Double Trouble: A case of synchronous high-grade serous carcinoma of the fallopian tube and borderline mucinous tumor of the ovary / Philippine Journal of Obstetrics and Gynecology

@#A 55‑year‑old, Gravida 2 Para 2 (2002), presented with postmenopausal vaginal bleeding. Workups pointed toward ovarian malignancy with distant metastasis (pleural effusion). Exploratory laparotomy, bilateral salpingo‑oophorectomy, surgical staging, and appendectomy were performed. On histopathological examination, synchronous high‑grade serous carcinoma of the right fallopian tube and borderline mucinous tumor of the left ovary were diagnosed. Primary fallopian tube carcinomas are very uncommon, while synchronous tumors of the female genital tract are extremely rare. Furthermore, there is a paucity of literature discussing the occurrence of synchronous primary malignancies arising from the fallopian tube and the ovary. It is crucial to differentiate primary malignancies from metastatic cancers to determine accurate staging and prognosis, as well as to assign appropriate treatment strategies. Immunohistochemistry and molecular testing play vital roles as adjunctive diagnostic tools to histologic examination in determining the origins of these tumors and distinguishing primary tumors from metastasis.

Primary Fallopian Tube Carcinoma: A Review Of A Single Institution Experience

Background: Primary fallopian tube carcinoma (PFTC) is rare. Herein, we investigate the clinico- pathological characteristics and response to cytoreductive surgery & appropriate therapies for PFTC. Materials and Methods: Aretrospective observational study of 5 women with a histopathologic diagnosis of PFTC from January 2004 to Dec 2018. Results: The mean age at diagnosis was 53 years (range, 46 to 62 years), and the mean follow-up period was 51 months. All (100%) patients were postmenopausal. Eighty percent had an ECOG score of 0-1.The most common clinical presentation was nonspecific pelvic pain (100%), followed by abnormal vaginal bleeding (80%), and adnexal mass of unknown origin (40%). Three (60%) patients were assumed preoperatively as primarily in the ovary. All patients were diagnosed postoperatively; Primary optimal cytoreductive surgery was achievable in 4/4 (100%) in advanced disease. Only 1 (20%) patient was in Stage IIA& four (80%) in Stage IIB - IIIB. The serous type histology was predominant (60%), 60 % were of grade 2 and 40% of high grade. All showed complete response (CR) to adjuvant paclitaxel and carboplatin (P+C).The mean progression-free survival (PFS) rate was 43.6 months and mean Overall survival (OS) was 51 months. Conclusion: PFTC is infrequently diagnosed preoperatively or intraoperatively due to its rarity, and has nonspecific presentation. Radical cytoreductive surgery, followed by postoperative adjuvant chemotherapy P+C is a standard treatment by which the survival potential of PFTC can be greatly enhanced.

MRI characteristics and misdiagnosis analysis of primary fallopian tube carcinoma / 实用放射学杂志

Objective To conclude MRI characteristics of primary fallopian tube carcinoma(PFTC),analyze the reason of misdiagnosis and improve the level of diagnosis.Methods MRI data of 10 patients with pathologically proved PFTC were analyzed retrospectively.The imaging features including tumor morphology,signal,enhancement and adjacent change were analyzed and discussed.Results There were 12 masses or lesions in 10 cases of PFTC.The lesions were located in the adnexal area,in which 2 cases were bilateral and 8 cases were unilateral (2 cases on the right side,6 cases on the left side).All of them appeared as sausage shaped mass.Among them,9 tumors (7 cases)were cystic solid masses and the other 3 tumors (3 cases)were solid tumor.The solid components showed equal or slightly lower signal on T1WI,signal heterogenicity and slightly higher signal on T2WI,and high signal on DWI sequence;The cystic component showed low signal on T1WI,high signal on T2WI,high signal on DWI for 2 tumors (2 cases).On enhanced scan,the solid components of the lesions were enhanced,but the cystic component was not.Correct diagnosis was made on MRI in only 2 cases before operation. Conclusion MRI high soft tissue resolution,can clear display PFTC carcinoma components in the stove,but no matter how solid and cystic components composition proportion,bump keep sausage sample forms,combined with clinical symptoms and laboratory tests, can improve the accuracy of preoperative diagnosis and reduce misdiagnosis.

