Adenocarcinoma of the fallopian tube. Natural history of an isolated splenic metastasis.
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Primary carcinoma of the fallopian tube is a rare malignancy of the female genital tract and infrequently diagnosed before an operation. The majority of patients have extensive disease at the time of diagnosis. We have experienced incidentally a case of a carcinoma of the fallopian tube coexisting with a benign cystic teratoma of the ovary in a 25-year-old woman. We report this case with a brief review of literatures.
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Authors describe a clinical course and morphological picture of three cases of primary carcinoma of the fallopian tube with urothelial differentiation. The diagnosis was sustain after retrospective review of the microscopic picture of tubal section which corresponded with transitional carcinoma with typical papillary formations. One of the patient diagnosed as I stage (FIGO) lived 5 years, two others diagnosed as II stage (FIGO) are alive for 5 and 9 years without any signs of cancer. Primary carcinoma of the fallopian tube with urothelial differentiation is associated with better prognosis than other types of tubal cancer and should be treated with adjuvant chemotherapy.
Medical records of patients diagnosed with primary fallopian tube carcinoma between 1979 and 1989 were reviewed. Twenty-six patients were eligible; 8 patients were excluded after pathologic review, leaving 18 patients included in the study for this analysis. The median and mean age were 61 and 59 years, respectively, with a range of 39-80 years. There were three Stage I, five Stage II, seven Stage III, and three Stage IV patients. The most common presenting symptoms were abdominal/pelvic pain, abdominal distension, and vaginal discharge/bleeding. The primary site of the lesion was determined to be the right tube in 44% of the cases, the left tube in 39% of the patients, bilateral lesions in 11% of the patients, and indeterminate in 6%. Histologic grade was poorly differentiated (Grade III) in 13 patients, moderately differentiated (Grade II) in 4 patients, and well differentiated (Grade I) in one. No patient was correctly diagnosed preoperatively. Survival at 5 years of the entire group was 35% with a 3 year minimum followup. Corresponding disease free survival was 30%. Mean and median survival times were 74 and 37 months, respectively. The range of survival times was from 1 to 120 months. All Stage I patients, 80% (4/5) of Stage II, and 29% (2/7) of Stage III patients are alive without disease. None (0/3) of the Stage IV patients are alive. Treatment regimens consisted of intraperitoneal P-32, external beam radiotherapy, and/or chemotherapy. Radiotherapy was associated with a low incidence of treatment-related complications, the majority being gastrointestinal related. There was one chemotherapy-related death. These patients and their treatment outcomes add to the data base of numerous previous reports on fallopian tube carcinoma. Stage I and II patients fared excellently with primary surgical and adjuvant therapy. While the prognosis of Stage III and IV patients is much worse, significant levels of long term survival can be achieved with aggressive treatment.
Here we report on histopathological findings from 46 cases of primary Fallopian tube carcinoma (PFTC) which were diagnosed and/or consulted in the Department of Pathology, University Medical School of Wrocław between 1982 and 1997. PFTCs can be classified according to the WHO International Classification of Ovarian Tumors. Reexamination of glass slides revealed at least five histological types of PFTC. Our results indicated better prognosis in patients with primary Fallopian tube endometrioid carcinoma rather than with serous carcinoma. Patients with PFTC expressing urothelial differentiation also show better prognosis. These findings confirm greater usefulness of primary ovarian carcinoma classification in the evaluation of the primary salpingeal carcinomas. The problems encountered in diagnosis, prognosis and therapy of PFTC are discussed.
Primary tubal cancer, unlike ovarian cancer, is not routinely suspected preoperatively, and thus diagnosis and therapy are delayed. We have recently encountered two cases in which primary Fallopian tube cancer masqueraded as other lesions. One presented as a pelvic inflammatory process, the second as cervical cancer. Primary Fallopian cancer should be suspected by the clinician, even if the presenting symptoms are atypical. Chemotherapy with taxol and cisplatin was instituted following debulking surgery.
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.
To establish prognosis, histologic appearance and p53 and c-erbB-2 expression in cancer tissue, six cases of primary transitional cancer of the fallopian tube were analyzed. Among 45 patients with the primary cancer of the fallopian tube diagnosed between 1992 and 1997, we found six cases diagnosed previously as solid (undifferentiated) cancer of the tube. p53 protein and c-erbB-2 oncoprotein expression were examined using an avidin-biothinyl-peroxydase complex method. The accumulation of p-53 protein and c-erbB-2 oncoprotein were used as prognostic marker of the transitional cancer of the tube. According to histologic picture all patients were diagnosed for primary cancer of the tube with transitional differentiation. In 4 cases strong positive and in 2 cases moderate positive reaction with antibody against p53 protein was seen for p53 protein. No positive expression of c-erbB-2 oncoprotein in membrane of cancer cells in our cases was detected. Presence p-53 protein in all our 6 cases deny the usefulness of the p53 protein as prognostic marker in primary cancer of the fallopian tube. Lack of expression of c-erbB-2 oncoprotein in membrane of cancer cells is significantly contributed to better prognosis in cases with primary cancer of the tube with transitional differentiation.
BACKGROUND: Because of the rarity of primary fallopian tube adenocarcinoma (PFTA), the outcome of advanced primary fallopian tube carcinoma has not been fully evaluated, especially in Taiwan. METHODS: We retrospectively studied patients with proven surgicopathologic stage III PFTA. Thirteen patients from 1965 to 1995 were identified. All patients received standard staging surgery including washing cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, retroperitoneal lymphadenectomy, infracolic omentectomy and excisional biopsy of all suspicious lesions. This was followed by adjuvant chemotherapy with four to eight courses of CAP or CEP (cyclophosphamide 500 mg/m2, adriamycin 50 mg/m2, or epirubicin 50 mg/m2, and cisplatin 50 mg/m2 intravenously, every 3 weeks) regimen. RESULTS: The accumulative disease-free survival rate was 15%. The incidence of retroperitoneal lymph node metastases was high, up to 69%, and the incidence of para-aortic lymph node metastases was 62%. Eighty-five percent of the cases were poorly differentiated carcinoma. Optimal debulking surgery was completed in 62% of patients, contributing to long-term patient survival (25% vs 0%), compared with those without optimal debulking surgery. CONCLUSIONS: The prognosis of stage III PFTA in our study was poor. Careful lymph node dissection in the retroperitoneal space including the para-aortic area is required. Optimal debulking surgery plus postoperative adjuvant chemotherapy appears to be the only option for enhancing long-term disease-free survival.