Imaging of primary fallopian tube carcinoma

Objective

To increase awareness of primary fallopian tube carcinoma (PFTC) and its relationship to serous epithelial ovarian carcinoma (EOC) and breast cancer. To review the characteristic imaging findings of PFTC thereby enabling radiologists to not only diagnose, but aid clinicians in staging, treatment planning and surveillance for recurrence.

Conclusions

There is increasing evidence of a relationship between PFTC and breast cancer and the breast cancer susceptibility gene mutation. Furthermore, studies in breast cancer gene mutation carriers suggest serous EOC arises from the epithelial lining of the fallopian tube. These theories indicate that the incidence of fallopian tube carcinoma is underestimated. Increased awareness is particularly important for radiologists reviewing surveillance studies in breast cancer patients. PFTC has characteristic imaging features that can aid in its detection and differentiation from other pelvic masses. Imaging is also helpful in tumor staging, identifying patients who may benefit from neoadjuvant chemotherapy and detection of recurrence following treatment. This article discusses the history, pathology, and patterns of spread of fallopian tube carcinoma, as well as reviewing and illustrating the cross-sectional imaging findings.     

晚期上皮性卵巢癌、输卵管癌、原发性腹膜癌患者新辅助化疗后Ki-67表达与预后的相关性分析

目的分析晚期上皮性卵巢癌、输卵管癌、原发性腹膜癌患者新辅助化疗后Ki-67水平与患者预后的关系。方法回顾性收集重庆医科大学附属第一医院2017年1月至2019年6月接受新辅助化疗联合间期肿瘤细胞减灭术的晚期上皮性卵巢癌、输卵管癌、原发性腹膜癌患者的病历资料,对其临床病理特征、术后病理标本中卵巢癌组织Ki-67表达情况及患者无进展生存期进行统计分析。结果根据时间依赖的受试者工作特征曲线(ROC曲线)分析,判断患者预后情况的Ki-67最佳临界值为20%。单因素分析显示,新辅助化疗后Ki-67≥20%的患者无进展生存期短于Ki-67<20%的患者,差异有统计学意义(P<0.05);在除外分期、肿瘤分级、原发部位、手术方式及手术结局等因素的作用后,Ki-67为患者无进展生存期的独立影响因素(P=0.004,HR=1.927,95%CI:1.240~2.995)。结论新辅助化疗后Ki-67水平是晚期上皮性卵巢癌、输卵管癌、原发性腹膜癌患者复发的独立影响因素,Ki-67≥20%的患者可能倾向于早期复发。     

The role of the fallopian tube in ovarian cancer

High-grade serous carcinoma (HGSC) is the most common and lethal subtype of ovarian cancer. Research over the past decade has strongly suggested that "ovarian" HGSC arises in the epithelium of the distal fallopian tube, with serous tubal intraepithelial carcinomas (STICs) being detected in 5-10% of BRCA1/2 mutation carriers undergoing risk-reducing surgery and up to 60% of unselected women with pelvic HGSC. The natural history, clinical significance, and prevalence of STICs in the general population (ie, women without cancer and not at an increased genetic risk) are incompletely understood, but anecdotal evidence suggests that these lesions have the ability to shed cells with metastatic potential into the peritoneal cavity very early on. Removal of the fallopian tube (salpingectomy) in both the average and high-risk populations could therefore prevent HGSC, by eliminating the site of initiation and interrupting spread of potentially cancerous cells to the ovarian/peritoneal surfaces. Salpingectomy may also reduce the incidence of the 2 next most common subtypes, endometrioid and clear cell carcinoma, by blocking the passageway linking the lower genital tract to the peritoneal cavity that enables ascension of endometrium and factors that induce local inflammation. The implementation of salpingectomy therefore promises to significantly impact ovarian cancer incidence and outcomes.     

