Fallopian tube carcinoma: a review

Primarian fallopian tube carcinoma: Clinical and radiological keys for diagnosis

Primary fallopian tube carcinoma (PFTC) is seldom diagnosed preoperatively and is often mistaken for epithelial ovarian carcinoma (EOC). This report details a case of primary high-grade serous carcinoma (HGSC) of the fallopian tube, highlighting radiological and clinical indicators to aid in accurate diagnosis and avoid misdiagnosis. A 46-year-old premenopausal woman presented with symptoms and a transvaginal ultrasound (TVUS) indicating a malignant ovarian tumor. Further imaging with CT and MRI revealed a solid-cystic mass suggestive of a fallopian tube tumor rather than an ovarian origin. Oncological surgery confirmed the presence of a high-grade serous carcinoma in the fallopian tube. This case underscores the diagnostic challenges of PFTC and the superior sensitivity and specificity of MRI over CT and US in distinguishing adnexal lesions. Key MRI features such as the sausage-shaped mass and associated hematosalpinx were crucial in differentiating PFTC from EOC. The report emphasizes the importance of considering PFTC in differential diagnoses of adnexal masses to ensure accurate preoperative identification.

Endometrioid carcinoma of the fallopian tube misdiagnosed as an infected endometrioma: A case report

INTRODUCTION

Fallopian tube cancer is a rare tumor, representing between 0.3 and 1.8 % of all malignant tumors in the gynecological sphere. Due to the proximity of the uterus and ovary, the diagnosis of primary fallopian tube cancer is very difficult to establish and relies on very strict criteria. The endometrioid form is exceptional and of controversial etiopathogenesis. Only a few cases have been previously reported. Diagnosis most often occurs incidentally during histological examination. This case presents a distinctive aspect with the rare occurrence of endometrioid-type fallopian tube cancer, notably associated with endometriosis, and initially misdiagnosed as an infected endometrioma. It underscores the diagnostic complexities encountered in identifying primary fallopian tube cancer.

CASE REPORT

We present the case of a 49-year-old patient, followed for chronic pelvic pain associated with menorrhagia. Imaging revealed a myomatous and adenomyotic uterus, a right ovarian endometrioma, and a left multicystic ovarian formation with thick walls, measuring 135 mm, requiring histological verification. She underwent an exploratory laparotomy. During the procedure, extensive retro- and supravaginal adhesive tissue involving the uterus, both adnexa, and the digestive tract was found. Careful adhesiolysis was performed. The left adnexa harbored a formation suggestive of an infected endometrioma. A total hysterectomy with bilateral adnexectomy and peritoneal washing was performed. The postoperative course was uneventful. Histopathological examination revealed an endometrioid carcinoma of the left fallopian tube, classified as pT1a according to FIGO guidelines.

DISCUSSION

Tubal cancer is a rare cancer of unknown etiology, underestimated, and sometimes confused with ovarian pathology. Preoperative diagnosis is difficult because the clinical presentation is polymorphic and imaging is nonspecific. The endometrioid form is exceptional and of controversial etiopathogenesis. Treatment mirrors that of malignant epithelial ovarian tumors, with prognosis depending on FIGO stage and histological type.

CONCLUSION

Due to its unpredictable nature, fallopian tube cancer should not be overlooked as a differential diagnosis for any adnexal mass.

Bowel perforation with generalised peritonitis secondary to recurrent primary fallopian tube carcinoma after 17 years

We describe a case of bowel perforation secondary to a recurrence of primary fallopian tube carcinoma treated more than a decade ago. A woman in her 70s presented to a rural centre with an acute abdomen. An abdominal CT showed a perforated ileum secondary to a pelvic mass. Emergency laparotomy identified the pelvic mass that was adherent to the side wall and invading the ileum at the site of perforation. Its adherence to the external iliac vessels posed a challenge to achieve en-bloc resection; therefore, a defunctioning loop ileostomy was created. Final histopathology and immunopathology were consistent with the recurrence of her primary fallopian tube carcinoma. The patient was further discussed in a multidisciplinary team meeting at a tertiary referral hospital. This case highlighted the importance of having a high index of suspicion for cancer recurrence, the utility of rapid source control laparotomy and multidisciplinary team patient management.

Lymphadenectomy and optimal excise lymph nodes count for early-stage primary fallopian tube cancer: a SEER-based study

BACKGROUNDS

There is still no consensus on the significance of Lymphadenectomy (LD) and the number of lymph nodes that need to be excised (ELNs) for adequate LD in patients with early-stage primary fallopian tube cancer (PFTC). Our endeavor is geared towards deepening comprehension of LD in early-stage PFTC and identify the optimal cut-off of ELNs.

METHODS

This SEER-based study analyzed the clinical data of patients with early-stage PFTC between 2000 and 2018. X-tile was employed to confirm the optimal cut-off of ELNs. The survival data between groups were analyzed by the Kaplan-Meier estimates, Log-rank test and Cox proportional hazards model.

RESULTS

There was significant improvement in both mean cancer-specific survival (CSS, p < 0.001) and overall survival (OS, p < 0.001) in LD group. Regardless of matched or not, LD was identified as an independent protective factor of CSS and OS. The optimal 3-year CSS-based cutoff of ELNs was 11 (p = 0.026) as determined by X-tile. Both the mean CSS (p = 0.001) and mean OS (p = 0.002) in adequate LD group (ELNs > 11, n = 574) were significantly longer than these in inadequate LD group (ELNs ≤ 11, n = 738). Adequate LD, FIGO stage, tumor grade and histology were significant prognostic factors for CSS and OS.

CONCLUSION

LD is an independent protective prognostic factor of patients with early-stage PFTC. The association between ELNs > 11 and an improved prognosis is evident. Future studies are needed to further clarify the results above.

