Prognostic factors of primary fallopian tube cancer in a single institute in Taiwan

Primary Fallopian Tube Carcinoma: An Extremely Rare Gynecological Cancer Misdiagnosed Intraoperatively as Benign Ovarian Neoplasm: A Case Report

Primary fallopian tube carcinoma is very rare. Diagnosis is challenging. The description of our case concerns an asymptomatic 71-year-old patient who came for a routine gynecological examination. Imaging of the pelvis revealed the presence of a two-chambered cystic formation in the anatomical position of the right ovary. It was decided to investigate the disease by laparotomy. Examination of the frozen section from the site of the cystic lesion was negative for malignancy. An abdominal total hysterectomy was performed with bilateral salpingo-oophorectomy. Serous carcinoma of the fallopian tube was diagnosed postoperatively by histological examination of the surgical preparation. Immediately after surgery, the patient’s health was good.The patient was referred to an oncology center and was monitored. Chemotherapy based on platinum and taxane was recommended. Six months after the operation the patient is in good health. The possibility of a second surgery to treat fallopian tube cancer with pelvic lymph node dissectionis under discussion and is expected to be decided by oncologists and gynecologists-oncologists. In this article, after describing the case report, a brief review of this rare entity disease’s diagnostic and therapeutic approach is attempted.

Lymphadenectomy in Primary Fallopian Tube Cancer is Associated with Improved Survival

BACKGROUND AND OBJECTIVES

Primary fallopian tube cancer (PFTC) shares the same diagnostic and management guidelines with epithelial ovarian cancer (EOC). The LION trail raised concerns regarding the role of systematic pelvic and para-aortic lymphadenectomy during debulking surgery. We aimed to evaluate the significance of lymphadenectomy in PFTC survival.

METHODS

This retrospective study analyzed the clinical features and survival of patients with PFTC who underwent primary surgery in our center between January 2013 and October 2020.

RESULTS

Sixty-one patients diagnosed with PFTC were included in the study. Twenty-five (41.0%, 25/61) were diagnosed with FIGO (International Federation of Gynecology and Obstetrics) stages I/II and 36 (59.0%, 36/61) were diagnosed with stage III/IV. Twenty-nine (47.5%, 29/61) underwent pelvic lymphadenectomy with or without para-aortic lymphadenectomy, among which 12 (41.4%, 12/29) had lymph node metastasis confirmed by postoperative pathology. The mean progression-free survival was 60.4 months in the lymphadenectomy group and 37.8 months in the no-lymphadenectomy group (p = 0.042, HR 0.374, 95% CI 0.145-0.966).

CONCLUSIONS

PFTC is often diagnosed earlier and has a better prognosis than EOC. Most patients with PFTC would benefit from lymphadenectomy. However, the extent to which this association translates to a more diverse population needs to be further identified.

Oncologic outcomes in patients undergoing maximal or optimal cytoreductive surgery for Stage 3C serous ovarian, tubal or peritoneal carcinomas

The aim of this study was to evaluate overall survival (OS) and disease-free survival (DFS) of patients with Stage 3C serous ovarian, tubal and peritoneal carcinomas. A retrospective analysis of 111 patients who underwent maximal or optimal cytoreductive surgery was performed. Patients were divided into three groups as ovarian cancer (n = 47), tubal cancer (n = 24) and peritoneal cancer (n = 40). Median follow-up was 30 months. There was no significant difference in DFS and OS among the groups. Complete cytoreduction was an independent prognostic factor for DFS in all groups (HR 2.3, 95% CI 1.14-4.93; p=.020). Positive peritoneal cytology (HR 2.2, 95% CI 1.02-4.78; p=.044), and retroperitoneal lymph node involvement (HR 2.3, 95% CI1.11-4.89; p=.025) were independent risk factors for decreased OS, and extended cytoreduction (HR 2.7, 95% CI 1.05-6.99; p=.039) were independent risk factors for increased OS. In conclusion, these malignancies should be considered a single entity during treatment.IMPACT STATEMENTWhat is already known on this subject? Epithelial ovarian cancer is the second most common gynaecological cancer in women worldwide. There are different histological types including ovarian, tubal and peritoneal carcinomas in which malignant cells form in the tissue covering the ovary or lining the fallopian tube of peritoneum. Recent data have supported the view that these malignancies should be considered a single entity and should be treated the same way.What the results of this study add? In the present study, we evaluated overall survival and disease-free survival of patients with Stage 3C ovarian, tubal and peritoneal cancer undergoing maximal or optimal cytoreductive surgery. We found similar oncologic outcomes in all patient groups. To the best of our knowledge, this is the first study to compare oncologic outcomes of these similar and often confused malignancies in the literature. We, therefore, believe that the present study provides additional information to the body of knowledge on this topic.What the implications are of these findings for clinical practice and/or further research? This study is important, as it indicates similar oncologic outcomes in patients undergoing maximal or optimal cytoreductive surgery for Stage 3C ovarian, tubal and peritoneal cancer. Based on these findings, clinicians should keep in mind that these malignancies should be considered a single clinical entity and be treated the same way. We believe that our study would pave the way for further studies regarding this subject.

Primary leiomyosarcoma of the fallopian tube: Three case reports and review of the literature

OBJECTIVE

Leiomyosarcoma of the fallopian tube is a rare malignant gynecologic neoplasm with poor prognosis. It is important to share experience and to collect more cases to improve the understanding of the disease.

CASE REPORT

We reported three patients with leiomyosarcoma of the fallopian tube who were treated in Fudan University Shanghai Cancer Center (Shanghai, China) from 2012 to 2016. Although the three cases shared the same diagnosis, they varied in the presentations, treatments, and outcomes.

CONCLUSION

Leiomyosarcoma of the fallopian tube seems to have some particularities in imaging manifestations and immunohistochemical results. It has a progressive course with limited therapeutic options such as surgery, chemotherapy or radiotherapy.

[Ultrasonographic features in the preoperative diagnosis of primitive fallopian tube carcinoma]

OBJECTIVES

To review the characteristic ultrasound features of primary fallopian tube carcinoma (PFTC) and its relationship to the clinical history in order to establish specific findings useful for the preoperative diagnosis.

METHOD

An extensive review of the current literature was done on Medline via PubMed by using the following keywords: "primary fallopian tube cancer", "tubal cancer", "adnexal malignancy mass" and "ultrasound".

RESULTS

PFTC corresponds to complex, sausage-shaped structures or cystic adnexal masses. A thick and an irregular capsule are in favour of a malignant lesion. Three-dimensional ultrasound is superior to 2D ultrasound for the detection of tubal wall irregularities such as papillary projections or pseudosepta who were suggestive of tubal malignancy and allows a better assessment of the extent of tumor infiltration through the capsule. Neovascularization with low resistance indices are typical of tubal malignancy. Three-dimensional power Doppler sonography acutely detected structural abnormalities of the malignant tumor vessels which are randomly dispersed within the papillary projections. Intra-uterine collection and peritumoral fluid are often found but ascite could be also an indirect proof of peritoneal carcinosis.

CONCLUSION

Sausage-shaped structures or cystic adnexal masses associated with imaging findings such as papillary projections and neovascularization with low resistance indices are in favour of PFTC. A standardized terminology, high-frequency and 3D power Doppler could improve diagnostic performance by allowing a better assessment of tubal wall and chaotic vessels architecture of these tumors.