Ultrasound imaging and clinical characteristics of primary fallopian tube carcinoma in peri-and post-menopausal women / 中华老年医学杂志

Objective:To analyze the characteristic ultrasonographic findings and clinical symptoms of primary fallopian tube cancer(PFTC)in peri-and post-menopausal women, and to provide a basis for the early diagnosis of PFTC via ultrasonography.Methods:A total of 34 patients with PFTC confirmed by surgery and pathology in Beijing Hospital from May 2012 to January 2022 were retrospectively analyzed.Patients aged between 46-85 years, including 1(2.9%)in early menopausal transition(46 years old), 3(8.8%)in late menopausal transition(48 years old, 49 years old, and 50 years old), and 30(88.2%)in post-menopause.The median age was 60 years(60.9±9.7 years). The ultrasound and clinical features were analyzed and compared with pathological results.Results:Irregular vaginal bleeding was the most common clinical symptom in the 34 patients.According to the characteristics of adnexal masses and the involvement of other organs in the pelvis and abdominal cavity, the 34 cases of PFTC were divided into 4 groups.In Group A, 6 cases showed sausage-like cystic masses in the adnexal area, with unsmooth inner walls, medium echo papillary projections on the inner wall, incomplete strip partitions, and rich or relatively rich blood flow signals on the papillary projections and partitions.On ultrasound, 1 case was diagnosed with hydrosalpinx, 2 cases with cysts in the adnexal area, and 3 cases with PFTC.In Group B, 13 cases presented with cystic or solid masses of irregular shapes and sausage-like changes in some areas.The cystic part had poor sound transmission and the solid part exhibited rich or relatively rich blood flow signals.On ultrasound, 2 cases were diagnosed with PFTC and 11 cases with ovarian cancer with 2 showing intrauterine effusion and 3 showing abdominal and pelvic effusion.There were 11 cases in Group C, presenting with hypoechoic irregular solid masses in the adnexal area, with some accompanied by thickening of the peritoneum of the anterior and posterior fornix and the omentum.There were abundant or relatively abundant blood flow signals inside the masses.On ultrasound, 10 cases were diagnosed with ovarian cancer and 1 with pelvic metastatic cancer.There were 4 cases in Group D, who showed no adnexal mass, but 3 cases had ascites and were suspected of having a malignant tumor of unknown origin.Postoperative pathological results of the 34 PFTC cases revealed that 30 had high-grade serous carcinoma, 1 had low-grade serous carcinoma, 2 had serous tubal intraepithelial carcinoma(STIC), and 1 had serous tubal in-situ carcinoma.There were 3 cases with bilateral PFTC, 10 cases with PFTC on the left and 21 cases on the right.There were 4 cases with PFTC plus ovarian cancer.According to FIGO pathological staging, 8 cases were in stage Ⅰ, 9 in stage Ⅱ, 11 in stage Ⅲ and 6 in stage Ⅳ.The accuracy of preoperative diagnosis of PFTC by ultrasound was 50.0% in Group A and 15.4% in Group B. Preoperative ultrasound did not correctly diagnose PFTC in Group C and Group D, and instead suggested pelvic malignant tumor.Conclusions:Clear display of bilateral ovaries, sausage-like masses in the adnexal area, abundant or relatively abundant low resistive index blood flow signals in papillary projections and low-speed neovascularization are helpful ultrasound signs for the early diagnosis of PFTC, but not very useful for predicting the pathological stages of PFTC.Postmenopausal woman with vaginal bleeding, vaginal secretions or lower abdominal pain should be alert to PFTC.