血清肿瘤标志物联合输卵管造影对输卵管癌和输卵管假癌性增生的鉴别诊断价值

目的 探讨血清肿瘤标志物联合输卵管造影对输卵管癌和输卵管假癌性增生的鉴别诊断价值.方法 回顾性选择2016年1月至2021年1月在辽阳市中心医院妇产科诊治的80例患者,包括40例输卵管癌患者和40例输卵管假癌性增生患者.选择40名在本院体检的健康志愿者作为健康对照组.通过静脉穿刺采集静脉血样本,使用Co-base 60...     

原发性输卵管癌49例临床分析

目的:分析原发性输卵管癌的误诊原因。方法:对我院1994年1月~2004年12月收治的49例原发性输卵管癌临床资料进行回顾性分析。结果:49例中,我院首诊45例,误诊42例,误诊率93.3%;外院转入4例,误诊3例。多误诊为卵巢肿瘤、子宫内膜癌、盆腔肿瘤、附件囊肿、子宫肉瘤等。结论:原发性输卵管癌较少见,缺乏特异性的临床表现和诊断措施,误诊率高。临床医师应提高对原发性输卵管癌的认识,以降低误诊率。     

Less Common Gynecologic Malignancies: An Integrative Review

ObjectiveTo review current data on vaginal, vulvar, and fallopian tube cancers, including incidence, diagnosis, staging, risk reduction measures, and management.Data SourcesA review of retrieved articles dated 2006–2018 from PubMed.ConclusionEarly diagnosis and treatment of rare gynecologic cancers is dependent on a thorough history and examination. Of particular interest is the role of fallopian tube as the location of primary origin of ovarian and peritoneal cancers as well as the potential for vaccination prevention of vaginal and vulvar cancers.Implications for Nursing PracticeNurses in diverse roles should have an understanding of these rare tumor types to support assessment and early identification with their patients.     

输卵管完全性葡萄胎误诊临床病理分析并文献复习

目的探讨输卵管完全性葡萄胎临床及病理特征、诊治方法、误诊原因、误诊防范措施。方法对2例曾误诊的输卵管完全性葡萄胎的临床资料进行回顾性分析并复习相关文献。结果本文1例因停经2月余,阴道出血6 d入院。查血β人绒毛膜促性腺激素(β-HCG)17 229.3 U/L。术前误诊为异位妊娠,行输卵管切除术。1例因阴道不规律出血1月余,下腹闷痛2周,加剧5 d入院。无明确停经史。查血β-HCG 84 140.0 U/L。术前考虑盆腔炎性包块,卵巢囊肿蒂扭转,异位妊娠。行开腹右输卵管切除、左输卵管结扎及诊断性刮宫术。2例均经术后病理检查确诊为输卵管完全性葡萄胎,皆随访2年,无异常发现。结论输卵管葡萄胎较少见,临床易误诊。临床医生应提高对本病的认识,在遇到类似异位妊娠表现患者时应想到异位葡萄胎的可能性,要综合全面对患者病情进行分析,并仔细鉴别诊断,以减少误诊误治。     

宫-腹腔镜联合手术在诊治女性不孕症中的应用

目的 :探讨宫腔镜、腹腔镜联合应用诊治女性不孕症的价值。方法 :回顾性分析 2年间应用宫腔镜、腹腔镜诊治女性不孕症 15 4例的病因及术后输卵管的通畅率。结果 :不孕的主要原因为 :输卵管炎性梗阻 5 4例 ,输卵管炎性梗阻合并盆腔粘连 31例、盆腔粘连 2 4例 ,子宫内膜异位症 11例 ,卵巢良性肿瘤 7例 ;手术后输卵管通畅率分别为 88.9%、77.4 %、95 .8%、81.8%、10 0 %。结论 :应用宫 腹腔镜联合诊治术能早期、直观、准确全面的明确不孕症盆腔、宫腔病因 ,并予以针对性治疗 ,大大提高手术疏通输卵管的成功率 ,提高手术治疗女性不孕症的疗效。     

