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Primary tumours of the fallopian tube: a report of eight cases of adenocarcinoma and one case of unusual carcinoma.

Nine patients with primary tumour of the fallopian tube were seen at the Royal Marsden Hospital and Chelsea Hospital for Women, London. All the tumours except one were adenocarcinomas. Histologically, the exception resembled an adenomatoid tumour, but was clinically malignant and had some features of a hemangiopericytoma.Postoperative irradiation did not increase survival. The only five-year survivor was a patient who received radiation therapy for a late local recurrence.

Adenocarcinoma↗

Positron emission tomography/computed tomography imaging for the detection of recurrent ovarian and fallopian tube carcinoma: a retrospective review.

PURPOSE: Imaging modalities to evaluate ovarian/fallopian tube cancer patients for recurrence are limited. Positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound lack the sensitivity to consistently detect recurrence or measurable disease in these patients. A new technique combines PET and CT (PET/CT) images to identify increased metabolic activity and to locate that signal with improved anatomic specificity. The objective of this study is to compare PET/CT, CT, and histologic findings in patients with recurrent ovarian/fallopian tube cancers. METHODS: Retrospective chart review of eight patients with primary ovarian (n = 6) or fallopian tube (n = 2) cancer was performed. All eight patients underwent initial cytoreductive surgery. Five patients initially received chemotherapy, one received radioactive phosphorus ((32)P), one received tamoxifen, and one received no therapy. Seven of eight patients had a suspected recurrence based on clinical examination, elevated CA-125 level, and/or abnormal CT findings; one patient requested a PET/CT. Histologic findings from surgery were correlated with PET/CT and CT findings. RESULTS: All eight patients had positive histology, and of these, seven patients had a negative CT and five patients had lesions that were correctly identified by PET/CT. CONCLUSIONS: Five of the eight (62%) patients had recurrent disease based on correlative histology with a positive PET/CT and a negative CT. These preliminary findings suggest that combined PET/CT may be an effective means of identifying patients with recurrent ovarian/fallopian tube cancer. Such patients could potentially proceed to salvage treatment and avoid the morbidity and expense of surgical assessment. Pilot studies comparing CT, PET, PET/CT, and histologic findings are underway.

Aged↗

Effect of estradiol and progesterone on the isometric tension developed by longitudinal and circular isthmus of rabbit fallopian tube.

The effect of estradiol and progesterone on the isometric tension developed by longitudinal and circular muscle of isthmus of rabbit fallopian tube to various agonists was studied. The isometric tension developed was reduced by about 50% under progesterone dominance as compared to estrogen dominance. This inhibition was of non-specific nature and did not involve adrenergic receptors. The non-specific effect of progesterone may have a role in regulating the entry of ova into the isthmus after their initial retention at the ampullary--isthmic junction.

Animals↗

Adenocarcinoma of the fallopian tube: report of a case with an unusual pattern of metastasis and response to combination chemotherapy.

A patient with stage I fallopian tube adenocarcinoma had disease recurrence in both lungs shortly after completing adjuvant therapy with intraperitoneal 32P and parenteral cyclophosphamide. She achieved a complete clinical response to cisplatin, Adriamycin, and cyclophosphamide (PAC) chemotherapy, but was subsequently found to have brain metastasis. The implications of these observations for understanding the natural history and optimal therapy of this disease are discussed.

Adenocarcinoma↗

WT1 is differentially expressed in serous, endometrioid, clear cell, and mucinous carcinomas of the peritoneum, fallopian tube, ovary, and endometrium.

