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Primary Fallopian Tube Malignancies in BRCA-Positive Women Undergoing Surgery for Ovarian Cancer Risk Reduction

Michael J. Callahan, Christopher P. Crum, Fabiola Medeiros, David W. Kindelberger, Julia A. Elvin, Judy E. Garber, Colleen M. Feltmate, Ross S. Berkowitz, Michael G. Muto

From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and Division of Women's and Perinatal Pathology, Department of Pathology Brigham and Women's Hospital; and Cancer Risk and Prevention Program, Dana-Farber Cancer Institute, Boston, MA

Address reprint requests to Michael G. Muto, MD, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; e-mail: mmuto{at}partners.org

Purpose: 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 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.

Conclusion: 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.

Presented in part at the New England Association of Gynecologic Oncologists 25th Annual Meeting, June 2-5, 2005, Bretton Woods, NH, and the Society of Gynecologic Oncologists 37th Annual Meeting, March 22-26, 2006, Palm Springs, CA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.