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PubMed1999

Florid cystic endosalpingiosis with tumor-like manifestations: a report of four cases including the first reported cases of transmural endosalpingiosis of the uterus.

Four cases of endosalpingiosis presenting as masses that resembled neoplasms are described in women 20, 41, 43, and 74 years of age. Each case was referred in consultation because of difficulties in pathologic diagnosis. In two patients, multiple cysts that involved the serosal surfaces of the uterus and adnexa in one case, and the colon, rectosigmoid, pelvic sidewalls, and the cul-de-sac in the other, were excised. In the other two cases, hysterectomy was performed for an enlarged cystic cervix in one case and presumed uterine leiomyomas in the other. In both of these cases, the uterine cervix and lower part of the uterine corpus were extensively involved by multiple cysts on gross examination, and in one of them, a frozen section of the cervical lesion was initially interpreted as "suspicious for invasive minimal deviation adenocarcinoma." On microscopic examination, benign endosalpingiotic glands and cysts were found in all four cases, with striking transmural involvement of the uterine cervix and lower uterine segment and contiguous corpus in the two cases with uterine involvement. The latter two cases are the first examples, to our knowledge, of endosalpingiosis involving the wall of the uterus; the differential diagnosis in these cases includes minimal deviation adenocarcinoma and florid tubal metaplasia with cystification. The four cases in this report, and rare previously reported cases, indicate that although usually a microscopic finding, endosalpingiosis can rarely present as a clinically or grossly evident mass that can be confused with a neoplasm.

Adenocarcinoma↗
PubMed1991

Acute chlamydial salpingitis with ascites and adnexal mass simulating a malignant neoplasm.

Chlamydia trachomatis is a well-known cause of acute and chronic salpingitis, accounting for approximately half of all cases of pelvic inflammatory disease. Typically, patients with acute chlamydial salpingitis present with acute lower abdominal pain, tenderness on bimanual pelvic examination, or vaginal discharge. We describe a case of acute chlamydial salpingitis with marked ascites and an adnexal mass that simulated a malignant neoplasm. Microscopically, a severe lymphofollicular salpingitis and a marked lymphofollicular hyperplasia of the omentum and retroperitoneal lymph nodes were found. Chlamydial inclusions in the fallopian tube epithelium were demonstrated by immunohistochemistry using a mouse monoclonal antibody to a genus-specific outer membrane lipoprotein. Chlamydial infection may cause marked ascites and a palpable adenexal mass and should be considered whenever marked chronic inflammation with a lymphofollicular hyperplasia involves the fallopian tube or other female genital tract sites.

Adnexa Uteri↗
PubMed1989

The epidemiology of malignant neoplasms of the ovary, fallopian tube, and broad ligament in Canada: 1950-1984.

Canadian patterns of incidence and mortality from malignancies of the ovary, fallopian tube, and broad ligament during the periods 1970-1980 and 1950-1984, respectively, were examined. Incidence rates during 1970-1980 remained stable at about ten new cases per 100,000 population per year. Analysis of age-specific rates demonstrated no significant changes in incidence for the eight age groups studied (P greater than .10). Although age-standardized mortality rates have not changed significantly during 1950-1984 (P = .61), four of the eight age groups studied (0-24, 25-34, 35-44, and 45-54) showed significant declines, whereas three other age groups (65-74, 75-84, and 85 and above) experienced significant rates of increase (P less than .025). Rates of increase for women aged 85 and over--0.94 additional new deaths per 100,000 population per year--were the most dramatic of any of the eight age groups studied.

Adnexa Uteri↗
PubMed1988

Ultrasonic evaluation of fallopian tube carcinoma.

Primary malignant neoplasms of the fallopian tube are the least common of all the gynecologic malignancies, and constitute only about 0.1-1% of all such malignancies. The actual 5-year survival is 64% in those with stage I, 60% in cases of stage II, and 18% and 25% for stages III and IV, respectively. Therefore, early detection of these neoplasm stages is most important to attain a cure. The preoperative diagnosis of this neoplasm has rarely been reported because these lesions are not common. We present herein the clinical and sonographic features in 4 Japanese women with fallopian tube carcinoma. While the sonographic features alone are not distinct enough to establish a definite preoperative diagnosis, the findings as seen in our patients suggest inclusion of tubal carcinoma in the differential diagnosis.

Carcinoma↗
PubMed1984

[Primary bilateral tubular adenocarcinoma with antecedents of invasive galactophoric carcinoma of the breast. Apropos of a case; review of the literature].

