Advertisement
Gynecologic Oncology
Advanced searchSave search
Research Article| Volume 132, ISSUE 2, P280-286, February 2014

Download started.

Ok

Outcome of unexpected adnexal neoplasia discovered during risk reduction salpingo-oophorectomy in women with germ-line BRCA1 or BRCA2 mutations

Published:December 31, 2013DOI:https://doi.org/10.1016/j.ygyno.2013.12.009
Outcome of unexpected adnexal neoplasia discovered during risk reduction salpingo-oophorectomy in women with germ-line BRCA1 or BRCA2 mutations
Previous ArticleA case for caution in the pursuit of the sentinel node in women with endometrial carcinoma
Next ArticleNeoadjuvant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients unsuitable for primary surgery: Safety and effectiveness

      Highlights

      • •
        Adnexal neoplasia was found in ~5% of risk reduction surgeries for BRCA1 or BRCA2 mutations.
      • •
        Recurrences developed from 9 to 17% over a median of 5 year follow-up.
      • •
        There were no ovarian cancer-related deaths at 5 years.

      Abstract

      Objective

      This study computed the risk of clinically silent adnexal neoplasia in women with germ-line BRCA1 or BRCA2 mutations (BRCAm+) and determined recurrence risk.

      Methods

      We analyzed risk reduction salpingo-oophorectomies (RRSOs) from 349 BRCAm+ women processed by the SEE-FIM protocol and addressed recurrence rates for 29 neoplasms from three institutions.

      Results

      Nineteen neoplasms (5.4%) were identified at one institution, 9.2% of BRCA1 and 3.4% of BRCA2 mutation-positive women. Fourteen had a high-grade tubal intraepithelial neoplasm (HGTIN, 74%). Mean age (54.4) was higher than the BRCAm+ cohort without neoplasia (47.8) and frequency increased with age (p < 0.001). Twenty-nine BRCAm+ patients with neoplasia from three institutions were followed for a median of 5 years (1–8 years.). One of 11 with HGTIN alone (9%) recurred at 4 years, in contrast to 3 of 18 with invasion or involvement of other sites (16.7%). All but two are currently alive. Among the 29 patients in the three institution cohort, mean ages for HGTIN and advanced disease were 49.2 and 57.7 (p = 0.027).

      Conclusions

      Adnexal neoplasia is present in 5–6% of RRSOs, is more common in women with BRCA1 mutations, and recurs in 9% of women with HGTIN alone. The lag in time from diagnosis of the HGTIN to pelvic recurrence (4 years) and differences in mean age between HGTIN and advanced disease (8.5 years) suggest an interval of several years from the onset of HGTIN until pelvic cancer develops. However, some neoplasms occur in the absence of HGTIN.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gynecologic Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

