Primary fallopian tube carcinoma (PFTC) is an extremely rare malignancy that arises from the fallopian tube. They account for ~1 (0.2-1.1)% all gynaecological malignancies (least common of all gynaecological malignancies 3).
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The estimated incidence is at ~3-4 per million women 3. It typically present in post menopausal females (peaks at 6th-7th decades).
Most patients are asymptomatic or tend to present with non specific or insiduous symptoms. 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.
Most primary fallopian tube cancers arise from ampulla with endoluminal growth that leads to obstruction and distension of the fallopian tube (hydrosalpinx), which explains why the majority of these patients are rarely asymptomatic in contrast with those with ovarian cancer.
Tumours can be bilateral in 20% of the cases, mainly in advanced disease.
The pattern of growth can be nodular, papillary, infiltrative, or mass forming.
Recognised histological types include:
papillary serous adenocarcinoma of fallopian tube
- most common histological sub type
- can be histologically identical to a serous cystadenocarcinoma of the ovary.
- endometrioid carcinoma of the fallopian tube
- transitional cell carcinoma of the fallopian tube
The tumour usually originates in the ampulla of the Fallopian tube. Bilateral involvement can in been is ~20% of cases 1.
Serum CA-125 levels often elevated 6,8
Advanced tumours are difficult to differentiate from ovarian tumours on imaging. The presence of a hydrosalpinx can be a useful feature.
While being non specific, it may be sonographically identified as a complex cystic mass involving the fallopian tube with papillary projections 10-11.
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While signal characteristics are not specific, they generally are as follows 1,3
- solid tumour portion is usually of low signal
- if there is an associated simple serous fluid containing hydrosalpinx this may be low signal
- if there is an associated simple haemorrhagic fluid containing hydrosalpinx this may be high signal
- solid tumour component is often homogeneously or heterogeneously low or of intermediate signal
- if there is an associated simple serous fluid containing hydrosalpinx this may be of high signal
- T1 C+ (Gd): solid portion often demonstrates enhancement
Treatment and prognosis
Compared with ovarian carcinoma, fallopian tube cancer more tends to present at an earlier stage but has a worse prognosis, stage for stage 2. The reposted better overall survival therefore may be on the basis of earlier stage at presentation 4. Treatment generally consists of surgical debulking followed by chemotherapy.
For a mass involving the fallopian tube, differential considerations would be:
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- 12. Kol S, Gal D, Friedman M et-al. Preoperative diagnosis of fallopian tube carcinoma by transvaginal sonography and CA-125. Gynecol. Oncol. 1990;37 (1): 129-31. - Pubmed citation
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