Review of findings in prophylactic gynaecological specimens in Lynch syndrome with literature review and recommendations for grossing

Histopathology. 2014 Aug;65(2):228-39. doi: 10.1111/his.12386. Epub 2014 Apr 16.


Aims: Prophylactic hysterectomy with bilateral salpingo-oophorectomy is being increasingly undertaken in patients with Lynch syndrome (LS). The pathological features in such specimens are not well described and, unlike the SEE-FIM protocol for salpingo-oophorectomy specimens in BRCA1/2 mutation carriers and the gastrectomy grossing protocols for patients with CDH1 (E-cadherin) mutations, guidelines have not been devised for the grossing of prophylactic gynaecological specimens from LS patients. We aimed to review the pathological findings in a series of prophylactic gynaecological specimens from LS patients and develop guidelines for the grossing of these specimens.

Methods and results: We reviewed the pathological findings in 25 prophylactic gynaecological specimens from LS patients and audited the grossing protocols in different centres across Ontario, Canada. We found a 32% incidence of endometrial carcinoma or a precursor lesion; the two endometrial cancers identified were low-grade, low-stage endometrioid adenocarcinomas. To address the absence of guidelines for pathological examination, we undertook a literature review of gynaecological malignancies and incidental findings in prophylactic specimens in LS patients.

Conclusion: We provide recommendations regarding the grossing of such specimens which includes in-toto examination of the lower uterine segment, endometrium, ovaries and fallopian tubes with representative sampling of the cervix.

Keywords: Lynch syndrome; endometrial cancer; ovarian cancer; prophylactic.

Publication types

  • Review

MeSH terms

  • Adult
  • Colorectal Neoplasms, Hereditary Nonpolyposis / complications*
  • Female
  • Genital Neoplasms, Female / prevention & control*
  • Humans
  • Hysterectomy
  • Middle Aged
  • Ovariectomy
  • Pathology, Surgical / methods*
  • Prophylactic Surgical Procedures*
  • Salpingectomy