Primary Transitional Cell Carcinoma of the Fallopian Tube: A Case Report and Review of the Literature

Primary carcinoma of the fallopian tube is extremely rare and the preoperative diagnosis is often misdiagnosed as an ovarian carcinoma. We report a patient with primary carcinoma of the fallopian tube, strongly suspected preoperatively on the basis of characteristic clinical symptoms, elevated CA125 levels, and transvaginal sonography, computed tomography, and magnetic resonance imaging findings. The histology of fallopian tube carcinoma was demonstrated as transitional cell carcinoma. Extensive review of the literature showed that our case seemed to be the 14th case of primary transitional cell carcinoma of the fallopian tube.     

A case of primary transitional cell carcinoma of the fallopian tube.

The primary carcinoma of the fallopian tube is the rarest of all gynecologic malignancies and histologically most of them are adenocarcinomas. Primary transitional cell carcinomas are extremely rare in the fallopian tube. A 63-year-old postmenopausal woman presenting with lower abdominal pain was found to have a left adnexal mass. Exploratory laparotomy revealed a mass arising from the fallopian tube with the histologic features of transitional cell carcinoma. Light and electron microscopic studies supported the notion of transitional cell carcinoma. The tumor was extended to the muscle layer and confined to the left fallopian tube without metastasis. The patient received 3 courses of systemic cisplatin-based chemotherapy and has been well with no evidence of recurrence until August, 1998.     

Primary serous carcinoma of the fallopian tube with synchronous cervical epidermoid carcinoma in situ: a case report

Primary carcinoma of the fallopian tube is rare and its preoperative diagnosis difficult due to the lack of specific symptoms. In this report we present a rare case of primary carcinoma of the fallopian tube with synchronous cervical high-grade squamous intraepithelial lesion (HSIL). A 39-year-old women was admitted to our hospital for routine gynecological examination and underwent surgery because of the finding of HSIL on a routine papanicolaou smear. The histological diagnosis on cervical biopsy and conization material were of cervical intraepithelial neoplasia III (CIN III). Serous carcinoma of the fallopian tube was incidentally found during a planned hysterectomy operation. Postoperatively the patient received six cycles of adjuvant chemotherapy (carboplatin and paclitaxel) and is still under routine control. In conclusion, the genital tract should be examined in detail in case of any existence of a primary genital tumor and CA125 should be added to the examination.     

Primary transitional cell carcinoma of the fallopian tube

The fallopian tube is the least common site for origin of malignancy in the female genital tract. Most primary fallopian tube malignancies are adenocarcinomas. Primary transitional cell carcinoma (TCC) of the fallopian tube is an extremely rare tumor with a small number of cases reported in the literature. We present a 67-year-old woman who was found incidentally to have a left adnexal mass on a screening pelvic ultrasound. Subsequently the patient underwent laparoscopic left salpingo-oophorectomy and the specimen was submitted for intraoperative frozen section, which revealed a high-grade carcinoma; therefore, she underwent a laparotomy and total abdominal hysterectomy, right salpingo-oophorectomy and omentectomy. Histopathology revealed high-grade transitional cell carcinoma in the left fallopian tube. Post-surgery she was treated with four cycles of adjuvant chemotherapy with carboplatin and paclitaxel with no complications. Our patient had a family history of malignancy, so genetic testing for BRCA1 and BRCA2 mutations was undertaken and did not reveal any mutation or unclassified variants. Multiplex ligation-dependent probe amplification (MLPA) was normal.     

Management of bilateral fallopian tube carcinoma coexistent with tuberculous salpingitis

Primary carcinoma of the fallopian tube is a rare gynecologic malignancy. Chronic tubal inflammation is associated with primary carcinoma of the fallopian tube. There are only a few reports on primary carcinoma of the fallopian tube coexisting with tuberculous salpingitis. We are reporting a patient with both the primary carcinoma of the fallopian tube and tuberculous salpingitis, which were detected in bilateral fallopian tubes. The histologic type was serous adenocarcinoma. The patient was treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, and bilateral pelvic lymphadenectomy followed by chemotherapy consisting of paclitaxel and cisplatin. She has been alive without evidence of disease for 18 months.     

