[Primary carcinoma of the fallopian tubes].
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Isolated torsion of the fallopian tube was discovered during labor. Tubal torsion may occur in the absence of adnexal disease. Diagnosing this disorder is especially difficult in labor, when other causes, such as disruption of a prior uterine scar, may be considered.
We developed a retrograde transvaginal-transcervical-transuterine sterilization technique capable of causing occlusive fibrosis and stricture in the human fallopian tube. The procedure is required to induce a lesion at the intramural-isthmic portion of the tube at sufficient depth to damage epithelium underlying the submucosa and inner muscular layer, without acute damage to the outer muscular layer and serosal surface. Nineteen nulliparous purpose-bred cats were induced and maintained in an anestrus state with testosterone cypionate 5 mg/kg intramuscularly and a 6-18-hour light-dark cycle. After laparotomy, all animals had focal radiofrequency lesioning of uterine horns. Ten of 30 treated uterine horns appeared grossly occluded at the time of sacrifice; however, histologic assessment demonstrated only 6 complete occlusions, and 4 horns showed lack of complete lumen occlusion with or without evidence of recanalization. Although no complications were encountered, bipolar radiofrequency failed to provide a consistent obstructive lesion in a tubular structure similar in size and morphology to the human fallopian tube.
Primary carcinoma of the fallopian tube is rarely diagnosed preoperatively. We report the case of a 42-year-old woman with primary tubal carcinoma, which was diagnosed preoperatively on the basis of an elevated CA-125 and characteristic features on transvaginal sonography.
The apparently smallest primary adenocarcinoma (2.3 mm in diameter) of the fallopian tube ever described was diagnosed by repeated blind sectioning of the surgical specimen after the preoperative finding of an abnormal cervical Papanicolaou smear and the subsequent finding of abnormal cells in fluid obtained by laparoscopic peritoneal lavage, although a survey of the patient for a primary cancer was negative.
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A 5-year-old male with ambiguous external genitalia, hypospadias and microphallus without an urethral orifice was referred for cytogenetic studies. Exploratory laparotomy revealed presence of an infantile uterus and unilateral gonadal dysgenesis with both testes and fallopian tube on the right side. The metaphase cells from peripheral blood culture showed both 45,X/46,X inverted Y (p11.2q11.23) cell-lines (98:2). The inverted Y was found to be of paternal origin. Maternal chromosomal pattern was normal 46,XX. The presence of a fallopian tube next to testis suggest absence of secretion of anti-Mullerian hormone by Sertoli cells. The absence of Wolffian duct derivatives suggest insufficient secretion of testosterone by Leydig cells.
The identification of germ-line mutations in 2 genes (BRCA1 and BRCA2) responsible for the majority of hereditary ovarian cancers has led an increasing number of women carriers of these mutations to undergo prophylactic oophorectomy (PO) to reduce their risk of subsequent ovarian carcinoma. A large number of unexpected, clinically occult neoplasms are thus being discovered. Up to December 2004, the Medical Genetics Service of the National Cancer Institute in Milan, Italy, has tested 756 probands from breast and/or ovarian cancer families for BRCA1 and BRCA2 germ-line mutations. Molecular screening of family members led to the identification of 344 female carriers of BRCA1 (239) or BRCA2 (105) germ-line mutations. Of the 186 potentially eligible women (37 of whom had tested positive for BRCA1 and 13 for BRCA2 mutation), 50 (26.8%) chose to undergo PO. Six clinically occult primary gynecologic malignancies (2 stage IIIC serous carcinomas of the ovary, 3 in situ serous carcinomas of the fallopian tube, and 1 stage IIB invasive serous carcinoma of the fallopian tube) and 1 occult ovarian metastasis from breast carcinoma were identified in the PO specimens of 7 women (all BRCA1 mutated). Four of the patients with occult primary gynecologic cancers are alive without disease 129, 87, 38, and 7 months after PO, respectively. One of the 2 patients with primary ovarian cancer and the single patient with tubal invasive carcinoma are alive with recurrent disease 83 and 20 months after PO, respectively. In addition, one of the patients whose PO specimen did not show any malignancy presented with stage IIIC tubal carcinoma 77 months after PO. The relatively high number of tubal neoplasms found at PO in this group of patients underlines the linkage between mutation and the risk of developing tubal cancer, and stresses the need to include removal of the entire tubes at the time of PO and of thoroughly evaluating the specimens at the microscopic level. The upstaging of all 3 invasive carcinomas after staging surgery, and the late recurrence and persistence of 2 of them despite treatment indicate that small size of the tumors should not preclude therapy.
This is a report on a new method of microsurgical transposition of the Fallopian tube. It was developed to deal with congenital malformations or with the different anatomic remnants after pelvic surgery or pelvic inflammatory diseases. The tube is mobilised by severing the mesosalpinx with the unipolar microelectrode without damaging the longitudinal vessels. After mobilisation, the bends of the tube disappear and the length increases almost doublefold. Then the tube can be laid to the contralateral ovary without any tension. The tube must be fixed to the ovary in such a way, that the fimbrial end is mobile enough to lay onto the ovary during ovulation. Up to now, six patients with longstanding tubal sterility were operated upon. Three of them became pregnant, one twice. There were no ectopic pregnancies and no abortions.