      1. Cancer facts and figures.
        American Cancer Society, Atlanta, Georgia, USA2013
        View in Article
        • Carlson J.
        • Roh M.H.
        • Chang M.C.
        • Crum C.P.
        Recent advances in the understanding of the pathogenesis of serous carcinoma: the concept of low- and high-grade disease and the role of the fallopian tube.
        Diagn Histopathol. 2008; 14: 352-365
        View in Article
        • Kindelberger D.W.
        • Lee Y.
        • Miron A.
        • Hirsch M.S.
        • Feltmate C.
        • Medeiros F.
        • et al.
        Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: evidence for a causal relationship.
        Am J Surg Pathol. 2007; 31: 161-169
        View in Article
        • Finch A.
        • Shaw P.
        • Rosen B.
        • Murphy J.
        • Narod S.A.
        • Colgan T.J.
        Clinical and pathologic findings of prophylactic salpingo-oophorectomies in 159 BRCA1 and BRCA2 carriers.
        Gynecol Oncol. 2006; 100: 58-64
        View in Article
        • Medeiros F.
        • Muto M.G.
        • Lee Y.
        • Elvin J.A.
        • Callahan M.J.
        • Feltmate C.
        • et al.
        The tubal fimbria is a preferred site for early adenocarcinoma in women with familial ovarian cancer syndrome.
        Am J Surg Pathol. 2006; 30: 230-236
        View in Article
        • Rose P.G.
        • Shrigley R.
        • Wiesner G.L.
        Germline BRCA2 mutation in a patient with fallopian tube carcinoma: a case report.
        Gynecol Oncol. 2000; 77: 319-320
        View in Article
        • Paley P.J.
        • Swisher E.M.
        • Garcia R.L.
        • Agoff S.N.
        • Greer B.E.
        • Peters K.L.
        • et al.
        Occult cancer of the fallopian tube in BRCA-1 germline mutation carriers at prophylactic oophorectomy: a case for recommending hysterectomy at surgical prophylaxis.
        Gynecol Oncol. 2001; 80: 176-180
        View in Article
        • Powell C.B.
        • Kenley E.
        • Chen L.M.
        • Crawford B.
        • McLennan J.
        • Zaloudek C.
        • et al.
        Risk-reducing salpingo-oophorectomy in BRCA mutation carriers: role of serial sectioning in the detection of occult malignancy.
        J Clin Oncol. 2005; 23: 127-132
        View in Article
        • Werness B.A.
        • Ramus S.J.
        • Whittemore A.S.
        • Garlinghouse-Jones K.
        • Oakley-Girvan I.
        • Dicioccio R.A.
        • et al.
        Histopathology of familial ovarian tumors in women from families with and without germline BRCA1 mutations.
        Hum Pathol. 2000; 31: 1420-1424
        View in Article
        • Werness B.A.
        • Ramus S.J.
        • DiCioccio R.A.
        • Whittemore A.S.
        • Garlinghouse-Jones K.
        • Oakley-Girvan I.
        • et al.
        Histopathology, FIGO stage, and BRCA mutation status of ovarian cancers from the Gilda Radner Familial Ovarian Cancer Registry.
        Int J Gynecol Pathol. 2004; 23: 29-34
        View in Article
        • Lee Y.
        • Miron A.
        • Drapkin R.
        • Nucci M.R.
        • Medeiros F.
        • Saleemuddin A.
        • et al.
        A candidate precursor to serous carcinoma that originates in the distal fallopian tube.
        J Pathol. 2007; 211: 26-35
        View in Article
        • Callahan M.J.
        • Crum C.P.
        • Medeiros F.
        • Kindelberger D.W.
        • Elvin J.A.
        • Garber J.E.
        • et al.
        Primary fallopian tube malignancies in BRCA-positive women undergoing surgery for ovarian cancer risk reduction.
        J Clin Oncol. 2007; 25: 3985-3990
        View in Article
        • Leeper K.
        • Garcia R.
        • Swisher E.
        • Goff B.
        • Greer B.
        • Paley P.
        Pathologic findings in prophylactic oophorectomy specimens in high-risk women.
        Gynecol Oncol. 2002; 87: 52-56
        View in Article
        • Mingels M.J.
        • Roelofsen T.
        • van der Laak J.A.
        • de Hullu J.A.
        • van Ham M.A.
        • Massuger L.F.
        • et al.
        Tubal epithelial lesions in salpingo-oophorectomy specimens of BRCA-mutation carriers and controls.
        Gynecol Oncol. 2012; 127: 88-93
        View in Article
        • Manchanda R.
        • Abdelraheim A.
        • Johnson M.
        • Rosenthal A.N.
        • Benjamin E.
        • Brunell C.
        • et al.
        Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status.
        BJOG. 2011; 118: 814-824
        View in Article
        • Agoff S.N.
        • Garcia R.L.
        • Goff B.
        • Swisher E.
        Follow-up of in situ and early-stage fallopian tube carcinoma in patients undergoing prophylactic surgery for proven or suspected BRCA-1 or BRCA-2 mutations.
        Am J Surg Pathol. 2004; 28: 1112-1114
        View in Article
        • Bijron J.G.
        • Seldenrijk C.A.
        • Zweemer R.P.
        • Lange J.G.
        • Verheijen R.H.
        • van Diest P.J.
        Fallopian tube intraluminal tumor spread from noninvasive precursor lesions: a novel metastatic route in early pelvic carcinogenesis.
        Am J Surg Pathol. 2013; 37: 1123-1130
        View in Article
        • Wethington S.L.
        • Park K.J.
        • Soslow R.A.
        • Kauff N.D.
        • Brown C.L.
        • Dao F.
        • et al.
        Clinical outcome of isolated serous tubal intraepithelial carcinomas (STIC).
        Int J Gynecol Cancer. 2013; 23: 1603-1611
        View in Article
        • Reitsma W.
        • de Bock G.H.
        • Oosterwijk J.C.
        • Bart J.
        • Hollema H.
        • Mourits M.J.
        Support of the ‘fallopian tube hypothesis’ in a prospective series of risk-reducing salpingo-oophorectomy specimens.
        Eur J Cancer. 2013; 49: 132-141
        View in Article
        • Liu J.
        • Cristea M.C.
        • Frankel P.
        • Neuhausen S.L.
        • Steele L.
        • Engelstaedter V.
        • et al.
        Clinical characteristics and outcomes of BRCA-associated ovarian cancer: genotype and survival.
        Cancer Genet. 2012; 205: 34-41
        View in Article
        • Hyman D.M.
        • Zhou Q.
        • Iasonos A.
        • Grisham R.N.
        • Arnold A.G.
        • Phillips M.F.
        • et al.
        Improved survival for BRCA2-associated serous ovarian cancer compared with both BRCA-negative and BRCA1-associated serous ovarian cancer.
        Cancer. 2012; 118: 3703-3709
        View in Article
        • Finch A.
        • Beiner M.
        • Lubinski J.
        • Lynch H.T.
        • Moller P.
        • Rosen B.
        • et al.
        Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 Mutation.
        JAMA. 2006; 296: 185-192
        View in Article
        • Powell C.B.
        • Swisher E.M.
        • Cass I.
        • McLennan J.
        • Norquist B.
        • Garcia R.L.
        • et al.
        Long term follow up of BRCA1 and BRCA2 mutation carriers with unsuspected neoplasia identified at risk reducing salpingo-oophorectomy.
        Gynecol Oncol. 2013; 129: 364-371
        View in Article
        • Crum C.
        • Herfs M.
        • Ning G.
        • Bijron J.
        • Howitt B.
        • Jimenez C.
        • et al.
        Through the glass darkly: intraepithelial neoplasia, top-down differentiation and the road to ovarian cancer.
        J Pathol. 2013; 231: 402-412
        View in Article
        • Piek J.M.
        • Torrenga B.
        • Hermsen B.
        • Verheijen R.H.
        • Zweemer R.P.
        • Gille J.J.
        • et al.
        Histopathological characteristics of BRCA1- and BRCA2-associated intraperitoneal cancer: a clinic-based study.
        Fam Cancer. 2003; 2: 73-78
        View in Article

      Article info

      Publication history

      Published online: December 31, 2013
      Accepted: December 5, 2013
      Received: September 28, 2013

      Identification

      DOI: https://doi.org/10.1016/j.ygyno.2013.12.009

      Copyright

      © 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX