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OJHAS Vol. 9, Issue 4:
Oct-Dec, 2010) |
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| Primary Fallopian
Tube Carcinoma |
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Prasad K Shetty, Balaiah K, Bafna UD, Gnana
Prakash S,
Department of Pathology,
Gynac-Oncology and Radiology, Bhagwan Mahaveer Jain Hospital, Bangalore,
India. |
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Address For Correspondence |
Department
of Pathology,
Bhagwan
Mahaveer Jain Hospital,
Millers
Road, Vasanthnagar,
Bangalore-560052,
India.
E-mail:
dr.pkshetty@gmail.com |
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Shetty PK, Balaiah K, Bafna UD, Gnana
Prakash S. Primary Fallopian
Tube Carcinoma. Online J Health Allied Scs.
2010;9(4):26 |
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Submitted: Oct 27,
2010; Accepted: Nov 3, 2010; Published: Jan 20, 2011 |
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| Abstract: |
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Primary Fallopian
Tube Carcinoma (PFTC) is rare and accounts for about 0.3% of all gynecologic
cancers. Less than 1500 cases have been reported in the literature. It arises in postmenopausal women and typically presents with
abdominal pelvic pain, vaginal bleeding and watery discharge. However, a correct diagnosis is rarely achieved preoperative,
and in many cases, the diagnosis is made after incidental surgery for
unrelated conditions commonly being ovarian carcinoma . Compared with
ovarian carcinoma, PFTC more often presents at early stages, but it
has a worse prognosis. PFTC is usually managed in the same manner as
ovarian cancer. We report a case of Left PFTC that presented
as Left ovarian mass, and we briefly review the literature.
Key Words: Primary fallopian
tube carcinoma; Ovary; CA 125.
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A 61 year old
female came with history of postmenopausal bleeding and abdominal pain
since 2 months. She also gives history of vaginal watery discharge since
5 days. She attained menopause 9 years back. Her blood pressure was
130/80 mm Hg. On vaginal examination, cervix showed a small cervical
erosion, the uterus was normal in size and mobile with a 8X8 cm mass
felt through the left fornix and placed anteriorly in the pelvis. The
right fornix was free.
Her hemogram,
hepatic and renal functions were normal. HbsAg, HIV I and II were negative
and urine examination were reported to be normal. X-ray chest was normal.
Abdominal pelvic CT scan showed no abnormality in upper abdomen and
revealed a uterus with normal echotexture, measuring 8.8 x 4.5x3.4 cm.
Endometrial thickness was 3 mm. Right ovary measured 2.2 x 1.0 cm and
had normal echotexture. Left ovary was enlarged, shows a tumor with
predominantly solid component and measured 7.6 x 6.2 cm. There was no
free fluid in the abdomen and pelvis.
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Figure 1: Abdominopelvic
CT scan showing Left ovarian mass with solid cystic component.
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Serum CA - 125
was 24.5 U/mL (Normal upto 35 U/mL). Pap smear showed inflammatory picture.
Endometrial curretings showed atrophic endometrium Based on the above
features a provisional diagnosis of ovarian malignancy was made and
total abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic
and aortic lymphnode dissection and omentectomy was done. Peritoneal
washings were negative for malignant cells.
On gross examination,
uterus, right tube and both ovaries appeared normal, left fallopian
tube was grossly dilated measuring 6x6cms, outer surface was smooth.
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Figure 2: Uterus cervix with normal right adnexa and left ovary
(finger points to grossly dilated Left fallopian tube) |
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Figure 3:
cut surface of Left tube with gray white tumor with hemorrhagic area
within tubal lumen (finger points to normal left ovary) |
Cut surface showed
a gray white friable tumor dilating and occupying tubal lumen, tumor
was solid with areas of haemorrhage.
The omentum measured
18x7 cm and was grossly unremarkable. On microscopic examination the
left fallopian tube showed tumor arising from tubal epithelium infiltrating
upto submucosa, muscular layer and serosa were free of tumor, tumor cells were
arranged in solid sheets and papillary pattern, cells were moderately
pleomorphic with high N/C ratio. There was no evidence of lymphovascular
invasion.
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Figure 4: Hematoxilin
and Eosin10x showing tumor cells infiltrating upto submucosa, |
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Figure 5: Hematoxilin and Eosin 10x shows tumor cells arranged in
papillary pattern |
There was no
evidence of tumor metastasis elsewhere. Based on the histological features
a diagnosis of PFTC morphologically papillary serous type FIGO
Stage 1A Grade I was made. She had an uneventful post-operative recovery
and was discharged from hospital on the 7th post-operative day.
