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Effects of interstitial fallopian tube polyps on isthmic tubal diameter.

OBJECTIVE: To study the apparent association between interstitial fallopian tube polyps and isthmic tubal dilatation. DESIGN: Retrospective clinical study. SETTING: Tertiary academic medical center. PATIENT(S): Sixty-five patients with normal hysterosalpingograms and 40 patients with interstitial tubal polyps (25 unilateral and 15 bilateral). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Proximal, medial, and distal isthmic diameters were measured digitally and normalized according to an internal standard. Polyp volumes were measured and divided into four groups according to increasing volume (<2 mm3, 2-5 mm3, 6-12 mm3, >12 mm3). RESULT(S): There was a significant increase in proximal isthmic tubal diameter in patients with interstitial polyps. Mean diameter increased from 0.6 mm to 0.9 mm. There was no significant change in more distal isthmic diameters. Larger polyps tended to be associated with larger luminal diameters. CONCLUSION(S): Interstitial fallopian tube polyps are associated with a significant increase in proximal isthmic luminal diameter as determined on hysterosalpingography. Although these polyps are nonobstructing and thus thought by most investigators not to affect fertility, their association with altered luminal diameter and perhaps altered function might be of clinical interest.

Fallopian Tube Diseases↗

The value of hysterosalpingography before reversal of sterilization procedures involving the fallopian tubes.

Knowledge of the length of the uterine end of the fallopian tube and the presence of tubal adhesions and fistulas is important when surgical reversal is undertaken in patients who have had tubal ligation. We retrospectively studied hysterosalpingograms in 127 such patients to determine their value in providing this information. The ligation was performed by using the Pomeroy technique in 57 patients. Sixty-one patients had bipolar electrocautery, six had Falope rings inserted, and three had Hulka clips applied. In all cases, the uterine ends of the tube were visualized to a point of obstruction. The sites of occlusion after Pomeroy ligation were midtubal (46%), cornual (16%), proximal ampullary (16%), proximal isthmic (14%), and intramural (8%). After the electrocautery procedure, the sites of occlusion were proximal isthmic (45%), intramural (20%), midtubal (19%), cornual (15%), and proximal ampullary (1%). When Falope rings and Hulka clips were used, the most frequent site of occlusion was midtubal (50%). Tubal adhesions, consistent with successful occlusion, were detected in 16 patients on the basis of a small confined area of extravasation of contrast material at the site of ligation. Tuboperitoneal fistulas, identified by the presence of contrast material spilled from the uterine end of the tube into the peritoneal cavity, were detected in five patients. Our results show that hysterosalpingography is a useful technique for determining the status of the uterine end of the fallopian tube after ligation when reversal of ligation is planned.

Female↗

The expression of class II MHC gene products by fallopian tube epithelium in pregnancy and throughout the menstrual cycle.

The expression of HLA class II antigens by human fallopian tube epithelium was investigated in ectopic tubal pregnancy, in normal early and full-term intrauterine pregnancy, and during the menstrual cycle. Monoclonal antibodies directed against non-polymorphic (DA6.231, CR3/43, B7/21) and polymorphic (DA6.147, DA6.164, anti-leu-10) determinants of the HLA-D locus were used in a standard indirect immunoperoxidase method on fresh cryostat sections of fallopian tube. In ectopic pregnancy the tube epithelium showed uniform, intense reactivity for DR, DP and DQ. A similar reaction pattern was observed in normal first-trimester pregnancy. At term, most epithelial cells were DR-, DP- and DQ-positive, but a few were DP- and DQ-negative. In fallopian tubes from non-pregnant individuals, a variable number of epithelial cells labelled for DR alpha and DR beta but there was essentially no reactivity for DP or DQ. These results suggest differential regulation of class II MHC gene expression by tube epithelial cells, possibly mediated by hormones and/or a trophoblast product.

Antibodies, Monoclonal↗

Clinical usefulness of endometrial aspiration cytology and CA-125 in the detection of fallopian tube carcinoma.

