patients with the diagnosis of infiltrating ductal breast carcinoma undergoing ovarian cortex extraction and cryopreservation. The antibody panel included Cytokeratin CAM 5.2, Gross Cystic Disease Fluid Protein-15 (GCDFP15), Wilms' tumour antigen-1 (WT1) and Mammaglobin 1.
RESULTS: Employing only morphologic criteria, suspicious neoplastic cells were detected in five biopsies, but in none of the six entire cortex analysed. These five cases were reclassified as hyperplasic surface epithelium-inclusion cysts (CAM 5.2+, WT1+) or apoptotic granulosa cells (CAM 5.2–, GCDFP15+, WT1–).
CONCLUSIONS: Using the methodology of the SLN our data suggest the absence of tumour cells in biopsies obtained from patients undergoing ovarian cortex cryopreservation to preserve their fertility potential, although future methods of cancer screening may change our perception of this procedure.
Key words: ovarian cortex cryopreservation/breast cancer/ovarian metastases
Presented in part at the 23rd Annual Meeting of the European Society of Human Reproduction and Embryology Lyon, France, 1–4 July 2007. Submitted on August 8, 2008; resubmitted on March 4, 2009; accepted on March 9, 2009.