腹腔镜下输卵管处理治疗不孕症

目的：探讨腹腔镜术中输卵管处理的好坏在不孕症治疗中的作用。方法：对150例不孕症合并妇科疾病的患者腹腔镜手术，术中注意保护及处理输卵管浆肌层，伞端及系膜并最大限度恢复输卵管正常形态功能以及与卵巢的正常解剖位置关系；检测术后输卵管通畅情况及追踪术后妊娠情况。结果：术后输卵管恢复率达88.76％；再通率达82．12％，妊娠率达56．0％。结论：提高腹腔镜术中输卵管的处理技巧及注意对输卵管的保护，对减少术中出血，提高不孕症治疗效果，增加术后妊娠率均有重要意义。     

发生在输卵管以外的异位妊娠96例诊治体会

目的 探讨发生在输卵管以外的异位妊娠的诊断与治疗。方法 回顾性分析我院1991～1998年收治的96例输卵管以外的异住妊娠的诊治经过。结果 96例均经手术和病理证实为异位妊娠，其中卵巢妊娠63例，宫角妊娠17例，宫颈妊娠11例，子宫肌壁间妊娠2例，子宫骶骨韧带妊娠、阔韧带妊娠、肝脏妊娠各1例。结论 发生在输卵管以外的异位妊娠术前诊断较困难，临床应提高对此类特殊异位妊娠的认识，提高诊治水平。     

选择性输卵管造影与再通术53例分析

目的：探讨选择性输卵管造影(输卵管再通术)诊断及治疗输卵管阻塞的效果。方法：对子宫输卵管造影(HSG)输卵管有阻塞的53例患者，行选择性输卵管造影(SSG)与再通术的诊疗。结果：子宫输卵管造影角部、峡部阻塞61条(72．6％)，行SSG证实只有47条(56％)阻塞(狭窄)，2条通畅，另有12条为壶腹部阻塞；84条常规子宫输卵管造影显示壶腹部阻塞23条(27．1％)，经SSG证实有32条(38％)阻塞(狭窄)，3条通畅；53例中SSG检查5例无阻塞；近端输卵管阻塞再通成功率83％，壶腹部成功率40．6％；随访49例，1～2年，9例生产，2例宫外孕。结论：选择性输卵管造影(输卵管再通术)诊治输卵管阻塞安全、有疗效。     

BRCA1 gene mutations in sporadic ovarian carcinomas: detection by PCR and reverse allele-specific oligonucleotide hybridization.

BACKGROUND: Although germline mutations in BRCA1 play a central role in familial breast and ovarian cancers, to date, no somatic mutations in BRCA1 have been reported in sporadic breast cancer, and only five somatic mutations have been identified in the sporadic ovarian carcinomas. Because loss of heterozygosity appears frequently at the BRCA1 locus in nonfamilial breast and ovarian carcinomas, we searched for mutations in the BRCA1 gene in sporadic ovarian tumors. METHODS: We developed a detection system based on PCR and reverse allele-specific oligonucleotide hybridization on membrane strips for the simultaneous detection of 17 frequently occurring mutations in the BRCA1 gene. RESULTS: As little as 2% mutant DNA in a sample could be detected. Two of 122 DNA samples isolated from sporadic ovarian tumor biopsies contained the Cys61Gly mutation. Both mutations were germline mutations. One of these was an ovarian metastasis of a primary fallopian tube carcinoma. The tubal carcinoma was also confirmed to contain the Cys61Gly mutation. CONCLUSIONS: This is the first report that a germline BRCA1 mutation is associated with primary tubal carcinoma. The 17 specific mutations in the BRCA1 gene do not play a major role in the tumorigenesis and progression of sporadic ovarian cancer.     

18-F fluorodeoxyglucose positron emission tomography/computed tomography findings of bilateral primary fallopian tube carcinoma and metastasis to the uterus: a case report and literature review

Existing literature on primary carcinoma of the fallopian tube is limited because of the rarity of this disease. We report a patient with intermittent vaginal bleeding and vaginal discharge who underwent transvaginal ultrasound, magnetic resonance imaging, and 18-F-fluorodeoxyglucose positron emission tomography/computed tomography (18-F FDG PET/CT) in our hospital. Ultrasound showed a bilateral fallopian tube mass and a uterine lesion. Magnetic resonance imaging revealed typical sausage-shaped bilateral adnexal masses, but overlooked a small lesion in the uterus in the initial diagnosis. FDG PET/CT findings not only showed bilateral fallopian tube masses and uterine lesions, but also ruled out distant metastasis. Postoperative pathology confirmed bilateral primary high-grade serous adenocarcinoma of the fallopian tube with implants in the uterus. These findings suggest that 18-F FDG PET/CT imaging could be a good approach for the diagnosis and staging of primary carcinoma of the fallopian tube.     

