Prophylactic Bilateralsalpingo-Oophorectomy with Hysterectomy: A Rare Nigerian Experience

Background: Prophylactic (or risk-reducing) bilateral salpingo-oophorectomy (PBSO) is one of the known preventive modalities against epithelial ovarian, fallopian tube and breast cancers in high risk individuals. These high risk individuals include women with mutations in BRCA1 and/or BRCA2 genes. The practice of PBSO is still highly few and far between in Nigeria due to lack of genetic screening for mutation carriers.

Case presentation: A 45-year-old Nigerian woman with four living children presented to the gynecology outpatient clinic on self-referral following a positive screening result for BRCA 1 gene mutation She had completed her desired family size. She was asymptomatic and had family history of ovarian cancer but no family history of breast, colorectal or endometrial cancer. She has a history of menorrhagia but does not consider it clinically significant. General examination showed normal findings and abdomino-pelvic ultrasound scan showed multiple uterine leiomyomata and normal adnexae. Pap smear was negative for intra-epithelial lesion or malignancy. She was counseled on the findings and subsequently had PBSO with total abdominal hysterectomy with unremarkable post-operative condition. The histology showed multiple uterine leiomyomata with normal ovaries, fallopian tubes and cervix.

Conclusion: Given our peculiarity, we have reported a rare experience of PBSO for a high risk woman with BRCA1 mutation carrier who had completed childbearing. Routine genetic screening for BRCA1 or BRCA2 mutation carriers are lacking in Nigeria. Gynecologists practicing in low-and middle income settings should be encouraged to make all options available for patients who could potentially be at high risk and offer PBSO when and where appropriate either as a stand-alone procedure or in conjunction with hysterectomy.

Keywords: Prophylactic (or risk-reducing) bilateral salpingo-oophorectomy; BRCA1; BRCA2, mutation; hysterectomy.