18-F fluorodeoxyglucose positron emission tomography/computed tomography findings of bilateral primary fallopian tube carcinoma and metastasis to the uterus: a case report and literature review

Existing literature on primary carcinoma of the fallopian tube is limited because of the rarity of this disease. We report a patient with intermittent vaginal bleeding and vaginal discharge who underwent transvaginal ultrasound, magnetic resonance imaging, and 18-F-fluorodeoxyglucose positron emission tomography/computed tomography (18-F FDG PET/CT) in our hospital. Ultrasound showed a bilateral fallopian tube mass and a uterine lesion. Magnetic resonance imaging revealed typical sausage-shaped bilateral adnexal masses, but overlooked a small lesion in the uterus in the initial diagnosis. FDG PET/CT findings not only showed bilateral fallopian tube masses and uterine lesions, but also ruled out distant metastasis. Postoperative pathology confirmed bilateral primary high-grade serous adenocarcinoma of the fallopian tube with implants in the uterus. These findings suggest that 18-F FDG PET/CT imaging could be a good approach for the diagnosis and staging of primary carcinoma of the fallopian tube.

Retrospective study of histopathological and prognostic characteristics of primary fallopian tube carcinomas: twenty-year experience (SOCRATE)

OBJECTIVE

Primary fallopian tube carcinoma represents a rare entity, accounting for about 0.75%-1.2% of all gynecological malignancies. The rationale of our study is to describe the prognosis of primary fallopian tube carcinoma.

METHODS

We retrospectively identified patients with FIGO stage I-IV, all histology types and grading primary fallopian tube carcinoma treated in three major oncological centers between January 2000 and March 2020. Exclusion criteria were bulky tubo-ovarian carcinomas, isolated serous tubal intraepithelial carcinoma or neoadjuvant chemotherapy.

RESULTS

A total of 61 patients were included. The vast majority of primary fallopian tube carcinomas were serous (96.7%) and poorly differentiated (96.7%) and arose from the fimbriated end of the tube (88.5%). Larger tumor size correlated with higher probability of correct preoperative differential diagnosis of primary fallopian tube carcinoma (p=0.003). Up to 82.4% of patients with small tumors (≤15 mm) presented with high FIGO stage (≥IIA). The most common site of metastasis was pelvic peritoneum (18.8%) and among 59% of patients who underwent lymphadenectomy smaller tumors had higher rate of nodal metastasis (42.9%≤10 mm vs 27.3%>50 mm). After 46.0 months of mean follow-up there were 27 recurrences (48.2%). The most common site of relapse was diffuse peritoneal spread (18.5%). The 5-year disease-free survival was 45.2% and 5-year overall survival was 75.5%. Of note, 42.9% of patients with stage IVB survived >36 months.

CONCLUSION

Primary fallopian tube carcinoma is a biologically distinct tumor from primary epithelial ovarian carcinoma and it is mostly located in the fimbriated end of the tube. In addition, it is characterized by a high rate of retroperitoneal dissemination even at apparently an early stage and its size does not correlate with FIGO stage at presentation.

Pelvic Lymph Node Lymphangiomyomatosis Found During Surgery for Gynecological Fallopian Tube Cancer: A Case Report and Literature Review

Background

Lymphangioleiomyomatosis (LAM) is a rare low-grade metastatic tumor with an unknown origin that spreads through lymphatic vessels. It is characterized by the proliferation of smooth muscle-like or epithelioid tumor cells in the lung and axial lymphatic system. Extrapulmonary LAM is a localized disease with a low incidence rate, and the location of the related lesions is atypical. It is difficult to diagnose. The LAM of pelvic lymph nodes is hidden. It is usually found through gynecological oncology surgery.

Case presentation

We report a 57-year-old postmenopausal woman with a pelvic mass and vaginal bleeding as the main symptoms. The patient had no history of pulmonary LAM, tuberous sclerosis complex (TSC), or renal angiomyolipoma and had not used exogenous hormones. We performed a total hysterectomy, bilateral adnexectomy, greater omentum resection, and pelvic lymphadenectomy under laparoscopy. The postoperative pathology confirmed high-grade serous carcinoma of the left fallopian tube, and four lymph nodes were found in the pelvic lymph nodes, suggesting lymphangiomyomatosis. Immunohistochemical results also showed that these cells could express markers of smooth muscle cells and melanoma cells. The patient was treated with chemotherapy after the operation. Chest CT did not suggest lung LAM during the postoperative follow-up, and there was no tumor recurrence.

Conclusion

The diagnosis of this disease is challenging. At the same time, due to insufficient clinical samples, it is still unknown whether there is a potential relationship between pelvic and peritoneal lymph node LAM found in the surgical staging of gynecological tumors and lung LAM and/or TSC. There is no evidence that pelvic and peritoneal lymph node LAM will increase the risk of pulmonary LAM. Therefore, additional clinical data are required to analyze and summarize the relationship between pelvic and peritoneal lymph node LAM, pulmonary LAM, and the source of LAM. We present a case of pelvic lymph node LAM and propose a hypothesis that the pathogenesis of endometriosis can be used for reference in the study of this disease.

HE4 is associated with clinical risk prognostic factors and survival outcome in primary fallopian tube carcinoma patients

AIM

To explore whether HE4 was associated with clinical risk prognostic factors and survival outcome in primary fallopian tube carcinoma patients.

METHODS

Ninety-six primary fallopian tube carcinoma (PFTC) patients from March 2011 to June 2019 were enrolled in this study. Serum CA125 and HE4 concentrations were measured at four time points including primary diagnosis, postsurgery, pre-recurrence, and recurrence. The relations between clinical risk prognostic factors with HE4 concentrations were investigated, and multivariate survival analysis was used to calculate the hazard ratios between HE4 levels with recurrence-free survival and overall survival.

RESULTS

HE4 were significantly elevated in poor performance status, advanced stage, high histological grade and residual tumor diameter >1 cm, and positive lymph node status, respectively, compared with those in well performance status, early stage, low histological grade, residual tumor diameter ≤1 cm, and negative lymph node status, respectively. Multivariate survival analysis indicated serum HE4 can predict outcome of recurrence-free survival and overall survival with hazard ratios of 9.92 (95% confidence interval [CI]: 2.95-33.32) and 3.12 (95% CI: 1.07-9.08), respectively.

CONCLUSION

HE4 is associated with clinical risk prognostic factors in PFTC and contributes to predict survival outcome in PFTC cases.

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.

