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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 5  |  Issue : 3  |  Page : 161-164

Primary fallopian tube carcinoma: A case of rare malignancy


Department of Pathology, ESI PGIMSR and ESIC Medical College and ESIC Hospital, Kolkata, West Bengal, India

Date of Submission17-Sep-2018
Date of Acceptance22-Oct-2018
Date of Web Publication24-Dec-2018

Correspondence Address:
Dr. Sudipta Bera
FD-465/2, Salt Lake City, Sector III, Kolkata - 700 106, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jhrr.jhrr_29_18

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  Abstract 

Primary fallopian tube carcinoma is an extremely uncommon tumor of female genital tract origin with the incidence of 0.1%–1.8% of all genital malignancies. Due to its nonspecific symptomatology and rarity of this neoplasm, correct preoperative diagnosis is made only in 4% of the cases and is usually first recognized by pathologist. Our case was a 39-year-old patient who presented with intermittent vaginal bleeding, lower abdominal pain, and pelvic mass. On physical examination, lower abdominal tenderness was found. Ultrasound examination revealed bilateral hydrosalpinx. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathological examination confirmed features of papillary serous adenocarcinoma of the left fallopian tube. The patient was referred to oncologist for chemotherapy. Six months following initial surgery, the patient is in good condition. This case is being reported due to the scarcity of data published from the Indian population and rarity of this neoplasm.

Keywords: Fallopian tube neoplasm, primary fallopian tube carcinoma, serous adenocarcinoma


How to cite this article:
Chakrabarti PR, Bera S, Rana S. Primary fallopian tube carcinoma: A case of rare malignancy. J Health Res Rev 2018;5:161-4

How to cite this URL:
Chakrabarti PR, Bera S, Rana S. Primary fallopian tube carcinoma: A case of rare malignancy. J Health Res Rev [serial online] 2018 [cited 2019 Dec 8];5:161-4. Available from: http://www.jhrr.org/text.asp?2018/5/3/161/248447


  Introduction Top


Primary  Fallopian tube More Details carcinoma (PFTC) is a rare gynecological tumor accounting for an approximately 0.14%–1.8% of female genital tract malignancies.[1],[2] It was first described by Renaud in 1847. In 1888, Orthmann presented the first case report.[3] PFTC is rarely diagnosed preoperatively due to its nonspecific symptomatology.[4] The etiology of this cancer is not known; its association with infertility, tuberculous salpingitis, chronic tubal inflammation, infertility, and tubal endometriosis has been reported.[5] An ovarian and fallopian tube malignancy shared similar BRCA germline and TP53 mutations.[6] Herein, we report a case of PFTC in a 39-year-old female with a review of literature due to its rarity of presentation.


  Case Report Top


A 39-year-old patient was presented with abnormal vaginal bleeding for the past 4 months and dysmenorrhea for 1 year. She also complained of lower abdominal pain which was dull in nature and intermittently radiated to back. There was no significant family history. She was known hypertensive and diabetic and was on medication for the same for the past 3 years.

On physical examination, she had lower abdominal tenderness. Per speculum examination revealed mild vaginal bleeding with healthy cervix and vagina. Transabdominal sonography showed bilateral hydrosalpinx and myoma measuring 36 mm × 34 mm. A diagnostic curettage was previously performed which revealed simple hyperplasia of the endometrium. The serum levels of cancer antigen (CA)-125 (11.8U/ML), alpha-fetoprotein (2.52 ng/ml), and CA-19.9 (21.7U/ML) were within normal limits. The patient after an informed consent underwent total abdominal hysterectomy withbilateral salpingo-oopherectomy. On gross examination of lymph node stations intraoperatively were unremarkable. Specimens were received in histopathology section.