The authors report a case of primary bilateral adenocarcinoma of the fallopian tube in a woman with invasive ductal carcinoma of the breast in her antecedents. The tubal carcinoma was in situ or invasive and appeared as a bilateral hydrosalpinx, fact which often happens in the literature. Gross examination showed a tumoral mass of about 2 cm diameter at the fimbriated end of the right tube, the diagnostic of bilaterality requiring serial cuts on the left tube. The electron microscopic study showed ciliated differentiation in the neoplastic cells, bearing out the primitive nature of the proliferation.

Adenocarcinoma↗
PubMed2002

Pathologic findings in prophylactic oophorectomy specimens in high-risk women.

OBJECTIVE: To ascertain the frequency of significant pathologic alterations in prophylactic oophorectomy specimens in high-risk women referred to a tertiary care center. METHODS: Surgical cases for prophylactic oophorectomy referred to a gynecologic oncology clinic from November 1996 to January 2001 were reviewed. Serial sections of entirely submitted tubes and ovaries were procured and reviewed by a pathologist with expertise in gynecologic malignancies. All patients had undergone genetic counseling and either underwent mutational analysis of BRCA1 and BRCA2 genes or had family history suggestive for ovarian and breast cancer susceptibility. RESULTS: Thirty women with either a documented deleterious BRCA1 or BRCA2 mutation or a suggestive family history underwent prophylactic oophorectomy during the study period. Seventy-three percent of women had undergone genetic testing. Of those, 63.5% harbored a BRCA1 mutation, 13.5% were BRCA2 carriers, and the remaining 23% tested negative. Five of the 30 women (17%) were found to have clinically occult malignancy. Four of the five were diagnosed only on histologic review. A single patient had grossly apparent primary peritoneal carcinoma at the time of laparoscopy. Three patients were found to have primary fallopian tube malignancy, two with in situ papillary serous carcinoma, and one with early invasive disease. Each of the fallopian tube neoplasms measured less than 1 cm. The final patient was diagnosed with an ovarian adenofibroma with a focus of low malignant potential neoplasm and clear cell features. Three of the five were known BRCA1 mutation carriers, one had a documented BRCA2 mutation, and one has not yet been tested. CONCLUSIONS: The high rate of occult malignancy detected in this series suggests that this finding in women at heightened risk for ovarian cancer is relatively common. Further, clinically occult tumors were not limited to ovarian origin, and the majority of cases harbored malignant foci less than 1 cm in greatest dimension that were not recognized at the time of surgery. These findings support the recommendations that in this high-risk population (1) the fallopian tubes and ovaries should be submitted entirely and be evaluated by a pathologist with expertise in gynecologic malignancies in serial sections; (2) laparoscopy and laparotomy are the surgical modalities of choice to allow inspection of the peritoneal surfaces at time of prophylactic oophorectomy and collect fluid for cytologic evaluation; (3) despite the rarity of fallopian tube carcinoma in the general population, BRCA1 and BRCA2 mutation carriers may be at increased risk for tubal cancers.

Adult↗
PubMed1997

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.

Carcinoma in Situ↗
PubMed2002

Tumor progression, histologic grading and DNA-ploidy as predictive factors of lymphogenous metastasis in primary carcinoma of the Fallopian tube.

UNLABELLED: The bad prognosis of primary carcinoma of the Fallopian tube (FTC), with 5-year overall survival rates of only 35%, is particularly ascribed to lymphogenous metastasis. Yet, we know very little on the pathophysiologic factors on which this lymphogenous metastasis is based. The present study, therefore, aims at evaluating the influence of intra-abdominal tumor progression and tumor-cell anaplasia on lymphogenous metastasis in FTC. We studied 41 cases of FTC, who had been subjected to radical lymphadenectomy during primary operation in a retrospective analysis. Staging was done by International Federation of Gynecology and Obstetrics-classification. Histologic grading and nuclear DNA-content (DNA-index) were used for evaluating tumor-cell anaplasia. Histologic grading discriminated between highly differentiated (G1), moderately dedifferentiated (G2), and dedifferentiated (G3) tumors. According to their DNA-indices, tumors were separated into three groups: DNA-index < or =1.1 (euploid cases), DNA-indices between 1.1 and 2.0 (cases of intermediate ploidy), and DNA-index >2.0 (aneuploid cases). The overall incidence of lymph node metastases was 43.9%. There was no correlation between histologic grading and DNA-index (P=0.98). Lymphogenous metastasis set in after the tumor had transgressed the tube (intra-abdominal stage II). Further intra-abdominal tumor progression (including omentum, liver, or peritoneum) significantly increases the incidence of lymph node metastases (P=0.02). There was only a single G1-tumor that had already disseminated into the lymph, all other cases of lymph node metastases were found in G2- or G3-tumors. DNA-index and the extent of lymphogenous metastases were not found to be correlated (P=0.74). CONCLUSIONS: The extent of lymphogenous metastases in FTC depends above all on intra-abdominal tumor progression. This fact has clinical consequences as the indication for lymphadenectomy can be obtained directly during operation. The results of histologic grading are of no impact on the surgical proceedings; the determination of DNA-ploidy is negligible.