Concurrent Clostridial Enteritis and Oviductal Adenocarcinoma with Carcinomatosis in an Adult Alpaca (Vicugna pacos)

An adult alpaca (Vicugna pacos) with a history of colic and anorexia was euthanized because of failure to respond to treatment. Macroscopically, pale-tan, multifocal to coalescing, firm nodules and plaques markedly expanded the omentum, mesentery and the parietal and visceral peritoneum of multiple abdominal organs, especially the right oviduct and associated mesosalpinx. Abundant dark-red watery digesta were present in the duodenum and jejunum. Histological evaluation of the right oviduct, abdominal visceral nodules and plaques and mesenteric lymph nodes revealed transmural expansion and replacement by an epithelial malignant neoplasm, comprised of tubules and acini of ciliated columnar cells supported by abundant fibrous connective tissue. Both ovaries were histologically normal. On the basis of the ciliated morphology of the neoplastic cells, the focus on the proximal reproductive tract and the unremarkable ovaries, a reproductive tubal adenocarcinoma with carcinomatosis was diagnosed, with both the endometrium and oviduct considered as the tissues of origin. The prominent ciliated morphology of the neoplastic cells and the classification of human fallopian tube (oviduct) neoplasia lead us to propose oviductal adenocarcinoma with widespread carcinomatosis as the definitive diagnosis. The lamina propria of the small intestine was infiltrated segmentally by lymphocytes, plasma cells and neutrophils, and Clostridium perfringens with beta2 toxin production was identified by polymerase chain reaction in the small intestinal contents. To our knowledge, this is the first report of these two distinct diseases in an alpaca.

Primary Fallopian Tube Cancer in an 89-Year-Old Patient

Fallopian tube cancer is an extremely rare gynecological condition, accounting for just 1 to 2% of all female tract malignancies. The mean age of diagnosis is similar to that of ovarian cancer, between 60 and 75 years, but it can affect a wide spectrum of ages. Advanced age and family history of ovarian and breast cancer are the main risk factors, since they are associated with increased incidence of this uncommon entity. In this study, we report a rare case of an elderly, 89-year-old patient that presented to our clinic due to vaginal bleeding.

Collision carcinoma of endometrial adenocarcinoma and primary serous fallopian tube carcinoma: a case report

Collision carcinoma is a rare malignancy that generally occurs in cervical, esophageal, pulmonary, and squamous cell cancers. Few studies have been reported involving endometrial adenocarcinoma and fallopian tube carcinoma. We reported the case of a 58-year-old woman who presented because of irregular vaginal bleeding for more than 1 month. Cervical biopsy suggested moderately differentiated cervical adenocarcinoma, and the patient underwent radical hysterectomy under general anesthesia. However, postoperative pathology and immunohistochemical results indicated a collision tumor comprising endometrial adenocarcinoma (grade I) and primary serous fallopian tube carcinoma. According to the treatment principle of multiple primary tumors, a regimen of paclitaxel combined with carboplatin was administered. The patient also underwent local pelvic radiotherapy to treat lymph node metastasis. One month later, the patient developed brain metastases and died.

Fallopian tube cancer- challenging to diagnose but not as infrequent as originally thought

Background: Primary fallopian tube carcinoma (PFTC) is a rare gynecological malignancy though its prevalence may be underestimated given that most ‘ovarian’ serous cancers originate in the fallopian tube. Its diagnosis is challenging due to its vague signs and symptoms on presentation and it is frequently under-diagnosed pre-operatively.

Case Presentation: We present a case of a pre-menopausal woman who presented with vaginal bleeding. Her laboratory testing and physical examination were grossly unremarkable. Gynecologic ultrasound demonstrated multiple uterine fibroids and a double layer endometrium measuring 4.5 mm. More importantly, the left ovary was seen with a complex cyst with mildly echogenic fluid and a solid excerscence. These findings were suspicious for malignancy. The clinical and radiological findings with elevated CA-125 were consistent with a malignant process. Patient subsequently underwent a diagnostic laparoscopy, which required conversion to exploratory laparotomy, supracervical hysterectomy, bilateral salpingo-oophorectomy, right ureteral lysis, right para-aortic and right pelvic lymph node debulking and omentectomy. Biopsy of left fallopian tube and ovary revealed invasive high-grade serous carcinoma of fallopian tube, with involvement of lymphovascular spaces and with surface involvement. Peritoneal washings were negative for malignancy.

She was diagnosed with a high-grade serous carcinoma of the fallopian tube after undergoing an endometrial biopsy, multiple imaging tests and finally surgical intervention that yielded the diagnosis. She was started on chemotherapy with carboplatin and paclitaxel.

Conclusion: Our aim is to highlight the importance of having PFTC among the differential diagnosis when women present with vaginal bleeding or abdominal pain, as the clinical presentation of PFTC tends to be non-specific, and is often under-diagnosed; reviewing the diagnosis and management, and characterizing the similarities and differences of PFTC with other gynecological malignancies such as ovarian cancer.

Developing and validating a novel nomogram used a competing-risks model for predicting the prognosis of primary fallopian tube carcinoma: a retrospective study based on the SEER database

Background

The current prognostic methods for primary fallopian tube carcinoma (PFTC) are inadequate. This study is the first to use a competing-risks model to perform an accurate analysis of the prognostic factors for PFTC cause-specific death (CSD). We used the model to established a nomogram for the 3-, 5-, and 8-year CSD rates based on the identified prognostic factors.

Methods

This study selected 1,924 patients from the SEER (Surveillance, Epidemiology, and End Results) database. The cumulative incidence function (CIF) was used in univariate analyses, and Gray’s test was used to determine the intergroup difference in the CIF. We then used the subdistribution proportional hazards model in a multivariate analysis. We finally used the prognostic factors identified in the analysis of the competing-risks model to construct a 3-, 5-, and 8-year CSD nomogram for PFTC patients. The concordance index (C-index) and calibration plots were used to evaluate the discrimination ability and consistency of the model.

Results

The subdistribution proportional hazards model showed that age, histological type, FIGO stage, and the log of the ratio between the numbers of positive and negative lymph nodes (LODDS) were independent prognostic factors for CSD. The 3-, 5-, and 8-year C-indexes were 0.744, 0.744, and 0.733 in the training cohort, and 0.737, 0.748, and 0.721 in the validation cohort. In the calibration plots, the forecast lines were very close to the reference lines.