Primary squamous cell carcinoma of fallopian tube accompanied by gastric metaplasia of female genital tract: case report and review

Primary squamous cell carcinoma arising from the fallopian tube (SCCFT) is extremely rare with only six reported cases. We report a case of primary SCCFT accompanied by multifocal pyloric glandular metaplasia in the genital tract. An accompanying review of the literature describes the characteristics of this rare histological subtype invading into the muscular layer of the fallopian tube to involve adjacent pelvic organs, while the most common serous type tends to spread into the abdominal cavity through tubal ducts. Due to the low response rate of adjuvant therapies, the 5-year survival rate of patients bearing primary SCCFT at stage II-IV is very poor, only accounting for 25%. All patients were alive without disease where optimal resection had been successfully achieved. These findings imply that radical tumor resection is mandatory for satisfactory treatment of primary SCCFT.     

Primary fallopian tube carcinoma

Primary fallopian tube cancer constitutes 1% of gynecologic malignancies. Early clinical manifestation and prompt investigations lead to diagnosis in the early stage of disease accounting for a better survival compared with ovarian cancer. Principles of management generally follow that of epithelial ovarian cancer. This article reviews the current understanding of this rare cancer. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the clinical features of a patient with fallopian tube carcinoma, to list the prognostic factors associated with fallopian tube cancer, and to outline the treatment options for a patient with fallopian tube cancer.     

Pure primary ovarian squamous cell carcinoma

A 65-year-old woman with pure primary ovarian squamous cell carcinoma invading the fallopian tube and the terminal ileum is described. The tumor recurred shortly after surgery in spite of complete resection. No response to chemotherapy was observed and the patient expired 6 months after diagnosis. In order to establish the diagnosis of pure primary ovarian squamous cell carcinoma extragenital and genital tumors containing squamous elements as well as endometriosis have to be excluded.     

Fallopian tube carcinoma: incidental finding during surgery for acute pelvic inflammatory disease--case report

BACKGROUND: Primary carcinoma of the fallopian tube is a rare condition. Preoperative diagnosis is difficult and in most cases it is an intraoperative finding or a histopathological diagnosis. CASE: A 49-year-old woman presented with pelvic pain, fever (38 degrees C), elevated white blood cell count and a right adnexal mass. Pelvic inflammatory disease was suspected and broad spectrum antibiotics were established. Five days later, due to lack of clinical response, a total abdominal hysterectomy, bilateral salpingo-oophorectomy and appendectomy were performed. Histopathology showed a primary fallopian tube carcinoma. Postoperatively she received chemotherapy. Afterwards she underwent a staging laparotomy. Some months later, new chemotherapy regimens were instituted because of the presence of lymph node metastases. CONCLUSION: Malignancy should be included in the differential diagnosis of pelvic inflammatory disease.     

Huge teratoma of the fallopian tube: a case report

BACKGROUND: Primary mature solid teratomas of the fallopian tube are extremely rare and only 11 cases have been reported in the literature. A woman presented with a mature, solid teratoma of the fallopian tube, possibly the largest solid teratoma on record. CASE: A 24-year-old, nulliparous woman presented with abdominal distention, intermittent abdominal pain, nausea and vomiting for 4 weeks and was admitted to the hospital. Abdominal examination revealed a palpable, nontender mass. Computed tomography showed a hypodense lesion in the abdomen. Serum concentrations of carcinoembryonic antigen (2.6 ng/mL) and beta-human chorionic gonadotropin (0.1 mIU/mL) were within normal limits, while serum levels of CA-125 (130 U/mL) and CA-19.9 (237 U/mL) were elevated. A multilobulated, pedunculated, mature, solid teratoma of the fallopian tube measured 31 x 21 x 14 cm and weighed 2,400 g. At laparotomy, it was located in the fimbrial portion of the left fallopian tube, and a left salpingectomy was performed. The tumor consisted of bone, hair, and sebaceous and sweat glands. The cavity of the cyst was lined mainly with skin composed of keratinized squamous epithelium and contained abundant sebaceous and sweat glands. CONCLUSION: In cases of undetermined pelvic or abdominal masses, especially with calcification, a teratoma of the fallopian tube should be considered.     

