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CASE REPORTS
A RARE CASE OF FALLOPIAN TUBE CARCINOMA
ABHISHEK GUPTA*, RASHNA UMRIGAR**, PREMA KANIA***, GAUTAM ALLHABADIA***, CM NARIANI+
INTRODUCTION
rimary tumour of fallopian tube, both benign and malignant are rare and accounts for 0.3% of all gynaecological cancers.1-3 Malignant lesions of fallopian tube are secondary malignancies usually arising from adjacent ovary or uterus, occasionally from gastrointestinal tract. This paper reports a case of fallopian tube carcinoma, for its rarity.
CASE REPORT
Mrs. XY 48 year’s old female was admitted in our institution, with complaints of lump in abdomen since two and a half months and pain in abdomen since one month. Her menstrual cycles were regular with normal flow. She had five full term normal deliveries and had undergone tubal ligation nineteen years back. General physical examination was unremarkable. Per abdomen mass was felt arising from the pelvis just above the suprapubic region with irregular surface, firm in consistency nontender and freely mobile. Per speculum examination showed that cervix and vagina were normal. On per vaginal examination uterus was bulky firm and mobile, the mass 7 by 8 cm size felt per abdomen was tipped from anterior left fornix, no tenderness could be elicited. Routine investigations were within normal limits. Tumour markers Ca-125-33.67, Beta hCG-1.11, Alpha feto protein-2.2. CT scan/USG with colour Doppler, showed bulky uterus with 7.5 by 8.7 cms. Left sided complex mass arising from pelvis with solid and cystic components with increased vascularity. An exploratory laparotomy done after complete pre-operative work up. Intraoperative findings revealed minimal ascites, with
omental mass, nodular attached with minimal adhesions to transverse colon, and left fallopian tube. Uterus was bulky. Right tube and ovary were normal. There was evidence of laparoscopic tubal ligation. The mass was excised completely, along with total abdominal hysterectomy and bilateral salpingo-oopherectomy. Specimen was sent for histopathological examination. Liver surface was normal, para aortic and pelvic lymph nodes wee not palpable and both para colic gutters were free. Post operative period was uneventful. Histopathology report showed poorly differentiated adenocarcinoma of the left fallopian tube with infiltration of tumour on to the surface. No deposits in omental fat seen. Evidence of less than 0.3 mm size focus of adenocarcinoma in left ovary near the surface. Patient was discharged on day 10 of surgery after suture
removal and was advised chemotherapy after 6 weeks.
DISCUSSION
Primary carcinoma of fallopian tube is rare but extremely aggressive neoplasm.4,8 It is rarely suspected pre-operatively. The symptom complex of “hydrops tubae profluence” said to be pathognomonic for this tumour is rarely encountered. The treatment approach is similar to that used for ovarian carcinoma and includes primary surgery comprised of total abdominal hysterectomy with bilateral salphingo-oopherectomy and staging followed by chemotherapy.5 Three dimensional ultrasound allows precise depiction of tubal wall irregularities such as papillary protrusions and pseudosepta.
Multiple sections of tubal sausage like structure enables determination of local tumour spread and capsule infiltration.6 The occurrence of fallopian tube cancer should alert the clinician to the possibility of an abnormality in the breast cancer susceptibility to BRCA 1 or 2 genes. The bad prognosis of primary carcinoma of the fallopian tube is ascribed to early
lymphogenous metastasis. Correct staging is obtained only on basis of pelvic and para aortic lymphadenectomy, radical
lymphadenectomy in tumours of equal size may markedly prolong survival.9 Chemotherapy and irradiation are two adjuvant therapy that are similarly effective in fallopian tube carcinoma stage 1 and 2, with chemotherapy being preferred at the present time. 40% tumour related deaths in stage 1 and up to 57% in stage 2. Primary surgical treatment is of
crucial importance on prognosis of fallopian tube carcinoma.10 Management of fallopian tube cancer consists of bilateral salphingo-oopherectomy, total abdominal hysterectomy, comprehensive surgical staging also including a systematic pelvic and para-aortic lymphadenectomy and aggressive debulking in patients with advanced tumour. Patients with
apparently early stage low risk fallopian tube carcinoma not submitted to complete surgical staging, as well as those with early stage high risk disease should receive adjuvant single agent carboplatin. Patients with advanced disease should undergo paclitaxel plus carboplatin based chemotherapy.11 Primary fallopian tube carcinoma though being
the rarest of all gynaecological malignancy histologically most of them are adenocarcinomas. Transitional cell carcinoma is extremely rare in the fallopian tube.12
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