Gross examination revealed uterus with cervix with bilateral adnexa, uterus with cervix measured 10 cm × 8 cm × 6 cm and cervix measured 3 cm. Cut section showed thickened myometrium with trabeculation [Figure 1]. Left-sided tube measured 8 cm × 4 cm × 3 cm and right tube measured 7 cm × 2 cm × 2 cm. Both the tubes were tortuous and dilated. Cut section through left fallopian tube revealed gray-white friable tissue with papillary excrescences attached to the wall and occluding lumen along with blood clot [Figure 2]. The right fallopian tube on cut section revealed blood clots. Serosal surface of both the tubes was grossly unremarkable. Both the ovaries were grossly unremarkable.
Figure 1: Gross photomicrograph displaying uterus with cervix and bilateral hydrosalpinx

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Figure 2: Gross photomicrograph displaying cut-opened specimen of the uterus with cervix and tortuous fallopian tube with neoplastic grayish white lesion

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Microscopic examination of uterus revealed features of adenomyosis. Cervix showed features of chronic cervicitis. Left fallopian tube showed atrophic lining epithelium with wall displaying infiltrating tumor composed of atypical epithelial cells with nuclear hyperchromasia, moderate anisonucleosis, prominent nucleoli arranged in glandular pattern, and forming papillae at places reaching up to two-thirds of muscle layer along with necrosis and mitotic figures [Figure 3] and [Figure 4]. Section from right fallopian tube showed features of hematosalpinx. Sections from both the ovaries were unremarkable. Histopathological diagnosis of primary papillary serous adenocarcinoma of the left fallopian tube was made. Uterus, both the ovaries and serosal surface of both tubes, was free of tumor.
Figure 3: Scanner view showing wall of fallopian tube displaying features of primary serous adenocarcinoma

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Figure 4: Low-power view displaying tumor cells arranged in ill-formed glandular pattern involving wall

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In our case, the diagnosis was arrived after histopathological examination. This is the fact that fallopian tube carcinomas are almost difficult to diagnose preoperatively due to its rarity and nonspecific symptomatology.[7] The patient was discharged after a week following surgery and was referred to oncologist for adjuvant therapy.


  Discussion Top


PFTC is the rarest tumor of the female genital tract and was first reported in literature 1897.[8] PFTC most commonly occurs in the postmenopausal age group with peak incidence in-between age 60 and 64 years and the mean age of incidence as 55 years (age range: 17–88 years).[9] In the present case, our patient was 39-year old with no history of predisposing factor such as nulliparity, pelvic inflammatory disease.

The clinical presentation of PFTC is usually nonspecific. The Latzko's triad of typical symptoms is consistent of intermittent profuse serosanguinous vaginal bleeding, colicky pain relieved by discharge and an abdominal or pelvic mass. The triad has been documented in only 15% of PFTC cases.[10] In our case, most of these symptoms were present. However, in most cases, PFTC is rarely diagnosed preoperatively.[4] The rate of preoperative diagnosis was in the range of 0%–10%.[2] Pathogenesis of fallopian tube serous cystadenocarcinoma is poorly understood. If the definitive oncogenic driver can be found out and confirmed through robust studies, gene-targeted therapy can be targeted.[11]

The diagnostic criteria for PFTC were first established by Hu et al. and later slightly modified by sidles. It is difficult to differentiate PFTC from epithelial ovarian carcinoma. The patients should meet at least one of the following criteria for the diagnosis of PFTC.[4] (a) The main tumor is in the tube and it arises from the endosalpinx; (b) histologically, the pattern reproduces the epithelium of the mucosa and it often shows a papillary pattern; (c) if the wall is involved, the transition between the benign and the malignant epithelium should be demonstrable; and (d) the ovaries and the endometrium are either normal or they may contain less tumor than that which is there in the tube. In our case, all the four criteria were fulfilled.

Routine imaging modalities for suspected gynecological malignancy are ultrasound of whole abdomen and pelvis, computed tomography (CT scan), or magnetic resonance imaging (MRI) of the abdomen. Transabdominal and transvaginal ultrasound is the initial and essential imaging investigation for diagnostic workup of the patient with other pelvic suspected tubal pathology. However, ultrasound finding of tubal carcinoma may mimic other pelvic conditions such as ovarian tumor and tubo-ovarian abscess; however, several other findings may provide diagnostic clue preoperatively. The echogram may display cystic mass with space and mural nodules, a sausage-shaped mass, or a multilobular mass with a cog-and-wheel appearance.[12] On CT scan, a solid papillary intratubal mass allows easy detection of PFTC. MRI is considered a better method than CT scan or ultrasound for detecting the infiltrating tumor.[4] In our case, due to a low suspicion of malignancy, ultrasonography of the abdomen and pelvis was done.