OBJECTIVE: To determine the clinical usefulness of endometrial aspiration cytology and CA-125 in the detection of fallopian tube carcinoma. STUDY DESIGN: Positive rates of gynecologic cytology and serum levels of CA-125 were examined in 20 consecutive patients with primary fallopian tube carcinoma before any treatment. RESULTS: The positive rates were 25% (5/20) for cervicovaginal smears and 50% (10/20) for endometrial aspiration smears in the absence of endometrial invasion. The positivity of endometrial aspiration cytology was not influenced by clinical staging or tumor differentiation. The presence of disease in all asymptomatic patients (4/4) was suspected by abnormal endometrial cytology. The features of endometrial cytology were consistent with those of extrauterine adenocarcinoma, from which ovarian carcinoma was unable to be differentiated. Serum levels of CA-125 increased with clinical staging. The positive rate for CA-125 was 20% in stage I, 75% in stage II, 88.9% in stage III, 100% in stage IV and 70% (14/20) in all cases. Eighty-five percent (17/20) of cases exhibited either positive endometrial cytology or elevated CA-125 levels. CONCLUSION: The series suggests that the use of endometrial cytology combined with determination of serum CA-125 levels covers most cases of fallopian tube carcinoma and is a potent aid in the detection of this rare disease.

Adenocarcinoma↗

Three-dimensional power Doppler imaging in the assessment of Fallopian tube patency.

OBJECTIVE: The aim of the study was to evaluate the feasibility of three-dimensional power Doppler imaging (3D-PDI) in the assessment of the patency of the Fallopian tubes during hysterosalpingo-contrast sonography (HyCoSy). METHODS: Women attending the fertility clinic were offered a Fallopian tubal patency test as part of the initial investigation. Hysterosalpingo-contrast sonography using contrast medium Echovist was performed on 67 women. Findings on the two-dimensional (2D) gray-scale scanning and three-dimensional power Doppler imaging were compared. The first technique visualizes positive contrast in the Fallopian tube; the second demonstrates flow of medium through the tube. RESULTS: Contrast medium Echovist produced prominent signals on the 3D-PDI image. Free spill from the fimbrial end of the Fallopian tubes was demonstrated in 114 (91%) tubes using the 3D-PDI technique and in 58 (46%) of tubes using conventional HyCoSy. The mean duration of the imaging procedure was less with 3D-PDI, but the operator time which included postprocedure analysis of the stored information was similar. A significantly lower volume of contrast medium (5.9 +/- 0.6 mL) was used for 3D-PDI in comparison with that (11.2 +/- 1.9 mL) used for conventional 2D HyCoSy. CONCLUSION: Color coded 3D-PDI with surface rendering allowed visualization of the flow of contrast through the entire tubal length and free spill of contrast was clearly identified in the majority of cases. The 3D-PDI method appeared to have advantages over the conventional HyCoSy technique, especially in terms of visualization of spill from the distal end of the tube, which was achieved twice as often with the 3D technique. Although the design of the investigation did not allow the side effects of the two techniques to be compared, the shorter duration of the imaging and lower volume of the contrast medium used suggested that the 3D-PDI technique might have a better side-effect profile. The 3D-PDI technique allowed better storage of the information for re-analysis and archiving than conventional HyCoSy.

Contrast Media↗

Isolated torsion of the fallopian tube in an adolescent: a case report.

Isolated torsion of the fallopian tube is an uncommon event. It is a difficult condition to evaluate clinically and surgery is often necessary to establish the diagnosis. This report focuses on a 15-year-old female who presented with acute pelvic pain, nausea, and vomiting. Pelvic ultrasound showed an adnexal mass. A diagnostic laparoscopy was performed which confirmed the diagnosis of isolated tubal torsion. Based on this experience as well as other similar reported cases, isolated torsion of the fallopian tube should be considered in the differential diagnosis of acute lower abdominal/pelvic pain in the female patient. Prompt surgical intervention may allow for preservation of the tube.

Abdominal Pain↗

Sister Mary Joseph's nodule as the first presenting sign of primary fallopian tube adenocarcinoma.