Fallopian tube
cancer was first described 1847. Since then, over 2000 cases have been
reported in literature. PFTC is the least common of all gynecologic
malignancies and the annual incidence about 3.6 per million women per
year.1
PFTC accounts
for approximately 0.14 -1.8% of all female genital malignancies. The
peak incidence is between the ages of 60 and 64 years, patients usually
present with abnormal vaginal bleeding (47.5%), lower abdominal pain
(39%), abnormal watery vaginal discharge (20%) and a palpable pelvic/abdominal
mass (61%) (10) as seen in our case.1-3 Tumor markers
such as serum Ca-125 may be raised.4 Because of its rarity,
the correct preoperative diagnosis is rarely made and it is usually
an incidental diagnosis in patient undergoing an exploratory laprotomy.
A correct diagnosis of PFTC was made preoperatively in only 4.6% of
cases in the series of Alvarado-Cabrero et al.5 PFTC should
be included in the differential diagnosis and especially if the patient
has clinical symptoms such as vaginal discharge or abnormal genital
bleeding with negative diagnostic curettage.6 On CT scan
tumors are completely solid and others are predominantly cystic and
the latter contain papillary projections or solid regions. Although
rare, PFTC must be considered in the differential diagnosis of adnexal
masses, and particularly in the presence of incomplete septations and
a highly vascular, solid component.7
PFTC spreads
by local invasion, transluminal migration and via the lymphatics and
the bloodstream. Patients with PFTC have a higher rate of retroperitoneal
and distant metastases than those patients with epithelial ovarian cancer.
Metastases to the para-aortic lymph nodes have been documented in 33%
of the patients with all stages of disease. The stage of disease at
the time of diagnosis is the most important factor affecting the prognosis,
PFTC carries five-year survival rates of about 68 -76% for Stage I disease,
27 - 42% for Stage II disease and 0 -6% for Stage III and IV disease
so it is very important to diagnose these neoplasms in the early stages.8,9 Surgery is the treatment of choice for PFTC, and the surgical
principles are the same as those used for ovarian cancer. The procedure
of choice is abdominal total hysterectomy, bilateral salpingo-oophorectomy,
omentectomy, selective pelvic and para-aortic lymphadenectomy for any
stage for fallopian tube carcinoma. Microscopically all major
types of carcinomas known to occur in ovary are reported, 95% of them
being Papillary serous and 5% comprising of Endometrioid, Mucinous,
Seromucinous, Clear cell and Transitional cell.10
Postoperative
adjuvant chemotherapy is similar to that used for ovarian carcinoma.
The diagnosis of PFTC is rarely considered preoperatively and it is
usually first appreciated at the time of operation or after operation
by the pathologist.8,9
- Stewart SL,
Wlke JM, Faster SL. The incidence of primary fallopian tube cancer in
the United States. Gynecol Oncol 2007;107(2):392-397
- King A, Seraj
IM, Thrasher T, Slater J, Wagner RJ. Fallopian tube carcinoma: a clinicopathological
study of 17 cases. Gynecol Oncol. 1989;33:351-355.
- Vaughan MM,
Evans BD, Baranyai J, Weitzer MJ. Survival of patients with primary
fallopian tube carcinoma. Int J Gynecol Cancer. 1998;8:16-22.
- Kosary C,
Trimble EL. Treatment and survival for women with fallopian tube carcinoma:
a population-based study. Gynecol Oncol. 2002;86:190-191.
- Alvarado-Cabrero
I, Young RH, Vamvakas EC, Scully RE. Carcinoma of the fallopian tube:
a clinicopathological study of 105 cases with observations on staging
and prognostic factors. Gynecol Oncol. 1999;72:367-379.
- Riska A, Leminen
A, Pukkala E. Sociodemographic determinants of incidence of primary
fallopian tube carcinoma, Finland 1953-97. Int J Cancer. 2003;104:643-645.
- Slanetz PJ,
Whitman GJ, Halpern EF, Hall DA, McCarthy KA, Simeone JF. Imaging of
fallopian tube tumors. Am J Roentgenol. 1997;169:1321-1324.
- Klein M, Rosen
A, Lahousen M, Graf AH, Rancin A. Lymphadenectomy
in primary carcinoma of fallopian tube. Cancer Lett 1999;147(1-2):63-66.
- Benedet JL,
Bender H, Jones H 3rd, Nagan HY, Pecorelli S. FIGO staging classifications
and clinical practice guidelines in the management of gynaecological
cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet 2000;70:209-262.
- Klein M,
Rosen A, Lahousen M, Graf AH, Rainer A. The relevance of adjuvant treatment
in primary carcinoma of fallopian tube stage 1 & 2: irradiation
v/s chemotherapy. Int J Radia Oncol Biol Phys 2000;48(5):1427-1431.
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