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A case of a ruptured ectopic pregnancy in an undescended fallopian tube is presented. The tube and its ipsilateral ovary were located near the splenic flexure of the colon. The embryology and the differential diagnosis of this potentially fatal condition are discussed.
In 25 women with primary or secondary infertility, primary hysterosalpingography (HSG) or laparoscopy with chromopertubation indicated 33 proximal and 2 distal tubal obstructions. Four salpingectomies had been performed earlier. All patients were considered for transcervical catheter salpingoplasty (TCSP) to reconstruct tubal patency. Secondary examination with repeat HSG or selective osteal salpingography confirmed 26 proximal and 3 distal tubal occlusions while 17 tubes were patent. Selective osteal salpingography was performed successfully in 32 of 33 (97%) tubes. Sixteen of 26 (61.5%) proximally occluded tubes were successfully recanalized by coaxial catheter and guidewire technique while two of three distally occluded tubes were reopened by forceful flushing of contrast medium. So far, one ectopic and five intrauterine pregnancies were achieved in ten patients with observation time more than four months. Three patients have had normal deliveries. The favorable results, lack of complications and low costs seem to justify the recommendation to use selective salpingography and fallopian tube recanalization as the first intervention in patients with obstruction of the proximal fallopian tube.
OBJECTIVES: From a review of 20 cases of primary carcinoma of the fallopian tube, we stress the various clinical aspects of the disease and discuss the possibilities of a preoperative diagnosis. MATERIALS AND METHODS: A retrospective study covering the period between 1982 and 1996. An analysis of the different etiological factors mentioned in the literature, of the physical signs and symptoms of the carcinoma, of the patients' age and hormonal status as well as the role of additional investigations was conducted. RESULTS: The average age of the patients was 62.3 years, 90% of the women had reached menopause and 15% were nullipara. A history of salpingitis was noted in 5% of the patients and another 5% had infertility problems. 20% of the patients had suffered from another carcinoma. Metrorrhagia was the most frequent clinical finding revealing the disease (55%) followed by abnormal secretions of blood stained liquid (15%). Hydrops Tubae Profluens was not observed in this series. The main complementary investigations performed were pelvic ultrasound scanning and hysterosalpingography, preoperative diagnosis was possible in 15% of cases; diagnosis was made during the operative procedure in 45% of cases and by pathologic examination in the remaining 40% of patients. CONCLUSION: Primary carcinoma of the fallopian tube is a rare form of cancer of unknown aetiology. Clinical signs are often unrelated and sometimes misleading; however, preoperative diagnosis is possible if one keeps in mind the existence of this carcinoma.
In the present investigation we have examined the possibility that endogenous purines may act as neuromodulatory agents in the human fallopian tube, using the selective adenosine receptor antagonist 8-p-sulfophenyltheophylline (PSOT). PSOT applied to untreated preparations enhanced the contractile responses to transmural nerve stimulation in the human fallopian tube, both in the secretory and proliferative hormonal phases. Furthermore, PSOT enhanced nerve-induced [3H]noradrenaline release during both hormonal phases. This can be taken as indirect evidence that endogenous purines inhibited the adrenergic neuroeffector transmission under the experimental conditions. The inhibitory effect presumably was exerted at both pre- and postjunctional adenosine receptors.
PROBLEM: To evaluate the site-specific immunoregulatory mechanisms against bacterial infection in the human fallopian tubes. METHOD OF STUDY: We investigated the effects of lipopolysaccharide (LPS) on the production of CXC chemokines by cultured oviductal epithelial cells (OEC) and oviductal stromal fibroblasts (OSF). The expression of Toll-like receptor (TLR) 4 and CD14 protein in OEC and OSF were evaluated. The phosphorylation of the inhibitor kappaB-alpha (IkappaB-alpha) protein after LPS stimulation was also examined. RESULTS: Lipopolysaccharide stimulated the secretion of granulocyte chemotactic protein-2, growth-regulated oncogene-alpha, and epithelial neutrophil activating peptide-78 by OSF, but not by OEC. The phosphorylation of the IkappaB-alpha protein was not detected in OEC after stimulation by LPS, whereas IkappaB-alpha phosphorylation was observed in OSF after stimulation by LPS. The expression of the TLR4 protein and mRNA was detected only in OSF but not in OEC. The expression of CD14 was not detected in either OEC or OSF. CONCLUSION: These results suggest that epithelial cells and fibroblasts in the human fallopian tube have evolved a unique, site-specific mechanism for recognizing Gram-negative pathogens. The lack of TLR4 in OEC may be important for avoiding a state of unnecessary inflammation that could disrupt the epithelial barrier and cause irreversible tubal scarring.
A case of primary adenocarcinoma and tuberculosis of the Fallopian tube is presented. The clinical symptoms of the patient were pelvic pain and primary infertility. The gynecologic examination revealed a palpable tubal mass and the diagnosis was performed from the laparotomy and the pathology report.
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We investigated the presence of Chlamydia trachomatis in fallopian tubes of patients undergoing Pomeroy tubal ligation in the immediate postpartum period with culture on cycloheximide-pretreated McCoy cells and with immunofluorescence staining. Two of 20 women were culture positive in both tubes, representing 10% culture positivity. Both patients were multiparous and black and reported no previous history of either pelvic inflammatory or sexually transmitted disease. Neither developed intrapartum or postpartum fever or any other signs of infection. These findings indicate that C trachomatis can be present in tubes of symptom-free pregnant women and not cause infectious morbidity either prepartum, intrapartum or postpartum.