Adult↗
PubMed1996

gamma-Linolenic acid supplementation can affect cancer cell proliferation via modification of fatty acid composition.

We examined the effect of gamma-linolenic acid (GLA) supplementation on the growth and fatty acid composition of three human tumor cell lines (the neuroblastoma CHP-212, the tubal carcinoma TG, and the colon carcinoma SW-620), in order to evaluate the relationship between GLA-induced tumor cell death and the distribution of fatty acids in tumor cells. At the highest GLA concentrations (10 and 20 micrograms/ml), the DNA synthesis was completely abolished; at 5 micrograms/ml GLA only SW-620 cells did not proliferate, while CHP-212 and TG cells showed a residual [3H]-thymidine incorporation. GLA levels were very low in cells grown in control medium; GLA supplementation caused a significant incorporation of GLA itself in all the cell lines at each concentration. In TG and CHP-212 cells, GLA was metabolized, although to a different extent, to dihomo-gamma linolenic acid and arachidonic acid. SW-620 cells neither elongated nor desaturated the incorporated GLA. The highest cytostatic effect was reached when GLA was not transformed into its metabolites, suggesting that the GLA toxicity to tumor cells is not dependent on metabolites but is due to GLA itself.

Cell Division↗
PubMed1998

Phase 2 trial of single agent ifosfamide/mesna in patients with platinum/paclitaxel refractory ovarian cancer who have not previously been treated with an alkylating agent.

Ifosfamide has been shown to possess modest activity in patients with platinum/cyclophosphamide refractory ovarian cancer. Current standard initial chemotherapy for ovarian cancer does not include an alkylating agent (paclitaxel substituting for cyclophosphamide). To evaluate the activity of ifosfamide in patients with refractory ovarian cancer who had not previously received an alkylating agent, 21 patients with platinum/paclitaxel refractory disease were treated with the drug as a single agent (1.8 g/m2/day x 3 days, with treatment repeated every 28 days). Treatment was reasonably well tolerated in most patients, although 1 individual was removed from study secondary to neurotoxicity. One patient exhibited an objective response of measurable disease, while a second individual had a major decrease in CA-125 levels (no measurable disease present) following therapy. An additional patient experienced disappearance of severe pelvic pain following treatment but failed to meet the criteria for a partial response. We conclude that ifosfamide has modest activity in platinum/paclitaxel refractory ovarian cancer. However, the level of effectiveness does not appear to be increased in individuals who are alkylating-agent naive, compared to previously reported experience in patients with prior exposure to this class of cytotoxic drugs (10-15% response rate).

Adult↗
PubMed2000

Phase 2 evaluation of topotecan administered on a 3-day schedule in the treatment of platinum- and paclitaxel-refractory ovarian cancer.

UNLABELLED: PURPOSE; The aim of this study was to investigate the toxicity and efficacy of a more convenient topotecan administration schedule (in contrast to the "standard" 1.5 mg/m(2)/day x 5 days q 21 days) in the management of platinum- and paclitaxel-refractory ovarian cancer. METHODS: Patients with clinically defined platinum- and paclitaxel-refractory ovarian cancer participating in this phase 2 trial conducted by the Gynecologic Cancer Program of the Cleveland Clinic Taussig Cancer Center received topotecan at a dose of 1.5 mg/m(2)/day x 3 days on a 21-day schedule. Both dose escalations and reductions were permitted in the protocol design. RESULTS: A total of 29 patients (median age: 61; range: 43-80) were treated with this modified topotecan schedule. These individuals had received a median of two prior regimens (range: 1-4) (retreatment with a platinum agent or paclitaxel considered a single regimen). The median number of topotecan courses delivered was 3 (range: 1-7). Major toxicity included grade 4 neutropenia (24% of patients); neutropenic fever (10%); grade 3 thrombocytopenia (10%); and requirement for blood transfusion (14%). Dose escalation was possible, and dose reductions required, in 14 and 28% of patients, respectively. Two patients exhibited evidence of a clinically relevant response to treatment. CONCLUSION: This 3-day topotecan program is more convenient and less toxic than the standard 5-day regimen. The limited level of activity observed is not inconsistent with that previously reported for the 5-day topotecan infusion schedule in platinum/paclitaxel-refractory ovarian cancer. Further investigation will be required to document the clinical utility of a 3-day topotecan schedule in a less heavily pretreated and more chemosensitive patient population.

Adult↗