The Wilms' tumor gene WT1 plays complex roles in the development of the organs of the genitourinary tract and mesothelium, as well as Wilms' tumors. Although its biologic role is still unclear, most serous carcinomas of the ovary and peritoneum, mesotheliomas, and Wilms' tumor have been shown to express WT1. A recent study, however, found no WT1 expression in serous carcinomas of the endometrium, suggesting that WT1 could be useful in identifying the primary site of serous carcinomas. We examined the expression of WT1 and p53 by immunohistochemistry in 69 cases of endometrial carcinoma (35 endometrioid, 18 clear cell, 16 serous), 68 cases of ovarian carcinoma (28 serous, 11 endometrioid, 18 clear cell, and 11 mucinous), 14 fallopian tube carcinomas (12 serous, 2 endometrioid), and 20 primary peritoneal serous carcinomas. WT1 nuclear reactivity of any extent and intensity was considered positive. Immunohistochemical stains were evaluated semiquantitatively using a four-tiered scale. Among endometrial carcinomas, WT1 immunoreactivity was seen in 10 of 16 serous, but in none of 35 endometrioid or 18 clear cell carcinomas. Among ovarian tumors, WT1 expression was seen in 24 of 28 serous and 4 of 18 clear cell carcinomas, but in none of 11 endometrioid and 11 mucinous tumors. All 12 serous carcinomas but none of 2 endometrioid carcinomas of the fallopian tube were positive for WT1. WT1 expression was seen in 19 of 20 serous primary peritoneal carcinomas. The difference in WT1 expression was highly significant between serous and other types of tumors in all sites (p<0.0001, chi-square test), although the level of WT1 expression was significantly different among serous carcinomas arising at different sites (p<0.0001, Kruskal-Wallis test). A significant positive correlation was found between the level of p53 and WT1 expression in all carcinomas combined (r = 0.3935, p<0.0001, Spearman test), but when only serous carcinomas were analyzed, the correlation between p53 and WT1 expression levels did not reach statistical significance. Our results suggest that WT1 expression in epithelial tumors of the female genital tract may be related to cell differentiation and histologic subtypes of carcinomas, rather than to primary site of origin.

Aged↗

Experimental study of CO2-laser-induced histological effects on human fallopian tube: determination of CO2 laser parameters to be used in microsurgery.

This experiment investigates CO2-laser-induced histological effects on fallopian tubes obtained during hysterectomies in women. Tubal transversal sections were performed at isthmic and ampullar sites. Forty strips were available for histological study of the cut section area. The role of different parameters such as radiation power and beam fractionation (continuous versus pulsed) on tissue lesions was assessed. In tubal microsurgery, the CO2 laser can be used as a scalpel with the predominant advantage of minimal tissular alterations. As a result of this study, our recommended parameters are the following: radiation power, 7-10 W; beam focalization zone, 0.2 mm; energy density, 20,000-35,000 W/cm2; continuous operation; moving speed, 1 cm/s.

Carbon Dioxide↗

Primary clear cell adenocarcinoma of the fallopian tube with brain metastasis: a case report.

The first reported case of cerebellar metastasis from primary clear cell adenocarcinoma of the fallopian tube is presented. Initially diagnosed as stage Ia, the patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy, followed by cisplatin-based chemotherapy and whole pelvic irradiation. Thirty six months later multiple pulmonary metastases were detected that did not respond to chemotherapy. Later the patient presented with cerebellar metastasis. She received whole brain radiotherapy and steroids. The brain lesion partially responded and the patient's neurologic symptoms improved. Throughout there was no evidence of local recurrence. This case suggests that with the prolonged survival achieved by aggressive treatment occult brain metastases might become apparent.

Adenocarcinoma, Clear Cell↗

Repeated Chlamydia trachomatis infection of Macaca nemestrina fallopian tubes produces a Th1-like cytokine response associated with fibrosis and scarring.

Chlamydia trachomatis-associated female infertility and ectopic pregnancy are caused by postinflammatory fibrosis and scarring of the upper genital tract. Scarring of the upper genital tract is associated with multiple infectious episodes with C. trachomatis. To study the immune response that occurs with multiple infections of C. trachomatis in the female upper genital tract, a Macaca nemestrina model was used. Subcutaneous pockets containing autologous salpingeal tissue implants were inoculated three times with C. trachomatis. The inflammation after three inoculations was associated with a mononuclear infiltrate dominated by CD8 T-cell lymphocytes. Perforin mRNA was induced in infected pockets, demonstrating that activated cytolytic lymphocytes were present in the lesions. Fibrosis, as evidenced by fibroblast proliferation and connective tissue deposition, was observed by the third infection. Cytokine mRNAs induced by repeated chlamydial infection included gamma interferon, interleukin-2 (IL-2), IL-6, and IL-10 mRNAs, but IL-4 mRNA was not induced. Nearly identical findings were found in macaque fallopian tubes infected in situ repeatedly with C. trachomatis, validating the subcutaneous pocket model of chlamydial salpingitis. However, it was not possible to evaluate if there was an induction of perforin mRNA in infected salpingeal tubes in situ, because there was a high basal level of perforin mRNA in these tissues. These results suggest that repeated chlamydial infection of the female upper genital tract leads to CD8 T-cell predominance, a Th1-like cytokine milieu, and these inflammatory changes are associated with progression to fibrosis associated with female infertility.

Animals↗

Parity, tubal sterilization, hysterectomy and risk of primary fallopian tube carcinoma in Finland, 1975-2004.

