Gynecologic Cancer
Distinctive symptoms flag early ovarian cancer … Where’s the blood test? … Don’t fail to counsel risk-reducing BSO … Serial histologic sectioning is vital
Powell et al found an increased number occult malignancies with this strategy:
- Complete removal of ovaries and fallopian tubes
- Serial histologic sectioning of both ovaries and fallopian tubes
- Peritoneal and omental biopsies
- Peritoneal washings for cytology
Of 67 procedures, 7 (10.4%) occult malignancies were discovered: 4 in the fallopian tubes and 3 in the ovaries. Six of the occult malignancies were microscopic.
Surgically, the entire ovary and fallopian tube should be removed. I perform washings and carefully look at the pelvis and paracolic gutters for small-volume disease.
Most importantly, ObGyns need to speak with the pathologist. For most benign cases in which the ovaries and fallopian tubes look grossly normal, pathologists take a single representative section of each ovary and fallopian tube for histologic diagnosis. However, in these high-risk cases, complete serial sectioning of ovaries and fallopian tubes is absolutely necessary to rule out microscopic cancer. Removal of the uterus should be based on other indications.
The author reports no financial relationships relevant to this article.
RELATED REFERENCES
- Lu KH, Garber JE, Cramer DW, et al. Occult ovarian tumors in women with BRCA1 or BRCA2 mutations undergoing prophylactic oophorectomy. J Clin Oncol. 2000;18:2728–2732.
- Colgan TJ, Murphy J, Cole DE, Narod S, Rosen B. Occult carcinoma in prophylactic oophorectomy specimens: prevalence and association with BRCA germline mutation status. Am J Surg Pathol. 2001;25:1283–1289.
