1. FALLOPIAN TUBE CARCINOMA – A CASE PRESENTATION PATHOLOGICAL FINDINGS
Authors – Dr. Preeti Yadav, Dr. Gauri Gandhi, Dr. Latika Sahu, Dr. Krishna Agarwal
Institute – Department of Obstetrics & Gynecology, Maulana Azad Medical College, New Delhi –
INTRODUCTION
INVESTIGATIONS
PATHOLOGICAL FINDINGS
Primary fallopian tube carcinoma (PFTC) is least common of all gynaecological cancers.
It is of unknown etiology.
Most commonly found in post menopausal infertile female.
Classical Latzko triad (profuse sero-sanguinous discharge, colicky pain and abdominopelvic mass) is seen only in 5% of the cases.
Preoperative diagnosis is made rarely and usually presents as unexpected finding at laparotomy for a pelvic mass.
USG pelvis - Lobulated solid cystic mass present in bilateral adnexal region with increased vascularity. Left side – 10X8 cm, Right side – 4X3 cm. Uterus normal size. Bilateral ovaries not separately seen.
CT abdomen and pelvis – Free fluid present. Peritoneal and omental nodules present. No other abnormality seen in abdomen.
Heterogenous solid cystic mass in left adnexa of 9.5X8 cm. Similar smaller mass seen in right adnexa of 4X3 cm. No pelvic lymphadenopathy seen.
Peritoneal washings showed no malignant cells.
Gross examination – 3X2 cm solid growth seen at fimbrial end of left fallopian tube. A normal looking left ovary seen separately. Uterus, right ovary and right fallopian tube were normal looking.
Cut section – Area of necrosis seen.
Histopathology – Histological sections of the solid area showed area of necrosis with dense chronic inflammatory background and residual viable tumour tissue suggestive of POORLY DIFFERENTIATED CARCINOMA.
Omentum and lymph node sections showed no tumour deposits.
DIAGNOSIS
CASE REPORT
POORLY DIFFERENTIATED PRIMARY FALLOPIAN TUBE CARCINOMA SURGICAL STAGE IC
A 45 year old perimenopausal female presented with a lower abdominal lump and generalized abdominal pain since one and a half month.
Patient had no menstrual complaints.
On physical examination ascites was found.
On vaginal examination cervix was normal and uterus was anteverted, normal size and mobile. A left sided firm to hard irregular adnexal mass of 9X8 cm was found.
Nodularity in POD was found.
FOLLOW-UP
Non healing ulcer at FNAC site
Resected ulcer
MANAGEMENT
Patient received 2 cycles of adjuvant chemotherapy.
CA-125 was 12 U/L after the chemotherapy.
USG of abdomen and pelvis at 3 months was normal.
Patient is doing fine at present.
Provisional diagnosis of malignant ovarian neoplasm was made.
Patient received 4 cycles of neo-adjuvant chemotherapy (paclitaxel and carboplatin every 3 weeks).
Patient developed a non-healing ulcer at FNAC site while on chemotherapy.
Edge biopsy of ulcer showed chronic inflammatory granulation tissue with no evidence of malignancy.
She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy with pelvic and para-aortic lymph node dissection and omentectomy with excision of ulcer with primary closure.
DISCUSSION
Although rare, PFTC must be considered in the differential diagnosis of adnexal masses.
It is possible that the true incidence of PFTC has been underestimated.
CA-125 can be used as a tumour marker for post-treatment follow-up.
INVESTIGATIONS
Hemogram - Hemoglobin: 11.4 g%;
TLC: 4100/mm3;
Platelet count – 4.5 lac/µl
LFT and KFT - Normal
Chest X-Ray - Normal
Paps smear - Normal
CA – U/ml (reference range <35U/L)
FNAC - Malignant epithelial neoplasia
USG abdomen- Free fluid present. Liver, Gall Bladder, Spleen, Pancreas, Bilateral kidneys normal.
No lymphadenopathy.
REFERENCES
Benedet JL, Bender H, Jones H 3rd, Nagan HY, Pecorelli S. FIGO staging classifications and clinical practice guidelines in the management of gynaecological cancers. FIGO Committee on Gynaecological Oncology. Int J Gynaecol Obstet 2000; 70:
Ajithkumar TV, Minimole AL, John MM et al. Priamry fallopian tube carcinoma. Obstet Gynaecol Surv 2005; 60:
Hefler LA, Rosen AC, Graf AH et al. Clinical value of CA-125 in patients with PFTC: A multicentre study. Cancer 2000; 89:
Gross specimen – posterior aspect
Hisotopathology showing poorly differentiated Ca