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Primary cancer of the fallopian tube. Report of 26 patients.

BACKGROUND: Due to rarity of fallopian tube cancer most series on this tumor are small and many problems have remained unsolved. The aim of this report is to review our experience with this neoplasm and to compare it with previously published data. METHODS: Retrospective study of 26 patients with fallopian tube cancer treated in one institution between 1974 and 1994. All patients underwent primary surgical treatment and 18 received adjuvant therapy including pelvic irradiation in 14 cases and chemotherapy in four. RESULTS: Relapse occurred in 18 out of 25 followed up patients. Upper abdominal component of relapse was encountered in 12 patients (67%), pelvic component - in eight (44%) and extraperitoneal component - six (33%). Pelvic relapse occurred in two out of 13 followed up patients treated with postoperative irradiation and in six out of 12 who did not receive postoperative radiotherapy. Survival ranged from 6 to 218+ months (median 23 months). Five-year actual survival was 33%. There were no 2-year survivors in patients presenting with stage II-IV disease. No correlation was found between tumor grade and survival. CONCLUSIONS: Fallopian tube cancer is a treatable disease but cure can be only achieved in patients with early tumor. Postoperative radiotherapy may result in better local control but does not preclude extrapelvic dissemination, therefore adjuvant chemotherapy should be considered in high risk patients. Registration of all new cases as well as prospective multicenter studies are warranted to establish optimal management.

Age Factors↗

Importance of sperm-to-epithelial cell contact for the capacitation of human spermatozoa in fallopian tube epithelial cell cocultures.

OBJECTIVE: To investigate the mechanisms involved in the stimulatory effect of fallopian tube epithelial cell coculture on sperm movement characteristics. DESIGN: Human spermatozoa were cultured with human fallopian tube epithelial cell monolayers. A microporous membrane was used to prevent sperm-to-epithelial cell contact. Sperm movement characteristics were measured at 4 and 24 hours. SETTING: University hospital and fertility center. PATIENT(S): Voluntary donors. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Movement characteristics of human spermatozoa. RESULT(S): Fallopian tube epithelial cell coculture increased sperm motility, curvilinear velocity, amplitude of lateral head displacement, and hyperactivated motility, mainly at 24 hours, compared with controls. These stimulatory effects were inhibited when a microporous membrane prevented cell-to-cell contact between sperm and fallopian tube epithelial cells. CONCLUSION(S): Physical contact between sperm and epithelial cells in coculture systems seems to be the main factor in stimulating sperm movement characteristics, and this could be the main mechanism of in vivo sperm capacitation.

Adult↗

Primary carcinoma of the fallopian tube. A report of 19 cases with literature review.

Primary carcinoma of the fallopian tube is the rarest cancer of the female genital tract with an incidence of 0.5% of all gynecologic tumors. Since the first report in 1847 about 1,500 cases have been published. Due to similarity of the clinical presentation the staging and therapeutic management have been adapted to that of ovarian cancer. We retrospectively evaluated all the 19 patients who had been diagnosed with primary carcinoma of the fallopian tube at the Department of Obstetrics and Gynecology of the University of Zurich between 1977 and 1998. All lesions were staged according to the rules of FIGO adopted in 1991. At the time of diagnosis the median age was 62 (46-87) years. Twelve (63%) women revealed FIGO stage III-IV, whereas four (21%) and three (16%) patients were diagnosed in stage I and stage II, respectively. Eight (42%) women were nullipara. Histology showed serous-papillary carcinoma, in ten (53%) cases. The 5-year survival rate was 22% for all FIGO stages and 80% for stage I. None of the patients with stage III and IV survived 5 years. Ovarian cancer and primary carcinoma of the fallopian tube are similar in many aspects. Both carcinomas have a similar age distribution, show an increase among nulliparous women, are often of serous papillary histology, have a poor prognosis with stage and residual tumor size as important prognostic factors, and respond initially well to platinum-based chemotherapy. Nevertheless, there appears to be a difference between the two diseases: primary carcinoma of the fallopian tube is more often diagnosed in an earlier stage. This many be due to lower abdominal pain resulting from tubal dilatation and to abnormal bloody-watery discharge.

