BRCA 1 or 2-Associated (BRCA+) Pelvic Serous Carcinomas Arise from Both the Ovaries and Fallopian Tubes: The Contrast between Symptomatic and Asymptomatic Women
S Schulte, M Roh, AK Folkins, EA Jarboe, J Garber, J Hecht, CP Crum. University of Pennsylvania, Philadelphia, PA; University of Michigan Medical Center, Ann Arbor, MI; Stanford University Medical Center, Palo Alto, CA; University of Utah Medical Center, Salt Lake City, UT; Dana Farber Cancer Institute, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA
Background: With greater emphasis on the distal fallopian tube as a source of pelvic serous carcinoma (PSC), the possibility that bilateral salpingectomy alone will prevent this disease in both BRCA+ women and the general population is being debated. This study was designed to compare PSCs in the two populations to determine if PSCs in the BRCA+ group are more likely to arise from the fimbria.
Design: Pathology reports from 55 symptomatic BRCA+ PSCs, including histologic review of 16, and 15 asymptomatic (early) carcinomas discovered at prophylactic salpingo-oophorectomy were reviewed and compared to 85 consecutively accessioned PSCs. The goal was to estimate the frequency of primary ovarian vs tubal carcinomas in these groups relative to consecutively accessioned PSCs.
Results: Of 15 asymptomatic BRCA+ women with early PSCs, 13 (87%) were documented in the distal fallopian tube. Of 55 symptomatic BRCA+ women, 49 were high grade PSCs. Review of the pathology in 15 revealed a probable source in the fallopian tube in 6 (40%) and in the ovary in five (33%), with 4 of unclear origin. In 31 of 85 PSCs in the general population (36%) the primary site was assigned to the tube. The difference in frequency of probable tubal origin between the BRCA+ and general population was not significant. The differences in frequency of probable tubal origin between symptomatic (either group) and asymptomatic PSCs (BRCA+) was significant (p<0.001).
Conclusions: The proportion of asymptomatic BRCA+ women whose tumors arise in the fallopian tube is substantial, but this group is only a subset of of women at risk for PSC. Tumors in the symptomatic BRCA+ women and the general population are indisinguishable, underscoring multiple origins for PSC. Without data to the contrary, prophylactic salpingectomy cannot be expected to prevent all PSC and further epidemiologic and pathologic comparisons of high and low risk women with PSC are needed to ascertain the risk reduction expected by salpingectomy alone.
Category: Gynecologic & Obstetrics
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 144, Tuesday Afternoon