Ovarian cancer is the 8^th most common cancer among women worldwide. The incidence of ovarian cancer worldwide is 11 per 100,000 and in Malaysia it is the 4^th most common malignancy in women after breast, colorectal and cervical cancer. Ovarian serous carcinoma is the most common epithelial ovarian malignancy. It is most often asymptomatic in early stages and most often diagnosed in advanced stages. It is found that the fallopian tubes may be the primary site of origin of ovarian or pelvic serous carcinoma of both low grade serous carcinoma (LG-SC) and high grade serous carcinoma (HG-SC). Non-invasive STICs have been identified in 3-12% of prophylactically removed tubes of BRCA carriers, especially in the fimbrial part. Asymptomatic patients with BRCA 1&2 gene mutation and p53 gene mutation expression were found to have STIC in the fimbriae of the fallopian tubes and it involved the secretory cells of the tubes.

Case: This is a case of a 40 year old Para 0+4 who initially presented with prolonged menses and lower abdominal pain for 2 weeks duration. An abdominal examination revealed a 24 week size mass which was found to be solid cystic in nature by bedside USG. CT scan revealed diffused lesions over the peritoneum as well as nodal involvement and multiple cystic lesions in the liver. A pipelle histopathology sampling revealed poorly differentiated adenocarcinoma unable to exclude primary or secondary origin. Her ca125 level was >2,000. She subsequently underwent a debulking surgery after 5 cycles of neoadjuvant chemotherapy. Histopathology report of the specimens sent revealed metastatic HG-SC of the uterine corpus and left ovary, STIC of the left fallopian tube with invasive HG-SC.

Discussion: Is ovarian cancer preventable? With supportive evidence that the fallopian tube is the likely source of pelvic serous carcinoma, bilateral salphingectomy with ovarian conservation (BSOC) may be the next line of management in high risk patients or for those who have completed families. In patients with BRCA 1 or 2 mutation, risk reducing salphingoophrectoomy (RRSO) can be considered once family is completed. Having said this, side effects of oestrogen depletion must be anticipated.