Adult↗

Diagnosis of primary adenocarcinoma of the fallopian tube.

Primary carcinoma of the fallopian tube is rare, but still occurs frequently enough to warrant consideration when certain specific symptoms are present. It is also possible to diagnose the tumor correctly if, in the presence of certain symptoms, the following diagnostic tools are used in addition to repeated Pap smears and dilatation and curettage: hysteroscopy, cervical biopsy, colposcopy, laparoscopy, laparotomy, and pathological examination of every tubal specimen.

Adenocarcinoma↗

Attachment to and invasion of human fallopian tube mucosa by an IgA1 protease-deficient mutant of Neisseria gonorrhoeae and its wild-type parent.

In an investigation of the possible role of IgA1 protease in the initial encounter of Neisseria gonorrhoeae with human genital mucosa, the pathogenicity of an isogenic, piliated, wild-type gonococcal clone was compared with that of its IgA1 protease-deficient mutant in organ cultures of human fallopian tubes. The fallopian tube mucosa released IgA into the organ culture medium throughout the course of the infection; the rate of release was substantially higher in gonococcus-infected organ cultures. The wild-type gonococcus but not the IgA1 protease-deficient mutant elaborated IgA1 protease into the medium. The rate and extent of attachment, damage, and invasion of the fallopian tube mucosa by the IgA1 protease-deficient mutant were indistinguishable from those by the parental clone. These data are compatible with the hypothesis that, in the initial encounter with previously uninfected human genital mucosa, the production of IgA1 protease is not critical to the ability of the gonococcus to act as a mucosal pathogen.

Adhesiveness↗

Have the Fallopian tubes a vital rôle in promoting fertility?

Diverse lines of evidence suggest that the Fallopian tubes make no overwhelming contribution to human reproduction other than as a conduit for gametes and embryos. Even so, bearing in mind global success rates for in vitro fertilization (IVF) coupled with uterine transplantation of embryos (20% fruitful pregnancies), the Fallopian tubes may make a subtle contribution to reproductive performance. The experimental evidence from monkeys and man arguing against an essential rôle for the tubes -- at least in individual instances -- would include (1) the results of Estes' operation, when ovaries are autotransplanted into the uterine lumen in women with blocked or missing Fallopian tubes and pregnancy ensues; (2) asynchronous embryo transfer when newly fertilized (pronucleate) eggs transplanted to the uterus can generate a pregnancy; (3) the transcervical transfer after IVF of early cleavage stage human embryos into the uterus, with subsequent establishment of pregnancy; (4) the trans-cervical transfer of human spermatozoa and oocytes into the uterus to give pregnancy, indicating that capacitation, fertilization and the earliest stages of embryonic development can be achieved in the uterus. In endeavoring to explain contrasts between these successful procedures in primates and their failure in non-primates, perhaps the simplex uterus in primates compared with a bicornuate or bipartite uterus in laboratory and farm species has relevance: there is lack of a clear-cut distinction between the endometrium and endosalpinx in the intra-mural segment and potential mixing of uterine and tubal fluids. Indeed, the latter may explain in part a susceptibility to tubal ectopic pregnancy, coupled with proliferating endometrial fragments in the Fallopian tube.

Animals↗

Fallopian tube adenocarcinoma: common extraperitoneal recurrence.

Fallopian tube adenocarcinoma is a rare gynecologic tumor that spreads like epithelial ovarian carcinoma. From 1954 to 1982, thirty patients with tubal adenocarcinomas were treated at UCLA and by the Southern California Permanente Medical Group. The mean age was 52 years. Pain, irregular or postmenopausal bleeding, and vaginal discharge were the most common presenting symptoms. Twenty-two had undergone previous pelvic or abdominal surgery. A pelvic mass was the most common physical finding, while Pap smears, IVP, and BE were rarely helpful in making the diagnosis or planning treatment. All of the patients in this report underwent primary therapeutic surgery. Nineteen patients received radiation and fourteen, systemic chemotherapy. Surgical stage was prognostic for survival. Fourteen patients with Stage I and II disease are NED (4 at 2 years; 10 at 5 years). No patients with Stage III or IV disease survived 5 years. Recurrences were noted as late as 6 years after primary therapy and 10 of 14 recurrent sites were extraperitoneal.

