Management of advanced-stage primary carcinoma of the fallopian tube: case report and literature review

Primary carcinoma of the fallopian tube is a very unusual gynecologic malignancy that accounts for less than 1% of all malignancies of the female genitalia. A 55-year-old, gravida 7, para 3 woman presented with no gynecologic complaints other than backache. TVS demonstrated a 35 x 25 mm heterogeneous mass that was not clearly separated from the left ovary, and another 31 x 14 mm cystic septated lesion in the left ovary region. Pelvic MRI demonstrated a 35 x 35 x 20 mm left adnexal mass that enhanced with contrast and a neighboring tubular-cystic mass. Upper and lower gastrointestinal endoscopy revealed no malignancy. Serum CA 125-level was merkedly elevated at 369 U/ml (normal < 35 U/ml). Laparotomy revealed left hydrosalpinx and a papillary-fimbrial mass. Pelvic lymph node metastases were observed. Frozen-section analysis identified the mass as a serous adenocarcinoma. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, omentectomy, pelvic and para-aortic lymph node dissection, and peritoneal washing were performed. The definitive histopathological diagnosis was primary serous adenocarcinoma of the fallopian tube with six of 25 lymph node biopsies showing metastasis. Six cycles of paclitaxel (175 mg/m2) plus cisplatin (75 mg/m2) combinatin chemotherapy were administered with 3-week intervals between cycles. Second-look laparotomy was performed; there was no evidence of disease. At the time of writing 12 months after the second-look laparotomy, she was still disease-free.

Fallopian tube carcinoma; Advanced stage; Debulking surgery; Chemotherapy; Paclitaxel; Platinum-based chemotherapy

[1] Hellstrom A. C.: "Primary fallopian tube cancer: a review of the literature". Med. Oneal., 1998, 15, 6.

[2] Alvarado-Cabrero I., Young R. H., Vamvakas E. C., Scully R. E.: "Carcinoma of the fallopian tube: a clinicopathological study of 105 cases with observations on staging and prognostic factors" Gynecol. Oneal., 1999, 72, 367.

[3] Rose P. G., Piver M. S., Tsukada Y.: "Fallopian tube cancer: the Roswell Park Experience". Cancer, 1990, 66, 2661.

[4] Demopoulos R. I., 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.

[5] Rose P. G., Shrigley R., Wiesner G. L.: "Germline BRCA2 mutation in a patient with fallopian tube carcinoma: a case report" Gynecol. Oneal., 2000, 77, 319

[6] Zweemer R. P., van Diest P. J., Verheijen R. H. et al.: "Molecular evidence linking primary cancer of the fallopian tube to BRCA I germline mutations". Gynecol. Oneal., 2000, 76, 45.

[7] Aziz S., Kuperstein G., Rosen B. et al.: "A genetic epidemiological study of carcinoma of the fallopian tube". Gynecol. Oneal., 2001, 80, 341.

[8] Kurjak A., Kupesic S., Ilijas M. et al.: "Preoperative diagnosis of primary fallopian tube carcinoma". Gynecol. Oneal., 1998, 68, 29.

[9] Kurjak A., Kupesic S., Jacobs I.: "Preoperative diagnosis of the primary fallopian tube carcinoma by three-dimensional static and power Doppler sonography". Ultrasound Obstet. Gynecol., 2000, 15, 246.

[10] Hefler L. A., Rosen A. C., Graf A. H. et al.: "The clinical value of serum concentrations of cancer antigen 125 in patients with primary fallopian tube carcinoma. A multicenter study". Cancer, 2000, 89, 1555.

[11] Kol S., Gal D., Friedman M., Paldi E.: "Preoperative diagnosis of fallopian tube carcinoma by transvaginal sonography and CA-125". Gynecol. Oneal., 1990, 37, 129.

[12] Thurnher S., Hodler J.. Baer S., Marincek B., von Schulthess G. K.: "Gadolinium-DOTA enhanced MR imaging of adnexal tumors". J. Comput Assist. Tomogr., 1990, 14, 939.

[13] Lehtovirta P., Kairemo K. J., Liewendahl, Seppala M: "Immunolymphoscintigraphy and immunoscintigraphy of ovarian and fallopian tube cancer using F(ab')2 fragments of monoclonal antibody OC 125". Cancer Res., 1990, 50 (Suppl. 3), 937s.

[14] Gadducci A., Landoni F., Sartori E. 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.

[15] Baekelandt M., Jorunn Nesbakken A., Kristensen G. B. et al.: "Carcinoma of the fallopian tube. Clinicopathologic study of 151 patients treated at the Norwegian Radium Hospital". Cancer, 2000, 89, 2076.

[16] Asmussen M., Kaern J., Kjoerstad K., W right P. B., Abeler V.: "Primary adenocarcinoma localized to the fallopian tubes: report on 33 cases". Gynecol. Oneal., 1988, 30, 183.