Conclusions

This study is the first to analyze the prognostic factors for PFTC based on a competing-risks model. This model indicates that age, histological type, FIGO stage, and LODDS are significant prognostic factors affecting CSD in PFTC patients. We have also constructed the first 3-, 5-, and 8-year CSD nomogram for PFTC patients. This nomogram exhibits good discrimination ability and accuracy and can help clinicians to provide individualized prognostic analysis for PFTC patients.

Responses of metastatic primary fallopian tube carcinoma to pembrolizumab and nab-paclitaxel: A case report

RATIONALE

Primary fallopian tube carcinoma (PFTC) is an extremely rare but invasive malignancy with a dismal prognosis. Very few data exist on the salvage treatment for patients with PFTC. Here we report a case showing an impressive response to immunotherapy combined with chemotherapy, which have never been reported before on patients with metastatic PFTC.

PATIENT CONCERNS

A 42-year-old woman, who was diagnosed with PFTC in 2010, had been failed of multiple systemic therapies and antiangiogenic therapy because of the disease recurrence and progression.

DIAGNOSIS

Metastatic primary fallopian tube carcinoma.

INTERVENTIONS

The patient underwent surgery in May 2010 and had multi-line chemotherapies plus an anti-vascular endothelial growth factor (anti-VEGF) monoclonal antibody for about 9 years. Due to treatment failure the patient accepted the immunotherapy with the checkpoint inhibitor, pembrolizumab, combined with nab-paclitaxel from December 2018 to April 2019.

OUTCOMES

The patient showed a complete response after 6 cycles treatment. Thus far, the patient is taking pembrolizumab as maintenance and remains in good health.

LESSONS

Pembrolizumab combined with chemotherapy for treatment of PFTC may provide a positive antitumor effect in multiple metastatic lesions, but more clinical evidence is needed to confirm the efficacy and safety.

Perineural Spread of Clear Cell Adenocarcinoma of Müllerian Origin Resulting in Neoplastic Lumbosacral Plexopathy

BACKGROUND

Adenocarcinomas of müllerian origin are malignancies derived from tissues of the proximal third of the vagina, cervix, uterus, and fallopian tubes. These organs develop from the embryologic müllerian ducts. While reports of perineural spread of certain uterine and cervical carcinomas exist in the literature, to our knowledge, no reports of clear cell-type müllerian adenocarcinoma presenting with neural invasion of the lumbosacral plexus exist in the literature.

CASE DESCRIPTION

A 77-year-old woman with a remote history of hysterectomy and bilateral salpingo-oopherectomy for benign disease presented for evaluation of foot drop. We present clinical, electromyographic, and imaging findings of her condition, which revealed a diffuse intraneural lesion of the ipsilateral lumbosacral plexus. Percutaneous biopsy of the lesion confirmed nerve infiltrating clear cell adenocarcinoma of müllerian origin.

CONCLUSIONS

We present the first case of adenocarcinoma of müllerian origin with confirmed perineural spread presenting with ipsilateral lower extremity weakness. This case illustrates the importance of recognizing potential perineural spread of gynecologic malignancies to avoid delay in treatment.

Anterior mediastinal metastasis of primary fallopian tube adenocarcinoma: a case report

BACKGROUND

Primary fallopian tube carcinoma (PFTC) is a malignant tumor of the female genital tract that mostly presents intraperitoneal dissemination in clinical practice. The incidence of upper anterior mediastinal metastasis in PFTCs is extremely rare. We herein report a rare case of PFTC mediastinal metastasis after radical resection. When anterior mediastinal metastasis of an unknown origin is encountered, the possibility of PFTC should be considered.

CASE PRESENTATION

A 68-year-old female who was previously diagnosed with PFTC after radical resection of a primary tumor in the fallopian tube was admitted to our department with a right anterior mediastinum mass. Radical resection of the mediastinal mass was performed, and poorly differentiated metastatic adenocarcinoma of the fallopian tube was confirmed. There was no recurrence in the 24 months after the curative operation.

CONCLUSION

To our knowledge, no mediastinal metastasis of PFTC has been reported yet. Thus, we presented this rare case indicating the heterogeneity of this malignant disease and to draw attention to the occasional distant metastasis of PFTC in clinical practice.

Nonovarian Mimics of Ovarian Malignancy

Once a pelvic mass is identified on an ultrasound examination, the first step in the differential diagnostic work up is to determine its origin. Most lateral pelvic masses in women are ovarian in origin, and the distinction between ovarian and nonovarian mimics of ovarian cancer is critical for appropriate clinical and surgical management. Adnexal masses detected on ultrasound can be further characterized by magnetic resonance imaging (MRI) when needed. Superior contrast resolution, multiplanar imaging, characteristic signal intensity of common pathology such as dermoid tumors or endometriomas allows one to accurately evaluate adnexal tumors with supplemental use of MRI. Commonly encountered extraovarian abnormalities that mimic ovarian malignancies are categorized as being either predominantly cystic or solid. The common causes of such extraovarian lesions that mimic ovarian pathology include fallopian tube diseases, paroaovarian cysts, peritoneal inclusion cysts, and a pedunculated or a broad ligament fibroid. Less common causes of cystic and solid nonovarian mimics of ovarian malignancy include mucocele of the appendix, lymphocele, spinal meningeal cysts, extraovarian endometriomas, extraovarian fibrothecomas, and gastrointestinal stromal tumors (Table 1). Identifying a normal appearing ovary is the key in distinguishing an extraovarian pelvic mass from an ovarian tumor. This becomes particularly challenging in postmenopausal women with atrophic ovaries. In this scenario, MRI comes into use by identifying small atrophic ovaries more often than ultrasound is able to. Extraovarian lesions typically displace the pelvic sidewall vasculature medially, ureters tend to be compressed, encased or medially displaced, enhancement matches pelvic arteries and may be associated with engorged mesenteric vessels compared to gonadal vessel engorgement seen with ovarian tumors.

