Prophylactic oophorectomy (PO) is an option for women at increased risk for ovarian carcinoma. In this study the value of intensive pathologic examination of PO specimens and accompanying resected tissues in the identification of occult carcinoma and any association of occult carcinoma with BRCA germline mutation status were ascertained. Specimens from 60 consecutive PO patients, who were not suspected of having any ovarian tumor at the time of surgery, were subjected to standardized, complete pathologic examination in a prospective study over an 8-year period. Extra-ovarian tissues were examined as well, but they were not subject to the same standardized protocol. Any occult carcinoma of the ovaries or fallopian tubes was noted. The BRCA status and follow-up of patients were obtained, if available. Fifty-five of the 60 PO specimens did not show any evidence of malignancy. Of the 32 patients in this group followed for >1 year, all are alive and well. The remaining five patients, all BRCA1 mutation positive, showed occult carcinoma of the ovaries and/or in situ or invasive carcinoma of a fallopian tube. One of these five patients has died of abdominal carcinomatosis; four continue to be well, but follow-up is <4 years in all cases. Occult carcinoma is present in a small proportion of BRCA-positive or unknown PO patients and may be of prognostic significance. The entire ovaries and tubes from PO patients should be submitted for histologic examination to identify malignancy.
From Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology (T.J.C.), University of Toronto; the Division of Gynecologic Oncology, University Health Network, and the Department of Obstetrics and Gynecology (J.M.), University of Toronto; the Adult Genetics Program, University Health Network, and the Department of Laboratory Medicine and Pathobiology (D.E.C.C.), University of Toronto; Breast Cancer Research, Center for Research in Women's Health (S.N.), University of Toronto, and Public Health Sciences; and the Familial Ovarian Cancer Clinic, University Health Network, (B.R.) and the Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
Address correspondence and reprint requests to Terence J. Colgan, MD, Department of Laboratory Medicine and Pathology, Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5, Canada; e-mail: firstname.lastname@example.org