Indian Journal of Pathology and Microbiology

HISTOPATHOLOGY SECTION - CASE REPORT
Year
: 2008  |  Volume : 51  |  Issue : 1  |  Page : 32--33

Primary bilateral tubal adenocarcinoma associated with uterine leiomyomas


B Sarangthem, S Laishram, A Barindra Sharma, R Konjengbam, K Debnath 
 Department of Pathology, Regional Institute of Medical Sciences, Imphal, Manipur, India

Correspondence Address:
A Barindra Sharma
Department of Pathology, Regional Institute of Medical Sciences, Imphal - 785 004, Manipur
India

Abstract

Primary adenocarcinoma of the fallopian tube is the least common primary malignant tumor of the female genital tract. Bilaterality is also rare. Often the diagnosis is mistaken for ovarian tumor or tubo-ovarian mass. A case of bilateral primary tubal adenocarcinoma of serous type associated with uterine leiomyomas, without evidence of metastasis occurring in a postmenopausal woman is being reported.



How to cite this article:
Sarangthem B, Laishram S, Sharma A B, Konjengbam R, Debnath K. Primary bilateral tubal adenocarcinoma associated with uterine leiomyomas.Indian J Pathol Microbiol 2008;51:32-33


How to cite this URL:
Sarangthem B, Laishram S, Sharma A B, Konjengbam R, Debnath K. Primary bilateral tubal adenocarcinoma associated with uterine leiomyomas. Indian J Pathol Microbiol [serial online] 2008 [cited 2023 Feb 5 ];51:32-33
Available from: https://www.ijpmonline.org/text.asp?2008/51/1/32/40388


Full Text

 Introduction



Primary adenocarcinoma of the fallopian tube is a rare tumor of the female genital tract accounting for only 0.3-1.1% of all gynecologic malignancies. [1],[2] The diagnosis is seldom made preoperatively because the signs and symptoms are not specific, and often mistaken for ovarian tumor or tubo-ovarian mass. The tumor usually occurs in postmenopausal women with vaginal discharge, pelvic pain, and pelvic mass. [1],[2] Metastasis is common at the time of diagnosis. Serum CA-125 is a useful marker for monitoring treatment response and disease progression. [3]

 Case History



A 55-year-old postmenopausal female, gravida 4, para 2, nontubectomized, presented with intermittent abdominal pain and serosanguinous vaginal discharge for about 1 year. She had history of irregular menstruation. Per abdominal examination revealed a vague mass in the right iliac fossa. Per vaginal examination was normal. No other organomegaly or lymphadenopathy was detected. Clinical and ultrasound diagnosis of right-sided ovarian cyst were made. Hemogram, urinalysis, biochemical parameters, and chest X-ray were within normal limits. Pap smear was negative for malignancy.

Peroperatively both tubes were enlarged and cystic, right one measuring10 x 5 cm 2 and left one 6 x 4 cm 2 . No adhesion and no seedlings were found. Uterus and other adnexae were found to be normal. A peroperative diagnosis of bilateral hydrosalpinx was made. Total abdominal hysterectomy and bilateral salpingo-oopherectomy were done and subjected to histopathological examination.

Pathological findings

Grossly, the uterus measured 8 x 4 x 3 cm 3 with two intramural nodules of 2 and 1.5 cm diameter, respectively. Both tubes were enlarged and larger on the right side. Cut sections showed cystic cavity containing reddish fluid with solid papillary growth on both sides [Figure 1]. Cervix, uterine cavity, and ovaries were normal and no metastatic deposits were detected. Microscopic examination of the tubes revealed adenocarcinoma cells with moderate differentiation of serous type with invasion into the muscularis [Figure 2]. Sections from the intramural nodules showed features of leiomyomas. There was no evidence of metastatic deposit in the uterus and adnexae. A histologic diagnosis of primary tubal adenocarcinoma (bilateral) of serous type with uterine leiomyomas was made. The case is being followed up in the radiotherapy department.