Gynecologic cancer in patients with subacute cerebellar degeneration predicted by anti-Purkinje cell antibodies and limited in metastatic volume

Between 1982 and 1989, 19 patients with gynecologic carcinoma, paraneoplastic cerebellar degeneration, and seropositivity for anti-Purkinje cell cytoplasmic antibodies were identified at our institution. Seven of the patients had no clinical, computed tomographic, or magnetic resonance imaging evidence of cancer but had undergone laparotomy solely because anti-Purkinje cell antibodies were found in their serum; all had high-grade adenocarcinoma. Cerebellar symptoms preceded or coincided with the initial cancer diagnosis in 15 patients and preceded the diagnosis of recurrent cancer in 4 patients. The cancers were 14 ovarian, 2 fallopian tube, 2 surface papillary, and 1 poorly differentiated metastatic adenocarcinoma in a periaortic lymph node. Two remarkable surgical observations in patients with high-grade ovarian and tubal cancers were the conspicuous lack of peritoneal implants and the small metastatic volume. A comparison of the 8 patients who had primary stage III cancer with 24 matched control patients without paraneoplastic cerebellar degeneration revealed no difference in primary tumor volume but a significantly smaller volume of metastatic tumor in the seropositive group (P = 0.05). Anti-Purkinje cell antibodies were not detected in 111 neurologically normal patients with advanced ovarian cancer. The small metastatic volume in the face of high-grade and advanced stage malignancy in seropositive patients with paraneoplastic cerebellar degeneration suggests that an immune response to the tumor (presumably cross-reactive with cerebellar cells) may impair the metastatic process. Earlier diagnosis and treatment of cancer, based on prompt serologic testing, may offer an improved neurologic and oncologic prognosis.     

经阴道子宫输卵管超声造影联合盆腔水造影在不孕症患者中的诊断价值

目的:探索经阴道子宫输卵管超声造影联合盆腔水造影在不孕症患者中的诊断价值。方法:本次研究对象均在2016年11月30日至2019年8月30日期间选取60例疑似不孕症患者,均采用盆腔水造影、经阴道子宫输卵管超声造影,随后对比各项诊断的正确率。结果:输卵管超声造影联合盆腔水造影对输卵管阻塞诊断正确率96.00%、对卵巢囊肿诊断正确率100.00%、对盆腔子宫内异症诊断正确率92.31%、对盆腔粘连诊断正确率100.00%高于单方面诊断结果(P<0.05)。同时输卵管超声造影联合盆腔水造影漏诊率、敏感度、误诊率、特异度分别为3.64%、96.36%、0.00%、100.00%。结论:在诊断不孕症患者时,实施经阴道子宫输卵管超声造影联合盆腔水造影诊断,正确率较高。     

超声造影在输卵管源性不孕症中的诊治价值研究

目的 探讨在诊断输卵管源性不孕症中经阴道超声造影评价输卵管通畅性的应用价值.方法 选择不孕症妇女222例,在经阴道超声下观察造影剂在宫腔及输卵管内的显影情况,并与输卵管通液术、X线子宫输卵管碘油造影、腹(宫)腔镜检查结果进行对照分析.结果 222例中73例双侧输卵管通畅,60例双侧梗阻,4例双侧通而不畅,72例一侧通畅,13例一侧通而不畅.超卢造影较输卵管通液术诊断准确率明显提高(P<0.05),与腹(宫)腔镜检查诊断准确率无明显差异(P>0.05),较X线子宫输卵管碘油造影的诊断符合率高.结论 超声造影安全性高,且有诊断和治疗的作用,是检查输卵管通畅性的较佳方法.     

