Primary fallopian tube carcinoma

Primary fallopian tube carcinoma (PFTC) isis an extremely rare malignancy that arises from the fallopian tube. They accountIt accounts for ~1 (0.2-1.1)% of all gynaecological malignancies (least common of all gynaecological malignancies ³).

Epidemiology

The estimated incidence is at ~3-4 per million women ³. It typically presents in post menopausal-menopausal females (peaks at 6^th-7^th decades).

Clinical presentation

Most patients are asymptomatic or tend to present with non specific-specific or insiduousinsidious symptoms. The symptoms are complex, comprising of an intermittent profuse serosanguineous vaginal discharge, colicky lower abdomino-pelvicabdominopelvic pain relieved by the vaginal discharge, and an adnexal mass can be present(present in ~15% of and). This clinical constellation is termed the Latzko triad^13-14,14. 

Pathology

Most primary fallopian tube cancers arise from the 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 bilateralBilateral involvement occurs in 20~20% of the cases, mainly in advanced disease¹.

• papillary serous adenocarcinoma of fallopian tube

  • most common histological sub typesubtype

  • can be histologically identical to a serous cystadenocarcinoma of the ovary.

• endometrioid carcinoma of the fallopian tube

• transitional cell carcinoma of the fallopian tube

Markers

Serum CA-125 levels are often elevated ^6,8.

Radiographic features

Advanced tumours are difficult to differentiate from ovarian tumours on imaging. The presence of a hydrosalpinx can be a useful feature.

Ultrasound

While being non specific-specific, it may be sonographically identified as a complex cystic mass involving the fallopian tube with papillary projections ^10-11,11. 

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MRI

While signal characteristics are not specificnon-specific, they generally are as follows ^1,3:

• T1

  • 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 

• T2

  • 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 

Staging 

See:staging of primary fallopian tube carcinoma

Treatment and prognosis

Compared with ovarian carcinoma, fallopian tube cancer morecarcinoma tends to present at an earlier stage but has a worse prognosis, stage for stage ². The repostedHowever, the better overall survival thereforeof fallopian tube carcinoma may be on the basis of an earlier stage at presentation ⁴. Treatment generally consists of surgical debulking followed by chemotherapy.

Differential diagnosis

For a mass involving the fallopian tube, differential considerations would be:

• tubal ectopic pregnancy: women of childbearing age and BHCG elevatedelevated β-hCG

• primary ovarian cancerscancer (especially ovarian epithelial tumours) with involvement of the fallopian tubes

• infective of inflammatory conditions

  • pelvic inflammatory disease +/- pyosalpinx