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Fallopian Tube Carcinoma
Fallopian Tube Cancer Type Carcinoma

Fallopian tube carcinoma is a very rare tumor of the female reproductive tract. Typical manifestations are the presence of an adnexal mass, abdominal or pelvic pain, and vaginal discharge that relieves pain, although they are not always present. The diagnosis is made postoperatively or through the use of imaging studies and histopathological examination of the tumor.

Presentation

Fallopian tube carcinoma is rarely encountered in clinical practice (incidence rates estimated at 3.6 in 1,000,000 women every year), comprising less than 2% of all malignancies of the female genital tract [1]. The tumor primarily affects women in their 5th, 6th, and 7th decades of life [1] [2]. Typical clinical presentation of fallopian tube carcinoma, known as the Latzko triad, encompasses three elements, namely a mass in the adnexal region, colicky abdominal or pelvic pain, and its relief after the appearance of a serosanguineous vaginal discharge [2] [3] [4] [5]. The term hydrops tubae profluens is used to describe the intermittent vaginal discharge spontaneously or after pressure, resulting in the decrease of the adnexal mass, and is considered to be a pathognomonic feature of fallopian tube carcinoma [3] [5]. Presumably, dynamic emptying and filling of the Fallopian tube blocked by the tumor is the related pathophysiological mechanism of hydrops tubae profluens [2] [3]. Only 15% of women present with the Latzko triad while hydrops tubae profluens is seen in only 5% of cases [2] [4]. Thus, the nonspecific clinical presentation and the rare occurrence of typical signs and symptoms might be the reasons why clinical suspicion is not raised early on, leading to a delayed diagnosis and poorer treatment outcomes [4] [5].

Gastrointestinal

  • Abdominal Pain

    We report the case of a 56-year-old woman who presented with a 2 1/2-year history of intermittent vaginal bleeding and lower abdominal pain. [ncbi.nlm.nih.gov]

  • Pelvic Mass

    Actually all these three cases presented as tubo-ovarian abscess because of the existence of tender pelvic mass. [ncbi.nlm.nih.gov]

    They are consulted for chronic pelvic pain with pelvic mass. The clinical assessment revealed an abdomino-pelvic mass of hard consistency. [omicsonline.org]

  • Abdominal Mass

    We described a patient who had back pain, an epigastric abdominal mass, a palpable right kidney and a palpable scalene node. [ncbi.nlm.nih.gov]

    […] vaginal discharge (20%) and a palpable pelvic/abdominal mass (61%). [9] The patients presents with the typical clinical symptoms termed as "hydrops tubae profluens" that is, they will have pelvic pain, lower abdominal mass, and serosanguinous vaginal [ccij-online.org]

    Abdominal pain, vaginal bleeding, hydrohematorrhea, impaired general condition and palpation of a pelvic mass are the most common symptoms during the primary cancer of the fallopian tube [ 11 ]. [panafrican-med-journal.com]

    The distinctive presentation of intermittent, profuse, watery, clear to yellow (cholesterol-rich) vaginal discharge is accompanied by colicky abdominal pain and followed by a decrease in the size of an abdominal mass (hydrops tubae profluens). [6], [7 [jmidlifehealth.org]

Musculoskeletal

  • Thigh Pain

    After surgery, the patient had progressive right thigh pain with activity. Radiographs of the femur showed a lytic lesion in the right proximal femur diaphysis with erosion of the medial cortex. [ncbi.nlm.nih.gov]

Urogenital

  • Vaginal Bleeding

    We report the case of a 56-year-old woman who presented with a 2 1/2-year history of intermittent vaginal bleeding and lower abdominal pain. [ncbi.nlm.nih.gov]

  • Vaginal Discharge

    Typical manifestations are the presence of an adnexal mass, abdominal or pelvic pain, and vaginal discharge that relieves pain, although they are not always present. [symptoma.com]

    Patients generally suffer from the three symptoms: vaginal bleeding, pelvic pain, and vaginal discharge; however, this is usually not sufficient for confirming the diagnosis preoperatively in most circumstances. [ncbi.nlm.nih.gov]

    The symptoms complex comprising of an intermittent profuse serosanguineous vaginal discharge, colicky lower abdomino-pelvic pain relieved by the vaginal discharge, and an adnexal mass can be present in ~15% of and is termed the Latzko triad 13-14. [radiopaedia.org]

  • Adnexal Mass

    During laparotomy, bilateral adnexal masses were identified, presumed to be of ovarian origin, and total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, and retroperitoneal lymph nodes sampling were performed. [ncbi.nlm.nih.gov]

    Typical manifestations are the presence of an adnexal mass, abdominal or pelvic pain, and vaginal discharge that relieves pain, although they are not always present. [symptoma.com]

  • Adnexal Tenderness

    Mucopurulent (green or yellow) discharge on speculum examination and acute cervical motion tenderness, uterine or adnexal tenderness are indicative for PID and TOA. [cancertherapyadvisor.com]

    Bilateral lower quadrant tenderness with rebound tenderness was noticed on the physical examination. She had findings of acute panperitonitis. On the pelvic examination, she had cervical motion and adnexal tenderness. [e-crt.org]