腹腔镜手术诊治女性不孕112例临床研究

【目的】探讨腹腔镜手术在诊断和治疗女性不孕中的价值。【方法】回顾性分析112例不孕症患者行腹腔镜术检查及治疗的临床资料。【结果】慢性盆腔炎盆腔粘连、子宫内膜异位症和多囊卵巢综合征是引起女性不孕最常见原因,腹腔镜和子宫输卵管碘油造影(HSG)在判断输卵管通畅程度方面有显著差异(P<0. 05),腹腔镜手术治疗单纯盆腔粘连、子宫内膜异位症和多囊卵巢综合征可获得理想效果,受孕率分别达57. 1% (12 /21)、52. 2% (12 /23)和53. 8% (7 /13)。【结论】腹腔镜手术可明确诊断女性不孕的病因,并能同时采取相应治疗,从而提高受孕率。     

Preoperative diagnosis of fallopian tube cancer by imaging

Primary cancer of the fallopian tube (FTC) is among the most unusual gynecologic malignancies and rarely is diagnosed correctly before surgery. The imaging results of eight patients with FTC and four with benign tubal disease were analyzed. FTCs were small cystic or solid masses that typically were shaped like a sausage, a snail, or a gourd, regardless of clinical stage.     

Isolated torsion of the distal part of the fallopian tube in a premenarcheal 12 year old girl: a case report

Isolated torsion of the fallopian tube in premenarcheal girls is very rare. However, correct diagnosis and treatment are needed in order to optimize salvage of fallopian tube. Here, we report a case of fallopian tube torsion in a premenarcheal girl. A 12-year-old premenarcheal girl was admitted with a rapid history of colicky lower abdominal pain. MR image demonstrated normal ovaries and a large spherical cystic tumor with hemorrhage-like contents. The differential diagnosis included torsion of a para-ovarian cyst or hydrosalpinx, hemorrhage within a non-communicating uterine horn or a pelvic hemorrhage of unknown origin. Laparoscopic inspection/operation was performed. The distal portion of the left fallopian tube was swollen with two twists evident in the middle portion. The distal portion of the left fallopian tube was laparoscopically removed with the aid of a YAG laser. The mechanisms underlying disorders of the left fallopian tube are not well understood. However, some intrinsic/extrinsic causative factors are discussed. Although torsion of the fallopian tube occurs rarely and exhibits variable clinical features, the diagnosis should be considered in all young girls presenting with sudden colicky abdominal pain. Laparoscopic inspection/surgery appears to be the most suitable management.     

Infertility

Infertility is defined as failure to achieve pregnancy during one year of frequent, unprotected intercourse. Evaluation generally begins after 12 months, but it can be initiated earlier if infertility is suspected based on history or if the female partner is older than 35 years. Major causes of infertility include male factors, ovarian dysfunction, tubal disease, endometriosis, and uterine or cervical factors. A careful history and physical examination of each partner can suggest a single or multifactorial etiology and can direct further investigation. Ovulation can be documented with a home urinary luteinizing hormone kit. Hysterosalpingography and pelvic ultrasonography can be used to screen for uterine and fallopian tube disease. Hysteroscopy and/or laparoscopy can be used if no abnormalities are found on initial screening. Women older than 35 years also may benefit from ovarian reserve testing of follicle-stimulating hormone and estradiol levels on day 3 of the menstrual cycle, the clomiphene citrate challenge test, or pelvic ultrasonography for antral follicle count to determine treatment options and the likelihood of success. Options for the treatment of male factor infertility include gonadotropin therapy, intrauterine insemination, or in vitro fertilization. Infertility attributed to ovulatory dysfunction often can be treated with oral ovulation-inducing agents in a primary care setting. Women with poor ovarian reserve have more success with oocyte donation. In certain cases, tubal disease may be treatable by surgical repair or by in vitro fertilization. Infertility attributed to endometriosis may be amenable to surgery, induction of ovulation with intrauterine insemination, or in vitro fertilization. Unexplained infertility may be managed with ovulation induction, intrauterine insemination, or both. The overall likelihood of successful pregnancy with treatment is nearly 50 percent.