Clinicopathological analysis of 39 cases with primary fallopian tube cancer / 实用肿瘤学杂志

Objective The objective of this study was to investigate the clinicopathological features and rational treatment of primary fallopian tube cancer(PFTC).Methods The clinical and pathological data of 39 patients with primary fallopian tube cancer from January 2006 to July 2016 in Beijing Tongren Hospital of Capital University were retrospectively analyzed.Results There were 39 cases of undifferentiated carcinoma,including 1 case of undifferentiated and transitional cell carcinoma,37 cases of undifferentiated adenocarcinoma,or 29 cases of simple adenocarcinoma and 10 cases of mixed type.Among them,7 cases were treated with clear cell carcinoma,endometriosis in 2 cases,combined with transitional cell carcinoma in 1 case.Extra-pelvic metastases were the most common site of the omentum with 17 cases.The preoperative test CA125 was increased in 13 cases and 38 patients received postoperative chemotherapy.The 5-year overall survival rate of 39 patients was 51.3%.Univariate analysis showed that postoperative pathologic stage(Ⅰ~Ⅱ vs.Ⅲ,P<0.001),intraoperative residual lesion size(P<0.001),omentum metastasis(P<0.001),ovarian metastasis(P=0.034),retroperitoneal lymph node metastasis(P=0.018)and preoperative CA125 elevation(P=0.002)were associated with prognosis,while age(P=0.310)and pathological grade(P=0.663)were not associated with prognosis.Multivariate analysis showed that the number of patients with postoperative lymph node metastasis(P=0.018)and preoperative CA125 elevation(P=0.002)were correlated with prognosis(HR=1.202,95% CI:2.354~63.290,P=0.003) and pathological stage(HR=3.810,95% CI:1.202~12.079,P=0.023).They were associated with prognosis as independent prognostic factors.Conclusion Tumor pathologic staging and omentum metastasis are important prognostic factors influencing the prognosis of patients with primary fallopian tube cancer.Early diagnosis and complete operation can improve the prognosis of patients.

Prognostic Significance of Retroperitoneal Lymphadenectomy, Preoperative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Primary Fallopian Tube Carcinoma: A Multicenter Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to evaluate the prognostic role of preoperative neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and the need for para-aortic lymphadectomy in patients with primary fallopian tube carcinoma (PFTC). MATERIALS AND METHODS: Ninety-one patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of six academic centers. Clinicopathological, surgical, and complete blood count data were collected. RESULTS: In univariate analysis, advanced stage, suboptimal surgery, and NLR > 2.7 were significant prognostic factors for progression-free survival, whereas in multivariate analysis, only advanced stage and suboptimal surgery were significant. In addition, in univariate analysis, cancer antigen 125 > or = 35 U/mL, ascites, advanced stage, suboptimal surgery, NLR > 2.7, PLR > 233.3, platelet count > or =400,000 cells/mm3, staging type, and histological subtype were significant prognostic factors for overall survival (OS); however, in multivariate analysis, only advanced stage, suboptimal surgery, NLR > 2.7, and staging type were significant. Inclusion of pelvic and para-aortic lymphadenectomy in surgery showed significant association with longer OS, with a mean and median OS of 42.0 months and 35.5 months (range, 22 to 78 months), respectively, vs. 33.5 months and 27.5 months (range, 14 to 76 months), respectively, for patients who underwent surgery without para-aortic lymphadenectomy (hazard ratio, 3.1; 95% confidence interval, 1.4 to 5.7; p=0.002). CONCLUSION: NLR (in both univariate and multivariate analysis) and PLR (only in univariate analysis) were prognostic factors in PFTC. NLR and PLR are inexpensive and easy tests to perform. In addition, patients with PFTC who underwent bilateral pelvic and para-aortic lymphadenectomy had longer OS.

