Case Reports - Ovarian carcinoma in situ of presumable fallopian tube origin in a patient with Lynch syndrome (fallopian tube

Open Access Article 

Conclusion

We reported a rare case of ovarian carcinoma in situ, with a p53 signature, originating from the fallopian tube epithelium and the coexistence of serous ovarian carcinoma in situ and serous borderline tumor in a LS patient. (subsequent to total colectomy)

Highlights

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Occult ovarian carcinoma of presumable fallopian tube origin in Lynch syndrome

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Atypical endometrial hyperplasia during a 10-year follow-up period after colon cancer

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Synchronous ovarian serous carcinoma in situ and borderline tumor in Lynch syndrome

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Introduction

Tubal intraepithelial carcinoma (TIC) has been proposed to be a precursor lesion of ovarian carcinoma based on studies of risk-reducing salpingo-oophorectomy (RRSO) specimens from hereditary breast and ovarian cancer patients [1]. On the other hand, one case of TIC has been reported in a patient with Lynch syndrome (LS) [2]. Furthermore, atypical proliferative (borderline) serous tumors account for only 4% of ovarian carcinomas in patients with LS. Detection of early-stage ovarian and fallopian tube cancers is difficult even with close follow-up of high-risk patients with LS [2–5]. This has complicated the identification of ovarian carcinomas of fallopian tube origin in patients with LS. Herein, we present a case of ovarian carcinoma in situ that presumably originated from the fallopian tube in a LS patient.

Case

A 34-year-old multipara woman was diagnosed with sigmoid colon cancer and underwent total colectomy. Her family history matched the Bethesda criteria for LS. Genetic testing showed the presence of a pathogenic MLH1 mutation (Exon3: IVS3 + 1 g>a)............ Although the advantages of total abdominal hysterectomy (TAH) with preventive bilateral salpingo-oophorectomy (BSO) were explained and this approach was recommended by cancer genetics professionals, the patient strongly desired preservation of the ovaries in the absence of an intraoperative malignancy diagnosis...........The patient did not wish to receive adjuvant chemotherapy. She is currently alive without evidence of disease 22 months after TAH/BSO.

Conclusion

We reported a rare case of ovarian carcinoma in situ, with a p53 signature, originating from the fallopian tube epithelium and the coexistence of serous ovarian carcinoma in situ and serous borderline tumor in a LS patient.