[1173] Histologic Evaluation of Prophylactic Hysterectomies in Women with Lynch Syndrome

Yevgeniy Karamurzin, Robert Soslow, Karuna Garg. Memorial Sloan-Kettering Cancer Center, New York, NY

Background: Women with Lynch syndrome (LS) are at increased risk for endometrial (EC) and ovarian carcinoma (OC).Current surveillance recommendations for detection of EC and OS in LS patients are not effective. Small studies have shown that prophylactic hysterectomy and bilateral salpingo-oophorectomy (P-TAH-BSO) are the most effective and least expensive preventive measures in these patients. Data regarding histologic findings in prophylactic specimens in these patients are lacking.
Design: All LS patients who underwent P-TAH-BSO at MSKCC from 2000 to 2011 were identified. Slides were evaluated for the presence of endometrial hyperplasia (EH), EC, OC or any other recurrent histologic findings.
Results: 25 patients were identified with (age 36-61 years). 16 patients had a history of colon carcinoma and 2 patients had a history of sebaceous carcinoma. Focal non-invasive FIGO grade 1 endometrioid ECs were detected in 2 patients, age 54 yrs (MSH2 mutation) and 56 yrs (MLH1 mutation). Focal complex atypical hyperplasia was seen in 2 patients, age 35 (MLH1 mutation) and 53 years (MSH2 mutation). One patient (44 year old with MSH2 mutation) showed a mixed endometrioid/clear cell OC and simple hyperplasia without atypia in the endometrium. The OC was adherent to the colon, but did not show distant metastasis. Other notable uterine findings included mucinous metaplasia (MM) and increased lymphoid aggregates (LA).

Table 1.
n (%)3/25 (12%)2/25 (8%)1/25 (4%)4/25 (16%)5/25 (20%)

Conclusions: In our study, prophylactic uteri and ovaries in LS revealed incidental EC and/or EH in 20%, and OC in 4% of cases. The endometrial carcinomas were low grade, confined to endometrium and seen in patients older than 50 yrs. Prophylactic hysterectomy allows recognition of early lesions in LS which appear to be small, focal and not diffuse. MM and LA were also frequently noted in benign uteri.
Category: Gynecologic & Obstetrics

Wednesday, March 21, 2012 9:30 AM

Poster Session V # 140, Wednesday Morning


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