Primary fallopian tube malignancies in BRCA-positive women undergoing surgery for ovarian cancer risk reduction.
OBJECTIVE
To review the frequency and location of malignancies detected after prophylactic salpingo-oophorectomy in women with BRCA mutations.


METHODS
Medical records and pathology findings were reviewed from BRCA-positive women undergoing prophylactic surgery for ovarian cancer risk reduction who underwent complete examination of the adnexa. Patients undergoing this procedure between January 1999 and January 2007 were identified.


RESULTS
From January 1999 to January 2007, 122 BRCA-positive patients underwent prophylactic surgery in the Division of Gynecologic Oncology at Brigham and Women's Hospital. The median age was 46.5 years (range, 33 to 76 years). Seven (5.7%) were found to have an early malignancy in the upper genital tract and all patients were age > or = 44 years at diagnosis. Of seven consecutive cancers culled between January 1999 and January 2007, all (100%) originated in the fimbrial or ampullary region of the tube; six had an early (intraepithelial) component. Two were associated with surface implants on the ovary and two required repeated sectioning to detect microscopic carcinomas in the fimbria.


CONCLUSIONS
The distal fallopian tube seems to be the dominant site of origin for early malignancies detected in approximately 6% of women undergoing ovarian cancer risk-reduction surgery. The greatest proportion of serous cancer risk in BRCA mutation-positive women should be assigned to the fimbria rather than the ovary, and future clinical and research protocols should employ thorough examination of the fimbria, including multiple sections from each tissue block, to maximize detection of early malignancies in this population.
Callahan
Michael J
MJ
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA.
Crum
Christopher P
CP
Medeiros
Fabiola
F
Kindelberger
David W
DW
Elvin
Julia A
JA
Garber
Judy E
JE
Feltmate
Colleen M
CM
Berkowitz
Ross S
RS
Muto
Michael G
MG
D000328:Adult; D017677:Age Distribution; D000368:Aged; D051017:Apoptosis Regulatory Proteins; D019313:BRCA1 Protein / Q000032:analysis*; D024682:BRCA2 Protein / Q000032:analysis*; D014408:Biomarkers, Tumor / Q000032:analysis*; D005185:Fallopian Tube Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D010535:Laparoscopy; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control*; D010052:Ovariectomy / Q000706:statistics & numerical data*; D040242:Risk Reduction Behavior
D051017:Apoptosis Regulatory Proteins; C118024:BLID protein, human; D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human; D014408:Biomarkers, Tumor