Primary carcinoma of the fallopian tube: study of 11 cases

OBJECTIVE: Primary fallopian tube carcinoma is a rare tumor that histologically and clinically resembles primary ovarian carcinoma. The purpose of this study was to present the experience of the Soroka Medical Center (SMC), Beer-Sheva, Israel of handling this tumor. STUDY DESIGN: Data from the files of 11 patients with primary fallopian tube carcinoma who were managed at the SMC between January 1978 and December 1998 were evaluated. RESULTS: The mean age of the patients was 59.4 years. Presenting symptoms and signs included abdominal pain, postmenopausal bleeding, watery vaginal discharge and adnexal mass. In all patients, the diagnosis of primary fallopian tube carcinoma was not made preoperatively. In ten patients in whom the adnexal mass was discovered preoperatively it was thought to be an ovarian tumor and in one patient the adnexal mass was first noticed during vaginal hysterectomy. Postoperatively, multi-drug chemotherapy was given to seven patients, multi-drug chemotherapy followed by pelvic radiotherapy to one patient, pelvic radiotherapy followed by single-agent chemotherapy to two patients, and one patient received no further treatment. The actuarial 5-year survival rate was 50%. CONCLUSIONS: Fallopian tube carcinoma is rarely suspected preoperatively. The symptom complex of 'hydrops tubae profluence', said to be pathognomonic for this tumor, is rarely encountered. The treatment approach is similar to that used for ovarian carcinoma and includes primary surgery comprised of total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging followed by chemotherapy. The prognosis of patients with primary fallopian tube carcinoma is similar to that of patients with primary ovarian carcinoma.     

Carcinoma indiferenciado de trompa

Primary carcinoma of the fallopian tube is a rare entity. Preoperative diagnosis is difficult and these tumors are usually detected during surgery or on histopathological examination. We describe the case of a 61-year-old woman with pelvic pain, left adnexal mass and elevated Ca125 levels. Diagnostic tests were compatible with uterine sarcoma or primary left ovarian carcinoma with uterine invasion. Histopathological analysis showed a primary undifferentiated carcinoma of the left fallopian tube involving the uterus and cervix. The patient is currently undergoing chemotherapy.     

Aggressive multimodality treatment in transitional cell carcinoma of the parafallopian tube: report of 2 cases and review of the literature

BACKGROUND: Primary carcinoma of the fallopian tube is a rare and aggressive cancer. Information regarding its epidemiologic, biologic, and prognostic characteristics is limited; consequently, no standard treatment has been developed. We report the case histories of 2 women with transitional cell carcinoma (TCC) of the parafallopian tube treated with aggressive multimodality therapy, and the literature is reviewed. CASES: Two women presented with stage IIB TCC of the parafallopian tube. Both were treated with cytoreductive surgery followed by adjuvant intravenous chemotherapy with cisplatin, gemcitabine, and paclitaxel. Our consolidation treatment consisted of intraperitoneal chemotherapy using the same agents, and 1 patient also received additional hyperthermic chemotherapy with docetaxel. Both patients remain free of disease. CONCLUSION: In these 2 cases, an aggressive, multimodality regimen proved to be feasible and effective in treating TCC of the parafallopian tube.     

Primary fallopian tube carcinoma: a retrospective clinicopathologic study

INTRODUCTION: Primary fallopian tube carcinoma is a rare tumor. The aim of this study was to evaluate clinical characteristics and management of fallopian tube malignancies at a large tertiary care cancer institute. METHODS: A retrospective review of the Tumor Registry was conducted to identify all primary fallopian tube carcinomas between 1980 and 2001. Medical charts were retrospectively reviewed. Primary endpoints were overall survival and disease recurrence. RESULTS: Thirty-five patients had histology consistent with fallopian tube carcinoma. The median age at diagnosis was 56 years. The most common signs or symptoms were abnormal vaginal bleeding (29%) and abdominal/pelvic mass (26%). The most common histology was adenocarcinoma in 16 (46%) patients. Five patients (14%) were Stage I, seven patients (20%) Stage II, 17 patients (49%) Stage III and six patients (17%) Stage IV. Thirty-two (91%) patients received adjuvant chemotherapy and 77% received platinum-based chemotherapy. Twenty-seven (77%) patients underwent second-look surgery, of which 17 patients (63%) were positive for disease. The 5-year survival rate was 64% for Stage I, 42% for Stage II, 32% for Stage III, and 17% for Stage IV. CONCLUSIONS: Fallopian tube malignancies are rare and carry a poor prognosis. More extensive research needs to be performed to have definitive etiologic, diagnostic and treatment guidelines.     

Occult cancer of the fallopian tube in BRCA-1 germline mutation carriers at prophylactic oophorectomy: a case for recommending hysterectomy at surgical prophylaxis

OBJECTIVE: BRCA-1 and BRCA-2 germline mutations increase the risk of ovarian and breast cancer. Primary cancer of the fallopian tube is rare; however, recent evidence suggests that patients harboring a germline mutation conferring an increased risk of ovarian cancer may be at risk for fallopian tube cancer as well. We discuss the finding of occult fallopian tube cancer diagnosed at surgical prophylaxis in women harboring BRCA-1 mutations. METHODS/RESULTS: Two patients undergoing surgical prophylaxis to address an increase in ovarian cancer risk were discovered to harbor occult primary fallopian tube carcinoma on final pathology review. Mutational analysis confirmed the presence of a deleterious mutation in BRCA-1 in both patients. CONCLUSION: Currently, consensus opinions regarding ovarian cancer surgical prophylaxis in gene mutation carriers do not include hysterectomy as part of the preventative procedure. This report as well as a growing number of cases of fallopian tube cancer reported in known BRCA-1 and BRCA-2 mutation carriers has important implications for recommendations regarding surgical prophylaxis in these women.     