We report a rare case of primary carcinoma of the fallopian tube. A 72-year-old post-menopausal woman presenting with abnormal secretion of blood-stained liquid, underwent surgery because of findings of atypical squamous cells (ASCUS) on a routine Papanicolaou smear. The histological diagnosis on cervical biopsy was of CIN 3. Adenocarcinoma of the Fallopian tube was incidentally found.
The secretory proteins of the mucosa of the cervix, uterus, and fallopian tubes were investigated by measuring the proteins that were released by isolated mucosal areas. Initial screening disclosed that the immunoglobulins IgG and IgA were released in measurable quantities, but that IgM and the secretory (T) piece of IgA were either absent or present only in trace amounts. Relatively low levels of diffusable total complement activity and the C3 component of complement were present, whereas the C1q, C1r, and C4 components were either absent or present only in trace quantities. No neutral proteinase activity was present, but lysozyme, plasminogen activator, alpha 1-antitrypsin, and alpha 1x-antichymotrypsin could be found in reasonable amounts. The site of secretion, concentration, and cyclic variation of the proteins that diffused from the mucosal sites in measurable quantities were studied. The types and amounts of protein secreted by a particular site in the cervix, uterus, or fallopian tube varied from those of protein from other sites, even within the same organ. During the menstrual cycle, variations occurred in the amount of protein secreted by each mucosal site. However, whether an increase or a decrease in the release of a particular protein took place varied with each protein, even at the same site. The mucosal sites also differed from each other in their response to the phase of the menstrual cycle, that is, whether more or less protein was released, even sites within the same organ. The conclusion is that each organ and even different sites within an organ can respond independently from each other to changes in hormone levels, producing different types and amounts of secretory proteins. The amount of diffusable protein produced by an individual site during the menstrual cycle depends on the type of protein as well as the mucosal site.
A case of adenocarcinoma of the fallopian tube that presented as a small mucosal papillary growth in a large, otherwise noncomplicated hydrosalpinx is reported. Computed tomography clearly delineated the mucosal tumor and characteristic unilateral tubular shaped adnexal mass of the hydrosalpinx which was easily distinguishable from ovarian cystic masses.
This study compared the abilities of ciprofloxacin and cefixime to kill intracellular Neisseria gonorrhoeae in a human fallopian tube organ culture assay. When invasion was inhibited by cytochalasin D, 0.996% of the tissue-associated gonococci survived ciprofloxacin exposure compared to 1.70% of gonococci exposed to cefixime (95% confidence interval for the ratio of the means, 0.267 to 1.30), indicating that the two antibiotics did not significantly differ in the ability to kill extracellular attached organisms. In the absence of cytochalasin D, 1.63% survived ciprofloxacin exposure while 9.76% survived cefixime treatment (95% confidence interval for the ratio of the means, 0.067 to 0.418). These results suggest that ciprofloxacin penetrated epithelial cells and killed intracellular gonococci better than did cefixime. Thus, at concentrations achievable in serum, ciprofloxacin was more effective in total gonococcal killing than cefixime in this human fallopian tube organ culture model.
Operative laparoscopy can be used for many surgical procedures on the fallopian tube and ovary. These include: (1) tubal sterilization; (2) salpingectomy and salpingostomy for tubal pregnancy; (3) fimbrioplasty, salpingoneostomy, and linear salpingostomy for tubal obstruction and infertility; (4) microsurgical tubal reanastomosis for reversal of tubal sterilization; (5) oophorectomy, cystectomy, cyst drainage and fulguration, and excision of ovarian tumors; (6) wedge resection and ovarian drilling for polycystic ovaries; and (7) fulguration and laser vaporization for endometriosis. Many of these procedures are conservative and involve reconstruction of the tube and ovaries to preserve fertility. Microsurgical techniques are incorporated into such fertility sparing or enhancing procedures. Comparison of similar surgical procedures on the tube and ovaries indicates better or similar surgical outcome when done through the laparoscope rather than laparotomy; less blood loss, faster recovery, and cheaper cost are the hallmarks when the procedure is done by laparoscopy. With further improvement and expansion in laparoscopy equipment, it can be expected that more surgical procedures on the adnexa can be undertaken safely and effectively.
A patient with mixed müllerian tumor of the fallopian tube was treated with cyclophosphamide and cisplatin. The regimen achieved a complete remission. No severe drug-related toxicity occurred.
Three cases of primary adenocarcinoma of the Fallopian tube have been treated at the Gynecology Department of Hospital A. C. Camargo, Fundación A. Prudente, São Paulo, between 1972-1987. The diagnosis was only possible at surgery. The poor prognosis was due to the advanced stage of the disease. In view of its rarity further studies are necessary for a better diagnostic and therapeutic approach.
A case of eosinophilic hyperplasia of the fallopian tube has been reported in a 71-year old woman with ovarian serous cystadenofibroma. Morphological characteristics and p53 protein expression of hyperplastic eosinophilic epithelium are then discussed.