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Primary adenocarcinoma of the fallopian tube: a case report.

We report a case of a 75-year-old postmenopausal woman with primary fallopian tube carcinoma confined to the left fallopian tube in Stage IA-2, who is alive without evidence of disease three years after total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, pelvic and paraaortic lymph node dissection were performed. Histopathological examination revealed a poorly differentiated (grade 3) papillary serous adenocarcinoma of the left fallopian tube. Adjuvant irradiation was given. Primary fallopian cancer should be suspected by clinicians even if the presenting symptoms are atypical and the primary treatment remains surgical resection followed by adjuvant chemotherapy or radiation. Appropriate therapy for each stage of the disease should be defined and new studies are needed to better depict the clinical course and prognostic factors.

Adenocarcinoma↗

Primary carcinoma of the fallopian tube. A clinicopathologic study.

Five cases of primary fallopian tube carcinoma were located in 30 years retrospective study (1965-1994) from the Department of Pathology, Kasturba Medical College, Mangalore, Karnataka. Abnormal vaginal bleeding was the presenting symptom in all the cases. Pelvic mass was palpable in four cases. The diagnosis was not suspected preoperatively in any case. All patients underwent surgical treatment. Laparotomy revealed the presence of a macroscopic growth in the fallopian tube which was confirmed to be adenocarcinoma histopathologically in all the cases. In three cases follow-up is available. Only one patient received postoperative radiotherapy and chemotherapy.

Adenocarcinoma↗

Fallopian tube prolapse misdiagnosed as vault granulation tissue: a report of three cases.

Prolapse of the fallopian tube into the vagina is an uncommon complication caused by either vaginal or abdominal hysterectomy. Recently, however, we encountered three cases with prolapse of the fallopian tube after abdominal hysterectomy. The patients presented with vaginal bleeding. A red hemorrhagic granular mass, misdiagnosed as vaginal granulation tissue both macroscopically and microscopically, was noted at the apex of vagina. Pathologically, one case was initially diagnosed as vaginal vault granulation tissue, but there were two recurrences after excision. Microscopically, the mass had a papillary or villous outer surface with a complex pattern of tubular and glandular structures, as well as acute and chronic inflammatory infiltrates in the fibrovascular stroma. A typical ciliated tubal type of epithelium was identified, and on immunohistochemical staining for cytokeratin, attenuated epithelial cells were detected. It is necessary to receive a pathologic confirmation by performing vaginal biopsy when fallopian tube prolapse is clinically suspected, thus preventing misdiagnosis.

Adult↗

Anaplastic carcinoma of the fimbriated end of the fallopian tube as an incidental finding.

Carcinoma of the fallopian tube is an uncommon gynecologic tumor that is usually diagnosed in an advanced stage. The majority are tubal in origin, and rarely arise in the fimbriae. It appears that the latter may have a worse prognosis than the equivalent stage of tubal tumors that do not arise from fimbriae. We present a case of a 53-year-old white woman with FIGO stage 1 primary anaplastic carcinoma of the fimbriated end of the fallopian tube that was incidentally found in a specimen resected during a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The patient underwent surgery because of findings of severe cervical dysplasia, atypia and dyskaryosis on a routine Papanicolau smear. Postoperative recovery was uneventful, and follow-up abdominal and pelvic CT scans showed no evidence of disease. However, because of the poor degree of differentiation, focal serosal infiltration and fimbrial end tube site of the carcinoma she was considered to have a high risk of recurrence. Thus, it was recommended that she undergo adjuvant chemotherapy with cyclophosphamide and carboplatin. Eighteen months after diagnosis, the patient is alive and well with no evidence of disease.

Adenocarcinoma↗

Brain metastases from fallopian tube carcinoma responsive to intra-arterial carboplatin and intravenous etoposide: a case report.

Fallopian tube carcinoma is the least common neoplasm of the female genital tract. Although rare, neurological complications such as brain metastases can develop. It remains unclear, however, what role chemotherapy has in the treatment of these patients and what route of administration is most effective. Intra-arterial (IA) regional administration of chemotherapy may increase intra-tumoral drug concentrations and improve efficacy. We report the case of a 47-year-old woman who developed bilateral fallopian tube cancer and multifocal brain metastases. After progression through radiation therapy and oral chemotherapy, she was placed on IA carboplatin (200 mg/m2/d x 2 days every 4 weeks) and intravenous etoposide (100 mg/m2/d x 2 days every 4 weeks). During treatment she had objective tumor shrinkage that has remained stable for more than 12 months. For patients with fallopian tube carcinoma that develop brain metastases and respond poorly to surgery and/or irradiation, multi-agent chemotherapy containing carboplatin should be considered. The effectiveness of carboplatin may be improved if administered by the IA route.

Adenocarcinoma, Papillary↗

Primary malignancies of the fallopian tube.