Clinical, diagnostic and therapeutic characteristics of a case of a fallopian tube adenocarcinoma splenic metastasis are reported. This case illustrates the diagnostic difficulties of this situation. These difficulties are both related to the poorly specific symptomatology and the low specificity of the current imagery. Percutaneous biopsy aspiration guided by ultrasonography or CT-scan could be helpful. The treatment is surgery, eventually combined with adjuvant radiotherapy: it can allow a long survival time. Splenic metastasis should be systematically checked up in every tumoral context.
Prospective randomization of 60 couples with unexplained infertility was performed for treatment either with intrauterine insemination (IUI), using a volume of 0.5 ml of the inseminate, or Fallopian tube sperm perfusion (FSP), using a volume of 4 ml of inseminate. The protocols for ovarian stimulation and induction of ovulation were the same in the two groups. The two groups were similar concerning age of the female at the start of treatment and the number of follicles > 15 mm diameter, the serum oestradiol concentrations and the endometrial thickness on the day of human chorionic gonadotrophin (HCG) administration. The mean (+/- SD) number of motile spermatozoa inseminated was significantly higher in the FSP group than in the IUI group (52 +/- 5 x 10(6) and 28 +/- 3 x 10(6) respectively). In the FSP group, 30 women were given a total of 52 treatment cycles; 14 clinical pregnancies occurred in this group, giving a pregnancy rate of 26.9% per cycle and 46.7% per woman. In the IUI group, 28 women were given a total of 51 treatment cycles; five clinical pregnancies occurred, giving a pregnancy rate of 9.8% per cycle and 17.9% per woman. The pregnancy rates per cycle and per woman in the FSP group were significantly higher than in the IUI group (P < 0.05, chi-square test). This study indicates that in the treatment of couples with unexplained infertility, Fallopian tube sperm perfusion (FSP) is more successful than intra-uterine insemination (IUI).
The more common methods of laparoscopic sterilization involve transection of the fallopian tubes. There are, however, a number of cases accumulating in which coagulation without transection has been employed. The risks of bleeding requiring the use of laparotomy are considerably reduced with this technic. There is no increased risk of electrical injury. The pregnancy rate is essentially the same in both methods. It is suggested that failures with tubal transection may be secondary to fistula formation and an inherent problem, whereas the failures with coagulation without transection are secondary to inadequate coagulation and are therefore more easily prevented.
Trophinin, tastin, and bystin have been identified as molecules potentially involved in human embryo implantation. Both trophoblasts and endometrial epithelial cells express trophinin, which mediates apical cell adhesion through homophilic trophinin-trophinin binding. We hypothesized that trophinin's function in embryo implantation is unique to humans and investigated the expression of trophinin, tastin, and bystin in ectopic pregnancy, a condition unique to humans. In tubal pregnancies, high levels of all three were found in both trophoblasts and fallopian tubal epithelia. Trophinin expression in maternal cells was particularly high in the area adjacent to the trophoblasts, whereas trophinin was barely detectable in intact fallopian tubes from women with in utero pregnancies or without pregnancies. When explants of intact fallopian tube were incubated with the human chorionic gonadotrophin (hCG), trophinin expression was enhanced in epithelial cells. Since the trophectoderm of the human blastocyst secretes hCG before and after implantation, these results suggest that hCG from the human embryo induces trophinin expression by maternal cells. As both beta-subunit of hCG and trophinin genes have diverged in mammals, the present study suggests a unique role of hCG and trophinin in human embryo implantation, including the pathogenesis of ectopic pregnancy.
Ciliary activity was studied in specimens of fallopian tube mucosa that were maintained as organ cultures and experimentally infected with Mycoplasma hominis. This activity was quantitated by an established method for recording of the light reflexes from the ridges and troughs in the mucous layer in which the cilia are beating. In organ cultures infected with M. hominis, a ciliostatic effect was observed; the proportion of organ cultures with no detectable ciliary activity was higher and the number of ciliary beats per minute in cultures with detectable activity was lower when M. hominis was present.
[3H]R5020 was bound to cytosolic and nuclear samples of human Fallopian tube with high affinity and specificity. The cytoplasmic and nuclear concentrations of progestagen receptor varied, throughout the menstrual cycle, in the ampulla, isthmus and fimbria. Concentrations were higher at the late proliferative stage of the cycle than at the early proliferative and late secretory stages. A positive linear regression was observed between cytosolic and nuclear progestagen receptor concentrations and plasma oestradiol levels. A negative linear relationship was observed between cytosolic progestagen receptor concentration and plasma progesterone levels during the secretory stages of the menstrual cycle.
We report a case of borderline papillary serous tumor of the fallopian tube in a 31-year-old woman. The tumor was characterized by the formation of papillary projections with focally prominent epithelial stratification and atypia. The histologic features of the tumor were largely similar to a borderline serous tumor of the ovary. Two years after initial presentation, the patient underwent in vitro fertilization and carried the ensuing pregnancy to term. There is no evidence of disease nearly 6 years after presentation, which suggests that these extremely uncommon tumors can be managed conservatively.