Relationship between the precursors of high grade serous ovarian cancer and patient characteristics: decreased incidence of the p53 signature in pregnant women / 부인종양

OBJECTIVE: To investigate the relationship between the precursors of high grade serous ovarian cancer (HGSOC) and the characteristics of patients with a low HGSOC risk in terms of the effects of pregnancy. METHODS: We prospectively examined consecutive cases in which the bilateral fallopian tubes were removed during benign gynecological or obstetric surgery and assessed the relationship between the patient characteristics, including parity and pregnancy, and the incidence of HGSOC precursors. All the fallopian tubes were examined by applying the Sectioning and Extensively Examining the Fimbriated End (SEE-FIM) Protocol. RESULTS: Of the 113 patients enrolled, 67 were gynecological and 46 were obstetric. The p53 signature was identified in 21 patients. No other precursors were identified. In a comparison of the p53 signature-positive and negative groups, parous women and pregnant women were significantly fewer in the p53 signature-positive group (53% vs. 86%, p=0.002, 10% vs. 47%, p=0.001, respectively). Current pregnancy was also associated with a significantly lower incidence of the p53 signature after multivariate adjustment (odds ratio [OR]=0.112; 95% confidence interval [95% CI]=0.017–0.731; p=0.022). Among gynecological patients, parous women were fewer in the p53 signature-positive group on univariate (47% vs. 73%, p=0.047) and multivariate analysis (OR=0.252; 95% CI=0.069–0.911; p=0.036). No other characteristics were associated with p53 signature positivity. CONCLUSIONS: The incidence of the p53 signature was significantly lower in parous women and pregnant women. This decreased incidence of early phase serous carcinogenesis may be one of the possible mechanisms underlying HGSOC risk reduction among parous women.

Significance and expression of PAX8,PAX2,p53 and RAS in ovary and fallopian tubes to origin of ovarian high grade serous carcinoma / 中华妇产科杂志

Objective To explore the origin of ovarian high grade serous carcinoma(HGSC) through analysing the expression and significance of PAX8,PAX2,p53 and RAS in the ovary and fallopian tube of different types and grades of serous carcinoma. Methods A total of 44 cases tissue samples of ovarian tumor including 34 malignant ovarian tumor and 10 normal normal tissue (as control group) were collected from the admitted patients in Affiliated Tumor Hospital of Guangxi Medical University from January 2015 to January 2016. Fallopian tube tissues were segmented in accordance with the fimbria, ampulla, isthmus and the corresponding ovarian tissues were by the side. There were 34 cases of patients with ovarian cancer including 29 cases of epithelial ovarian cancer (27 serous carcinoma, 1 mucinous carcinoma,1 endometrioid adenocarcinoma)and 5 non-epithelial ovarian cancer(sex cord-interstitial tumor). Among 27 cases of patients with ovarian serous cancer,there were 23 HGSC and 4 low-grade ovarian serous cancer (LGSC). One hundred fifty-three cases of samples were diagnosed as ovarian serous cancer by Shandong University Affiliated Qilu Hospital from 2005 to 2013 and these samples were made tissue microarray.(1)To analyze the expression and differences of PAX8,PAX2,p53 and RAS in the above tissues and tissue microarray from ovarian and tubal of HGSC and control women by immunohistochemistry methods.(2)To compare the expression levels of PAX8,PAX2,p53 and RAS in ovarian and fallopian tubes of ovarian cancer patients with different pathological types. (3) To analyze the correlations of tubal and ovarian tissue in PAX8,PAX2,p53 and RAS expression of HGSC.(4)To analyze the factors of the prognosis of ovarian serous cancer in tissue microarray by single factor analysis method. Results (1)PAX8,PAX2, p53 and RAS expression was negative in normal ovarian epithelium of control group,but the expression of PAX8, PAX2, p53 and RAS were strongly positive brown in secrete cells of normal fallopian tube epithelium.(2)p53 and RAS expression of fallopian tube epithelium in the epithelial ovarian cancer group were significantly higher than those in the non-epithelial ovarian cancer groups(P<0.05),but the expression of PAX8 and PAX2 in fallopian tube and the expression of PAX8,PAX2,p53 and RAS in ovarian tissue was not statistically significant in the groups(P>0.05).PAX8,PAX2 and p53 expression of the ovarian in HGSC group were significantly higher than those in LGSC group(P<0.05),while the expression of RAS was lower in the ovarian of the high-grade group (P<0.05), while the expression of PAX8, PAX2, p53 and RAS in fallopian tube was not statistically significant in the groups(P>0.05).(3)There was a significantly positive correlation between fallopian tube and the corresponding ovary of HGSC in PAX8 and PAX2 expression(r=0.422, P=0.045; r=0.693, P=0.000), but not correlation in p53 and RAS expression (r=0.058, P=0.793; r=-0.190,P=0.384).(4)Univariate survival analysis showed that the progression free survival time in patients with ovarian serous cancer group was significantly correlated with the protein expression of PAX8, PAX2 and RAS(P<0.05),but there were not correlated with age,surgical staging,cell differentiation,lymph node metastasis and preoperative chemotherapy and p53 protein expression (P>0.05). The total survival time in patients with ovarian serous cancer group was significantly correlated with the protein expression of PAX8 (P<0.05),but there were not correlated with age,surgical staging,cell differentiation,lymph node metastasis and preoperative chemotherapy and the protein expression of PAX2, RAS and p53 (P>0.05). Conclusions PAX8, PAX2, p53, RAS are of great significance for the study of origin of HGSC. HGSC may be derived from fallopian tube, but further investigation would be necessary to confirm this. PAX8, PAX2, p53, RAS could be expected to be used as predictors of survival prognosis in patients with ovarian serous cancer.