Adenocarcinoma↗

Combination chemotherapy in advanced adenocarcinoma of the fallopian tube.

Advanced adenocarcinoma of the fallopian tube has a poor prognosis, with 5-year survival rates commonly less than 20%. Since 1980, we have managed 12 patients with disseminated tumor with combination chemotherapy following surgical cytoreduction. Analogous to the International Federation of Gynecology and Obstetrics staging of ovarian carcinoma, 3 patients were classified in Stage II, 8 in Stage III, and 1 in Stage IV. Ten patients received cisplatin-containing regimens. The 3 Stage II patients, without measurable disease after primary surgery, had an indeterminate response to chemotherapy. In Stages III-IV there were 4 complete responses (3 confirmed by second-look laparotomy) and 2 partial responses, for an overall response rate of 67%. Disease progressed in 2 patients and was stable in 1 patient. After median follow-up of 3.5 years, 4 of the Stage III-IV patients have no evidence of disease, 1 is alive with disease, and 4 are dead.

Adenocarcinoma↗

Expression of IgA and secretory component in the normal and in adenocarcinomas of Fallopian tube, endometrium and endocervix.

The occurrence and localization of IgA and secretory components (SC) were examined in the normal and in adenocarcinomas of Fallopian tube, endometrium and endocervix. IgA-containing immunocytes were identified in the stroma of 90% of normal Fallopian tubes. It is suggested that the Fallopian tube may have an immunological function and may, together with the endocervix, constitute the local secretory immune system of the female genital tract. IgA and SC were frequently demonstrated in the cytoplasm and luminal secretion of adenocarcinomas of the endocervix, endometrium and Fallopian tube. This study has shown a decrease in immunoreactivity of SC among poorly differentiated adenocarcinomas but has failed to demonstrate any correlation between the expression of IgA and the degree of differentiation of the tumours. Secretory component appears, therefore, to be more useful than IgA as an indicator of secretory activity and differentiation of adenocarcinomas of the female genital tract.

Adenocarcinoma↗

Glycogen distribution in porcine fallopian tube epithelium during the estrus cycle.

Histochemical features of two different parts of the porcine Fallopian tube have been studied, with special reference to cyclic changes in the distribution of glycogen particles. Porcine Fallopian tubes were obtained from a local slaughterhouse. Slides were studied under light microscopy utilising histological and histochemical techniques. The most striking feature during the periovulatory stage of the estrus cycle was the occurrence of glycogen granules in the apical cytoplasm of epithelial cells in both the ampulla and isthmus of the Fallopian tubes. In the isthmus, cells containing numerous granules of polysaccharides aggregated into areas of different sizes were noted after ovulation. During the midluteal phase their number was minimal or were even absent. In the ampula typical extrusion of secretory granules and nuclei protruding into the tubal lumen was visible after ovulation. In the luteal phase a lot of nuclei protruded into the tubal lumen and some free in the lumen were noted. It is possible that glycogen in the preovulatory stage functions as a source of energy for ciliary movement and as a nourishment for the ovum. In the isthmus large number of aggregated glycogen particles was observed also after ovulation. In this stage of the cycle, numerous granules of polysaccharide aggregated in isthmus epithelium could be the major energy source for embriogenesis when the embryo travels down the Fallopian tubes, during the early cleavage stage.

Animals↗

Localization of endothelin receptor messenger ribonucleic acid in the rat ovary and fallopian tube by in situ hybridization.

