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PubMed2005

Primary fallopian tube carcinoma - the experience of a UK cancer centre and a review of the literature.

Primary fallopian tube carcinoma (PFTC) is rare but may be under-diagnosed. We have analysed the incidence, clinical findings and outcome in patients with PFTC at the RUH Gynaecological Cancer Centre in Bath between 1999 and 2004, and compared the incidence with that of advanced ovarian carcinoma (OC). Eight patients had PFTC, seven of whom were diagnosed after 2001, and 55 patients had advanced OC. Our data suggest a relative increase in the number of patients with PFTC over the study period. PFTC patients had a mean age of 69.6 years, most presented with postmenopausal bleeding, two had a second carcinoma, three were nulliparous and none were diagnosed pre-operatively. All were treated surgically and received platinum-based chemotherapy. Although PFTC patients had better outcomes than those with advanced OC, the difference was not statistically significant (p = 0.088). Accurate diagnosis and differentiation of PFTC from advanced OC are important for monitoring trends in incidence, for better characterisation of prognostic features and improved management.

Age Distribution↗
PubMed1998

Prognosis of primary fallopian tube adenocarcinoma: report of 25 patients.

PURPOSE OF INVESTIGATION: Because of the rarity of primary fallopian tube adenocarcinoma (PFTA), the optimal management has not been well-defined, especially in early-stage disease. Furthermore, prognosis of primary fallopian tube carcinoma has not been fully understood. METHODS: We retrospectively studied patients with proven surgico-pathological stage PFTA and excluded patients without a standard surgicopathological staging procedure. Twenty-five patients from 1970 to 1995 were identified. Eleven were in Stage I, four in Stage II and ten in Stage III and IV. Twenty patients received adjuvant chemotherapy with four to eight courses of CAP or CEP (cyclophosphamide 500 mg/m2, adriamycin 50 mg/m2 or epirubicin 50 mg/m2, and cisplatin 50 mg/m2 intravenously, every three weeks) regimen. One patient received two courses of chemotherapy and another received one course of chemotherapy; both followed with radiotherapy due to refusal of further chemotherapy. The remaining three patients did not receive any adjuvant therapy. RESULTS: Accumulative disease-free survival rate in spite of different st ages was 36%. Univariate analysis showed postoperative adjuvant chemotherapy, optimal debulking surgery, nulliparity, extent of the disease, and tumor differentiation as significant factors for disease-free survival of patients with PFTA. However, multivariate analysis did not show significance due to the small number of cases. CONCLUSION: Nearly half of the patients (44%) were diagnosed in early stage of PFTA, but patient survival was still disappointing. Understanding possibile risk factors for therapeutic failure and more aggressive and effective multi-modality treatments should be further defined.

Adenocarcinoma↗
PubMed1991

[Microsurgical sterility operations in female patients with deficient contralateral tube--pros and cons].

Microsurgical operations of sterility on 39 women with only one remaining tube have been analysed in order to examine the justification of primary operations of sterility on these patients. 13 out of 26 women (50%), who had been followed up for at least 9 months after the operation, have become pregnant. Live birth rate was 30.8% abortion rate 7.7% and the rate of ectopic pregnancies 11.5%. The results correspond to these obtained from women bilaterally operated on, so that microsurgical operations are justified in sterile women with a lacking opposite tube, too. The removal of the opposite tube during the actual operation of sterility is prognostically more advantageous than the exstirpation before it. Salpingectomy has better results than salpingo-oophorectomy.

Abortion, Spontaneous↗
PubMed1991

Antigen CA 19-9: presence in mucosa of nondiseased müllerian duct derivatives and marker for differentiation in their carcinomas.

CA 19-9, a side branch of the Lewis blood group system, is a sialylated Lewis A antigen that is highly expressed by many adenocarcinomas of the digestive tract. The müllerian duct-derived mucosa of the uterus and fallopian tubes also synthesizes Lewis blood group antigens. To test whether the expression of CA 19-9 is enhanced in carcinomas of müllerian duct origin, we performed immunohistochemical staining for CA 19-9 in normal tissues from 33 women and in adenocarcinomas from 88 patients. In the normal uterine cervix, CA 19-9 was expressed in the cytoplasm of scattered glandular cells in 26 of 29 specimens. It was observed in the apical regions of mucosal cells in six of 26 normal endometrial samples and two of 13 normal fallopian tube specimens. These results are consistent with the presence of antigen CA 19-9 on a secretory product of the nondiseased mucosa of the müllerian duct. In adenocarcinomas of the endocervix, endometrium, and fallopian tubes, CA 19-9 was found in seven of 11, 57 of 71, and five of six samples, respectively. Progressive loss of differentiation was accompanied by disruption of subcellular localization of CA 19-9 and its secretion toward the glandular lumina. In well-differentiated regions of tumors, the antigen was detected mainly at the luminal surface of cancerous glands, whereas the staining was mostly cytoplasmic or vacuolar in less differentiated areas. The degree of CA 19-9 expression was inversely related to tumor differentiation (P less than .001).

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1981

Gestational choriocarcinoma of the fallopian tube.