Ten cases of primary adenocarcinoma of the fallopian tube occurring over 23 year period are presented. The mean age of the patients was 61.2 +/- 9.2 years (range 48-77). Eight of the patients were postmenopausal. Abnormal vaginal bleeding was the most common symptom and was present in six patients. A pelvic mass was detected in seven cases. In one of the patients abnormal vaginal cytology was leading to correct diagnosis. The problem of the disease is a late diagnosis. Eight of the ten patients with tubal adenocarcinoma represented clinical Stage III or IV. Four of the patients are alive more than ten years after the diagnosis. A rare case of carcinosarcoma of the fallopian tube is presented. Only 26 such cases have been described in the literature to date. In addition a case of tubal choriocarcinoma is reported.

Adenocarcinoma↗

Early occurrence and prognostic significance of p53 alteration in primary carcinoma of the fallopian tube.

The pathogenesis of primary carcinoma of the fallopian tube (PCFT) is poorly understood. Tumor suppressor p53 gene alterations are common in human malignancies, but their role in the tumorigenesis and survival of PCFT is undefined. The objectives of this study were to define the occurrence and prognostic role of p53 alteration in PCFT and to examine the efficiency of immunohistochemistry (IHC) in detecting p53 alteration in PCFT. Fifty-two PCFT and 10 normal fallopian tubes were examined for p53 alteration by IHC and polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP). The Kaplan-Meier method was used to derive the survival function, while the log-rank test was used to compare curves for two or more groups. Other patients' characteristics were analyzed by two-tailed Fisher's exact tests. IHC correlated well with PCR-SSCP with 100% sensitivity and 83.3% specificity for detecting p53 alteration in this study. Thirty-one of 52 (57%) PCFT showed p53 alteration. Alteration of p53 occurred in all stages of PCFT with a similar incidence in carcinoma in situ and late-stage disease. Alteration of p53 was related to tumor histologic type. Significant survival difference was noted between advanced and early clinical stages but no such difference was identified among different tumor grades. Compared to the p53-nonaltered group, the presence of p53 alteration in PCFT was related to significantly decreased patient survival (RR = 6.8, 95% CI = 2.9-16.2) in multivariate analysis. In the subgroup of patients with residual tumor after surgery, those with p53-altered tumors had a significantly decreased survival compared to those with p53-nonaltered group (RR = 7.4, 95% CI = 1.9-28.2). Alteration of p53 is common and IHC is an efficient method to detect p53 alteration in PCFT. Shorter survival is associated with p53 alteration which is an independent marker for the disease in this study. Alteration of p53 may be an early event in tubal tumorigenesis and may play an important role in the development of PCFT. Whether detection of p53 alteration may serve as an indicator of high-risk patients for whom more aggressive adjuvant chemotherapy may be considered needs to be explored in the future.

Aged↗

Novel coexpression of human chorionic gonadotropin (hCG)/human luteinizing hormone receptors and their ligand hCG in human fallopian tubes.

The human uterus, including its blood vessels, contains hCG/human LH receptors. We now demonstrate that human fallopian tubes also contain a 4.4-kilobase hCG/LH receptor mRNA transcript and an 80-kilodalton immunoreactive protein that can bind [125I]hCG. Tubal mucosa contain more receptor transcripts, receptor protein, and [125I] hCG binding than the tubal smooth muscle or blood vessels. Human fallopian tubes also contain hCG protein and a 0.6-kilobase hCG alpha mRNA transcript. However, very little hCG is found in tubal cell layers other than mucosa. Ampullary segments contain more hCG/LH receptors and hCG than isthmus. Secretory phase tubes contain more than proliferative phase, postpartum, or postmenopause tubes. Incubation with highly purified hCG resulted in an increase in catalytically active 5-lipoxygenase, cyclooxygenase-1, and cyclooxygenase-2 enzymes in tubal tissues. In summary, human fallopian tubes, which have never previously been considered a direct target of hCG/LH action, express functional hCG/LH receptor gene as well as the gene of its ligand. These novel findings suggest numerous possibilities of both physiological and pathological importance in human fallopian tubes.

Arachidonate 5-Lipoxygenase↗

[Fluoroscopically guided fallopian tube recanalization with a simplified set of instruments].