 Discussion



Primary adenocarcinoma of the fallopian tube was first described by Renand in 1897. [2] The tumor is usually seen in the peak range of 60-64 years; the youngest patient reported was 14 years and the oldest was 88 years. [1],[2] Carcinomas of the various surface epithelial types encountered in the ovary have been reported in the tube, the tumor most often similar in appearance being serous carcinoma. [4]

Bilaterality has been reported in 10-20% of cases but in one series the figure is only about 3%. [5] Bilateral tumor following tubal sterilization has also been reported. [6] Chronic salpingitis has been suggested as a predisposing factor. [7] Germline mutation of BRCA 1 has been found with increased frequency in tubal carcinoma. [8]

By convention, in primary tubal carcinoma, the uterus, and ovaries should appear largely normal on gross examination; the foci of malignancy in these organs, when present, should have the appearance of metastases or independent primaries by virtue of their size and distribution. [4] Cervico-vaginal smear positivity is low, but an endometrial smear will reveal malignant cells in a high percentage of cases. [2] The association of uterine leiomyomas in the present case may be a coincidence.

Tumor stage has better prognostic value than the histologic grade. [5] Adenocarcinoma particularly of the papillary type may be associated with marked chronic inflammation and has been mistaken for an inflammatory process. On the other hand, various forms of salpingitis including tuberculous and bacterial, may produce severe hyperplasia of the tubal epithelium with sufficient reactive atypia and mitotic activity to mimic in situ or invasive adenocarcinoma. Close attention to severe nuclear atypia, abnormal mitosis, and evidence of invasion is always necessary to prevent the misdiagnosis. [9] Of particular importance to pathologists is that occult carcinoma in prophylactic salpingo-oopherectomy specimens may be found in the fallopian tube as in the ovary. Thus, both tubes must be submitted in entirety and serially sectioned for microscopic evaluation. [10]

In conclusion, a postmenopausal woman with profuse vaginal discharge or bleeding with no satisfactory explanation after D and C, and cervico-vaginal smear should be evaluated for the possibility of tubal carcinoma.

References

1Sonmezer M, Ustum Y, Gungor M, Ensari A, Ortac F. Primary carcinoma of the fallopian tube in a 88 years old woman: review of the literature. Indian J Cancer 2001;38:61-4.
2Nordin AJ. Primary carcinoma of the fallopian tube: a 20-year literature review. Obstet Gynecol Surv 1994;49:349-61.
3Hefler LA, Rosen AC, Graf AH, Lahousen M, Klein M, Leodolter S, et al . The clinical value of serum concentration of cancer antigen 125 in patients with primary fallopian tube carcinoma: A multicenter study. Cancer 2000;89:1555-60.
4Rose PG, Piver MS, Tsukada Y. Fallopian tube cancer. The Rosewell Park experience. Cancer 1990;66:2661-7.
5Alvarado-Cabrero I, Young RH, Vamvakakas 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.
6Toki T, Imai T, Kobayashi H, Oguchi O, Silverberg SG, Fuji S. Adenocarcinoma of the bilateral fallopian tube occurring after tubal sterilization. Gynecol Oncol 1995;58:400-3.
7Demopoulos RI, Aronov R, Mesia A. Clues to the pathogenesis of fallopian tube carcinoma: a morphological and immunohistochemical case control study. Int J Gynecol Pathol 2001;20:128-32.
8Aziz S, Kuperstein G, Rosen B, Cole D, Nedelcu R, McLaughlin J, et al . A genetic epidemiologic study of carcinoma of the fallopian tube. Gynecol Oncol 2001;80:341-5.
9Cheung AN, Young RH, Scully RE, Scully RE. Pseudocarcinomatous lesions of the fallopian tube associated with salpingitis. A report of 14 cases. AMJ Surg Pathol 1994;18:1125-30.
10Colgan TJ. Challenges in the early diagnosis and staging of fallopian - tube carcinomas associated with BRCA mutations. Int J Gynecol Pathol 2003;22:109-20.