Synchronous primary endometrial and fallopian tube cancers: A report of four cases and literature review / 肿瘤

Objective: To evaluate the diagnosis, treatment and prognosis of patients with synchronous primary endometrial and fallopian tube cancers. Methods: The clinical records of four cases of synchronous primary endometrial and fallopian tube cancers from Jiangxi Maternal and Child Health Hospital between October 2008 and October 2013 were reviewed. The follow-up was performed in all patients. The date of last contact was June 30, 2014. Results: The preoperative diagnosis for four cases was endometrial cancer. Two of them underwent extensive abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy and para-aortic lymph node biopsy, and the other two cases underwent extrafascial abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy and para-aortic lymph node biopsy. The postoperative diagnosis for four cases was stage IA endometrioid adenocarcinoma and stage IA/IB fallopian tube adenocarcinoma. Three patients received 1-3 cycles of chemotherapy of docetaxel plus platinum, and one patient didn't receive any chemotherapy. The follow-up time was 38-71 months. All patinets remained tumor-free survival by June 30, 2014. Conclusion: The patients with synchronous primary stage I endometrial cancer and stage I fallopian tube cancer has a good prognosis, and the extensive/extrafascial abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy and para-aortic lymph node biopsy are appropriate surgical procedures for these patients. The necessity of postoperative chemotherapy should be further explored.

Fallopian tube origin of supposed ovarian high-grade serous carcinomas

INTRODUCTION: Serous carcinomas are the most frequent histologic type of ovarian and peritoneal cancers, and can also be detected in the endometrium and fallopian tubes. Serous carcinomas are usually high-grade neoplasms when diagnosed, yet the identification of an associated precursor lesion remains challenging. Pathological examination of specimens obtained from prophylactic bilateral salpingo-oophorectomies that were performed for patients harboring BRCA1/2 mutations suggests that high-grade serous carcinomas may arise in the fallopian tubes rather than in the ovaries. OBJECTIVE: To investigate the presence and extent of fallopian tube involvement in cases of serous pelvic carcinomas. METHODS: Thirty-four cases of serous pelvic carcinoma with clinical presentations suggesting an ovarian origin were analyzed retrospectively. Histologic samples of fallopian tube tissues were available for these cases and were analyzed. Probable primary site, type of tubal involvement, tissues involved in the neoplasia and vascular involvement were evaluated. RESULTS: Fallopian tube involvement was observed in 24/34 (70.6 percent) cases. In 4 (11.8 percent) of these cases, an intraepithelial neoplasia was present, and therefore these cases were hypothesized to be primary from fallopian tubes. For an additional 7/34 (20.6 percent) cases, a fallopian tube origin was considered a possible primary. CONCLUSIONS: Fallopian tubes can be the primary site for a subset of pelvic high-grade serous carcinomas.

Primary Adenocarcinoma of the Fallopian Tube Mimicking Pelvic Inflammatory Disease

Primary fallopian tube carcinomas are rare and are difficult to diagnose preoperatively. We describe a fallopian tube carcinoma in a 50-year-old lady who presented with symptoms of pelvic inflammatory disease. Ultrasound examination showed bilateral hydrosalphinx. However, CT scan showed features suggestive of a malignant ovarian tumour. At surgery, a markedly dilated left fallopian tube was found and histopathological examination confirmed the presence of a primary serous adenocarcinoma. The uterus and both ovaries were free of tumour. This report highlights that carcinoma of the fallopian tube should be considered as a differential diagnosis in females who present with lower abdominal pain.

Early stage (IA-IB) primary carcinoma of the fallopian tube: case-control comparison to adenocarcinoma of the ovary / 부인종양

OBJECTIVE: Early stage primary carcinoma of the fallopian tube (PCFT) is an uncommon condition when strict criteria are applied. The aim of this study was to compare the outcome stage IA-IB PCFT to a matched group of ovarian cancer (OC). METHODS: Between 1990 and 2008, 32 patients with stage IA-IB of PCFT were recorded in the database of three French Institutions. A control group of patients with OC was constituted. RESULTS: Eleven eligible PCFT cases and 29 OC controls fulfilled the stringent inclusion criteria. Median follow-up was 70.2 months. Five-year overall survival was 83.3% (95% confidence interval [CI], 27.3 to 97.5) for PCFT and 88.0% (95% CI, 66.9 to 96.0) for OC (p=0.93). In the subgroup of patients with grade 2-3, the outcome was similar in PCFT compared to OC patients (p=0.75). Five-year relapse-free survival was respectively 62.5% (95% CI, 22.9 to 86.1) and 85.0% (95% CI, 64.6 to 94.2) in the PCFT and OC groups (p=0.07). In the subgroup of patients (grade 2-3), there was no difference between PCFT and OC (p=0.65). CONCLUSION: The findings did not reveal any difference in prognosis between early stage of PCFT and OC when grade is taken into account. Management of PCFT should mirror that of ovarian carcinoma.

