A substantial part of the fallopian tube is left after standard prophylactic bilateral salpingo-oophorectomy

Abstract

Women with a deleterious germline mutation in BRCA1 or BRCA2 are candidates for bilateral salpingo-oophorectomy (BSO). To address the need for adjustment of the current BSO procedure, we investigated the length and the nature of the fallopian tube epithelium that is not removed by BSO. Fourteen consecutive hysterectomy specimens were collected. Complete cross-sections with a 3-mm interval were made of the tubal lumen from the outside of the uterus at the cutoff point of the current BSO procedure to the uterine cavity and examined for the presence or absence of tubal type (ciliated) epithelium and subepithelial endometrial stroma. The fallopian tube remnant had a median length of 12 mm (range 6-15 mm). Tubal type (ciliated) epithelium was shown to be present in all uteri in the first cross-section containing 100% endometrial stroma, as well as in the uterine cavity of all but two of the hysterectomy specimens. A substantial part of the fallopian tube remains in situ after prophylactic BSO and is covered with tubal type ciliated epithelium. More research is necessary to investigate the role of this remnant part of the tube for BRCA carriers.

Use of total abdominal hysterectomy and hormone replacement therapy in BRCA1 and BRCA2 mutation carriers undergoing risk-reducing salpingo-oophorectomy

“…Tamoxifen chemoprevention and treatment for breast cancer is associated with an increased risk of endometrial carcinoma which is avoided by hysterectomy [21]. BRCA1/2 carriers also are 100 times more likely to develop fallopian tube cancer as compared to the general population [22]; TAH/RRSO ensures that the full fallopian tube is removed, while a remnant remains after a RRSO [23]. Whether the residual fallopian tube is of any clinical importance is not yet clear.…”

Chimioprévention et chirurgie prophylactique du cancer de l'ovaire

“…Il n'est pas exclu que ces cancers « péritonéaux » soient le fruit d'une faute technique lors du geste prophylactique. En effet, une étude récente de Gerritzen et al montre sur une série d'hystérectomies après annexectomie prophylactique pour mutation BRCA que la longueur moyenne du moignon tubaire résiduel est 12 mm (6-15 mm) [53]. On comprend donc, qu'il est possible, qu'une partie des cancers « résiduels » puisse se développer sur ces moignons tubaires, même si aucun cas ne semble avoir été décrit [54].…”