Umbilical metastasis (Sister Mary Joseph's nodule) is often the first sign of intraabdominal and/or pelvic carcinoma. We describe the fourth case reported in the literature of Sister Mary Joseph's nodule originating from fallopian tube carcinoma. In a 54-year-old woman, Sister Mary Joseph's nodule was unexpectedly detected during umbilical hernia repair. Subsequent laparoscopy revealed a 2-cm friable tumor located at the fimbriated end of right fallopian tube and 1-cm peritoneal implant in the pouch of Douglas. Laparoscopic bilateral adnexectomy and resection of the peritoneal implant were performed. Because frozen section examination revealed fallopian tube carcinoma, the procedure was continued with laparotomy including total abdominal hysterectomy, omentectomy, and pelvic lymph node sampling. Final diagnosis was stage IIIB fallopian tube carcinoma. The patient received postoperative adjuvant chemotherapy with single-agent carboplatin and has remained alive and with no evidence of disease. It is concluded that in cases of Sister Mary Joseph's nodule, laparoscopy can be a useful tool in the search of the primary tumor in the abdomen and/or pelvis. Laparoscopy can provide crucial information with respect to the location, size, and feasibility of optimal surgical resection of the intraabdominal and/or pelvic tumors.

Abdominal Neoplasms↗

[Carcinoma of the fallopian tube after prophylactic laparoscopic ovariectomy in a patient with a BRCAI mutation].

A 48-year-old woman with a distended abdomen appeared to have ascites and was admitted to the gynaecological ward. At the age of 31 years she had been diagnosed with breast cancer and had undergone surgical breast conservation of the right breast. There was a history of both ovarian cancer and breast cancer in her family. Genetic evaluation showed that she was carrying a BRCAI germline mutation. At the age of 42 years she underwent a prophylactic bilateral laparoscopic ovariectomy and 5 years later she underwent a complete mastectomy due to breast carcinoma of the left breast. Two months later she developed ascites, a raised CA125 level and on a CT scan carcinoma of the peritoneum. During the laparotomy a fallopian tube carcinoma was found. After the uterus, fallopian tubes and omentum had been surgically removed, chemotherapy took place. The patient tolerated this well and the CA125 value decreased. Recently, the first molecular evidence was found that linked fallopian tube cancer to germline mutations in BRCAI patients. Patients harbouring a BRCA germline mutation not only have an increased risk of ovarian carcinoma but also of fallopian tube carcinoma. Therefore, in patients with a BRCA mutation, prophylactic surgery should take the form of an adnexectomy, not an oophorectomy.

Carcinoma↗

Transcervical fallopian tube recanalization: a safe and effective therapy for patients with proximal tubal obstruction.

Over a 13-month period, 14 patients with proximal tubal obstruction underwent transcervical fallopian tube recanalization under fluoroscopic guidance in an outpatient setting at the hospital of the University of Pennsylvania. Twenty-one of 24 attempted tubal dilations (87.5%) were successful, as demonstrated by tubal opacification and contrast spillage into the peritoneal cavity at the conclusion of the procedure. Four intrauterine pregnancies, and no ectopic pregnancies, have followed the recanalization. One pregnancy ended in an early miscarriage, one patient delivered a healthy term female, and two pregnancies are ongoing at greater than twenty weeks' gestation. Two procedure-related complications occurred: in one patient, the isthmic segment of a fallopian tube was perforated, but healed without incident, and another patient experienced a low-grade fever, which resolved with p.o. antibiotics. We therefore conclude that fallopian tube recanalization is a well-tolerated, safe, and effective procedure for the treatment of proximal tubal occlusion.

Adult↗

Genomic alterations in fallopian tube carcinoma: comparison to serous uterine and ovarian carcinomas reveals similarity suggesting likeness in molecular pathogenesis.