The Sign of Leser-Trelát and Malignant Acanthosis Nigricans Associated With Fallopian Tube Carcinoma

BACKGROUND

The sign of Leser-Trelát is controversial and rarely reported in gynecologic malignancies. It is characterized by rapid development of new or enlarging seborrheic keratoses.

CASE

A 78-year-old woman presented with unintentional weight loss and new-onset erythematous patches and plaques with thickened, rugated skin and stuck-on brown waxy papules on the chest and back. Her symptoms were concerning for a paraneoplastic eruption; workup revealed an elevated CA 125 level and an ovarian mass on abdominal computed tomography scan. Exploratory laparotomy revealed a stage IIIC serous fallopian tube carcinoma and a synchronous low-grade endometrioid adenocarcinoma of the endometrium.

CONCLUSION

The sign of Leser-Trelát can be associated with fallopian tube carcinoma. When recognized, paraneoplastic dermatoses can prompt clinicians to initiate a workup for occult malignancy.

Magnetic resonance diffusion-weighted imaging in diagnostics of primary fallopian tube carcinoma - is it useful?

Purpose

Primary fallopian tube carcinoma (PFTC) is the rarest form of female genital malignancy. The imaging applied for suspected adnexal masses includes transvaginal ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), but the vast majority of PFTC is recognised intraoperatively.

Material and methods

The study group consisted of seven women with postoperatively histopathological diagnosis of PFTC. To recognise characteristic findings for PFTC, retrospective analysis of preoperative MRI was performed. All patients underwent MRI of the pelvis and abdomen using a 1.5T MR system. Based on the results of the above imaging, suspected adnexal masses were recognised. MRI protocol contained T2-weighted images, fat-suppressed T2-weighted, T2-TIRM, DW EPI, pre- and postcontrast dynamic 3D T1 GRE in transverse orientation, with diffusion weightings of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2. Regions of interest were outlined by a radiologist, who documented the character of adnexal masses on diffusion-weighted (DW) images and apparent diffusion coefficient (ADC) maps.

Results

In all seven patients with PFTC unilateral tumour was found. On all DW images (with β values of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2) the mean signal intensities of solid parts of tumour were significantly higher than the mean signal intensities of normal ovarian tissue (p = 0.0001). There were no statistically significant differences between eight β values applied for ADC calculations.

Conclusions

Preoperative diagnostics of PFTC is difficult and mainly based on morphological features. Previous research did not show characteristics of PFTC in post-contrast dynamic imaging. In our material a clear increasing of signal intensity in DW imaging occurred independently of the β value.

Port-site metastasis as a primary complication following diagnostic laparoscopy of fallopian tube carcinoma: A case report

RATIONALE

Fallopian tube carcinoma is a rare female genital cancer with no specific clinical and surgical features. It is hardly diagnosed on imaging due to non-specific presentation. Laparoscopy has been recommended as the diagnostic procedure for the assessment of suspicious ovarian and adnexal masses. However, it has brought new complications like tumor recurrences at the trocar insertion sites, called port-site metastasis (PSM).

PATIENT CONCERNS

A 65-year-old, postmenopausal woman presented to hospital with loss of appetite, Ultrasound showed ill-defined pelvic mass. The patient was diagnosed with fallopian tube carcinoma by a diagnostic laparoscopy.

DIAGNOSES

The PSM as a primary complication following diagnostic laparoscopy of fallopian tube carcinoma, which is presumed by positron emission tomography/computed tomography and confirmed by Nodule resection and further pathological assessment.

INTERVENTIONS

As port-site metastasis was suspected, the patient was advised to undergo umbilical mass resection.

OUTCOMES

the patient has no signs of recurrence was detected 20 months after the last surgery during follow-up.

LESSIONS

Laparoscopy plays a significant role in the diagnose and treatment of fallopian tubal and ovarian malignancies but has a risk of PSM occurrence. When isolated PSM occurs the management should be local resection.

Primary leiomyosarcoma of the fallopian tube: A case report and literature review

RATIONALE

Primary leiomyosarcoma (LMS) of the fallopian tube is extremely uncommon. To the best of our knowledge, so far only 21 cases of primary fallopian tube LMS have been reported in English-language literature. No new case has been reported in the past 7 years.

PATIENT CONCERNS

A 44-year-old premenopausal patient presented with a 5-day history of lower abdominal pain.

DIAGNOSES

Pelvic ultrasonography detected an 8.8 × 7.8 × 6.5 cm solid and cystic mass in the left side of the pelvic cavity. The tumor was diagnosed as a primary fallopian tube LMS on paraffin section.

INTERVENTIONS

The patient treated surgically followed by 4 cycles of postoperative chemotherapy with dacarbazine and DDP.

OUTCOMES

The patient succumbed to the disease 27 months after the initial therapy.

LESSONS

Tube LMS is a rare malignant tumor with unknown etiology, difficult early diagnosis, highly invasiveness, high local recurrence and distant metastasis rate, rapid progress, and poor prognosis. It is extremely rare so we can only summarize limited experience from limited data. Every case of tubal LMS is worth being reported.

Amino acids metabolism and degradation is regulated during porcine oviductal epithelial cells (OECs) primary culture in vitro – a signaling pathways activation approach

The ovary is part of the reproductive system, possessing very important functions in the reproduction process (ovum and embryo transfer, providing a suitable environment for sperm capacitation, etc.). There are two types of cells in the fallopian tubes: alveolar and secretive cells. These study shows the metabolic processes in pig oviductal epithelial cells associated with the activation of signaling pathways of amino acids metabolism and degradation during long-term in vitro culture. Oviductal epithelial cells from 45 colonies in the anestrous phase of the estrous cycle have been utilized in this study. RNA extract from the OEC primary cultures was pooled after 24h, 7days, 15 days and 30 days from the beginning of culture and the transcriptome investigated by Affymetrix® Porcine Gene 1.1 ST. From the whole transcript that consisted of 2009 different genes, 1537 were upregulated and 995 were downregulated after 7 days of culture, 1471 were upregulated and 1061 were downregulated after 15 days of culture and 1329 were upregulated and 1203 were downregulated after 30 days of culture. The results of these studies provide, for the first time, information on the activation of metabolic pathways of amino acids such as valine, leucine, isoleucine, cysteine, and methionine in the investigated tissue. They also indicate genes that may be OECs-specific genetic markers that are expressed or upregulated during long-term in vitro culture.

