Adenocarcinoma of Müllerian origin developed 22 years after Salpingo-oophorectomy in a woman with BRCA1 mutation: a thought about modification of chemotherapy dose and peritoneal resection.

Late recurrence of ovarian cancer is exceedingly rare. We report a case of adenocarcinoma of Müllerian origin that developed 22 years after hysterectomy and bilateral salpingo-oophorectomy (BSO) for ovarian cancer in an 81-year-old woman with a pathogenic BRCA1 mutation. The patient underwent six cycles of reduced-dose carboplatin and paclitaxel, achieving remission with a dramatic decline in CA-125 levels. Women with BRCA mutations have a significantly increased risk of ovarian/tube/peritoneal cancer. Although risk-reducing BSO effectively decreases the risk of ovarian and fallopian tube cancers, the risk of peritoneal cancer remains substantial. This case not only illustrates the persistent lifetime risk of ovarian/tube/peritoneal cancer despite BSO but also underscores the need for reevaluation of prophylactic surgical strategies, particularly regarding the extent of peritoneal resection, in BRCA mutation carriers. Additionally, this case report demonstrated the efficacy of dose-modified chemotherapy for BRCA-associated cancers. Further research is warranted to refine surgical and therapeutic strategies for patients with BRCA mutation.