Pathologic quiz case: an incidental finding in the fallopian tube. Fallopian tube, left, tubal ligation: metaplastic papillary tumor of fallopian tube.
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Adult↗
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Scanning electron microscopy of the human fallopian tube.
Fallopian tubes from women of reproductive and postmenopausal ages were examined by scanning electron microscopy. The surface topography of these Fallopian tubes is described and illustrated.
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[Spontaneous healing after transverse resection of the fallopian tubes: observations on operated fallopian tube pregnancies].
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Animals↗
Proximal fallopian tube occlusion: diagnosis and treatment with transcervical fallopian tube catheterization.
Transcervical fallopian tube catheterization (TFTC) was performed in 22 infertile patients with bilateral fallopian tube obstruction and a mean duration of infertility of 3.3 years. A high prevalence of previous ectopic pregnancy (n = 8, 36%), tubal ligation and/or reconstruction (n = 5, 23%), spontaneous or therapeutic abortion (n = 6, 27%), and previous intrauterine device use (n = 14, 64%) was noted. The authors successfully catheterized 40 (98%) of 41 tubes without serious complication and visualized the distal tube in 36 (88%) of 41 tubes. Free spill in at least one tube was seen in 17 (77%) of 22 patients. Nineteen patients had a history of previous laparoscopy or laparotomy for tubal disease, in 16 of whom laparoscopic results were available for review. Retrospectively, in 15 (94%) of 16 patients all clinically relevant abnormalities would have been detected by means of TFTC alone. Five patients conceived, three with intrauterine and two with ectopic pregnancies. Patients with intrauterine pregnancies had normal-appearing tubes after TFTC, while those with ectopic pregnancies had residual tubal abnormalities after recanalization. TFTC is a safe, accurate diagnostic procedure that provides more information than hysterosalpingography and, in most cases, as much or more information about the fallopian tubes than laparoscopy.
Adult↗
Fallopian tube disease: limited value of treatment with fallopian tube catheterization.
PURPOSE: Therapeutic role of fallopian tube catheterization was prospectively studied in patients with bilateral fallopian tube obstruction. MATERIALS AND METHODS: Catheterization was performed in 42 patients with bilateral obstruction; 36 of the patients (67 fallopian tubes) underwent recanalization. RESULTS: Fifty-two tubes with 54 proximal obstructions were successfully recanalized (technical success rate, 96%), 36 with selective catheterization and 16 with coaxial techniques. Among 13 tubes blocked at the distal portion of the tube, six tubes were negotiated. Perforation or subintimal injury occurred in three tubes, and one patient eventually had a tubal pregnancy. During follow-up of 3 months to 4 years, five patients had conceived, including the patient with a tubal pregnancy and one patient who experienced spontaneous abortion during the first trimester. CONCLUSION: Fallopian tube catheterization is technically highly successful and diagnostically useful. However, its role in treating fallopian tube diseases is limited, and patients with distally blocked tubes are not good candidates for this procedure.
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HER-2 oncogene is not amplified in primary carcinoma of the fallopian tube. Austrian Cooperative Study Group for Fallopian Tube Carcinoma.
73 women suffering from primary carcinoma of the fallopian tube underwent surgical excision of their tubes. The tissue was embedded in paraffin and investigated for HER-2 oncogene amplification with a quantitative polymerase chain reaction method. DNA could be extracted and successfully prepared in 65/73 samples. None of the tissue samples exhibited amplified the HER-2 oncogene. Data suggest that the HER-2 oncogene does not play a role in tumor transformation and progression in fallopian tube carcinomas. This contrasts with observations in ovarian carcinomas, with which fallopian tube carcinomas share many clinical, histological and biochemical similarities.
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Expression of insulin-like growth factor-I (IGF-I) in the rat fallopian tube: possible autocrine and paracrine action of fallopian tube-derived IGF-I on the fallopian tube and on the preimplantation embryo.
