[Primary carcinoma of the fallopian tube].
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A controversial discussion has arisen between endoscopists and oncologists about laparoscopic management of ovarian cancer and borderline tumours. A questionnaire was mailed to 273 German Departments of Gyn./Obst. A response rate of 46% (127 hospitals) was obtained concerning the endoscopical technique used, the kind and delay of post-endoscopical cancer operation and the early findings (follow-up) in cases of ovarian cancer, dysgerminoma, malignant teratoma, tubal cancer and borderline tumours of the ovary. In this German survey it could be shown that laparoscopic management of malignant ovarian tumours was not uncommon between 1991-1994. Totally, 61% of ovarian cancer stage Ia and 84% of ovarian borderline tumours stage Ia have been reported without any pathological finding in laparotomy subsequent to laparoscopic management of the lesions. The 192 cases cited here are undoubtedly an underestimate of the real present frequency of endoscopically managed ovarian malignancies. Patients with this early "negative" report should be followed up carefully and may not permit conclusions that laparoscopic management of ovarian malignancies may be harmless for them. In 16% of the stage Ia borderline tumours and in 39% of the stage Ia ovarian cancer early spread has been found totally, demonstrating that implantations and metastases subsequent to the endoscopical procedure can be found even in an early follow-up phase. In 92.4% laparoscopic capsule rupture, tumour morcellement with intraabdominal spilling, subsequent cystectomy or adnectomy had been the technique of choice with additional rinsing of the intraabdominal cavity. This was harmful for the majority of patients if the subsequent cancer surgery by laparotomy was delayed for more than 8 days. Early progression of these cases to stage I c has been reported in 20% (7/36 cases) and to stage II-III in 53% (19/36 cases). Only in 7.4% the endobag procedure was used in laparoscopic management of ovarian cancer stage Ia. In ovarian cancer stage Ic-III (n = 50) an early seeding in the laparoscopic tract was reported in 52% (13/25) if subsequent cancer surgery by laparotomy was delayed more than 8 days. The endoscopical techniques and the early findings after an endoscopical management are reported in detail. In conclusion, in respect of common oncological standards the actual practice in laparoscopic management of ovarian malignancy is considered poor surgery. Capsule rupture, tumour morcellement and unprotected "biopsy" in the intraabdominal cavity and an additional delay of adequate cancer surgery are the main pitfalls of that procedure. For the overwhelming majority of patients undergoing such endoscopical procedures very early implants and metastases in the pelvis, the abdominal cavity or the laparoscopic tract have been found. It seems necessary that laparoscopic management of ovarian malignancies and borderline tumours under the present technical conditions are given up and that we should return to reliable standards of oncological surgery comparable to laparotomy. This should be discussed urgently.
The case of a 34-year-old woman who had a radical hysterectomy for stage 1 b squamous cell carcinoma of the cervix and in whom an epithelial polyp was identified in the left fallopian tube is presented. The case is unusual in that the polyp developed in the absence of any evidence of tubal damage as demonstrated by a history of endometriosis or tubal sterilisation.
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Although the simultaneous presentation of endometrial and ovarian carcinomas of the endometrioid type is well described, little is known about a similar phenomenon involving the endometrium and fallopian tube (FT). We present the clinicopathologic features of 13 such cases seen in the Department of Pathology at The University of Texas M.D. Anderson Cancer Center over an 8 year period (1995 to 2002). FT tumors that could have represented luminal extension of the endometrial carcinoma or that represented an unequivocal metastasis to the FT were excluded. The patients' ages ranged from 34 to 77 years (median 54). The most common symptom was abnormal uterine/vaginal bleeding (11) and all of the patients were considered overweight or obese (mean body mass index was 41). The size of the endometrial carcinomas ranged from 0.3 to 8 cm. According to the FIGO grading of the endometrial endometrioid carcinomas, the cases were distributed as follows: Grade 1 (3) and Grade 2 (10). In 2 cases, there were also small areas of other histologic types, papillary serous carcinoma (1 case), and papillary endometrial carcinoma of intermediate grade (another case). The size of the fallopian tube carcinomas ranged from 0.2 to 17.5 cm. Seven of these tumors were located in the distal/fimbriated end of the FT. There was bilateral involvement in 2 cases. Three of the FT tumors were in situ. The grades of the fallopian tube carcinomas were as follows: Grade 1 (2), Grade 2 (6), and Grade 3 (2). In situ components were seen in all cases. One fallopian tube carcinoma was mixed with serous carcinoma. In 4 cases, there was also an endometrioid carcinoma involving the ovary, all of them with an intact ovarian capsule. Patients were treated as follows: total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) (4), TAH/BSO/chemotherapy (chemo) (4), TAH/BSO/radiation (3), and TAH/BSO/chemo/radiation (2). Follow-up ranging from 6 to 54 months was available in 10 patients: 1 patient died of disease (at 38 mo), 1 patient is alive with disease (at 9 mo), 7 patients have no evidence of disease (6 to 54 mo), and 1 patient died of metastatic endometrial carcinoma (at 9 mo). Simultaneous endometrioid carcinomas of the uterus and FT are unusual and occur primarily in obese perimenopausal women. The tumors are predominantly well or moderately differentiated with dissimilar endometrial and FT grades. The FT carcinoma is usually unilateral and located at the distal end of the tube.
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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.
This is a case of malignant mixed Müllerian tumor arising primarily from the fallopian tube. The tumor was distant metastasis to the omentum and the serosa of the sigmoid colon. Literatures published in the last two decades are reviewed and discussed.
A 17-year-old female with severe pain of the midabdomen was found to have a retroperitoneal cystic tumor, an ectopic ovary and a fallopian tube without fimbriated end. An attempt is made to determine whether these early embryonic malformations could be traced to a common origin. This is possible provided that the tumor is regarded as a mesonephroma. A histological study of the normal development of the Mullerian duct was performed utilizing human embryonic series. Previous development theories and more recent investigations are discussed. Malformations of the tube described in the literature and possible etiologies are summarized.
A case of tubal carcinoma is presented, which was initially misdiagnosed as an endometrial carcinoma. This was due to a superficial metastasis yielding material during the curettage which simulated an anaplastic adenocarcinoma. The difficulty of correctly diagnosing tubal carcinoma preoperatively has been discussed.
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A case of early bilateral serous papillary adenocarcinoma of the ovaries in an asymptomatic 58-year-old woman was diagnosed by the discovery of psammoma bodies in routine cervicovaginal and endometrial smears. Multiple small foci of carcinoma in-situ involving both fallopian tubes were also present. The significance of psammoma bodies in the cervicovaginal smear is discussed and the literature on the subject briefly reviewed.
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