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Prolapse of a Fallopian tube through the vaginal vault following abdominal hysterectomy is a rare complication. A case is described in which the patient presented with a spurious symptom and which illustrates certain characteristic features of the condition with regard to aetiology and clinical findings.
A small flexible microendoscope with an outside diameter (OD) of 0.5 mm has been developed for effective visualization of the entire length of the human fallopian tube. Using a transvaginal approach, a small flexible operating hysteroscope with an OD ranging from 3.3 to 4.5 mm, was used to visualize the uterotubal ostium (UTO) for cannulation of the tube. A coaxial technique, incorporating guidewire cannulation, placement of an "over the wire" Teflon catheter, and replacement of the guidewire with a falloposcope, for video documentation of endotubal surface anatomy has been carried out without complication in 55 women who had a total of 84 tubes available for tubal endoscopy. Characterization of normal and abnormal epithelial changes has been documented for the intramural, isthmic, ampullary, and fimbrial tube. Technical difficulties related to failure to negotiate the entire tubal lumen in the absence of obstructive disease occurred in 9 (11%) of the 84 endoscopy cases. These technical difficulties have been partly overcome by the incorporation of smaller directional guidewires, softer distortion-free Teflon catheters, improved microendoscopes, and the acquisition of new surgical skills necessary for safe and successful endoscopy of the fallopian tube. Minor difficulties were experienced in 7 (8%) of 84 endoscopies due to ostial spasm secondary to attempted guidewire cannulation. Cannulation was successful once spasm ceased. Of the 75 (89%) remaining successful tubal endoscopies, documentation of endotubal lesions ranging from accumulated debris, nonobstructive intraluminal adhesions, stenosis, polyps, to total fibrotic obstruction were observed in 43 (57%) examinations. The majority (70%) of these lesions were confined to the medial third of the tube, between the UTO and ampullary isthmic junction (AIJ). The tubal lumen was considered to be endoscopically normal in 32 (42%) examinations. Techniques of tubal aquadissection (TA), guidewire cannulation (GC), wire guide dilitation, and direct balloon tubuloplasty (DBT) under hysteroscopic-falloposcopic-laparoscopic control were devised for attempting to break down intraluminal adhesions, dilate a stenosis, or open up an obstruction in 35 of the 43 tubes containing a lesion. Combinations of these tubuloplasty techniques were effective for dislodging debris, breaking down adhesions, or dilating stenoses in 16 (58%) of 29 cases and consistently ineffective for bypassing true fibrotic obstructions in 6 (100%) of 6 cases. A detailed description of the falloposcope, its accessory instrumentation, and technique of falloposcopy is outlined. Additionally, preliminary evaluation of falloposcopically directed tuboplasty techniques and their effects on tubal lesions are described. This transvaginal endoscopic technique has been termed falloposcopy and the microendoscopic instrument, a falloposcope.
Two patients with advanced adenocarcinoma of the fallopian tube were treated with cis-diamminedichloroplatinum, adriamycin, and progestins. Cyclophosphamide was added to the treatment of 1 patient. Both regimens achieved surgically proved complete remission. No severe drug-related toxicity occurred.
Torsion of the fallopian tube is encountered in the diseased tube. The present report describes a hematosalpinx and its tubal torsion in a virgin girl who experienced no prior predisposing factors suggested for tubal obstruction and adhesions. This rare case may highlight a new insight into pathophysiology of tubal torsion associated with hematosalpinx.
We present a case of primary squamous cell carcinoma of the fallopian tube, the third case in the English literature. To make this diagnosis, metastasis from genital and nongenital squamous cell carcinoma should be excluded. This carcinoma reflects the multipotential differentiation of the müllerian duct system.
Vascularised transplantation of the Fallopian tube is a technically feasible operation, but its functional result remains questionable. This article documents a pregnancy after vascularised contralateral autotransplantation of the oviduct in a ewe.
The origin of rarely encountered transitional cell carcinomas of the fallopian tubes has, to date, been ascribed to transitional cell metaplasia of the tubal serosa or subserosal Walthard rests. We report here three examples of transitional cell metaplasia of the mucosa of the fallopian tubes--in each instance an incidental finding--and propose this lesion as a hitherto unreported possible precursor for such tumors.
