Occult Gynecological Cancer in Prophylactic Risk-Reducing Salpingo-Oophorectomies from BRCA Mutation Carriers
Ann E Walts, Jenny Gross, Ilana Cass. Cedars-Sinai Medical Center, Los Angeles
Background: Women with BRCA mutations are at increased lifetime risk for breast, ovarian, tubal, and peritoneal carcinoma (CA). Bilateral risk-reducing salpingo-oophorectomy (RRSO) is an effective strategy to signifcantly reduce this risk. We describe occult gynecologic cancers (OGC) diagnosed at prophylactic RRSO in BRCA mutation carriers.
Design: 210 consecutive BRCA+ women who underwent RRSO were identified in our oncology registry. Medical records and pathology were reviewed, demographics and pathological findings were charted, and the two diagnostic RRSO groups (OGC and benign) were compared for mutation, ethnicity, age at RRSO, prevalence of breast CA, and age at diagnosis of breast CA.
Results: 14(6.7%) of the 210 RRSO from BRCA+ women had OGC and 196 RRSO were benign. OGC was present in 13(6.7%) of 194 RRSO that had been serially sectioned and entirely submitted for microscopy and in 1(6.3%) of 16 RRSO that had routine sectioning and sampling. Women with OGC ranged from 43 to 76 years in age at RRSO, 10(71.3%) were of Ashkenazi Jewish descent, 12(85.7%) were BRCA1+ and 2(14.3%) were BRCA2+. The OGC included serous tubal intraepithelial carcinoma/STIC (8), invasive tubal CA (2), STIC and bilateral ovarian CA (1), ovarian CA [bilateral (1); unilateral (1)], and primary peritoneal CA (1). STICs were the most frequent tumors, measured up to 0.3 cm, and involved the distal tube/fimbria. Most STICs were unifocal. All OGC were serous and high grade. The largest tumor was a 4 cm tubal CA. Post RRSO followup (4 to 114 mos) is available in 13 OGC cases;no followup is available in one case. Two women with stages II and III CA at RRSO had recurrent CA at 21 and 28 months, respectively. Of the 8 women who had only STIC at RRSO, 6 have had no recurrence, 1 returned with mullerian CA in an isolated celiac lymph node at 32 months, and 1 was diagnosed with stage 3 peritoneal CA at 42 months. In both cases, the adnexa had been entirely submitted for microscopy and the excised uterus/cervix were benign. When the OGC and the benign groups were compared, there was a significant difference in the mean age at RRSO (55.9 vs 48.4 yrs, respectively p=0.0085). No significant difference (p>0.05) was observed in the prevalence of BRCA1 mutation, Ashkenazi Jewish origin, or breast CA, or in the mean age at breast CA diagnosis between the two groups.
Conclusions: -OGC was present in 6.7% of asymptomatic BRCA+ women who underwent prophylactic RRSO.
-STIC is the most frequent OGC diagnosed in these women.
-Women with OGC, even if confined to STIC when found at prophylactic RRSO, warrant ongoing surveillance for CA.
Category: Gynecologic & Obstetrics
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 139, Tuesday Afternoon