Review of a world literature of 93 reported cases of choriocarcinoma primary in the fallopian tube yields 58 acceptable cases, to which 18 are added from the files of the Armed Forces Institute of Pathology. Patients ranged from 16 to 56 years old, with a mean age of 33. About 66% presented with acute symptoms consistent with banal ectopic pregnancy. The remainder usually presented with a gradually expanding adnexal mass clinically indistinguishable from an ovarian tumor. Grossly, the tumor is usually a hemorrhagic friable mass, occasionally containing spongy tissue resembling placenta. Smaller tubal choriocarcinomas are difficult to distinguish on gross inspection from common ectopic pregnancy, ruptured or not. Histopathological features and distribution of metastases are similar to gestational choriocarcinoma arising in the uterus. Chorionic villi were found in two cases, an uncommon observation in primary uterine choriocarcinoma. Of 47 acceptable cases treated prior to modern chemotherapy, 41 died, a mortality of 87%. Of 16 cases treated with modern chemotherapy, 15 survive, a salvage of 94%. Five cases in the world literature, plus three in the present series, were cured by unilateral salpingectomy or salpingo-oophorectomy alone.

Adolescent↗
PubMedDate not supplied

Paraovarian and paratubal cysts: preoperative diagnosis using transabdominal and transvaginal sonography.

OBJECTIVE: Paraovarian and paratubal cysts constitute about 10% of adnexal masses. Our purpose was to determine whether pathologically proven examples of these lesions were correctly identified during preoperative transabdominal and transvaginal sonographic evaluations. METHODS: Between 1990 and 1994, 15 women with 10 paraovarian cysts and 5 paratubal cysts undewent preoperative sonography. The sonograms were performed using transabdominal and transvaginal probes. Mean interval before surgery was 22 days (range: 1-96 days). The sonographic interpretation at the time of the examination was correlated with the pathological findings. RESULTS: In only 1 of 15 patients was a paraovarian or paratubal cyst suggested before surgery. Paraovarian cysts were misdiagnosed as ovarian cysts. Because of the microscopic size of paratubal cysts in our series, none was diagnosed before surgery and these were usually an incidental finding in patients with ovarian masses. CONCLUSIONS: In our experience, paraovarian and paratubal cysts are difficult to diagnose before surgery with the use of transabdominal and transvaginal sonography. We speculate that when there is close proximity of a paraovarian cyst to the ovary, an ovarian cystic mass cannot reliably be differentiated from a paraovarian cyst.

Adolescent↗
PubMed1999

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.

Adult↗
PubMedDate not supplied

A case of fallopian tube carcinoma: successful preoperative diagnosis with MR imaging.

We report a case of fallopian tube carcinoma, successfully diagnosed preoperatively. The patient was a 64-year-old woman. Transvaginal sonography and computed tomography showed a cystic and solid tumor on the left side of the uterus, suggesting ovarian cancer. The tumor was, however, suspected to be a fallopian tube carcinoma on MR imaging. MR images showed a solid mass surrounded by a tube-shaped cystic part. At surgery, a solid and cystic tumor was found in the left fallopian tube. MR imaging may be useful to assist in the diagnosis of fallopian tube carcinoma.

Cystadenocarcinoma, Papillary↗
PubMed1977

[The primary isolated ovarian abscess. Clinical and bacteriological observations and a new pathogenetic hypothesis (author's transl)].

42 of 86 patients with suppurated ovaries had primary isolated ovarian abscesses (PIOA), 44 secondary tubo-ovarian abscesses (STOA). Parts of ectopic endometrium in the abscess wall could be identified by serial sections in 23 PIOA. With Berlin-blue-staining was a special phenomenon in 28 of 42 PIOA demonstrated: a basal layer of hemosiderophages underlying the abscess membrane. Thus in 36 of 42 PIOA the histogenesis out of cystic ovarian endometriosis or other pathologic ovarian hematomas is assured. The PIOA is a typical major complication of ovarian hematomas, especially in cases of ovarian endometriosis caused by vaginal aplasia (gynatresia). Concomitant salpingitis in PIOA is therefore often better explained as secondary descending infection from pelveoperitonitis. Before laparotomy it is extremely difficult to diagnose PIOA on a clinical basis only. More than laboratory data helps this special consideration if an inflammatory adnexal mass could be or not the result of an ascending infection and if an ovarian endometriosis could exist. Besides the abscesses out of cystic ovarian endometriosis PIOA were observed after hysterectomies and complicated appendectomies possible due to the infection of traumatic ovarian hematomas. The only curative therapy for PIOA is surgery--as soon as possible. Antibiotics are poorly helpful. However the inefficacy of antibiotics usually gives the final indication for laparotomy. Knowing the usual etiology of PIOA out of pathologic (endometriotic) ovarian hematomas we have new guidelines in other clinical problems also: Thus every ovarian endometriosis has to be cured--hormonally or surgically; evacuation of endometriotic cysts during pelvic endoscopy is not a sufficient therapy, for the endometrium would be left in the ovary. During operations provocation of traumatic hematomas of the adnexa should be avoided.

Abscess↗
PubMed1994

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↗
PubMed1984

Successful pregnancy outcome following removal of bilateral cornual polyps by microsurgical linear salpingotomy with the aid of the CO2 laser.

Various surgical approaches have been advanced to treat cornual obstruction secondary to intraluminal polyps. This case illustrates microsurgical principles incorporating the CO2 laser to maximize the preservation of normal uterotubal anatomy and function after excising large bilateral cornual polyps and multiple uterine myomata and vaporizing endometriosis and pelvic adhesions. The subsequent conception and delivery of a viable full-term infant demonstrates the efficacy of this new approach. Additional studies are warranted to further evaluate the role of microsurgical linear salpingotomy with the CO2 laser in the treatment of cornual polyps to enhance fertility.

Adult↗