A case of endometrioid carcinoma of the fallopian tube is reported with histologic description and clinical follow-up of four years. Only two other cases have been documented previously. This case is thought to be unique as the carcinoma arose in a benign endometrioid tumor. Inferences concerning Mullerian duct expression and neoplasia are reviewed.
Vaughan MM, Evans BD, Weitzer MJ. Survival of patients with primary fallopian tube carcinoma. Int J Gynecol Cancer 1998; 8: 16-22. Thirty-seven patients with primary fallopian tube carcinoma (PFTC) presenting between 1952 and 1995 were studied. The mean age was 57 years. Seven patients had stage I disease, 20 stage II, 8 stage III, and 2 stage IV. Actuarial 5-year survivals were 73% for stage I, 33% for stage II and 0% for stage III. Stage was a significant predictor of survival at 5 years (Stage I vs. III, P = 0.0006; stage II vs. III, P = 0.0001), however, the majority of patients, even with early stage disease, died of progressive PFTC within 10 years. Grade appeared highly significant at 5 and 10 years (Grades 1 & 2 vs. 3, P = 0. 0023). Neither age nor lymphocytic infiltrate appeared definitely predictive of survival. Eleven of 22 stage II patients received adjuvant treatment. While their median and 5-year survivals were superior to those not receiving adjuvant treatment (51 vs. 30 months, 47% vs. 22%), the difference was not statistically significant. This retrospective analysis confirms the poor prognosis of patients with PFTC. The majority of patients, even with early stage tumors, eventually succumb to their disease. Larger studies may identify a group of patients potentially curable with surgery alone, and clarify the role of adjuvant therapy.
Fallopian tube recanalization is now a well established radiological procedure (1). We describe a case in which the tubal obstruction was resistant to the standard technique of recanalization by the passage of a platinum tipped wire but in which we were able to achieve success with the aid of a hydrophillic "glide" wire (Radifocus angled tip, Terumo Corporation, Tokyo, Japan).
Primary cancer of the fallopian tube (FTC) is among the most unusual gynecologic malignancies and rarely is diagnosed correctly before surgery. The imaging results of eight patients with FTC and four with benign tubal disease were analyzed. FTCs were small cystic or solid masses that typically were shaped like a sausage, a snail, or a gourd, regardless of clinical stage.
Epithelial inclusion cysts (EICs) are considered a preferential site for ovarian carcinogenesis. Local inflammation, associated to ovulatory wound repair and epithelial inflammatory conditions, facilitates EIC formation and involves activation of macrophages. The aim of this study was to analyse the presence and numbers of macrophages in the ovarian surface epithelium (OSE), in EICs, and in the fallopian tubes, as tubal metaplasia is a common finding in EICs. Immunohistochemical analysis of macrophages was performed in 25 fallopian tubes in different phases of the menstrual cycle, and in 30 ovaries showing EICs from cycling and postmenopausal women. In the fallopian tube, macrophages were abundant and underwent cyclic changes during the menstrual cycle, being particularly abundant within the epithelium at early and mid-luteal phases. Macrophages were not found in the normal OSE. However, OSE areas and EICs showing tubal metaplasia were invariably associated with infiltration by abundant macrophages. Macrophages were present among epithelial cells, infiltrating the cyst wall, as well as free in the cyst lumen. No significant differences existed between follicular and luteal phases of the cycle, or between cycling and postmenopausal women. This study has demonstrated that macrophages are associated with metaplastic EICs, and raises the possibility that these cells contribute to the particular microenvironment of EICs through secretion of cytokines and growth factors that may reach bioactive concentrations in the confined space of the EICs.
PURPOSE: This retrospective multicenter study aimed to assess the survival and prognostic factors of primary fallopian tube carcinoma. METHODS: The medical records of 29 patients with fallopian tube carcinoma from two centers were reviewed for age, stage, surgical intervention, relapse and survival. RESULTS: The mean age of the patients was 56 years (range, 37-76). Six patients were in Stage I (20.7%), eight cases in Stage II (27.6%), nine cases in Stage III (31%) and two cases in Stage IV (6.9%). Data on stage was not available in four cases (13.8). Fifteen patients underwent lymph node evaluation. The median follow-up was 29 months (range, 3-122). The median survival was 95 months with a 5-year survival rate of 69.7%. The median progression-free survival was 76 months with a 5-year survival rate of 51.8%. CONCLUSION: Age, stage and lymphadenectomy were found to be significant prognostic factors on overall survival.