[17] Harrison C. R., Haverette H. E., Jarrell M. A. et al.: "Carcmoma of the fallopian tube: clinical management". Gynecol. Oneal., 1989, 32, 357.

[18] Tonin P., Moslehi R., Green R. et al.: "Linkage analysis of 26 Canadian breast and breast-ovarian cancer families". Hum. Genet., 1995, 95, 545.

[19] Paley P. J., Swisher E. M., Garcia R. L. et al.: "Occult cancer of the fallopian tube in BRCA-1 germline mutation carriers at prophylactic oophorectomy: a case for recommending hysterectomy at surgical prophylaxis". Gynecol. Oneal., 2001, 80, 176.

[20] Zheng W., Sung C. J., Cao P. et al.: "Early occurrence and prognostic significance of p53 alteration in primary carcinoma of the fallopian tube". Gynecol. Oneal., 1997, 64, 38.

[21] Rosen A. C., Ausch C., Klein M. et al.: "p53 expression in fallopian tube carcinomas". Cancer Lett., 2000, 156, I.

[22] Hanton E. M., Malkasian G. D., Dahlin D. C., Pratt J. H.: "Primary carcinoma of the fallopian tube". Am. J. Obstet. Gynecol., 1966, 94, 832.

[23] Nordin A. J.: "Primary Carcinoma of the fallopian tube: a 20-year literature review". Obstet. Gynecol. Surv., 1994, 49, 349.

[24] Peters W. A., Andersen W. A., Hopkins M. P., Kumar N. B., Morley G. W.: "Prognostic features of carcinoma of the fallopian tube". Obstet. Gynecol., 1988, 71, 757.

[251 Sedlis A.: "Carcinoma of the fallopian tube". Surg. Clin. North Am., 1978, 58, 121.

[26] Kawakami S., Togashi K., Kimura I. et al.: "Primary malignant tumor of the fallopian tube: appearance at T and MI imaging" Radiology, 1993, 186, 503.

[27] Obermair A., Taylor K. H., Janda M. et al.: "Primary fallopian tube carcinoma: the Queensland experience". Int. J. Gynecol Cancer, 2001, 11, 69.

[28] Rosen A. C., Klein M., Hafner E. et al.: "Management and prognosis of primaiy fallopian tube carcinoma. Austrian Cooperative Study Group for Fallopian Tube Carcinoma". Gynecol. Obstet Invest., 1999, 47, 45.

[291 Tamimi H. K., Figge D. C.: "Adenocarcinoma of the uterine tube potential for lymph node metastases". Am. J. Obst et. Gynecol., 1981, 147, 132

[30] Asmussen M., Kaern J., Kjoerstad K. et al.: "Primary adenocarcinoma localized to the fallopian tubes: report on 33 cases". Gynecol. Oneal., 1988, 30, 183.

[31] Maxson W. Z., Stehman F. B., Ulbright T. M. et al.: "Pnmary carcinoma of the fallopian tube: evidence for activity of cisplatin combination therapy". Gynecol. Oncol., 1987, 26, 305.

[32] Pectasides D., Barbounis V., Sintila A. et al.: "Treatment of primary fallopian tube carcinoma with cisplatin-containing chemotherapy". Am. J. Clin. Oncol., 1994, 17, 68.

[33] Barakat R. R., Rubin C. C., Saigo P. E. et al.: "Cisplatin-based combination chemotherapy in carcinoma of the fallopian tube" Gynecol. Oncol., 1991, 42, 156.

[34] Muntz H. G., Tarraza H. M., Goff B. A. et al.: "Combinallon chemotherapy in advanced adenocarcinoma of the fallopian tube" Gynecol. Oncol., 1991, 40, 268.

[35] Gemignani M. L., Hensley M. L., Cohen R. et al.: "Paclitaxelbased chemotherapy in carcinoma of the fallopian tube". Gynecol. Oncol., 2001, 80, 16.

[36] Verschraegen C. F., Sittisomwong T., Kudelka A. P. et al.: "Docetaxel for patients with paclitaxel-resistant Mullerian carcinoma" J. Clin. Oncol., 2000, 18, 2733.

[37] Markman M., Kennedy A., Webster K. et al.: "Combination chemotherapy with carboplatin and docetaxel in the treatment of cancers of the ovary and fallopian tube and primary carcinoma of the peritoneum". J. Clin. Oneal., 2001, 19, 1901.

[38] Conte P. F., Gadducci A., Cianci C.: "Second-line treatment and consolidation therapies in advanced ovarian cancer". Int. J. Gynecol. Cancer, 2001, 11 (Suppl. 1), 52.

[39] Eisenkop S. M., Friedman R. L., Spirtos N. M.: "The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma". Cancer, 2000, 88, 144.

[40] Gadducci A., Iacconi P., Cosio S. et al.: "Complete salvage surgical cytoreduction improves further survival of patients with late recurrent ovarian cancer". Gynecol. Oncol., 2000, 79, 344.