Rat mRNAs encoding two subtypes of the endothelin (ET) receptor (ET(A) and ETB) were studied in the rat ovary and fallopian tube by means of Northern blotting and in situ hybridization. The mRNA transcripts for the endothelin-1-specific type receptor (ET(A)) in pooled RNA from the ovary and fallopian tube were 4.2 and 5.2 kilonucleotides, and that for the nonselective type receptor (ETB) was 4.7 kilonucleotides; these were similar to transcripts for endothelin receptors from other tissues. ET(A) mRNA expression was abundant in the muscle cell layer of the fallopian tube, but low in the ovary. On the other hand, ETB mRNA was abundant in the granulosa cells in the developing follicles, but low in atretic follicles and absent in the fallopian tube. These results demonstrated that the mRNAs for the two subtypes of the rat endothelin receptor have different expression profiles in the ovary and fallopian tube. ETs may mainly affect the granulosa cells in the dominant follicles as well as the muscle cells of the fallopian tube through ETB and ET(A), respectively.

Animals↗

Clues to the pathogenesis of fallopian tube carcinoma: a morphological and immunohistochemical case control study.

The purpose of this study was to identify histopathological fallopian tube changes that might be related to the development of fallopian tube carcinoma (FTCA). Each of 14 unilateral cases of the latter was matched with 2 controls for age, hospital, and year of diagnosis. The uninvolved fallopian tube from patients with FTCA, all of which were of serous type, was compared to fallopian tubes from the same side in 28 matched controls. The features evaluated included plical bridging, trapped gland-like structures, inflammation, epithelial stratification, tufting, nuclear atypia, plical atrophy, luminal dilatation, and presence or absence of in situ carcinoma. The significant changes (p < 0.05) in the contralateral tubes of patients with FTCA were luminal dilatation (p = 0.0004), plical atrophy (p = 0.0015), and chronic inflammation (p = 0.0089). FTCA may therefore develop in tubes demonstrating histologic features of chronic healed salpingitis, findings that reflect bilateral tubal disease which apparently antedates the development of the FTCA. p53 stains were strongly positive in 9 of 14 FTCAs and in 5 of 6 foci of in situ carcinoma found in the tubes with unilateral FTCA. No p53 staining was found in any of the contralateral tubes. Serous FTCAs may be etiologically related to antecedent bilateral healed chronic salpingitis and arise from in situ carcinoma in a background of atrophy.

Aged↗

Leiomyomas of the fallopian tube. A case report.

Both heterotopic pregnancies and primary neoplasms of the fallopian tube are rare occurrences. A patient presented with early pregnancy, abdominal pain and ultrasound findings of an intrauterine gestation and a fallopian tube mass. Laparotomy revealed a primary leiomyoma of the fallopian tube.

Abdominal Pain↗

Differential impact on pregnancy rate of selective salpingography, tubal catheterization and wire-guide recanalization in the treatment of proximal fallopian tube obstruction.

A total of 66 patients with proximal Fallopian tube (113 tubes) obstruction, as diagnosed by both laparoscopy and hysterosalpingogram, were each subjected to a transcervical recanalization procedure sequentially using selective salpingography followed, if necessary, by tubal catheterization with a soft Teflon 2-French catheter and finally, if needed, wire-guide cannulation. Each procedure were terminated once patency had been achieved without recourse to the next technique. Bilateral obstruction was present in 47 patients and unilateral in 19 patients. Patency was achieved in 39 (34.5%) Fallopian tubes by selective salpingography alone, in 52 (46.0%) by tubal catheterization and in 10 (8.9%) by wire guide, with 12 (10.6%) tubes remaining obstructed. Pregnancy occurred in 24 (36.4%) patients without recourse to other treatment (mean follow-up, 17 months). Where patency was achieved (59 patients), 19 out of 43 (44.1%) of those treated for bilateral obstruction and five out of 16 (31.3%) of those treated for unilateral obstruction achieved a pregnancy. Pregnancy occurred in six out of 22 patients (27.3%) where selective salpingography was used to produce tubal patency, in 17 out of 30 patients (56.7%) where tubal catheterization was used and in one out of seven (14.3%) where a wire guide was used, which was an ectopic pregnancy. The difference between the ongoing pregnancy rates following tubal catheterization (50.0%) and wire-guide cannulation (0.0%) was significant (P = 0.033). While wire-guide cannulation is the most effective method used to achieve tubal patency, these results indicate that when it is truly necessary, as opposed to electively used by clinicians, the prognosis with regard to pregnancy is poor and alternative therapy such as microsurgery or in-vitro fertilization should be considered early.

