FALLOPIAN TUBE CARCINOMA - CASE REPORT

A 46-year-old woman with 3 births, who underwent hysterectomy with unilateral salpingo-oophorectomy, is referred to oncologic surgeon after pathology showing malignancy, bringing the following tests: 1 -Transvaginal ultrasound with uterus of 234 cm³, right ovary cyst with trabeculations and irregular contours of 3.4 mm and echogenic image of 2.8 cm; 2 - Pelvic magnetic resonance with serpiginous cystic image in the right adnexal region with partial septations (up to 2.2 cm in diameter) and some nodular irregularity inside with high diffusion signal and early post-contrast enhancement measuring 3.5 × 2 , 7 × 2.7 cm suspected for fallopian tube neoplasia; 3 - Anatomopathological showing right tubule covered with swollen, congestive serosa, with adhered cystic formations and 2 × 1.9 cm whitish solid formation compatible with high-grade serous carcinoma restricted to right fallopian tube with narrow radial margins (less than 1 mm). Transvaginal ultrasound already defines the surgical approach. However, resonance or computed tomography serves to better evaluate the connexion of mass with adjacent structures, as well as to evaluate lymph node enlargement and peritoneal dissemination. The staging of fallopian tube cancer and ovarian cancer is surgical. Exploratory laparotomy was indicated due to incomplete staging, presence of high-grade serous adenocarcinoma and preservation of the contralateral ovary. CA 125 of 63.2 U/ml was also requested, which is useful as a marker of response degree to treatment and relapses during follow-up. In the surgery, three suspicious lymph nodes were found next to the common iliac vessels on the right and laterally to the bifurcation of aorta, whose freezing was positive for carcinoma. Left ovary and remaining abdominal cavity didnt have evidence of disease. Pelvic and infrarenal intercaval-aortic lymphadenectomy was performed together with inframesocolic omentectomy and diffuse peritoneal biopsies. Pathology confirmed neoplastic infiltration only in three ganglia (16 resected) and the remaining disease free. Since it is staged as IIIC fallopian tube carcinoma, adjuvant chemotherapy is indicated. The presentation of this case reinforces the similar behavior between ovarian and fallopian carcinomas. The need for their differentiation in the adnexal pelvic masses is of fundamental importance and should be addressed by a specialist surgeon, avoiding late diagnosis, worsening prognosis and increased morbidity and mortality.

Publication History

Article published online:
23 October 2019