PURPOSE: Fluoroscopically guided transcervical fallopian tube recanalization is recognized as an important step in the workup of female infertility. In the present study, a simplified set of recanalization instruments was tested. MATERIALS AND METHODS: Forty-two women with infertility and sonographically confirmed or suspected uni- or bilateral tubal occlusion were examined. After vaginal placement of a plastic speculum and fixation of a tenaculum, a 4F glide catheter with a 0.89 mm glidewire was advanced transcervically. After documentation of tubal occlusion by hysterosalpingography, the uterotubal junction was catheterized with the same instruments. Under fluoroscopic guidance, the glidewire was negotiated beyond the intramural portion of the tube. Selective salpingography documented the outcome of the recanalization. RESULTS: Hysterosalpingography confirmed tubal occlusions in 26 of 42 patients (in 12 cases unilateral and in 14 cases bilateral). Fallopian tube recanalization was successful in 23 of 26 patients (technical success rate of 88 %). The resulting fertility rate was 30 % (7/23), without any ectopic pregnancy. Complications such as tubal perforation, infection, or bleeding did not occur. Tubal catheterization was straightforward and smooth in 17/23 cases. For a hyperflexed uterus (6/23), a curved tip of the catheter was helpful in tubal probing. CONCLUSION: Fluoroscopically guided transcervical fallopian tube recanalization is a patient-friendly alternative to tubal microsurgery and in-vitro fertilization. Tubal catheterization with 4F glide catheter and glidewire further streamlines the procedure.

Adult↗

Unusual fallopian tube neoplasm in a 10-year-old patient with Proteus syndrome: a case report and review of the literature.

We report a case of fallopian tube and peritoneal lesions resected from a 10-year-old girl with Proteus syndrome. The papillary fallopian tube tumor expressed CA-125 and demonstrated negative staining for CEA, CD15, calretinin, and CK 5/6. Nondilated portions of fallopian tube exhibited evidence of an in situ component. This patient was also found to have peritoneal mesothelial hyperplasia as well as cystic peritoneal lesions of mesothelial origin, with positive calretinin staining. This case provides direct evidence of both Müllerian and mesothelial lesions arising concurrently in a patient with Proteus syndrome and represents the 1st documented fallopian tube neoplasm. Previously reported lesions involving the female and male genital tracts in patients with Proteus syndrome are reviewed.

Biomarkers, Tumor↗

Pharmacological characterization of P2-receptors in human fallopian tubes.

In women with various gynecological disorders, ATP, ADP, and 2-methylthio-ATP dose-dependently potentiated spontaneous contractility of isolated fallopian tubes, while alpha,beta-methylene-ATP and uridine triphosphate were little efficient. Pyridoxal phosphate-6-azophenyl-2',4'-disulphonic acid, a P2-receptor antagonist, inhibited responses to 2-methylthio-ATP, produced no effect on responses to ATP, and potentiated ADP-induced responses in fallopian tubes. During inflammation, sensitivity of fallopian tubes to P2 agonists and antagonists decreased. The data attest to the presence of functionally active P2 receptors in human fallopian tubes probably involved in the regulation of their mechanical activity.

Adenosine Diphosphate↗

[Cyclic changes in mast cell response and capillaries in the wall of the Fallopian tubes of women].

Mast cells reaction in the wall of the normal fallopian tubes has been studied morphometrically in 48 women subjected to the operation for a uterine myoma and ovarian retention cyst. It has been stated that volume and degree of the mast cell degranulation depends on the menstrual cycle phase, age and part of the fallopian tube. The changes of the mast cells reaction correlate with the capillary diameters in the ampulla and the isthmus of the oviduct. Labrocytes participate in regulation of the microcirculatory blood stream of the fallopian tubes.

Adolescent↗

Sterilization with methyl cyanoacrylate-induced fallopian tube occlusion from a nonsurgical transvaginal approach in rabbits.

PURPOSE: To evaluate a nonsurgical, nonhormonal sterilization procedure performed with use of transvaginal microcatheterization techniques and methyl cyanoacrylate (MCA) as a sclerosing agent MATERIALS AND METHODS: Seventeen adult virgin female rabbits underwent bilateral fallopian tube cannulation through a nonsurgical transvaginal approach with use of a coaxial catheter system with fluoroscopic guidance. Fourteen of the rabbits underwent bilateral fallopian tube occlusion with direct MCA injection; the remaining three rabbits were separated as controls. Three of the rabbits with occlusions were killed as temporal histologic controls. The remaining 11 rabbits with occlusions and the initial three controls underwent 6 months of mating trials. All 17 rabbits were killed. Gross inspection was performed and histologic specimens of their fallopian tubes were obtained. RESULTS: None of the 11 rabbits with occlusions that underwent mating became pregnant. All three control rabbits became pregnant. Histologic examination of the occluded fallopian tubes demonstrated long-segment tubal wall fibrosis with varying degrees of occlusion. No peritoneal abnormalities were identified. Histologic findings for the three control animals were normal. CONCLUSION: With use of a nonsurgical transcervical coaxial catheter system, MCA can be placed directly into fallopian tubes without difficulty. MCA administration leads to fallopian tube fibrosis and occlusion. A 100% nonpregnancy rate was demonstrated. Further investigation may lead to a safer, more convenient, and less expensive form of permanent sterilization.