原发性输卵管癌误诊原因分析

原发性输卵管癌是最罕见的女性生殖系统恶性肿瘤之一,由于其临床表现缺乏特异性、输卵管的盆腔解剖特点、有限的辅助检查手段,以及临床医生的思路时常局限,因此常会出现误诊。重视“阴道排液”的症状、综合分析辅助检查的结果可提高输卵管癌的术前诊断准确率。     

Carcinoma of the fallopian tube presenting as acute pelvic inflammatory disease

BACKGROUND: Primary carcinomas of the fallopian tube are rare and their preoperative diagnosis is difficult due to the lack of specific symptoms. CASES: We present two tumors diagnosed in women 74 and 77 years old. On examination both patients presented as acute pelvic peritonitis with abdominal pain and tenderness with guarding and rebound, as well as fever and leukocytosis. At surgery, a left tubal carcinoma was found in each patient. Marked inflammatory and purulent reaction involving the uterus, the adnexa, and the pelvic peritoneum, and no abnormalities in the digestive tract were identified. A total hysterectomy with bilateral salpingo-oophorectomy was performed in both patients. CONCLUSION: Carcinoma of the fallopian tube should be considered in the differential diagnosis of pelvic peritonitis, a previously poorly reported clinical presentation.     

Primary fallopian tube carcinoma: the Queensland experience

Abstract. Obermair A, Taylor KH, Janda M, Nicklin JL, Crandon AJ, Perrin L. Primary fallopian tube carcinoma: the Queensland experience.
The pupose of this study was to review the experience with fallopian tube carcinoma in Queensland and to compare it with previously published data. Thirty-six patients with primary fallopian tube carcinoma treated at the Queensland Gynaecological Cancer Center from 1988 to 1999 were reviewed in a retrospective clinicopathologic study. All patients had primary surgery and 31/36 received chemotherapy postoperatively. Abnormal vaginal bleeding (15/36) and abdominal pain (14/36) were the most common presenting symptoms at the time of diagnosis. Median follow-up was 70.3 months and the median overall survival was 68.1 months. Surgical stage I disease ( P = 0.02) and the absence of residual tumor after operation ( P = 0.03) were the only factors associated with improved survival. Twenty of the 36 patients (55%) presented with stage I disease and survival was 62.7% at 5 years. No patient with postoperative residual tumor survived.
The majority of the patients with fallopian tube carcinoma present with stage I disease at diagnosis, but their survival probability is low compared with that of other early stage gynecological malignancies. If primary surgical debulking cannot achieve macroscopic tumor clearence, the chance of survival is extremely low.     

A case report: rare case of primary transitional cell carcinoma of the fallopian tube

Carcinomas other than adenocarcinomas are extremely rare in the fallopian tube. A 42-year-old woman with watery, intermittent vaginal discharge was found to have a left adnexal tumor. This case was diagnosed as primary carcinoma of the fallopian tube, FIGO Stage Ia. She underwent a total abdominal hysterectomy, a bilateral salpingo-oophorectomy, a pelvic and periaortic lymphoadenectomy, and an omentectomy, followed by cisplatin-based chemotherapy. Four years after the initial diagnosis of the disease, she remains in a disease-free state. Histologically, the tumor revealed a primary transitional cell carcinoma of the left fallopian tube. The findings on an immunohistochemical test for an epithelial membrane antigen, the CA125 antigen, were positive, whereas findings on a test for CEA were negative. We report a case of a malignant neoplasm of the fallopian tube with histological features of transitional cell carcinoma that arose from the tubal epithelium.     

Carcinoma de las trompas de Falopio

Primary fallopian tube carcinoma is a rare tumor that histologically and clinically resembles epithelial ovarian cancer. The early clinical manifestations can often lead to a correct diagnosis at an early stage of the disease, leading to more favorable survival compared with epithelial ovarian cancer. However, the diagnosis of primary fallopian tube carcinoma is rarely preoperative and is usually made by the pathologist. Surgical staging and the use of chemotherapy follow the model used in epithelial ovarian cancer.