Successful diagnosis of an occult fallopian tube carcinoma detected from the diaphragm metastasis

We herein reported a rare case of an occult fallopian tube carcinoma first detected from the diaphragm metastasis. An 83-year-old woman who had a 30-mm tumor on the right diaphragm underwent radical resection. Pathologically, the tumor was diagnosed as a high-grade serous adenocarcinoma, suggesting metastasis from the pelvic visceral carcinoma. Although the primary site could not be detected by imaging examinations, laparoscopy revealed multiple peritoneal disseminations; therefore, total hysterectomy was performed. Finally, microscopic tumor invasion into the right fimbriae of the fallopian tube was found. A precise and detailed pathological and immunohistochemical examinations of the resected metastatic diaphragm tumor helped us obtain a proper diagnosis of the primary lesion and treat the patient appropriately. Since it is difficult to diagnose diaphragm tumors before surgery based on the anatomy, surgical options have played an important role in their treatment and diagnosis clinically.

Primary Adenocarcinoma of the Fallopian Tube: A Rare Entity

Primary fallopian tube carcinoma is an uncommon gynaecologic malignancy usually seen in postmenopausal females. We present a case of a 66-year-old postmenopausal female who presented with complaint of blood mixed vaginal discharge on and off for past one month. Workup of the patient revealed no abnormality other than presence of atypical squamous cells on Papanicolaou (PAP) smear. MRI showed mildly bulky cervix with around 4cc fluid in endometrial cavity. As the patient remained symptomatic and fluid in endometrial cavity persisted, total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. On histopathological examination, fimbrial end of left tube had features of poorly differentiated papillary serous adenocarcinoma. Postoperatively, she was given chemotherapy and is doing well with more than 3 years of follow up. This case highlights the importance of high suspicion in postmenopausal women with bleeding per vaginum, where there is little to suggest clinically or radiologically.

Identifying features of primary fallopian tube carcinoma using magnetic resonance imaging

Definitively diagnosing primary fallopian tube carcinoma (PFTC) prior to surgery is difficult. In the first working diagnosis, PFTC is often misdiagnosed as ovarian cancer. Preoperative workups using magnetic resonance imaging (MRI) are capable of differentiating PFTC from epithelial ovarian carcinomas (EOCs). Both the sensitivity and the specificity of MRI for identifying PFTC are high. The presence of a hydrosalpinx is a hallmark of PFTC. On MRI, hydrosalpinges have characteristic sausage-shaped appearances due to intrauterine fluid accumulation and fallopian tube distention. Additionally, MRI scans are superior to computed tomography (CT) scans or ultrasound images in detecting tumor infiltration into surrounding organs. Here, we report a case in which PFTC was pre-operatively misdiagnosed as EOC.

Bilateral Primary Papillary Serous Carcinoma of the Fallopian Tube

Primary fallopian tube carcinoma is considered one of the rarest female genital cancers, and its bilateral occurrence is even rarer. Because of the rarity of fallopian tube carcinomas as well as the clinical presentation which simulates an ovarian cancer, a correct preoperative diagnosis of fallopian tube carcinoma is seen only in 4% of cases, and is usually first appreciated by Pathologists. We are reporting our experience of a case of bilateral primary serous carcinoma of the fallopian tube in a 36-year-old female.

Primary Fallopian Tube Carcinoma: A Case Report and Literature Review

BACKGROUND

Primary fallopian tube carcinoma (PFTC) is a rare tumour of the female genital tract with an incidence of 0.1-1.8% of all genital malignancies, and it is very difficult to diagnose preoperatively, because of its non-specific symptomatology. In most cases, it is an intraoperative finding or a histopathological diagnosis. It is a tumour that histologically and clinically resembles epithelial ovarian cancer.

CASE PRESENTATION

We are reporting a case of a 62-year-old, postmenopausal women with primary fallopian tube carcinoma of the right fallopian tube in stage IA. The patient has lower abdominal pain, watery vaginal discharge and repeated episodes of bleeding from the vagina. The clinical and radiological findings suggested a right adnexal tumour with elevated CA-125 levels. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and peritoneal washing were performed. Pathologic confirmation of primary serous cystadenocarcinoma of the right fallopian tube was made. Peritoneal washings were negative for malignancy. FIGO stage was considered as IA, and the patient received no courses of chemotherapy and postoperative radiation because she refused it. Ten months after initial surgery, the patient is alive and in good condition.

CONCLUSION

Cytoreduction surgery followed by adequate cycles of chemotherapy is an important strategy to improve patients' prognosis.

Pelvic splenosis-a very unusual location

We present a rare case of pelvic splenosis, and its imaging findings, in a 54-year-old female complaining of pelvic pain and vaginal bleeding for several months. Splenosis is a benign acquired condition defined as heterotopic auto-transplantation of splenic tissue to other compartments of the body and occurs after rupture of the spleen, either traumatic or iatrogenic. Symptoms are unspecific and vary according to the location of the implants; commonly the presenting symptom is abdominal pain or enlarging abdominal mass. Owing to its intrinsic properties and safety, magnetic resonance imaging is a valuable imaging modality, in which the splenosis implants may be securely identified, showing the same signal characteristics and enhancing patterns of the normal spleen, especially visualization of serpiginous enhancement on the arterial phase is virtually diagnostic.