We report a unique tumor of the fallopian tube that was an incidental finding in a 60-year-old woman. The tumor was characterized by nests of spindle cells embedded in a partially ossified, hyalinized stroma, that also contained amyloid and basement membrane-like material. The histologic appearance of the tumor cells suggested an epithelial nature, but no immunohistochemical or ultrastructural evidence of such was found. The circumscription of the tumor and its lack of mitotic activity and cytologic atypia suggest a benign nature, but the histogenesis and appropriate classification of the tumor remain unclear.
Gonococci damaged the mucosa of human fallopian tubes in organ culture (FTOC), producing characteristic pathologic features. Filter-sterilized supernatant fluid from donor gonococcal-infected FTOC damaged recipient FTOC in a similar fashion. Gonococcal lipopolysaccharide (LPS) was detected in these toxic donor fluids in concentrations of 1.2 to 8.3 microgram/ml. Purified gonococcal LPS in concentrations as low as 0.015 microgram/ml produced damage equivalent to that caused by toxic donor fluid and was neutralized by polymyxin B. Such LPS-mediated damage to ciliated cells, if it occurs in gonococcal salpingitis, may impair mucociliary flow and predispose to ectopic pregnancy and recurrent ascending infection.
Functional inadequacy of the fallopian tube cannot be adequately diagnosed by classical tubal patency tests. A new method using novel ova surrogates, microspheres transport test, is designed to diagnose dysfunctional tubal sterility. Biodegradable test microspheres with diameters matching that of the native ovum were used. According to the optimum procedure, the suspension of test microspheres was applied through the vaginal wall into the Douglas' space under local anesthesia, and the transported microspheres were collected in a modified cervical cap. The microspheres were readily identified in the sediment of cervical secretion by their fluorescence. The method was tested in 139 long-term infertility patients. Transport was observed in 100% of the control group, and positive correlation between the transport findings and the anticipated frequencies of dysfunctional tubal sterility cases in other groups was found. Optimum diameter of test microspheres was estimated at about 175 microns. The test appears to be useful for examination of functional disorders of the ovum transport in human practice.
With a view to establishing whether cells of the human Fallopian tubes possess the cholesterol side-chain cleavage activity, homogenates of the tubes, obtained from 6 women (39-45 years) following abdominal hysterectomy for benign conditions, were incubated with (7n-3H)-cholesterol as substrate. Controls (n=6, age 40-44 years) were homogenates heated in a boiling water bath for 10 min. Using the reverse-isotope dilution technique, (3H)-pregnenolone was isolated and characterized. No such metabolite was evident in control incubations of heat-denatured enzymes. The extent of enzymic conversion varied from 1.9 x 10(-3) to 1.3 x 10(-2)%. The results reveal for the first time the existence of an active cholesterol-specific C-20, 22 desmolase system in the viable tissues. It is suggested that there exists a potential for substantial pregnenolone synthesis in vivo. This rate-limiting steroid biosynthetic conversion provides a new dimension to the functional capacity of the Fallopian tubes in the synthesis of steroids, which may be necessary for modulating ciliary beat frequency and in maintenance of hormonal milieu essential for embryogenesis.
Primary carcinoma of the fallopian tube is one of the least common neoplasms arising from the female genital tract with rare preoperative correct diagnosis. Recently, we had chances to experience two cases of this tumor, one of which was examined electron microscopically. Both of them revealed the well-differentiated pattern of papillary adenocarcinoma. Electron microscopically, most of the cancer cells had pleomorphic nuclei, giant or multiple nucleoli, numerous mitochondria, poorly developed rER and abundant polysomes. Small number of cells rich in lysosome-like granules were also observed near the basement membrane. Among the cancer cells, "ultrastructural alveolar spaces", composed of several cancer cells, were prominent. In the cancer cells, there were observed the following interesting observations; annulate lamellae-like structure, unusual bundles of the filamentous elements and lamellar body-like structures. Normal tubal epithelium consisted of ciliated cells, secretory cells, peg cells and so-called "indifferent cells". The fact that the present tumor had no ciliated cells and few secretory cells indicated that this tumor was originated from "indifferent cells" or peg cells.