The surgical procedure of choice is total abdominal hysterectomy, bilateral salpingo-oophorectomy, selective pelvic, and para-aortic lymphadenectomy depends on the stage of PFTC. Given the early lymphatic spread, the role of the routine lymph node evaluation is advised in PFTC. In our case, the patient after informed consent underwent total abdominal hysterectomy with bilateral oophorectomy with intraoperative inspection of lymph node which was grossly insignificant; postoperative platinum-based combination adjuvant chemotherapy is the most commonly used therapy for PFTC.[13]


  Conclusion Top


The incidence of PFTC is rather low accounting for 0.1%–1.8% of all genital malignancies. Due to nonspecific symptomatology, it is very difficult to diagnose preoperatively. In most cases, it is a histopathological diagnosis. Hence, it should be considered in differential diagnosis of pre and postmenopausal women who presented with unexplained uterine bleeding, pelvic pain, and adnexal mass.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Balaya V, Metzger U, Denet C, Herry M, Lecuru F. Isolated fallopian tube metastasis from colorectal cancer: Ultrasonographic features. J Ultrasound 2018;21:69-75.  Back to cited text no. 1
    
2.
Toyoda T, Suzuki H, Nakajima T, Iwata T, Matsuoka A, Nishikimi K, et al. Successful diagnosis of an occult fallopian tube carcinoma detected from the diaphragm metastasis. Gen Thorac Cardiovasc Surg 2018;66:484-7.  Back to cited text no. 2
    
3.
Chen Y, Ling C, Bian C. Port-site metastasis as a primary complication following diagnostic laparoscopy of fallopian tube carcinoma: A case report. Medicine (Baltimore) 2018;97:e11166.  Back to cited text no. 3
    
4.
Rexhepi M, Trajkovska E, Ismaili H, Besimi F, Rufati N. Primary fallopian tube carcinoma: A case report and literature review. Open Access Maced J Med Sci 2017;5:344-8.  Back to cited text no. 4
    
5.
Hariprasad P, Hariprasad S, Srinivas T, Shetty KJ. Primary bilateral fallopian tube carcinoma the report of a single case with review of the literature. J Clin Diagn Res 2013;7:930-2.  Back to cited text no. 5
    
6.
Howitt BE, Hanamornroongruang S, Lin DI, Conner JE, Schulte S, Horowitz N, et al. Evidence for a dualistic model of high-grade serous carcinoma: BRCA mutation status, histology, and tubal intraepithelial carcinoma. Am J Surg Pathol 2015;39:287-93.  Back to cited text no. 6
    
7.
Puig F, Lapresta M, Lanzon A, Crespo R. Fallopian tube carcinoma: Incidental finding during surgery for acute pelvic inflammatory disease – Case report. Eur J Gynaecol Oncol 2006;27:526-7.  Back to cited text no. 7
    
8.
Tongsong T, Wanapirak C, Tantipalakorn C, Tinnangwattana D. Sonographic diagnosis of tubal cancer with IOTA simple rules plus pattern recognition Asian Pac J Cancer Prev 2017;18:3011-5.  Back to cited text no. 8
    
9.
Manjunatha HK, Mohan B, Geethamani V. Bilateral primary papillary serous carcinoma of the fallopian tube. J Clin Diagn Res 2017;11:ED38-9.  Back to cited text no. 9
    
10.
Lau HY, Chen YJ, Yen MS, Chen RF, Yeh SO, Twu NF, et al. Primary fallopian tube carcinoma: A clinicopathologic analysis and literature review. J Chin Med Assoc 2013;76:583-7.  Back to cited text no. 10
    
11.
Kristeleit R, Shapiro GI, Burris HA, Oza AM, LoRusso P, Patel MR, et al. A phase I-II study of the oral PARP inhibitor rucaparib in patients with germline BRCA1/2-mutated ovarian carcinoma or other solid tumors. Clin Cancer Res 2017;23:4095-106.  Back to cited text no. 11
    
12.
Balaya V, Metzger U, Lecuru F. Ultrasonographic features in the preoperative diagnosis of primitive fallopian tube carcinoma. J Gynecol Obstet Biol Reprod (Paris) 2016;45:11-20.  Back to cited text no. 12
    
13.
Berek JS, Crum C, Friedlander M. Cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet 2015;131 Suppl 2:S111-22.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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