How would you approach post op management of a patient s/p BSO for cystic pelvic mass with fallopian STIC lesion on final pathology?

STIC lesions are considered precursors to ovarian cancer. The role of surveillance and chemotherapy is unclear. In a comprehensive review of 78 women with isolated STIC lesions, Patrono et al found 3 patients with subsequent primary peritoneal cancer among the BRCA patients with a STIC lesion; this represented 4.5% of the BRCA patients. None of these patients had received chemotherapy after the STIC lesion was found, and all were diagnosed 4-6 years after their STIC diagnosis. None of the BRCA wild-type patients had subsequent primary peritoneal cancer. This review suggests that patients with STIC lesions should undergo BRCA testing and that chemotherapy is likely not warranted.

It is important to ensure that there is no other evidence of d...

This is a great question! There are no definitive management criteria for patients with isolated serous tubal intraepithelial carcinoma (STIC) lesions. The incidence at the time of risk-reducing salpingo-oophorectomy (RRSO) ranges from 0.6 to 7% in women with BRCA1/BRCA2 mutations. In patients undergoing surgery for benign indications, such as in this case, STIC lesions are observed less frequently (<1%). The true incidence in a population of women without BRCA mutations is unknown. (1) These are worrisome lesions, believed to be a precursor to the majority of high-grade serous carcinoma (HGSC). STIC lesion following RRSO has a high risk of subsequent HGSC and peritoneal carcinomatosis and has also been identified in the setting of STIC les...