Workup

To make the diagnosis of Fallopian tube carcinoma, it is necessary to conduct a thorough workup. A detailed patient history and a meticulous physical examination are the first steps in raising suspicion toward this malignancy, but because typical signs and symptoms are not always present, imaging studies are the cornerstone in making the initial diagnosis [2] [3] [4]. Abdominal (but also transvaginal) ultrasonography is a very useful initial method in detecting a tumor in the area where the Fallopian tubes are located, but many reports have revealed that the mass may be often misidentified as ovarian carcinoma [2] [4] [5] [6] [7]. However, more advanced methods, such as magnetic resonance imaging (MRI), are used to confirm the diagnosis [2] [3]. A small tubular or sausage-shaped mass that exerts low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging are main findings on MRI [2] [7]. Computed tomography (CT), on the other hand, is beneficial for determining the stage of the tumor. Histopathological examination is often performed postoperatively [2]. The cancer antigen 125 (CA-125) is a protein tumor marker that is frequently expressed by carcinoma of the Fallopian tube, and its assessment should be done whenever clinical and radiographic findings point to an adnexal mass [4] [6] [7].

X-Ray

  • Right Pleural Effusion

    Evaluation demonstrated a right pleural effusion, fluid of which was malignant. The immunohistochemical profile, including negative calretinin, favored metastatic adenocarcinoma over mesothelioma but could not identify the primary tumour site. [ncbi.nlm.nih.gov]

Ultrasound

  • Ovarian Mass

    A vague mass was palpable in the lower abdomen. Transvaginal ultrasonography revealed bilateral tubo-ovarian masses. Patient underwent abdominal hysterectomy with bilateral salpingo-oophorectomy. [casereports.in]

    Left-sided tubo-ovarian mass was present, cut section of which showed yellowish solid area in tubal wall and encroaching on ovarian surface. [jmidlifehealth.org]

    […] associated with the finding of STIC (11%) as compared to those patients without a dominant ovarian mass (45%). [cancerjournal.net]

    Cases with a dominant ovarian mass(es) and identifiable fallopian tubes without STIC should be classified as ovarian primaries. [nature.com]

Treatment

This report demonstrates the significance of anti-angiogenesis therapy in the treatment of these tumors. [ncbi.nlm.nih.gov]

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. [ncbi.nlm.nih.gov]

Etiology

The etiology, incidence, natural history, treatment and prognosis of fallopian tube carcinoma and retroperitoneal fibrosis are discussed. [ncbi.nlm.nih.gov]

Conclusion Primary tubal cancer is rare, of unknown etiology and sometimes mistaken for uterine or ovarian pathology. The clinical signs are rarely present in full. The diagnosis is rarely made preoperatively or on histology. [panafrican-med-journal.com]

Epidemiology

In this chapter, we clarify the possible epidemiological factors behind this disease. [ncbi.nlm.nih.gov]

The authors report a review of the literature regarding the epidemiology, diagnosis, treatment and prognosis of this cancer. Introduction Primary cancer of the fallopian tube is very rare [ 1-4 ]. [panafrican-med-journal.com]

Pathophysiology

Presumably, dynamic emptying and filling of the Fallopian tube blocked by the tumor is the related pathophysiological mechanism of hydrops tubae profluens. [symptoma.com]

Pathophysiology of Fallopian Tube Cancer 673 views Fallopian tube cance r develops in the tubes that connect a woman's ovaries and uterus. It is very rare and accounts for only 1-2% of all gynecological cancers. [checkorphan.org]

Prevention

“We have an opportunity to … embrace a new surgical paradigm for ovarian cancer prevention.” [cmaj.ca]

Fallopian Origin and Prevention of Ovarian Cancer A proposed model for ovarian carcinogenesis arising in the fallopian tube has emerged over the last decade [9, 10]. [journalofethics.ama-assn.org]

[…] in order to prevent what they were still calling ovarian cancer. [statnews.com]

Causes, Risk Factors, and Prevention Learn about the causes and risk factors associated with ovarian cancer. Read here about how you might help lower your risk. [cancer.org]

Prophylactic salpingectomy may offer clinicians the opportunity to prevent ovarian cancer in their patients. [acog.org]

References

  1. Veloso Gomes F, Dias JL, Lucas R, Cunha TM. Primary fallopian tube carcinoma: review of MR imaging findings. Insights Imaging. 2015;6(4):431-439.
  2. Rezvani M, Shaaban AM. Fallopian tube disease in the nonpregnant patient. Radiographics. 2011;31(2):527-548.
  3. Pectasides D, Pectasides E, Economopoulos T. Fallopian tube carcinoma: a review. Oncologist. 2006;11(8):902-912.
  4. Jeung IC, Lee YS, Lee HN, Park EK. Primary Carcinoma of the Fallopian Tube: Report of Two Cases with Literature Review. Cancer Res Treat. 2009;41(2):113-116.
  5. Kalampokas E, Kalampokas T, Tourountous I. Primary fallopian tube carcinoma. Eur J Obstet Gynecol Reprod Biol. 2013;169(2):155-161.
  6. Chaudhry S, Hussain R, Zuberi MM, Zaidi Z. Rare primary fallopian tube carcinoma; a gynaecologist's dilemma. J Pak Med Assoc. 2016;66(1):107-110.
  7. Lau HY, Chen YJ, Yen MS, Chen RF, Yeh SO, Twu NF. Primary fallopian tube carcinoma: a clinicopathologic analysis and literature review. J Chin Med Assoc. 2013;76(10):583-587.
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