Primary Fallopian Tube Carcinoma: A Retrospective Clinical Analysis of 40 Patients / 中国肿瘤临床

Objective: To investigate the clinical features and survival factors of primary fallopian tube car-cinoma. Methods: We used Kaplan-Meier survival analysis, single factor analysis and multivariate analysis to evaluate the prognostic factors of 40 patients diagnosed with primary fallopian tube cancer. Results: The aver-age age of the patients was 51 years and all of them received surgery. There were 29 (72.5%) stage Ⅰ or Ⅱ patients, 11 stage Ⅲ or Ⅳ patients. Thirty-one (77.5%) patients were diagnosed with poorly differentiated tu-mors and 22 (55%) patients had serous adenocarcinoma. Thirty-seven patients received PAC/PC or TC che-motherapy after surgery. Six patients (15%) had recurrences within 23 to 56 months after surgery. The medi-an survival of Ⅰ～Ⅱ and Ⅲ～Ⅳ stage patients was 79 and 35 months, respectively. The total 5-year survival was 58% and 0 (P=0.005). Univariate and multivariate analysis showed that stage (Ⅰ～Ⅱ vs. Ⅲ-Ⅳ), grade (G_1+G_2 vs. G_3), residual disease after surgery (none, <1cm vs. >1cm) were significant factors affecting surviv-al. In accordance with the formula to calculate the half-life of CA125 and compare preoperative serum CA125 with the value at 3 weeks after surgery (T_(1/2)>3 week, T_(1/2)<3 week), the 5-year survival was 78% and 50%, re-spectively (P=0.036). Conclusion: Special attention should be paid to the joint screening of primary fallopian tube cancer in clinical practice in order to avoid misdiagnosis. The consecutive measurements of serum CA-125 level may have significant value as a prognostic indicator for patient survival.

A case of primary transitional cell carcinoma of the fallopian tube / 대한산부인과학회지

Primary carcinoma of the fallopian tube is a rare entity that accounts for about 1% of all gynecologic malignancies, and most are discovered during or after surgery. Primary transitional cell carcinoma of the fallopian tube is an extremely rare tumor that is reported only occasionally in the worldwide literature. Histologically, fallopian tube carcinomas are almost always papillary adenocarcinomas, but other histologic types such as endometrioid carcinoma, clear cell carcinoma, and mixed carcinoma have been reported. As primary transitional cell carcinoma (TCC) of the fallopian tube is so rare, the clinicopathologic characteristics are as yet unknown. The authors recently experienced a case of primary transitional cell carcinoma arising in the fallopian tube, and thus report the clinical features, management, and also a review of the past pertinent literature.

Brain metastases from a primary carcinoma of the fallopian tube / 대한산부인과학회잡지

Carcinoma of the fallopian tube account for less than 1% of all cancers of the female genital tract. Central nerve system involvement by tubal cancer is considered an uncommon event. Attention should be paid to the possibility of distant metastasis associated the tubal carcinoma in order to treat these patients promptly. We have experienced one case of fallopian tube cancer with cerebellar metastasis and reported with brief review of literature.

Primary carcinoma of the fallopian tube coexisting with benign cystic teratoma of the ovary

Primary carcinoma of the fallopian tube is a rare malignancy of the female genital tract and infrequently diagnosed before an operation. The majority of patients have extensive disease at the time of diagnosis. We have experienced incidentally a case of a carcinoma of the fallopian tube coexisting with a benign cystic teratoma of the ovary in a 25-year-old woman. We report this case with a brief review of literatures.

Two Cases of Primary Carcinoma in the Fallopian Tube / 대한부인종양콜포스코피학회잡지

Primary carcinoma of the fallopian tube is an extremely rare malignancy of the female genital tract. We have experienced two cases of primary carcinoma in the fallopian tube. One case with huge mass which was diagnosed incidentally on the basis of the biopsy findings, and the other case of the 3 years follow-up. We reported the cases with a brief review of the concemed literatures.