Ultrasonography imaging feature of primary fallopian tube carcinoma and the reason of misdiagnosis analysis / 中华医学超声杂志（电子版）

Objective To analyze ultrasonographic imaging feature of primary fallopian tube carcinoma (PFTC) and the reasons for misdiagnosis.Methods Clinical data and ultrasonographic imaging feature of 41 patients with pathologically confirmed PFTC were retrospectively analyzed from August 2008 to November 2016 in General Hospital of Chinese People's Liberation Army.Results Ultrasonographic characteristics of 41 PFTC cases:(1) Type Ⅰ (6 cases),the cystic adnexal mass with single or multiple papillary projections and circuity tubular structures,color Doppler flow imaging showed abundant blood flow signal inside the nipples.(2) Type Ⅱ (2 cases),the sausage shaped complex adnexal mass showed clear boundary,the cystic area that lined along the fallopian tube was around or at the side of the solid part,color Doppler flow imaging showed rich or abundant blood flow signal inside the solid part.(3) Type Ⅲ (13 cases),the sausage shaped hypoechoic adnexal mass showed clear boundary,color Doppler flow imaging showed rich or abundant blood flow signal inside the mass.(4) Type Ⅳ (14 cases),the single or multiple adnexal masses showed irregular surface,with predominant solid components,color Doppler showed rich or abundant blood flow signal inside the tumor;the normal ovarian structure was not detected in unilateral or bilateral adnexa area;and one or more signs of metastasis were found,such as the peritoneal thickening of vesicouterine pouch,uterine rectum pouch and omental,metastasis to other distant organs,and so on.(5) Type Ⅳ (6 cases),only hydrosalpinx or no abnormal ultrasonographic changes in the adnexal area.Nineteen (46.3％,19/41) cases were correctly diagnosed by preoperative ultrasonography,while 22 (53.7％,22/41)cases were missed or misdiagnosed.Conclusions Ultrasonography imaging of PFTC has certain characteristics,but it tends to be missed or misdiagnosis when the lesion is small.Ultrasound can show the location,size,internal echo,blood flow and distant metastasis of lesion,which can be taken as the first choice of imaging methods for preoperative diagnosis and postoperative follow-up of PFTC.

