Ovarian Remnant Syndrome and its Implications in a Brca1 Positive Patient

Presentation: A 44 year old Caucasian female with a BRCA1 variant c.3598C>T (p.Q1200X) mutation carrier was referred to the cancer genetics services to discuss risk reduction.

Treatment: She opted for risk reducing prophylactic bilateral salpingo-oophorectomy. Despite the initial procedure she continued to menstruate and underwent two further procedures to remove remnant ovarian tissue.

Diagnosis: Ovarian remnant syndrome

Discussion: Despite risk reducing salpingo-oophorectomy some patients still develop ovarian cancer. In BRCA1 mutation carriers, bilateral salpingo-oophorectomy is associated with a 70% reduction in risk of ovarian cancer in women without a prior breast cancer and 85% in those with a prior breast cancer. It is possible that remnant ovarian tissue could account for some of these cases of ovarian cancer after risk reducing surgery.