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Primary adenocarcinoma of fallopian tube is the rarest gynecological malignancy of female genital system which is usually misdiagnosed as ovarian tumour or tubo-ovarian mass. We present a case in a 40 year old female.
A female aged 49 years presented with pain and progressive swelling of right lower abdomen. She was operated upon and gross examination revealed a proliferative growth in the fimbrial end of the right fallopian tube. Microscopically the tumour comprised of adenocarcinoma and component of spindle cell stromal sarcoma with areas of chondrosarcoma as heterologous element. A diagnosis of malignant mixed mullerian tumour of the fallopian tube, clinically FIGO stage III was made, which is extremely rare in available literature.
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The advantages of microsurgical anastomosis for cornual occlusion are evaluated in a series of 82 pure cases of pathologic cornual occlusion. The term pregnancy rate was 44% and the ectopic pregnancy rate was 7%. The following factors were found influencing the pregnancy rate: maximized tubal length; preserved intramural portion; absence of chronic inflammation; absence of tubal inclusions; absence of tubal endometriosis.
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The authors have carried out a prospective study from the 1 January 1977 to the 31 December 1981 on 168 women, 89.3% of whom (150/168) had pure distal tubal microsurgery and 10.7% (18/168) had mixed surgery. The results were studied in relationship to the aetiological reason for tubal sterility, which was: salpingitis in 60 cases = 35.7%; appendicitis in 23 cases = 13.7%, endometriosis in 29 cases = 17.3%, termination of pregnancy in 22 cases = 13.1% and unknown causes in 34 cases = 20.2%. The figures for intra-uterine pregnancies were 32.74% after 24 months using a classical method of determining it and 31% using an actuarial method. There was a significant difference between endometriosis and the four other aetiologies. These latter could not be differentiated between one another. The level of ectopic pregnancies was 5.3% at 24 months, or 6.3% using an actuarial method. It was higher after endometriosis. It would therefore appear from the results of this study that endometriosis seems to be poor from a prognostic point of view when compared with the other aetiological causes and the results shown in the literature. Finally the authors discuss in cases of endometriosis whether it is correct to carry out a second operation after the first or to resort to the other possibility, namely in vitro fertilisation.
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Although endometriosis appears as a rare cause in long series of cases of extrauterine pregnancy, the study of pregnancies which survive after treatment of endometriosis show a significant increase of extrauterine pregnancy, especially in cases of proximal lesions. The authors thinks that careful anatomo-pathological examination of tubes resected because of extrauterine pregnancy undoubtedly permit a large number of endometriosis lesions to be found.
A review of 79 cystic lesions found in the routine study of the fallopian tube and its surrounding areas between the years 1980 and 1982, revealed that the majority of the lesions represented accessory lumina of the fallopian tube. These tubal cysts commonly have been described as hydatids or parovarian cysts, but their relationship to the normal tube has not been identified clearly, their frequency has not been determined, their clinical significance rarely has been considered, and their embryologic origin remains imperfectly understood.
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The study of tubal cytosol receptors for estradiol and progesterone shows that they are (in comparison with normal tubes) less in number in post-infection cases (proximal or distal) and increased in number in proximal endometriotic lesions. These variations are only significant for the progesterone receptors. These results are compared with those in the literature, and their implications, concerning hormone treatments used together with microsurgical tubo-plasties, are discussed.
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Proliferative epithelial lesions of the oviduct have been called adenomatous hyperplasia or carcinoma in situ. In order to assess the incidence and significance of these lesions, we sectioned entire oviducts from 124 nonselected hysterectomies. We found 23 cases (18.5%) with lesions corresponding to those described in the literature. We have found no justification for diagnosing and treating these lesions as carcinoma in situ. There appears to be an association with salpingitis.
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