Original ArticleThe Tubal Fimbria Is a Preferred Site for Early Adenocarcinoma in Women With Familial Ovarian Cancer SyndromeMedeiros, Fabiola MD*; Muto, Michael G MD†; Lee, Yonghee MD*; Elvin, Julia A MD, PhD*; Callahan, Michael J MD†; Feltmate, Colleen MD†; Garber, Judy E MD‡; Cramer, Daniel W MD†; Crum, Christopher P MD*Author Information From the *Division of Women's and Perinatal Pathology, Department of Pathology, and the †Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital; and the ‡Dana Farber Cancer Research Institute, Boston, MA. Supported by P50 CA10500 (SPORE) (to D.W.C.) and the Francis Ward Paine and TSA Pemberton Funds of the Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital. Reprints: Christopher P. Crum, MD, Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (e-mail: [email protected]). The American Journal of Surgical Pathology: February 2006 - Volume 30 - Issue 2 - p 230-236 doi: 10.1097/01.pas.0000180854.28831.77 Buy Metrics Abstract A proportion of adenocarcinomas in prophylactic adnexectomies (bilateral salpingo-oophorectomies [BSOs]) from women with BRCA mutations (BRCA positive) occur in the fallopian tube. We analyzed a consecutive series of BSOs from BRCA-positive women following an index case of fimbrial serous carcinoma. To determine if the fimbria is a preferred site of origin, we followed a protocol for Sectioning and Extensively Examining the FIMbria (SEE-FIM). Immunostaining for p53 and Ki-67 was also performed. Thirteen BRCA-positive women (cases) and 13 women undergoing BSOs for other disorders (controls) were studied. Tubal carcinoma was detected in 4 cases at the initial histologic evaluation and in no controls. A fifth carcinoma was discovered following further sectioning of the fimbriae. Three were BRCA2 positive and two BRCA1 positive. Three were in the fimbria, one in both the fimbria and proximal tube, and one involved the ampulla. Four were serous carcinomas, four were confined to the tube, and three were noninvasive (intraepithelial). No ovarian carcinomas were identified. All tumors were Ki-67 positive (>75% of cell nuclei), and excluding one endometrioid carcinoma, p53 positive (>75% cell nuclei); p53 positivity in the absence of elevated Ki-67 did not correlate with morphologic neoplasia. The fimbria was the most common location for early serous carcinoma in this series of BRCA-positive women. Protocols that extensively examine the fimbria (SEE-FIM) will maximize the detection of early tubal epithelial carcinoma in patients at risk for ovarian cancer. Investigative strategies targeting the fimbriated end of the fallopian tube should further define its role in the pathogenesis of familial and sporadic ovarian serous carcinomas. © 2006 Lippincott Williams & Wilkins, Inc.