Serous carcinomas of the fallopian tube, uterus, and ovary resemble each other both histologically and in clinical behavior. Comparative genomic hybridization was performed on 20 primary fallopian tube carcinoma specimens to find regions of the genome involved in tubal carcinogenesis and to compare the genomic alterations with those previously detected in serous ovarian and uterine carcinomas. The most frequent changes detected in fallopian tube carcinoma were gains at 3q (70%) and 8q (75%), with high-level amplifications in several cases. Other common gains occurred at 1q, 5p, 7q, 12p, and 20q. The most frequent losses were found at 18q, 8p, 4q, and 5q. The frequency and the pattern of chromosomal changes detected in tubal carcinoma were strikingly similar to those observed in serous ovarian and uterine carcinomas, suggesting common molecular pathogenesis.

Chromosome Aberrations↗

Morphometric studies of the endometrium, the fallopian tube and the corpus luteum during contraception with the 300 micrograms norethisterone (NET) minipill.

Biopsy specimen from endometrium, Fallopian tube and corpus luteum were obtained from 35 women treated with 300 micrograms norethisterone daily and from 10 untreated, normally menstruating women. Peripheral levels of LH, progesterone and estradiol were measured. In the norethisterone-treated women four different ovarian reactions were identified. Ovarian activity was completely suppressed (Type A) in 3 women, follicular activity only (Type B) in 10 women, follicular activity was followed by insufficient luteal function (Type C) in 12 women, and peripheral estradiol and progesterone levels compatible with normal ovulation (Type D) in 10 women. The histology of the endometrium varied between atrophy (3 subjects), suppressed proliferation (9 subjects), proliferation (8 subjects), irregular secretory changes (12 subjects) and apparently normal secretory activity (3 subjects). When the histology of endometrium and Fallopian tube was compared with the peripheral hormonal levels and the corpus luteum steroid production in vitra, no correlation was found. Nor was a correlation found between the histologic changes of corpus luteum, endometrium and Fallopian tube. Thus, these target organs seem to react independently to norethisterone treatment.

Adult↗

Fallopian tube obstruction: selective salpingography and recanalization. Work in progress.

Seven infertile women, in whom interstitial fallopian tube obstruction (IFTO) was suspected at hysterosalpingography and who were recommended for surgical evaluation and treatment, were treated with catheterization techniques. Selective salpingography with ostial injection demonstrated tubal patency in two patients; direct intratubal salpingography demonstrated patency in another patient. Four patients with a true IFTO underwent fallopian tube recanalization: in the first two, a small soft-tipped guide wire was used, and in the other two, a guide wire and 3-F catheter were used. The suggested catheterization techniques have the potential to make evaluation and treatment of IFTO more efficient, safer, and less expensive than presently used methods.

Adult↗

A unilateral twin extrauterine pregnancy occurring in a solitary fallopian tube: therapeutic choices.

A unilateral twin tubal pregnancy occurring in a solitary fallopian tube is presented. The gynecological history was notable for a previous extrauterine pregnancy in the contralateral fallopian tube and reconstructive surgery to the ipsilateral one. Radical total salpingectomy was performed. The rationale for this management is discussed and different therapeutic alternatives presented.

Adult↗

[Radioactive gold treatment of primary carcinoma of the fallopian tube (author's transl)].

20 cases of primary carcinoma of the fallopian tube from 1958 to 1974 are reported. An operation was performed in all cases. A post-operative intra-peritoneal installation of radioactive gold was done in 14 cases. 6 patients which had radioactive gold treatment survived for more than 5 years. None of the patients survived for more than 5 years who did not have radioactive gold treatment. The positive effect on treatment of carcinoma of the fallopian tube of a complete operation with post-operative intra-peritoneal administration of radioactive gold is discussed in detail.

Adult↗

Complex karyotypic abnormalities in a primary carcinoma of the fallopian tube.

Short-term cultures from a primary carcinoma of the Fallopian tube, a tumor type not characterized before by chromosome banding, were examined cytogenetically. Complex chromosome aberrations were found in all mitoses, yielding the karyotype 41,XX,del(1)(p34),del(2)(q31),i(8)(q10),-9, + dic(9;19)(p13;p13), der(12)t(9;12)(p13;q22),-13,-16,-17,-18,-19,-22, +r [61]/84-86,idemx2[15]. Several of the aberrations in the present case are similar to changes found in adenocarcinomas of other organs, including carcinomas of the ovaries and uterus, indicating pathogenetic similarities between Fallopian tube malignancies and the more common gynecologic cancers.