We studied the possible relationship among parity, female sterilization, hysterectomy and the risk of primary fallopian tube carcinoma (PFTC) in a case-control study in Finland in cases occurring between 1975 and 2004. A total of 573 PFTC cases were identified from the Finnish Cancer Registry, and 10 age-matched controls per case were randomly selected from the Finnish Central Population Registry. In multivariate analysis (including 189 PFTC cases and 1764 controls) parity was protective: the odds ratio (OR) for 1-2 deliveries was 0.63 (95% CI 0.44-0.91) and for > or =3 deliveries, 0.32 (95% CI 0.19-0.52). The OR for sterilization was 0.74 (95% CI 0.42-1.30) and for hysterectomy 1.27 (95% CI 0.73-2.21). Our findings suggest a possible hormonal background as regards the development of PFTC.

Carcinoma↗

Ability of monomeric peptidoglycan fragments from Neisseria gonorrhoeae to damage human fallopian-tube mucosa.

Purified disaccharide peptide monomers obtained from Neisseria gonorrhoeae by enzymatic digestion of gonococcal peptidoglycan damaged the mucosa of human fallopian tubes in organ culture. Two peptidoglycan fragments were tested: a nonreducing, anhydromuramyl-containing monomer (the principal fragment shed by growing gonococci) and the analogous reducing, muramidase-derived monomer. The damage produced by either of these peptidoglycan monomers resulted in sloughing of ciliated cells from the mucosa and resembled the damage observed in active gonococcal infection and that produced by filter-sterilized toxic supernatant fluids from gonococcal-infected organ cultures. The minimal toxic dose of peptidoglycan monomers was 0.75 micrograms/ml. Neither lipopolysaccharide, sodium dodecyl sulfate, nor Triton X-100, possible contaminants from the monomer-purification procedures, was present in sufficient quantity to account for the damage. Both of the gonococcal peptidoglycan monomers may be present in vivo and thus may play a role in the pathogenesis of gonococcal infection.

Cilia↗

Second-look laparotomy in the management of fallopian tube carcinoma.

OBJECTIVE: To evaluate the role of second-look laparotomy following platinum-based combination chemotherapy in patients with fallopian tube carcinoma. METHODS: A retrospective chart review was conducted on 21 patients with tubal carcinoma who underwent second-look laparotomy following cytoreductive surgery and platinum-based combination chemotherapy. RESULTS: Thirteen patients (62%) were found to be free of disease at second-look operation. Neither stage nor grade were predictive of findings at second-look procedure. The absence of gross residual disease following primary surgery was the only predictor of disease-free status at second-look laparotomy (p < 0.01). With a mean follow-up of 49 months among the survivors, four (31%) of the patients with negative second-look laparotomy have had a recurrence. The median survival following a positive second-look laparotomy was 18 months (range 5-42 months). CONCLUSION: Second-look laparotomy provides useful prognostic information in patients with tubal carcinoma. The high rate of recurrent disease after negative second-look laparotomy, and the lack of an effective second-line treatment in patients with persistent disease, represent major criticisms of this procedure.

Adult↗

Primary carcinoma of the fallopian tube in a 88 years old woman: review of the literature.

A woman of 88 years old with primary carcinoma of the fallopian tube, the oldest patient reported in the English literature according to the best of our knowledge, was presented. After debulking surgery four courses of chemotherapy including paclitaxel and carboplatin was performed. The patient was free of disease during two years follow-up.

Adenocarcinoma↗

Carcinoma of the fallopian tube: a clinicopathological study of 105 cases with observations on staging and prognostic factors.

One hundred five cases of carcinoma of the fallopian tube were subjected to a clinicopathological study to investigate the validity of various prognostic factors. A higher stage of tumor, an absence of closure of the fimbriated end of the tube, and an age of 66 years or older were the major predictors of a shorter length of recurrence-free postoperative survival in a univariate analysis. In a multivariate analysis, however, stage was a highly significant prognostic factor, absence of fimbriated-end closure, marginally significant, and older age, not significant. Within Stage I cases the presence or absence of invasion of the tubal wall, the depth of invasion when present, and the location of the tumor within the tube (fimbrial or nonfimbrial) appeared to be prognostically important. These findings strongly suggest that the FIGO staging system should be expanded to permit staging of noninvasive tubal carcinomas and fimbrial carcinomas, which cannot be staged according to the current system, and that depth of invasion of the tubal wall merits future investigation as an additional prognostic factor.

Adenocarcinoma↗