Pathologic features of fallopian tubal fimbriae in patients with endometrial serous carcinoma / 中华妇产科杂志

Objective To discuss the potential relationship between endometrial serous carcinoma (ESC) and tubal epithelial lesions by pathologic examination of fallopian tubes with ESC. Methods A total of 30 cases of typical ESC were reexamined and chosen by the pathologist. In each case, bilateral fallopian tubes were submitted to examination of pathologic morphology and immunostaining for p53, annexin Ⅳ(ANX-Ⅳ), human epidermal growth factor receptor 2(HER2)/neu, and high-mobility group protein A2 (HMGA2). Results Fallopian tubal epithelial lesions were found in 15 cases, including 9 cases tubal serous carcinoma, 2 cases serous tubal intraepithelial carcinoma (STIC) and 2 cases epithelial hyperplasia. Both sides of tubal serous carcinoma and STIC were found in 1 case. The results showed the positive expression for p53 in 26(87%)out of 30 endometrial malignant specimens tissues and 9(30%)tubal tissues samples (P>0.05). Twenty-five(83%)endometrial malignant specimens tissues and 6(20%)tubal tissues samples showed the positive expression of ANX-Ⅳ. Twenty-one(70%)endometrial malignant tissues and 7(23%) tubal tissues showed the positive expression of HER2/neu. Twenty-five(83%) endometrial malignant tissues and 6(20%)tubal tissues showed the positive expression of HMGA2. While, there were significant differences among the expression of three proteins between endometrium and the fallopian tube site (all P<0.05). Conclusions STIC may be associated with the occurrence of ESC. The expression of p53 was positively correlated between the fallopian tube and the endometrium. ANX-Ⅳ,HER2/neu and HMGA2 were extensively expressed in ESC.

CT Features of Atypical Primary Carcinoma of the Fallopian Tube and Ovarian Cystadenocarcinoma / 中国医学影像学杂志

Purpose To summarize the CT features and clinical characteristics of atypical primary fallopian tube cancer (PCFT) and ovarian cystadenocarcinoma (OCA), in order to improved the diagnosis. Materials and Methods CT findings and clinical data of 12 patients with atypical PCFT (PCFT group) and 20 patients with OCA (OCA group) were retrospectively studied. All patients were confirmed by pathology. Serum CA125 level, clinical characteristics and CT features of two groups were compared. Results Serum CA125 level of PCFT group and OCA group were (486.13±23.89) U/ml and (1606.94±62.86) U/ml, respectively. There was statistic difference between the two groups (P0.05). Conclusion Clinical findings of serum CA125 level, vaginal bleeding, and vaginal discharge combine with imaging findings of diameter of the ovarian vein in the affected side, diameter of ipsilateral round ligament of uterus, tumor volume, CT values of the mass in venous and delay phase would be the key points for differential diagnosis of PCFT and OCA.

The predict value of serum CA125 in epithelial ovarian cancer,fallopian tube cancer and peritoneal cancer chemotherapy reactivity / 重庆医学

Objective To investigate the changes of CA125 level with intra-abdominal tumor(epithelial ovarian cancer ,fallopian tube cancer and peritoneal cancer ) before and after chemotherapy serum and their effect on the prognosis of patients and their the clinical predictive value .Methods 174 cases(107 cases of epithelial ovarian cancer ,35 cases of fallopian tube cancer ,and 32 cases of peritoneal cancer) with peritoneal cancer patients were selected from January 2007 to January 2008 .The percentage decrease of ser-um CA125 were calculated after 3 courses of chemotherapy and CA125 decreased level of sensitivity with chemotherapy were ana-lyzed .The different levels of CA125 of median survival time and median survival time were compared .Results After chemothera-py ,CA125 decreased ≥ 75% in 42 cases ,decreased from 51% to 75% in 62 cases ,decreased from 25% to 50% in 32 cases ,and de-creased less than 25% in 38 cases .In CA125 decreased ≥ 75% group ,the chemotherapy effects was better than the other groups (P<0 .05) .Univariate analysis showed that the decrease proportion of CA 125 was positively correlated with chemotherapy effect (r=0 .396 ,P=0 .000) .Using the Kaplan-Meier method ,the patient's survival rate and median survival time were caculated and it showed that the 5 years survival and median survival time were significantly better in group CA 125 decline ≥ 75% than the other groups(P<0 .05) .Univariate analysis shows that the CA125 decline proportion of patients and long term efficacy was positively correlated(r=0 .412 ,P=0 .000) .The COX risk model analysis showed that FIGO stage ,CA125 level and the effect of chemothera-py were independent prognostic risk factors .Conclusion The level of CA125 is the independent risk factor of epithelial ovarian cancer ,fallopian tube cancer and peritoneal cancer prognosis .CA125 decline proportion could be used to know the effect of chemo-therapy and long term treatment ,and be the prognosis indicators for patients with intra abdominal tumor .

