Pathological diagnosis of ovarian cancer

Case 1: Serous tubal cancer detected on PAP smear A 60 year old woman with a history of breast cancer was referred after malignant cells were found on PAP smear. Abdominal exam, cervical visualisation, transvaginal ultrasound and CT of the abdomen and pelvis were all normal. Endocervical and endometrial curettings demonstrated serous carcinoma cells consistent with tubal / ovarian origin. CA125 was slightly elevated at 53 (Upper Limit of Normal 35). At laparatomy uterus, fallopian tubes and ovaries appeared normal. She had a hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal biopsies and washings. There was no macroscopic evidence of cancer, but microscopic examination confirmed serous cancer in the fimbrial end of the left fallopian tube(A) with scattered malignant cells in the lumen of both fallopian tubes(B), the omentum(C) and surface of the ovaries(D), surface of uterus and paracolic gutter. Washings were positive. Family history was unremarkable. BRCA mutation screening revealed a BRCA1 mutation. Despite intraperitoneal cisplatin and paclitaxel she relapsed and died 4 years later.