Recent studies have indicated that growth factors such as insulin-like growth factors (IGFs) increase the growth rate of cultured preimplantation embryos. We therefore hypothesized that the fallopian tube may produce IGFs which in turn participate in the regulation of preimplantation embryo development in vivo. In the present study we examined the expression of IGF-I in the fallopian tube. We demonstrated that IGF-I transcripts (7.0, 1.7, and 1.2-0.8 kilobases) were abundant in the fallopian tube. Immunoreactive IGF-I was most abundant in the epithelial cells in the fallopian tube, and IGF-I messenger RNA (mRNA) was detected in the luminal region of the fallopian tube. A solution hybridization assay was used to examine the regulation of IGF-I mRNA. The abundance of IGF-I transcripts changed markedly during the 4-day estrous cycle with the highest levels on the day of proestrus. The increase in IGF-I mRNA between the day of diestrus II and the day of proestrus was 4-fold (P < 0.01). The pattern of IGF-I mRNA expression in the fallopian tube resembled the pattern of ovarian estrogen production during the estrous cycle. The level of IGF-I mRNA decreased after hypophysectomy. The expression of IGF-I mRNA in the fallopian tube was dose-dependently regulated by estradiol, and a single sc injection of estradiol [5 micrograms/100 g body wt (BW)] increased the IGF-I mRNA in a time-dependent manner with a significant increase after 3 h (P < 0.01). The lowest estradiol dose tested (0.1 microgram/100 g BW) increased the expression after 6 h, whereas progesterone (5 micrograms/100 g BW) was ineffective. The presence of embryos in the fallopian tube did not statistically significantly influence the abundance of IGF-I transcripts as measured with a solution hybridization assay on RNA extracted from whole fallopian tubes. In order to determine possible targets for fallopian tube-derived IGF-I we examined the expression of IGF-I receptor mRNA. Northern blot analysis revealed that an 11-kilobase IGF-I receptor transcript was expressed in the fallopian tube. Using a reverse transcriptase-polymerase chain reaction, IGF-I receptor mRNA was also detected in the eight-cell but not two-cell preimplantation embryo. The present study demonstrates that IGF-I is produced in the fallopian tube and its expression is regulated by estradiol. Both the fallopian tube and the eight-cell preimplantation embryo express IGF-I receptors and are therefore potential target tissues.
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Management and prognosis of primary fallopian tube carcinoma. Austrian Cooperative Study Group for Fallopian Tube Carcinoma.
We retrospectively analyzed 143 women treated in 28 departments from 1980 to 1995, to study the impact of prognostic factors in primary carcinoma of the fallopian tube. Further aims of the study were to evaluate the treatment of fallopian tube carcinoma in Austria. Staging of disease was done according to the modified FIGO system, and grading according to the criteria suggested by Hu et al. The mean age of the patients was 62.5 years. Sixty (42%) tumors were found to be in stage I, 28 (19%) in stage II, 38 (27%) in stage III, and 17 (12%) in stage IV. Radical resection was achieved in 102 (71%) patients. In 122 (85%) women surgery involved removal of the uterus, the adnexa, and/or the omentum or lymph nodes. Postoperatively patients underwent adjuvant therapy consisting of either irradiation (n = 40; 28%) or chemotherapy (n = 70; 49%); 33 women (23%) did not receive any treatment after surgery. The 5-year survival rate for all stages of disease was 43%. The 5-year survival rate was 59% for stages I and II and 19% for stages III and IV. FIGO stage, histologic grading and residual tumor showed an independent prognostic impact in multivariate analysis.
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Contractile effect of acetylcholine on isolated ampullar segment of Fallopian tubes.