Primary Fallopian Tube Carcinoma Diagnosed with Endoscopic Ultrasound Elastography with Fine Needle Biopsy

Primary fallopian tube carcinoma (PFTC) is a rare gynecological cancer that is very difficult to diagnose preoperatively. Here, we report the case of a 66-year-old female patient with PFTC that was diagnosed preoperatively on the basis of the characteristic features on endoscopic ultrasound (EUS) elastography and fine needle biopsy (FNB). EUS showed a sausage-shaped hypoechoic mass, 8 cm in size, with irregular margins and heterogeneous internal echoes extending to both adnexa. EUS elastography revealed that the mass had a blue color pattern, representing hard stiffness, and a heterogeneous green/red color pattern distributed outside the tumor, representing intermediate stiffness. Histopathologic analysis of the FNB and operative specimens confirmed the diagnosis of fallopian tube carcinoma. This is the first reported case of a combined EUS elastography and FNB of an adnexal mass leading to a preoperative diagnosis of fallopian tube carcinoma.

Re-evaluation of interval debulking surgery in advanced epithelial ovarian cancer / 中华妇产科杂志

Objective Previous study showed that interval debulking surgery (IDS) may improve the survival of patients with advanced epithelial ovarian cancer (EOC).The precise significance of IDS needs to be evaluated.Methods Totally 136 consecutive patients with stage Ⅲ c or Ⅳ EOC (including primary peritoneal carcinoma and primary fallopian tube carcinoma ) who completed primary debulking surgery (PDS) and platinum-based chemotherapy were enrolled from January 2000 to December 2009 in a retrospective cohort study.The study group was divided into three groups:65 cases underwent optimal PDS (Group A ),41 cases received chemotherapy alone after suboptimal PDS (Group B ),and 30 patients underwent IDS after suboptimal PDS (Group C).All patients received six to eight courses of platinum-based combination chemotherapy (paclitaxel plus carboplatin/cisplatin,cyclophosphamide plus epirubicin and cisplatin).Patients' clinical characteristics,perioperative situation and prognosis were compared. Results Sixty-five cases (47.8％,65/136) from 136 patients achieved optimal PDS.For Group C,77％ (23/30)patients obtained optimal debulking surgery after IDS.Intraoperative injury rates were similar between Group B and Group C ( P ＞ 0.05 ).Mild perioperative complications rate was also similar ( P ＞0.05 ).Median progression-free survival (PFS) of Group A was 26 months.Median overall survival (OS) of Group B and Group C were 3l months and 40 months,respectively (P =0.254).Median PFS of Group B and Group C were 13 months and 24 months,respectively (P =0.289).Although when it came to 20 months after PDS,patients who underwent IDS had a significantly lower progressive disease (PD) rate (Group B 33％ versus Group C 61％,P =0.046 ),it still showed that there was no significant difference in either OS or PFS of these two groups.Those patients in Group C who obtained no visible residual got similar PFS (27 months) comparing to Group A (26 months,P =0.730),but OS was still shorter (P =0.010).Conclusions For advanced EOC patients,IDS has little effect on improving survival.While it is safe and acceptable,also may prolong PFS in those patients who got no visible residual after IDS.The results suggest that IDS might be used as an alternative treatment for advanced EOC patients who cannot obtain optimal PDS in certain local hospitals.

