Transtubal Spread of a Superficially Invasive Cervical Adenocarcinoma to the Ovaries After 11 Years.

We report a 55-yr-old woman who presented with bilateral ovarian masses, 11 yr after hysterectomy for superficially invasive stage IA1 cervical adenocarcinoma of usual (human papillomavirus-associated) type. The bilateral ovarian tumors were composed of glands lined by malignant mucinous epithelium and these tumors were metastases from her previous cervical adenocarcinoma, based on morphology, immunophenotype, and positive in situ hybridization for human papillomavirus. In addition, there was extensive involvement of the mucosa of the left fallopian tube by malignant mucinous epithelium. The patient is alive and well 2 yr after the ovarian recurrence. The phenomenon of minimally invasive cervical adenocarcinoma metastasizing to the ovary has been described previously; the extrauterine disease is typically limited to the ovaries and associated with a relatively favorable prognosis. The presence of fallopian tube involvement by cervical adenocarcinoma has rarely been reported, and suggests transtubal spread of tumor. Unique to this case is the >11 yr interval between diagnosis of the cervical and ovarian disease, with previously described cases showing up to a 7 yr latency period. This case demonstrates that spread of cervical adenocarcinoma to the ovaries, via the fallopian tube lumen, can occur after a very long latent period and this possibility must be considered when examining adnexal mass(es) in women who have previously had a hysterectomy for cervical adenocarcinoma.

Detection of human papilloma virus subtypes 16 and P16(ink4a) in invasive squamous cell carcinoma of the fallopian tube and concomitant squamous cell carcinoma in situ of the cervix.

Squamous cell carcinoma (SCC) of the fallopian tube is rare and often diagnosed postoperatively. Cervical cancer is considered as a long-term sequaele, resulting from sexual transmitted infection with certain common high-risk human papilloma virus (HPV) types. The role of human papilloma virus in the development of the tubal SCC is unknown. We report an unusual case of SCC of the fallopian tube, synchronously occurring with cervical SCC in situ in a 49-year-old patient. Histological examination of the entire endometrium revealed no involvement Both tubal and cervical lesions showed the presence of high risk HPV 16 by PCR and increased expression of p16(INK4a) protein. Both SCC of the fallopian tube and cervical SCC in situ were positive for p63, while the non-involved tubal epithelium was positive for WT-1, but negative for p63. In conclusion, the concomitant occurrence of fallopian tube and cervical SCC can be explained by: (i) the 'field effect' of HPV infection resulting in the concomitant development of primary SCC in various sites of the female genital tract; (ii) the primary fallopian tube SSC metastasizing to the uterine cervix; or (iii) primary cervical SCC metastasizing to the fallopian tube. The detection of HPV 16 and p16(INK4a) in both the fallopian tube and cervicalSCCs strengthens the hypothesis of the 'field effect' of HPV infection.

Human papillomavirus infection and primary fallopian tube carcinoma: a seroepidemiological study.

OBJECTIVE: To evaluate the role of human papillomavirus (HPV) types 6, 11, 16, 18, 31 or 33 infection in primary fallopian tube carcinoma (PFTC). DESIGN: A retrospective case-control study. SETTING: Department of Obstetrics and Gynaecology, Helsinki University Hospital, Finland. POPULATION: Seventy-eight consecutive women with PFTC diagnosed between 1985 and 2000 were studied. For each case, two healthy controls were selected. METHODS: Serum immunoglobulin G antibodies to HPV types 6, 11, 16, 18, 31 and 33 were measured from women with PFTC and their healthy controls. MAIN OUTCOME MEASURES: Analysis of HPV 6, 11, 18, 31 and 33 seropositivity among women with PFTC and controls. RESULTS: Seropositivity rates of non-oncogenic or oncogenic HPV types did not differ between cases and controls, odds ratios being 1.04-1.30 for oncogenic HPVs and 1.08-1.19 for non-oncogenic HPVs, similarly. We did not find any multiplicative joint effect in PFTC by antibodies to more than one oncogenic HPV type; neither did we find any antagonistic effect among women with antibodies to non-oncogenic and oncogenic HPV types. CONCLUSIONS: Our results do not suggest any link between PFTC and serological evidence for HPV infection.

Cervical squamous cell carcinoma in situ with intraepithelial extension to the upper genital tract and invasion of tubes and ovaries: report of a case with human papilloma virus analysis.

A 55-year-old woman, who was found to have malignant squamous cells on a routine cervical smear, underwent a conization biopsy, followed by hysterectomy with bilateral salpingo-oophorectomy. No gross tumor was present in the uterus, but both ovaries, which were of normal size, contained multiple cysts filled with light brown, soft material. Microscopic examination showed squamous cell carcinoma in situ of the cervix with contiguous spread to the endometrium, fallopian tubes, and ovaries; squamous cell carcinoma extensively replaced the endometrial and tubal epithelium, focally invaded the wall of the fallopian tubes, and involved the parenchyma of both ovaries. Although an invasive cervical carcinoma occasionally spreads to the ovary, this case illustrates that exceptionally an in situ tumor spreads along the epithelium of the upper genital tract and the ovarian surface and invades the ovary and tubes. The detection of human papillomavirus DNA in the cervical, endometrial, tubal, and ovarian tumors by the polymerase chain reaction suggests a role for human papilloma virus infection in this case.