Bilateral primary fallopian tube papillary serous carcinoma in postmenopausal woman: Report of two cases

Primary carcinoma of the fallopian tube is rare and accounts for about 0.14-1.8% of all gynecological malignancies. Correct diagnosis is rarely made preoperatively as clinically tubal carcinoma closely resembles ovarian carcinoma. Here, we report two cases of bilateral primary fallopian tube carcinomas. Case 1: A 54-year-old female presented with postmenopausal bleeding, abdominal pain, and pervaginal watery discharge for 10 days. Ultrasonography (USG) of pelvis showed endometrial thickening and multiple tiny echogenic foci in omentum suggestive of omental cake. With a provisional diagnosis of endometrial carcinoma, total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy was done. On gross examination, small and rudimentary right ovary was adherent to the fimbrial end of the tube. Left-sided tubo-ovarian mass was present, cut section of which showed yellowish solid area in tubal wall and encroaching on ovarian surface. On histological examination, sections from the fimbrial end of both fallopian tubes showed features of papillary serous adenocarcinoma. Case 2: 70-year-old lady, 15 years postmenopausal presented with gradual onset pain and swelling of abdomen, urinary incontinence since 4 days. USG showed bulky uterus, 5 cm × 2 cm fibroid, bilateral tubes, and ovaries were not visualized. Serum cancer antigen-125 was raised (159.7 U/ml). Total hysterectomy and bilateral salpingo-oophorectomy with infracolic omentectomy was done. On gross examination, ovaries were firmly attached to tubes and no apparent solid area was noted. On microscopy, papillary serous adenocarcinoma arising from tubal wall was seen infiltrating focally into ovarian stroma; tubal epithelium showed dysplastic change. Sections from omentum showed numerous psammoma bodies.

Examination of the Fractalkine and Fractalkine Receptor Expression in Fallopian Adenocarcinoma Reveals Differences When Compared to Ovarian Carcinoma

Fallopian adenocarcinoma is a rare malignancy arising in the epithelium of the fallopian tube. Fallopian tube epithelium has been proposed as a tissue origin for high-grade serous ovarian carcinoma, the deadliest gynecologic malignancy. Given the commonalities in dissemination and treatment of these malignancies, we contemplated the possibility of similar patterns of gene expression underlying their progression. To reveal potential similarities or differences in the gene expression of fallopian adenocarcinoma and high-grade serous ovarian carcinoma, we tested expression of the fractalkine receptor (CX₃CR1) and its ligand, fractalkine (CX₃CL1), in the specimens of normal and pathologic fallopian tube using immunohistochemistry. Our data show that CX₃CR1 is expressed in the normal, cancer adjacent normal, inflammatory, and malignant fallopian epithelium. CX₃CL1 was expressed only by the normal and cancer adjacent normal fallopian tube epithelium; its expression was largely lost in the inflammatory and malignant fallopian epithelium. In opposite, both CX₃CR1 and CX₃CL1 are expressed in high-grade serous ovarian carcinoma. These findings are consistent with an idea that fallopian adenocarcinoma and high-grade serous ovarian carcinoma, although currently thought to arise from the same organ, may not share similar molecular characteristics.

Primary fallopian tube carcinoma: review of MR imaging findings

OBJECTIVES

To review the epidemiological and clinical features of primary fallopian tube carcinoma (PFTC), and to illustrate the spectrum of MRI findings, with pathological confirmation.

METHODS

This article reviews the relevant literature on the epidemiological, clinical, and imaging features of primary fallopian tube carcinoma, with pathological confirmation, using illustrations from the authors' teaching files.

RESULTS

Primary fallopian tube carcinoma came under focus over the last few years due to its possible role on the pathogenesis of high-grade serous epithelial ovarian and peritoneal cancers. Typical symptoms, together with the presence of some of the most characteristic MRI signs, such as a "sausage-shaped" pelvic mass, hydrosalpinx, and hydrometra, may signal the presence of primary fallopian cancer, and allow the radiologist to report it as a differential diagnosis.

CONCLUSIONS

Primary fallopian tube carcinoma has a constellation of clinical symptoms and magnetic resonance imaging features, which may be diagnostic. Although these findings are not present together in the majority of cases, radiologists who are aware of them may include the diagnosis of primary fallopian tube cancer in their report more frequently and with more confidence.

TEACHING POINTS

• PFTC may be more frequent than previously thought • PFTC has specific clinical and MRI characteristics • Knowledge of typical PFTC signs enables its inclusion in the differential diagnosis • PFTC is currently staged under the 2013 FIGO system • PFTC is staged collectively with ovarian and peritoneal neoplasms.

Primary Fallopian Tube Clear Cell Adenocarcinoma in Pregnancy: Case Presentation and Review of the Literature

Primary fallopian tube cancer in pregnancy is rare and is even more so for the clear cell variant. Our case is the third case of primary fallopian tube cancer in pregnancy and the first case of clear cell adenocarcinoma of the fallopian tube in pregnancy. The patient presented with increasing pelvic pain starting in the second trimester. Serial ultrasound evaluations were performed and revealed a rapidly growing complex adnexal mass adjacent to the uterus. Her pregnancy was further complicated by spontaneous preterm labor and she delivered prematurely per vaginam at 31 weeks. She underwent an urgent laparotomy in the immediate postpartum period for acute aggravation of her right pelvic pain and fever. The diagnosis of tubal clear cell adenocarcinoma was subsequently made on histopathology examination.

Primary carcinoma of the fallopian tubes: Analysis of sixteen patients

OBJECTIVE

The aim of this study was to review patients with tubal carcinoma who underwent surgery in our clinic due to primary carcinoma of the fallopian tubes, a very rare gynecologic malignancy.

MATERIALS AND METHODS

Sixteen patients who were diagnosed as having primary carcinoma of the fallopian tubes and underwent surgery in Zeynep Kamil Research and Training Hospital between January 2007 and December 2014 were included in the study. Demographic data such as age, gravidity, parity, menopausal condition, symptoms, adjuvant therapy, recurrence of tumor, as well as time and type of operation were extracted from patient epicrisis reports and oncology files. Patient information was extracted from the patients' current files and phone calls were made with patients and their relatives.

RESULTS

The mean age of patients was 59.6 (range, 43-78) years. Seventy-five percent of the women were menopausal at admission; the mean menopause duration was 10 years (range, 1-20 years). None of the patients were nulliparous and mean parity was 4.3 (2-8). The most common presenting symptom was abdominopelvic pain, followed by abnormal uterine bleeding. The most common histopathologic type was high-grade serous carcinoma. The mean follow-up duration was 23.7 months (range, 2-53 months). During follow-up, recurrence was seen in 4 (25%) patients. One patient left the study during follow-up. The mean disease-free survival was 48 months. No relation was found between disease-free survival, age, stage, grade, and histologic type in univariate logistic regression analysis.