The Fallopian tubes are scarcely innervated with cholinergic nerve fibers. Acetylcholine released from these nerves contracts smooth muscles of the tubes. The aim of our study was to investigate the effect of acetylcholine on the Fallopian tubes using selective antagonists in different hormonal settings. We have investigated effects of acetylcholine on isolated ampulla of Fallopian tubes taken from 83 patients during abdominal hysterectomy with adnexectomy. Twenty-eight patients were in follicular, 36 were in luteal phase of menstrual cycle, and 19 patients were in menopause. Selective and non-selective muscarinic and nicotinic receptor blockers were used for investigation of the effects. Acetylcholine (from 1.8 to 658.6 microM/l) produced concentration-dependent tonic contraction of ampulla taken from the patients in follicular phase, luteal phase and menopause. The nicotinic receptor blocker mecamylamine (6.5 microM/l) and local anesthetic lidocaine (230.8 microM/l) did not affect the effect of acetylcholine. While M(1)- and M(2)-selective muscarinic receptor blockers pirenzepine (1.6 microM/l) and methoctramine (0.9 microM/l) did not show specific effect, atropine (0.01 microM/l) and selective M(3)-receptor blocker p-fluoro-hexahydro-sila-difenidol (pFHHSiD, 0.2 microM/l) effectively blocked contractions caused by acetylcholine (maximal pA(2) values 9.74 and 7.54, respectively). The affinity of pFHHSiD for muscarinic receptors was highest in the follicular phase. The results of our study suggest existence of functional M(3) muscarinic receptors in ampulla of Fallopian tubes, located on the smooth muscle cells.
Acetylcholine↗
A 15-year overview of management and prognosis in primary fallopian tube carcinoma. Austrian Cooperative Study Group for Fallopian Tube Carcinoma.
143 women treated in 28 departments from 1980 to 1995 were retrospectively analysed to study the impact of prognostic factors in primary carcinoma of the fallopian tube. The mean age of the patients was 62.5 years. Sixty (42%) tumours were FIGO stage I, 28 (20%) stage II, 38 (27%) stage III, 17 (12%) stage IV. Complete radical resection was achieved in 102 (71%) patients. In 122 (85%) women, surgery involved removal of the uterus, the adnexa, and/or the omentum or lymph nodes. Postoperative therapy consisted of either irradiation (n = 40; 28%) or chemotherapy (n = 70; 49%); 33 women (23%) did not receive any treatment after surgery. The 5-year survival rate for all cases was 43%. The 5-year survival rate was 59% for stages I and II and 19% for stages III and IV (P < 0.00001). FIGO stage, histological grade and presence of residual tumour had an independent prognostic impact in multivariate analysis. In order to investigate the role of p53 in primary fallopian tube carcinomas, we analysed the immunohistochemical expression of p53 protein regarding survival and FIGO stage in 63 patients (44%). No statistical significance was observed.
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Prognostic factors in primary fallopian tube carcinoma. Austrian Cooperative Study Group for Fallopian Tube Carcinoma.
A retrospective nationwide evaluation of primary fallopian tube carcinomas for a period of 10 years (1980-1990) was performed to evaluate the prognostic impact of various factors. Sixty-six cases were investigated for the prognostic influence of estrogen (ER) and progesterone (PgR) status, mitotic activity, degree of nuclear anaplasia, and inflammatory reaction. ER and PgR receptors were detected by immunohistochemistry from paraffin sections. Forty-two percent were PgR-positive and 26% were ER-positive. However, no correlation of steroid receptors with survival could be found. Ninety-two percent of all tumors showed a moderate and high degree of nuclear anaplasia and only 8% showed a low degree of nuclear anaplasia. Thirty-four (52%) samples from all patients revealed low mitotic activity compared to 32 (48%) with an intermediate and high mitotic rate. Twenty-four (37%) tissue samples showed a positive inflammatory reaction which correlated with a significantly better outcome compared with tumors without this feature. This finding was also confirmed in multivariate analysis as an independent prognostic factor.
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Physiologic significance of 17beta-estradiol binding in the rabbit Fallopian tube.
