DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20183000

A rare presentation of a pyosalpinx in a post-menopausal woman

Ashwin Rao, Reddi Rani, Setu Rathod

Abstract


Primary fallopian tube carcinoma is a rare tumour of the female genital tract with an incidence of 0.1-1.8% of all genital malignancies, which is generally an intra-operative or a histological diagnosis.  It is a tumour that resembles epithelial ovarian cancer. A 61-year-old postmenopausal woman presented with complaints of continuous bleeding per vaginum with history of loss of appetite and weight for 6 months. She was also a known diabetic and hypertensive. On examination, per abdominal, per speculum and per vaginal findings were unremarkable.  A transvaginal ultrasonography done previously showed fluid in the endometrial cavity suggestive of hematometra/pyometra due to cervical stenosis. A fractional curettage done previously had shown strips of acanthotic squamous epithelium in the endocervical curetting.   She underwent abdominal hysterectomy with bilateral salpingo ovariectomy. Histopathological findings were suggestive of primary fallopian tube adenocarcinoma. Hence the patient was advised chemotherapy followed by a second look laparotomy. Preoperative diagnosis of fallopian tube carcinoma is difficult due to the silent course of this neoplasm and is usually first appreciated at the time of operation or by a pathologist. The treatment approach is similar to that of ovarian carcinoma, and it should consist of a total abdominal hysterectomy with bilateral salpingo-ovariectomy, omentectomy and lymph node dissection from the pelvic and the para-aortic regions.


Keywords


Epithelial ovarian tumours, Gynaecological malignancies, Hydrops tubae profluens, Primary fallopian tube carcinoma, Pyosalpinx

Full Text:

PDF

References


Nordin AJ. Primary carcinoma of the fallopian tube: a 20-year literature review. Obstet Gynecol Surv. 1994;49(5):349-61.

Tahiri Elousrouti L, Erragad FZ, Jayi S, Hammas N, Harmouch T. Primary Adenocarcinoma of the Fallopian Tube: Report of Two Cases. J Clin Case Rep. 2016;6:5.

Moore KN, Moxley KM, Fader AN, Axtell AE, Rocconi RP, Abaid LN, et al. Serous fallopian tube carcinoma: a retrospective, multi-institutional case-control comparison to serous adenocarcinoma of the ovary. Gynecol Oncol. 2007;107:398-403.

Riska A, Leminen A, Pukkala E. Sociodemographic determinants of incidence of primary fallopian tube carcinoma, Finland 1953-97. Int J Cancer 2003;104:643-5.

Boutselis JG, Thompson JN. Clinical aspects of primary carcinoma of the Fallopian tube: a clinical study of 14 cases. Am J Obstet Gynecol 1971;111:98-101.

Sedlis A. Carcinoma of the fallopian tube. Surg Clin North Am 1978;58:121-9.

Lin CK, Chang CC, Pan SH, Yu MH. Primary fallopian tube carcinoma. Obstet Gynecol Surv 2005;60:247-52.

Tonin P, Moslehi R, Green R, Rosen B, Cole D, Boyd N, et al. Linkage analysis of 26 Canadian breast and breast-ovarian cancer families. Hum Genet. 1995;95:545-50.

Rose PG, Shrigley R, Wiesner GL. Germline BRCA2 mutation in a patient with fallopian tube carcinoma: a case report. Gynecol Oncol. 2000;77:319-20.

Zweemer RP, Van Diest PJ, Verheijen RH, Ryan A, Gille JJ, Sijmons RH, et al. Molecular evidence linking primary cancer of the fallopian tube to BRCA1 germline mutations. Gynecol Oncol 2000;76:45-50.

Aziz S, Kuperstein G, Rosen B, Cole D, Nedelcu R, McLaughlin J et al. A genetic epidemiological study of carcinoma of the fallopian tube. Gynecol Oncol 2001;80:341-5.

Ajjimakorn S, Bhamarapravati Y, Israngura N. Ultrasound appearance of fallopian tube carcinoma. J Clin Ultrasound 1988;16:516-8.

Subramanyam BR, Raghavendra BN, Whalen CA, Yee J. Ultrasonic features of fallopian tube carcinoma. J Ultrasound Med. 1984;3:391-3.

Kol S, Gal D, Friedman M, Paldi E. Preoperative diagnosis of fallopian tube carcinoma by transvaginal sonography and CA-125. Gynecol Oncol. 1990;37:129-31.

Kurjak A, Kupesic S, Ilijas M, Sparac V, Kosuta D. Preoperative diagnosis of primary fallopian tube carcinoma. Gynecol Oncol. 1998;68:29-34.

Kurjak A, Kupesic S, Ilijas M, Sparac V, Kosuta D. Three-dimensional ultrasonographic and power Doppler characterization of ovarian lesions. Ultrasound Obstet Gynecol. 2000;16:365-71.

Hu CY, Taymor ML, Hertig AT. Primary carcinoma of the fallopian tube. Am J Obstet Gynecol. 1950;59:58-67.

Tamimi HK, Figge DC. Adenocarcinoma of the uterine tube: potential for lymph node metastases. Am J Obstet Gynecol. 1981;141:132-7.

Baekelandt M, Kockx M, Wesling F, Gerris J. Primary adenocarcinoma of the fallopian tube. Review of the literature. Int J Gynecol Cancer. 1993;3:65-71.

Gadducci A, Landoni F, Sartori E, Maggino T, Zola P, Gabriele A et al. Analysis of treatment failures and survival of patients with fallopian tube carcinoma: a cooperation task force (CTF) study. Gynecol Oncol 2001;81:150-9.

Gemignani ML, Hensley ML, Cohen R, Venkatraman E, Saigo PE, Barakat RR. Paclitaxel-based chemotherapy in carcinoma of the fallopian tube. Gynecol Oncol. 2001;80:16-20.

Bookman MA, Malmström H, Bolis G, Gordon A, Lissoni A, Krebs JB, et al. Topotecan for the treatment of advanced epithelial ovarian cancer: an open-label phase II study in patients treated after prior chemotherapy that contained cisplatin or carboplatin and paclitaxel. J Clin Oncol 1998;16:3345-52.

Hoskins P, Eisenhauer E, Beare S, Roy M, Drouin P, Stuart G, et al. Randomized phase II study of two schedules of topotecan in previously treated patients with ovarian cancer: a National Cancer Institute of Canada Clinical Trials Group study. J Clin Oncol. 1998;16:2233-7.

Kosary C, Trimble EL. Treatment and survival for women with Fallopian tube carcinoma: a population-based study. Gynecol Oncol 2002;86:190-1.

Alvarado-Cabrero I, Young RH, Vamvakas EC, Scully RE. Carcinoma of the fallopian tube: a clinicopathological study of 105 cases with observations on staging and prognostic factors. Gynecol Oncol 1999;72:367-79.