Preliminary study on the relationship between tubal intraepithelial carcinoma of the fimbria and pelvic high-grade serous carcinoma / 中华妇产科杂志

Objective To explore the relationship between tubal intraepithelial carcinoma (TIC) of the fimbria and pelvic high-grade serous carcinoma.Methods All 34 cases of pelvic high-grade serous carcinoma with clear fimbria were evaluated from January 2009 to June 2010,including ovarian carcinoma (n=26),tubal carcinoma (n=7) and peritoneal carcinoma (n=1).Among of these ovarian carcinomas,12 cases were surface deposits and the other 14 cases within ovarian parenchyma.All 42 cases of non highgrade serous carcinoma in this period including 13 endometrioid ovary carcinomas,11 clear cell ovary carcinomas,11 mucinous ovary carcinomas,6 low-grade serous ovary carcinomas,1 low-grade serous tubal carcinoma,were also collected as a reference.The presence of tubal intraepithelial carcinomas was assessed.Based on the presence of TIC,high-grade serous ovary carcinomas were divided into TIC positive (+) and TIC negative (-) groups,and the clinical and pathological features of them were also evaluated.Results Fifteen cases (44％) were identified TIC in 34 high-grade pelvic serous carcinomas,and all of them were in the fimbria only,while none of TIC was found in control cases.There were significant difference between the two groups (x2=23.086,P=0.000).Eleven cases(42％) were identified TIC in all 26 high-grade ovarian serous carcinomas,in which 8 cases with unilateral ovary carcinomas were associated with ipsilateral TIC,2 cases with bilateral ovary carcinomas associated with unilateral TIC and one case with bilateral ovary carcinoma was associated with bilateral TIC.Four TIC (4/7) were identified in 7 cases with high-grade tubal serous carcinomas,and there was no presence of TIC in the 1 high-grade serous peritoneal carcinoma.Of all 26 high-grade ovarian serous carcinomas,6/11 cases were surface deposits,and 5/11 were parenchyma tumors in TIC (+) group while 6/15 cases were surface deposits and 9/15 were parenchyma tumors in TIC (-) group,in which there were correlated in distribution of TIC between the two groups( P＞0.05 ).The average diameter of ovarian cancer were 6.9 and 6.5 cm between the two groups with no significant differences ( t=0.409,P=0.690).Conclusion TIC is specific to high-grade serous carcinomas and maybe have something to do with the pathogenesis of pelvic serous carcinomas.

Leiomyoma Arising in Ampulla of the Fallopian Tube: A Case Report / 대한산부인과학회잡지

Leiomyoma of the fallopian tube is rare and very rarely found in the ampullary portion. A case of this exceedingly rare occurrence is herein reported. A 76-year-old woman presented with palpable abdominal mass. A huge mucinous cystadenoma of right ovary was noted at laparotomy and a small leiomyoma of ampulla of left fallopian tube was found, incidentally. The literature is briefly reviewed.

CT and MRI diagnosis of tubo ovarian masses / 中华放射学杂志

Objective To evaluate the diagnostic value of CT and MRI in tubo ovarian masses. Methods CT scan was performed in 67 patients with tubo ovarian masses confirmed by pathology. 19 of them underwent MRI. Results (1) 20 primary malignant ovarian tumors showed cystic, solid or cystic solid masses; papillary projections on cystic wall; pelvic organs and pelvic wall invasion. Chocolate cysts with malignant degene ration exhibited small nodules on thickened cystic wall on CT and MRI.T 1WI was better for revealing the lesions. (2) Of 11 cases of metastasis to tubo ovary, 4 showed peritoneal linear enhancement. (3) There were 9 cystadenomas and 2 adenofibromas , one of the cystadenomas contained fat, two adenofibromas were similar to uterus in density on CT while showing lower signal intensity on MRI (both T 1WI and T 2WI). (4) Three cases of thecoma exhibited cystic or solid masses, solid thecomas revealed granular enhancement.(5) Teratomas were most spicific, one of them was associated with thecoma.(6) Tubo ovarian abscesses and tuberculosis depicted cystic or cystic solid masses.(7) Two cases of tubal pregnancy showed inhomogeneous soft tissue masses, the lower density areas in the centers were clot and organized tissues confirmed by pathology. Conclusion (1) CT and MRI had higher sensitivity but lower specificity for tubo ovarian masses, the diagnosis should be combined with clinical history and patients′ age. (2) Tumors of two different types may coexist and sometimes fat may be present in tumors other than teratoma.