Rabbit Fallopian tube contractility was recorded in vitro during perfusion with either Locke's solution or that solution containing CN-55, 945-27 (CN; or CI-628), a nonsteroidal estrogen antagonist (Endocrinology 79: 153, 1966). Contractility was inhibited and 17beta-estradiol (E2) displaced from both its cytoplasmic (8S) and nuclear (4S) receptors in the presence of the above agent. These effects result from a direct interaction between CN and the E2-receptor complexes. Two types of evidence show the specificity of the foregoing responses: (1) nonspecific binding of E2 to serum proteins was unaffected by the antagonist and (2) CN had no effect on contractility of a nontarget tissue, i.e., rabbit ileum. In addition, Fallopian tube contractions induced by strong electrical stimulation of K-depolarized tissues (i.e., in the absence of normal ionic gradients) were inhibited by CN and a decrease in the binding capacities of 8S and 4S receptors was again observed. Thus, antagonism of specific E2 binding inhibits the contractile mechanism at a level other than the cell membrane. These observations, and additional findings concerning the reversibility of CN action, indicate that E2 binding is essential for contractility of the rabbit Fallopian tube.
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What is the true incidence of primary fallopian tube carcinoma?
Fallopian tube carcinoma can be histologically indistinguishable from and has a similar clinical behavior to epithelial ovarian carcinoma. However, it is considerably less common; only approximately 1000 cases have been recorded in the literature. In the prevalence screen of 22000 women participating in The Royal London Hospital, London, UK, ovarian cancer screening project, three cases of early stage primary fallopian tube carcinoma were diagnosed following the finding of an elevated serum level of the CA 125 antigen. The ratio of epithelial ovarian : tubal cancer developing in these postmenopausal volunteers was 6:1. This is 25-fold greater than the expected ratio. It is difficult to attribute this finding to population selection bias. However, it is possible that the screening test was particularly effective in detecting tubal carcinoma or that, in clinical practice, the true primary site of origin of some tumors classified as widely disseminated ovarian cancer is in the fallopian tube.
Journal Article↗
Torsion of the fallopian tube.
Isolated fallopian tube torsion is a rare entity that most frequently occurs during the menstruating years, but has also been reported in premenopausal and postmenopausal women. Diagnosis of this condition is often delayed because of the rarity of its occurrence and prolonged investigations to rule out more common causes of acute abdominal pain. A case of a 13-year-old girl with isolated left fallopian tube torsion is presented. A high index of suspicion must be maintained for adnexal torsion in women with abdominal pain so that an attempt can be made to salvage the adnexal structures.
Abdominal Pain↗
[Tubal catheterization with selective salpingography in the diagnosis and therapy of fallopian tube obstruction].
Fallopian tube catheterization with selective ostial [correction of osteal] salpingography is a new technique for the diagnosis of tubal factors of infertility and also for the treatment of proximal tubal occlusion (PTO). In this study, 246 women were considered, 20-42 years old, with primary or secondary infertility, who presented a unilateral or bilateral PTO at hysterosalpingography (HSG). Catheterization and selective salpingography have been successful in 93.9% of the cases. Failures (5.6%) have been ascribed to obstructive organic diseases, where it was impossible to overcome the stenosis with the catheter or the guide-wire. Twenty-six spontaneous pregnancies were obtained (15 full-term deliveries) and 17 patients became pregnant after GIFT (13 full-term deliveries). At follow-up, after 12 months 4 of 10 patients had normal tubes, while 6 patients presented a new unilateral or bilateral PTO. No major complications occurred; nevertheless, ectopic pregnancy is a possible event, because of the mechanically re-established patency in a nonfunctioning tube.
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Primary carcinoma of the fallopian tube--a retrospective analysis of 115 patients. Austrian Cooperative Study Group for Fallopian Tube Carcinoma.