CONCLUSION

Primary carcinoma of the fallopian tubes is a rare gynecologic tumor that is seen in older patients, has no specific signs, and usually cannot be diagnosed before surgery. Therefore, we think that large-series, multi-centered studies with long-term follow-up duration are needed to define its etiopathogenesis and treatment strategies for the disease.

Adenocarcinoma of Mullerian origin: review of pathogenesis, molecular biology, and emerging treatment paradigms

Traditionally, epithelial ovarian, tubal, and peritoneal cancers have been viewed as separate entities with disparate origins, pathogenesis, clinical features, and outcomes. Additionally, previous classification systems for ovarian cancer have proposed two primary histologic groups that encompass the standard histologic subtypes. Recent data suggest that these groupings no longer accurately reflect our knowledge surrounding these cancers. In this review, we propose that epithelial ovarian, tubal, and peritoneal carcinomas represent a spectrum of disease that originates in the Mullerian compartment. We will discuss the incidence, classification, origin, molecular determinants, and pathologic analysis of these cancers that support the conclusion they should be collectively referred to as adenocarcinomas of Mullerian origin. As our understanding of the molecular and pathologic profiling of adenocarcinomas of Mullerian origin advances, we anticipate treatment paradigms will shift towards genomic driven therapeutic interventions.

Clinical characteristics and outcomes of patients with stage I epithelial ovarian cancer compared with fallopian tube cancer

OBJECTIVE

The purpose of this study was to compare clinical characteristics and survival between patients with stage I epithelial ovarian cancer and fallopian tube cancer.

STUDY DESIGN

We identified women with stage I epithelial ovarian cancer and fallopian tube cancer who underwent treatment from 2000-2010. Correlation between categoric variables was assessed with χ2 test. The Kaplan-Meier survival analysis was used to generate overall survival data. Factors predictive of outcome were compared with the use of the log-rank test and Cox proportional hazards model.

RESULTS

The study group consisted of 385 women with epithelial ovarian cancer and 43 women with fallopian tube cancer. Patients with fallopian tube cancer had a higher rate of stage IA disease (65% vs 48%; P=.02) and grade 3 tumors (60.4% vs 30.9%; P<.001). Patients with fallopian tube cancer had a significantly higher rate of breast cancer (25.6% vs 5.7%; P<.001) and BRCA 1 mutations (45.8% vs 9.1%; P<.001). There was no difference in the rates of platinum-based and paclitaxel chemotherapy between the groups. Women with fallopian tube cancer were more likely to have received ≥6 cycles of chemotherapy (58.1% vs 44.1%; P=.02). The 5-year disease-free survival rates were 100% in women with fallopian tube cancer and 93% in patients with epithelial ovarian cancer (P=.04). The 5-year overall survival rates were 100% and 95% for fallopian tube cancer and epithelial ovarian cancer, respectively (P=.7).

CONCLUSION

We found a higher rate of stage IA, grade 3, and serous carcinoma in fallopian tube cancer. Women with fallopian tube cancer had a higher rate of breast cancer. There was no difference in overall survival between the groups.

Clinical and survival analysis of 36 cases of primary fallopian tube carcinoma

Background

Primary fallopian tube carcinoma (PFTC) is rarely seen clinically. Herein, we investigate the clinical and pathological characteristics and appropriate therapies for PFTC.

Methods

A total of 36 patients for whom PFTC was pathologically confirmed from January 2001 to July 2011 in Beijing Hospital of Gynecology and Obstetrics, an affiliate of Capital Medical University, were retrospectively analyzed.

Results

A total of 36 cases underwent surgical staging in our hospital: 47.2% were early stage cases , and 52.8% were advanced stage cases. Of the 36 cases, 24 cases were pure adenocarcinoma, 10 cases were mixed, and there was 1 case of undifferentiated carcinoma, 1 case of undifferentiated carcinoma combined with transitional cell carcinoma, 5 cases of moderately differentiated carcinoma, and 29 cases of moderately to poorly differentiated carcinoma. There were no cases of highly differentiated carcinoma. Among the cases examined, 38.9% (14/36) had omentum metastasis, and 19 cases had an elevated CA125 during a preoperative biochemical laboratory test. Approximately 35 cases received postoperative adjuvant chemotherapy. The 3-year and 5-year overall survival rates for the 36 cases were 80.7% and 65.4%, respectively. Single-factor analysis showed that the pathological conditions of residual tumor diameter >1 cm (P <0.001), omentum metastasis (P = 0.003), ovary metastasis (P = 0.004) and elevated preoperative CA125 (P = 0.044) were associated with prognosis, whereas pathological surgical staging (P = 0.069), retroperitoneal lymph node metastasis (P = 0.499), and pathological classification (P = 0.183) were not associated with prognosis. Multifactor analysis showed that a residual tumor diameter >1 cm (P = 0.019) and omentum metastasis (P = 0.015) were associated with prognosis, and were, therefore, the independent risk factors of prognosis.

Conclusions

PFTC is a rare female genital tract malignancy. Most patients are in an advanced stage at diagnosis, which results in a poor prognosis. Complete surgical staging and maximal resection should be recommended.

Primary fallopian tube carcinoma diagnosed with endoscopic ultrasound elastography with fine needle biopsy

Primary fallopian tube carcinoma (PFTC) is a rare gynecological cancer that is very difficult to diagnose preoperatively. Here, we report the case of a 66-year-old female patient with PFTC that was diagnosed preoperatively on the basis of the characteristic features on endoscopic ultrasound (EUS) elastography and fine needle biopsy (FNB). EUS showed a sausage-shaped hypoechoic mass, 8 cm in size, with irregular margins and heterogeneous internal echoes extending to both adnexa. EUS elastography revealed that the mass had a blue color pattern, representing hard stiffness, and a heterogeneous green/red color pattern distributed outside the tumor, representing intermediate stiffness. Histopathologic analysis of the FNB and operative specimens confirmed the diagnosis of fallopian tube carcinoma. This is the first reported case of a combined EUS elastography and FNB of an adnexal mass leading to a preoperative diagnosis of fallopian tube carcinoma.