Background: Malignant neoplasm of fallopian tube is one of the rarest female genital cancers. The resemblance to epithelial ovarian carcinoma leads to difficulty in diagnosing the condition clinically as well as histopathologically. Case: We present a case of a 50-year-old postmenopausal woman with a history of watery vaginal discharge and lower abdominal pain. Clinical examination revealed a solid adnexal mass, which was confirmed upon pelvic ultrasonography with an additional feature of increased vascularity. Her CA-125 was 8.5 IU/mL. The decision for laparotomy was taken when abdominopelvic CECT (Contract Enhanced Computer Tomography) failed to confirm the nature of the mass. Results: An intraoperative solid mass of 6×5×5 cm size was present at the fimbria with a distended left fallopian tube. Uterus, bilateral ovaries, and the contralateral fallopian tube appeared normal. No evidence of intraperitoneal dissemination, and ascites was seen. A staging laparotomy comprising a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection was performed. A diagnosis of left tubal papillary serous adenocarcinoma was confirmed by a histopathology report. She is undergoing chemotherapy and on regular follow-up. Conclusion: A correct preoperative diagnosis is made only in 4.6% of the cases. The Latzko's triad of watery vaginal discharge, a colicky lower abdominal pain, and a pelvic mass typical of a fallopian tube carcinoma is noted only in less than 15% of patients. This case is being reported for its diagnostic dilemma, which resulted due to its rarity, even though it presented with Latzko's triad. (J GYNECOL SURG 31:224)
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References
1.
BenedetJL, BenderH, JonesHIII, NganHY, PecorelliS. FIGO staging, classifications and clinical practice guidelines in the management of gynaecological cancers. FIGO Committee on Gynaecological Oncology. Int J Gynaecol Obstet, 2000; 70:209.
2.
ColganTJ. Challenges in the early diagnosis and staging of fallopian tube carcinoma associated with BRCA mutations. Int J Gynecol Pathol, 2003; 22:109.
3.
PowellCB, ChenLM, McLennanJ. Risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers: Experience with a consecutive series of 111 patients using a standardized surgical pathological protocol. Int J Gynecol Cancer, 2011; 21:846.
KosaryC, TrimbleEL. Treatment and survival for women with fallopian tube carcinoma: A population based study. Gynecol Oncol, 2002; 86:190.
6.
CrumC P, DrapkinR, KindelbergerD, MedeirosF, MironA, LeeY. Lessons from BRCA: The tubal fimbria emerges as an origin for pelvic serous cancer. Clin Med Res, 2007; 5:35.
7.
CohenCJ, ThoasGM, HagopianGS, KufeDW, PollockRE, HollandJF. Neoplasm of the fallopian tubes cancer medicine, 5th ed. Canada, BC: Decker, Inc., 2000.
8.
RiskaA, LeminenA, PukkalaE. Sociodemographic determinants ofincidence of primary fallopian tube carcinoma, Finland 1953–97. Int J Cancer, 2003; 104:643.
9.
DomchekSM, FriebelTM, GaberJE, IsaacsC, MatloffE, EelesR, EvansDG, et al.Occult ovarian cancers identified at risk–reducing salpingo-oophorectomy in a prospective cohort of BRCA1/2 Mutation carriers. Breast Cancer Res Treat, 2010; 124:195.
10.
BaekelandtM, Jorunn NesbakkenA, KristensenGB, TrapeCG, AbelerVM. Carcinoma of the fallopian tube. Cancer, 2000; 89:2076.
11.
LawsonF, LeesC, KelleherC. Primary cancer of fallopian tube. In: StuddJ, ed. Progress in obstetrics and gynaecology. United Kingdom; Churchill Livingstone, 1960:393.
12.
SlantezPJ, WhitmanGJ, HalpernEF, HallDA, Mc-CarthyKA, SimeoneJF. Imaging of fallopian tube tumors. Am J Roentgenol, 1997; 169:1321.
13.
JohnsonGA. Primary malignancy of the fallopian tube: A clinical review of 13 cases. J Surg Oncol, 1983; 24:304.
14.
BaekelantM, KockxM, WeslingF, GerrisJ. Primary adenocarcinoma of the fallopian tube: Review of the literature. Int J Gynecol Cancer, 1993; 3:65.
15.
LiJ, FadareD, XiangL, KongB, ZhengW. Ovarian serous carcinoma: Recent concepts on its origin and carcinogenesis. J Hematol Oncol, 2012; 5:8.
16.
KurmanRJ, Shin LeM. Molecular pathogenesis and extra ovarian origin of epithelial ovarian cancer shifting the paradigm. Hum Pathol, 2011; 12:818.
17.
VangR, WheelerJE. Diseases of the fallopian tube and paratubal region. In: KurmanRJ, EllensonLH, RonnettBM, eds. Blaustein's pathology of the female genital tract, 6th ed. New York: Springer, 2011:529.
18.
Alvarado-CabreroJ, YoungRH, VamvakasEC, SceellyRE. Carcinoma of the fallopian tube: A clinical pathological study of 105 cases with observation onstaging and prognostic factors. Gynecol Oncol, 1999; 72:367.
19.
LevanonK, CrumC, DrapkinR. New insights into the pathogenesis of serous ovarian cancer and its clinical impact. J Clin Oncol, 2008; 26:5284.
20.
KleinM, LahousenM, GrafAH, RainerA, VavraN. Primary carcinoma of the fallopian tube a retrospective analysis of 115 patients. Austrian Cooperative study group for fallopian tube carcinoma. Br J Cancer, 1993; 68:605.
21.
BhartiMK, ChauhanA, SabharwalR. Primary fallopian tube adenocarcinoma: A case report. IJPSR, 2011; 2:3002.
22.
RosenAC, SeveldaP, KleinM, GrafAH, LahousenM, ReineraA, et al.A comparative analysis of management and prognosis in stage I and II fallopian tube carcinoma and epithelial ovarian cancer. Br J Cancer, 1994; 69:577.