Animals↗

Torsion of the fallopian tube during pregnancy.

We describe 3 cases of torsion of the Fallopian tube during pregnancy, caused by sactosalpinx, a cyst of the mesosalpinx, and an ovarian cyst. Other causes of torsion of the Fallopian tube are discussed. The difficulty of diagnosing this condition during pregnancy is emphasized.

Adult↗

Management of advanced-stage primary carcinoma of the fallopian tube: case report and literature review.

Primary carcinoma of the fallopian tube is a very unusual gynecologic malignancy that accounts for less than 1% of all malignancies of the female genitalia. A 55-year-old, gravida 7, para 3 woman presented with no gynecologic complaints other than backache. TVS demonstrated a 35 x 25 mm heterogeneous mass that was not clearly separated from the left ovary, and another 31 x 14 mm cystic septated lesion in the left ovary region. Pelvic MRI demonstrated a 35 x 35 x 20 mm left adnexal mass that enhanced with contrast and a neighboring tubular-cystic mass. Upper and lower gastrointestinal endoscopy revealed no malignancy. Serum CA 125-level was merkedly elevated at 369 U/ml (normal < 35 U/ml). Laparotomy revealed left hydrosalpinx and a papillary-fimbrial mass. Pelvic lymph node metastases were observed. Frozen-section analysis identified the mass as a serous adenocarcinoma. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, omentectomy, pelvic and para-aortic lymph node dissection, and peritoneal washing were performed. The definitive histopathological diagnosis was primary serous adenocarcinoma of the fallopian tube with six of 25 lymph node biopsies showing metastasis. Six cycles of paclitaxel (175 mg/m2) plus cisplatin (75 mg/m2) combinatin chemotherapy were administered with 3-week intervals between cycles. Second-look laparotomy was performed; there was no evidence of disease. At the time of writing 12 months after the second-look laparotomy, she was still disease-free.

Antineoplastic Combined Chemotherapy Protocols↗

Viability of Chlamydia trachomatis in fallopian tubes of patients with ectopic pregnancy.

OBJECTIVE: To use standard molecular methods to define the prevalence and metabolic characteristics of Chlamydia trachomatis during infection of fallopian tubes in women with ectopic pregnancies. DESIGN: Polymerase chain reaction (PCR)- and reverse transcription-PCR (RT-PCR)-based assessment of presence of chlamydial DNA and various RNA species in fallopian tube biopsy samples. SETTING: Hospital and molecular genetics laboratory. PATIENTS: Ten women of varying ages, each presenting with ectopic pregnancy. MAIN OUTCOME MEASURE(S): Positive signal in specific chlamydia-directed PCR and RT-PCR assays. RESULT(S): Nucleic acid preparations from 7 of the 10 fallopian tube patient samples were PCR-positive for C. trachomatis DNA. Each of the 7 PCR-positive samples also showed the presence of several transcripts from the bacterium, including primary transcripts from the ribosomal RNA operons. CONCLUSION(S): A higher proportion of ectopic pregnancies than was believed previously may be attributable to infection of the fallopian tubes by C. trachomatis. The presence of various chlamydial RNA molecules suggests that viable, metabolically active bacteria were present in fallopian tubes of the patients studied.

Adult↗

Human fallopian tubes in organ culture: preparation, maintenance, and quantitation of damage by pathogenic microorganisms.

An experimental organ culture model has been developed in which rates of damage to fallopian tube mucosa by agents of sexually transmitted diseases can be quantitated. This required assessment of the effect on organ cultures of such variables as the anatomic area of the fallopian tube employed, endocrinological status of the donor, and composition of media. Organ cultures established from the ampulla of tubes of nonpregnant, premenopausal women and maintained with Eagle minimal essential medium containing 0.05 M N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid buffer were most suitable for quantitative studies. Various means of quantitating damage to fallopian tube mucosa were evaluated. Of these, sequential estimations of ciliary vigor and percentage of the periphery of fallopian tube pieces with active cilia proved the most successful. To assess the specificity of the model, fallopian tube organ cultures were infected with Neisseria gonorrhoeae or N. pharyngis, a commensal Neisseria. Damage by N. gonorrhoeae was significantly greater than that by N. pharyngis at each period of observation (P less than 0.001), suggesting that, by using the model, differences in virulence can be determined in vitro that reflect differences in virulence for humans. This model is a potentially valuable tool for studying the interaction of human genital mucosa with known or suspected agents of sexually transmitted diseases.

Anti-Bacterial Agents↗

Primary adenocarcinoma of fallopian tube--a case report.

Primary adenocarcinoma of fallopian tube is the rarest gynecological malignancy of female genital system which is usually misdiagnosed as ovarian tumour or tubo-ovarian mass. We present a case in a 40 year old female.

Adenocarcinoma↗