Adult↗

Transvaginal fallopian tube catheterization in an animal model.

A rabbit model for testing the safety and effectiveness of diagnostic and interventional techniques of fallopian tube catheterization is presented. Hysterography with injection into the terminal portion of the uterine horn visualized the fallopian tube in only 6% of cases; however, this increased from 33% to 50% by pretreatment with progesterone, administration of glucagon or phentolamine, or increased pressure of injection with balloon obstruction of the uterine horn. Salpingography with a catheter introduced in the tubal ostium or directly inside the tube was most effective and resulted in a consistent (100%) visualization of the fallopian tube. The technique also allowed coaxial introduction of small diameter guidewires and catheters deep into the fallopian tube.

Animals↗

[Primary fallopian tube carcinoma. Report of a single case with review of the literature].

With an incidence of 0.1-1.0% of all genital malignancies, primary fallopian tube carcinoma is an extremely uncommon neoplasm of the female genital tract. We report a 58-year-old postmenopausal woman with primary fallopian tube carcinoma confined to the right fallopian tube in primary stage pT2a pN0 G3 M0, who is alive without evidence of disease 2 years after abdominal hysterectomy, bilateral adnexectomy, omentectomy and lymphonodectomy followed by an adjuvant cisplatin (70 mg/m2) and treosulfan (5 g/m2) chemotherapy. An accompanying literature review indicates that clinical signs and symptoms of fallopian tube neoplasms are usually nonspecific and include lower abdominal pain. The primary treatment remains surgical resection followed by adjuvant chemotherapy or radiation. Prognosis is poor, although long-term survivors have been reported.

Antineoplastic Combined Chemotherapy Protocols↗

The effect of human fallopian tube epithelium on human sperm velocity motility and binding.

PURPOSE: A prospective, controlled in vitro study was conducted to evaluate the effects of human fallopian tube epithelium on the motility, velocity, and binding of human spermatozoa. METHODS: Eleven fallopian tubes from six women undergoing hysterectomy and semen samples from 14 male partners of women undergoing in vitro fertilization were collected. Human spermatozoa were cultured with monolayer of human fallopian tube epithelial cells. The motility and velocity were analyzed subsequently at 0, 2, 6, 24, and 48 hr of incubation. The sperm binding capacity was analyzed after 48 hr in the hemizona assay (HZA). RESULTS: The presence of the human fallopian tube epithelial cells did not have any beneficial effects on sperm motility and velocity. On the other hand, significant promoting effect was observed in the ability of the sperm to bind to the zona pellucida. CONCLUSIONS: The interaction of human spermatozoa with fallopian tube epithelial cells significantly increases sperm binding in the HZA.

Epithelial Cells↗

Preoperative diagnosis of primary fallopian tube carcinoma by magnetic resonance imaging: a case report.

Because of the rarity and insidious onset of primary adenocarcinoma of the fallopian tube, early diagnosis is very difficult. Primary fallopian tube carcinoma is also rarely diagnosed preoperatively. This report reviews the value of magnetic resonance imaging (MRI) in aiding the detection of early-stage primary fallopian tube carcinoma in a 48-year-old female. The diagnosis was based on clinical suspicion, elevated CA-125 and MRI. MRI demonstrated the tumor as an area of solid masses with marked enhancement after gadolinium-diethylenetetraaminepentaacetic acid (Gd-DTPA) administration. Primary fallopian tube carcinoma was confirmed by pathologic examination. We hope that, with improvements in imaging, early diagnosis of such a malignant disease could become routinely possible in the future.

Fallopian Tube Neoplasms↗