Incidence and prognostic factors of primary carcinoma of the Fallopian tube were studied in a retrospective multi-centre analysis of 115 women during the period 1980 to 1990. Data of 28 departments (university as well as general hospitals) were included in the present study which was designed to evaluate the current diagnosis and treatment of carcinoma of the Fallopian tube in Austria, and to compare the results with those from the literature. Stages were classified according to the modified FIGO-system for ovarian cancer; grading followed the criteria of Hu et al. (1950). The mean age of the patients was 62.5 years. Forty-seven (40.9%) tumours were found to be in stage I, 20 (17.4%) in stage II, 34 (29.6%) in stage III, and 14 (12.1%) in stage IV. In 82 patients, the tumour could be completely removed. The surgical method applied in 95 cases was removal of the uterus, the adnexa, and/or the omentum, or lymph nodes. Postoperatively patients underwent adjuvant therapy which was either irradiation (n = 40; 34.8%), or chemotherapy (n = 49; 42.6%); 26 women (22.6%) had no therapy after operation. The 5-year survival rate for all stages was 36.5%. In stages I and II the 5-year survival was 50.8% compared to 13.6% in stages III and IV. FIGO-stage I and II and a residual tumour less than 2 cm in advanced disease had a prognostically favourable impact, which was proven in univariate as well as multivariate analysis.
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Primary fallopian tube carcinoma--a retrospective survey of 51 cases. Austrian Cooperative Study Group for Fallopian Tube Carcinoma.
OBJECTIVE: To evaluate retrospectively the importance of invasion beyond the basement membrane on overall survival in Fallopian tube carcinoma and its influence on the necessity of postoperative adjuvant therapy (stage 0 vs. stage I). DESIGN: In a nationwide analysis the data of 51 patients were evaluated. The participating departments provided the study center with histologic specimens. A re-staging was done according to the FIGO-classification for Fallopian tube carcinomas. Stage 0 patients received no further postoperative therapy, in stage I patients were divided in 2 groups to evaluate the impact of postoperative adjuvant therapy (chemotherapy vs. irradiation). RESULTS: Patients of stage 0 had a significantly better prognosis than patients of stage I (p = 0.035). Stage I patients treated by irradiation showed a significantly better prognosis than patients treated by chemotherapy (p = 0.017). CONCLUSION: Tumour penetration through the basement membrane causes prognosis to deteriorate significantly (5-year survival rate about 50% in stage I). Postoperative therapy is thus indicated with stage I disease. Irradiation seems to give better results than chemotherapy.
Adenocarcinoma↗
[Trans-uterine fallopian tube catheterization--a noninvasive, ambulatory evaluation of fallopian tube patency].
In a prospective clinical study (March 89-June 91), we examined 114 infertile women to evaluate the diagnostic value of trans-uterine tubal cannulation with the injection of sterile fluid and consecutive sonographical control in the assessment of tubal patency. The results of this technique were compared with the findings of laparoscopy and/or hysterosalpingography. With the Jansen-Anderson Catheter (J-A-C) it was possible to reach the isthmic part of the tube without any analgesia or anaesthesia. 10 to 15 ml of sterile culture medium were injected. In case of tubal patency the fluid was detectable in the pouch of Douglas by transvaginal ultrasound. In 108 out of 114 women (94.7%), the cannulation of at least one tube was possible. All 97 patients with patent tubes (laparoscopy) were diagnosed correctly via the J-A-C. The three cases of proximal tubal occlusion were also diagnosed correctly, 8 patients with one or two-sided hydrosalpinx were also recognized. All five patients with bilateral hydrosalpinx were detected. Three women showed a unilateral hydrosalpinx in the laparoscopy. In these cases the diagnosis obtained by the J-A-C was once bilaterally patent and twice bilaterally distally occluded. Trans-uterine cannulation of the tubes with injection of sterile fluid and consecutive transvaginal sonography is an easy and safe method to evaluate the tubal status. It becomes possible thereby to prove tubal patency in a very early stage of diagnostics. Loss of time and futile treatment cycles (stimulations or inseminations in cases of tubal occlusion) can thus be avoided.
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