Adenocarcinoma, Papillary↗

Type 2 11beta-hydroxysteroid dehydrogenase activity in human fallopian tube and correlation of enzyme levels with endometrial histopathology.

PROBLEM: The inter-conversion of hormonally active cortisol and inactive cortisone is catalyzed by 11beta-hydroxysteroid dehydrogenase (11beta-HSD). This conversion controls the level of active glucocorticoid concentration in tissues. As the fallopian tube plays a major role in the process of fertilization, we wanted to investigate whether 11beta-HSD is present in the human fallopian tube to control the glucocorticoid levels as in other tissues. METHOD OF STUDY: Isthmic, ampullary and fimbrial portions of the fallopian tube are obtained from patients undergoing hysterectomy and salpingo-oopherectomy for symptomatic leomyomata uteri. 11beta-HSD activities were measured in the homogenates of the tube, cortisol as the steroid substrate. The enzyme activity was expressed as nanomolar cortisone formed per minute per gram of tissue (mean +/- S.D.). RESULTS: A significant level of 11beta-HSD activity in oxidation direction was found in all three parts of the tube. There is no significant difference in the distribution of the enzyme activity throughout the tube. When tubal 11beta-HSD activity was compared with endometrial histology, the enzyme activity is significantly lower in proliferative endometrium when compared with secretory endometrium (P = 0.002). The enzyme activity in inactive endometrium is significantly higher than the active endometrium (P = 0.05). CONCLUSION: The presence of 11beta-HSD throughout the fallopian tube and its correlation to endometrial histology is indicative of its probable role in controlling the glucocorticoid levels in the tissue, which in turn may influence the fertilization process.

11-beta-Hydroxysteroid Dehydrogenase Type 2↗

The efficacy of Interceed(TC7)* for prevention of reformation of postoperative adhesions on ovaries, fallopian tubes, and fimbriae in microsurgical operations for fertility: a multicenter study. Nordic Adhesion Prevention Study Group.

OBJECTIVE: To evaluate the efficacy of Interceed as an adjuvant in the prevention of postoperative adhesion reformation to the ovary, fallopian tube, and fimbria when used together with microsurgical techniques. DESIGN: Prospective, randomized, multicenter, controlled clinical study. SETTING: Normal human volunteers in an academic research environment. PATIENTS: Sixty-six women suffering from infertility due at least in part to bilateral tubal disease with bilateral adhesions attached to ovaries, fallopian tubes, and fimbriae. INTERVENTION: Adhesiolysis bilaterly through laparotomy with microsurgical techniques, application of Interceed on one of the sides randomly assigned not known by the surgeon before application, follow-up laparoscopy 4 to 10 weeks postoperatively, with each patient serving as her own control. MAIN OUTCOME MEASURES: Adhesion severity scores at all sites and number of adhesion free organs after laparotomy and follow-up laparoscopy. RESULTS: When the initial scores registered at the operation for fertility were compared with those registered at the second-look laparoscopy, the results indicated that gentle microsurgical techniques resulted in a significant reduction of postoperative adhesions. Adnexa, which were covered with Interceed, had significantly lower adhesion scores than the control adnexa, representing an improvement of 39% compared with microsurgery alone (control) in reducing adhesion reformation scores. When combined with microsurgical techniques, Interceed reduced adhesion reformation scores by 70%. The number of ovaries, fallopian tubes, and fimbriae without adhesions at the time of second-look laparoscopy was significantly increased by approximately twofold when organs were covered with Interceed. CONCLUSION: In a prospective, randomized, multicenter, controlled clinical study using a protocol in which other adjuvants have been shown not to be efficacious, Interceed was shown to reduce significantly the incidence and severity of adhesion reformation to the ovary, fallopian tube, and fimbria after infertility surgery.

Cellulose, Oxidized↗