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Case History

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Image not available. A 58-year-old woman is admitted with a two months history of post-menopausal bleeding and abdominal pain. Recto-vaginal examination reveals a right adnexal mass. Computed tomography (CT) of the abdomen shows a mixed solid and cystic right adnexal mass with some ascites but no lymphadenopathy. Serum CA125 level is 950 units/ml. A laparotomy is performed and mass involving the right fallopian tube is identified. The frozen section of the lesion is reported as high-grade fallopian tube carcinoma.

What are the clinical features of a fallopian tube carcinoma?

What is the appropriate surgery for a fallopian tube carcinoma?

How is a fallopian tube carcinoma staged?

What is the current standard of adjuvant care for a fallopian tube carcinoma?

What is the prognosis for patients with a fallopian tube carcinoma?

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Background

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Image not available. Fallopian tube carcinomas are the rarest of the gynaecological cancers, accounting for approximately 0.14%–1.8% of female genital malignancies. Epidemiologically, the risk factors for tubal cancer remain obscure, but it is reasonable to presume that hormonal, reproductive and perhaps genetic factors that increase the risk for ovarian carcinoma may also be relevant to fallopian tube cancer. It is part of the BRCA mutation phenotype.1 Therefore, the risk for this malignancy should be considered when prophylactic oophorectomy is performed in high-risk women. The incidence of fallopian tube carcinomas increases with age but peaks at age 60–66 years.

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What are the clinical features of a fallopian tube carcinoma?

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Patients may present with vaginal bleeding or unexplained vaginal discharge, pelvic pain and a pelvic mass. The presence of pain is significant since cancers of the ovary, endometrium and cervix usually do not cause it. Nevertheless, pre-operative diagnosis of a fallopian tube carcinoma is extremely rare. The classic description of 'hydrops tubae profluens', which is characterized by colicky lower abdominal pain relieved by passing blood-tinged fluid, is rarely spontaneously encountered but is almost pathognomonic. Although serum CA125 level per se is not diagnostic for fallopian tube cancers, >80% of patients have elevated pre-treatment values (Table 49.1).2

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Table Graphic Jump Location
Table 49.1Typical clinical features of a fallopian tube carcinoma
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The diagnosis of a fallopian tube carcinoma is usually first made by a pathologist on histopathological examination. Because it is difficult to differentiate between fallopian tube carcinomas and epithelial ovarian carcinomas, at least one of the following criteria should have the diagnosis of fallopian tube carcinoma: (a) grossly, the main tumour is in the tube and arises from the endosalpinx; (b) histologically, the pattern reproduces the epithelium of tubal mucosa and shows a papillary pattern; (c) transition from benign to malignant tubal epithelium should be demonstrated; ...

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