Occult carcinoma in prophylactic oophorectomy specimens - Prevalence and association with BRCA germline mutation status

Prophylactic oophorectomy (PO) is an option for women at increased risk for ovarian carcinoma, In this study the value of intensive pathologic examina tion of PO specimens and accompanying resected tissues in the identificatio n of occult carcinoma and any association of occult carcinoma with BRCA ger mline mutation status were ascertained. Specimens from 60 consecutive PO pa tients, who were not suspected of having any ovarian tumor at the time of s urgery, were subjected to standardized, complete pathologic examination in a prospective study over an 8-year period. Extra-ovarian tissues were exami ned as well, but they were not subject to the same standardized protocol. A ny occult carcinoma of the ovaries or fallopian tubes was noted. The BRCA s tatus 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 pati ents in this group followed for >1 year, all are alive and well. The remain ing five patients, all BRCA1 mutation positive, showed occult carcinoma of the ovaries and/or in situ or invasive carcinoma of a fallopian tube. One o f these five patients has died of abdominal carcinomatosis; four continue t o be well, but follow-up is <4 years in all cases. Occult carcinoma is pres ent in a small proportion of BRCA-positive or unknown PO patients and may b e of prognostic significance. The entire ovaries and tubes from PO patients should be submitted for histologic examination to identify malignancy.