Preoperative diagnosis of primary fallopian tube carcinoma by magnetic resonance imaging: a case report

Because of the rarity and insidious onset of primary adenocarcinoma of the fallopian tube, early diagnosis is very difficult. Primary fallopian tube carcinoma is also rarely diagnosed preoperatively. This report reviews the value of magnetic resonance imaging (MRI) in aiding the detection of early-stage primary fallopian tube carcinoma in a 48-year-old female. The diagnosis was based on clinical suspicion, elevated CA-125 and MRI. MRI demonstrated the tumor as an area of solid masses with marked enhancement after gadolinium-diethylenetetraaminepentaacetic acid (Gd-DTPA) administration. Primary fallopian tube carcinoma was confirmed by pathologic examination. We hope that, with improvements in imaging, early diagnosis of such a malignant disease could become routinely possible in the future.     

Tracheal intubation in infants

BACKGROUND: So far only a few cases of carcinoma in situ of the fallopian tube have been reported, but its detailed clinical and pathologic findings, including cytology, have not been fully described. CASE: A 70-year-old female was admitted to our hospital because of irregular genital bleeding. Endometrial smear revealed a small number of atypical cells with a clear background. Hysterectomy, bilateral salpingo-oophorectomy and omentectomy were performed. Grossly, a grayish white papillary tumor, measuring 1.5 x 1.0 cm, was observed within the lumen of the left fallopian tube. Microscopically, the diagnosis of papillary adenocarcinoma in situ of the left fallopian tube was made according to 1992 International Federation of Gynecologists and Obstetricians fallopian tube staging. CONCLUSION: Although endometrial brush cytology is not sensitive enough to detect a primary carcinoma of the fallopian tube, our case indicates that it may contribute useful information on extrauterine diseases and can detect a stage 0 cancer of the fallopian tube. Clinicians, as well as pathologists, should consider the possibility of fallopian tube cancer if cervical or endometrial cytology shows atypical cells with papillary patterns with a clear background but endometrial curettage cannot prove malignancy.     

Argon laser therapy of benign tumors of the eyelid

Although a common site of metastases, primary fallopian tube carcinoma comprises only 0.3% of all gynaecological malignancies. Presenting symptoms are variable and non-specific, with preoperative diagnosis rarely entertained. The FIGO system assigns nearly two-thirds of patients to stage I or II and is based on surgical staging criteria similar to those for ovarian cancer. Likewise, management is based on that for ovarian cancer-radical debulking followed by platinum-based combination chemotherapy. Five-year survival for patients with disease confined to the tube at diagnosis (stage I) is only about 60% and only 10% of patients with advanced disease will be cured.     

Children with chronic arthritis: the management of transition to adulthood

Primary fallopian tube carcinoma represents less than 1% of all gynecologic malignancies and is therefore one of the less common malignancies of the female genital tract. Fallopian tube carcinoma is rarely diagnosed preoperatively and is often mistaken for benign pelvic disease or ovarian cancer. Compared with ovarian carcinoma, fallopian tube cancer more often presents in early stage but seems to have a worse prognosis, stage for stage. Treatment consists of surgical debulking followed by chemotherapy, adjuvant or otherwise. New studies are needed to better delineate the clinical course, prognostic factors, and appropriate chemotherapy recommendations.     

Isolated torsion of the fallopian tube. A case report

BACKGROUND: While torsion of the adnexa is relatively common, isolated torsion of the fallopian tube alone remains a rare occurrence. Diagnosis and surgical intervention are often delayed. CASE: A 38-year-old woman presented with acute lower right abdominal pain initially managed as renal colic. She returned to the emergency department three days later. After surgical consultation, a computed tomography scan and ultrasound showed a cystic pelvic mass with normal ovarian flow studies. Ultimately, the gynecology team performed laparoscopy with the suspicion of intermittent adnexal torsion. A 6 x 8-cm, twisted, dusky purple right fallopian tube was noted. A laparoscopic salpingectomy was performed. CONCLUSION: In the differential diagnosis of acute lower abdominal pain, isolated torsion of the fallopian tube should be considered. A timely diagnosis and surgical intervention may allow preservation of the tube. Even when irreversible damage has occurred, laparoscopic management is recommended.     

Genomic alterations in fallopian tube carcinoma: comparison to serous uterine and ovarian carcinomas reveals similarity suggesting likeness in molecular pathogenesis

Serous carcinomas of the fallopian tube, uterus, and ovary resemble each other both histologically and in clinical behavior. Comparative genomic hybridization was performed on 20 primary fallopian tube carcinoma specimens to find regions of the genome involved in tubal carcinogenesis and to compare the genomic alterations with those previously detected in serous ovarian and uterine carcinomas. The most frequent changes detected in fallopian tube carcinoma were gains at 3q (70%) and 8q (75%), with high-level amplifications in several cases. Other common gains occurred at 1q, 5p, 7q, 12p, and 20q. The most frequent losses were found at 18q, 8p, 4q, and 5q. The frequency and the pattern of chromosomal changes detected in tubal carcinoma were strikingly similar to those observed in serous ovarian and uterine carcinomas, suggesting common molecular pathogenesis.     

Selective salpingography and tubal cannulation through hysteroscopy

In this paper the procedure of selective salpingography and tubal cannulation through hysteroscopy for diagnosis and treatment of fallopian tube obstruction at the interstitial portion was introduced. We combined hysteroscopic tubal cannulation with selective salpingography under fluoroscopic quidance in 28 infertile women with 49 obstructed interstitial portion of fallopian tubes diagnosed previously. After the procedures 27 tubes (55.1%) became patent in 16 cases. In 16 women with patent tubes followed up over 6 months after the procedures 5 intrauterine pregnancies occurred. This procedure is a safe and simple diagnostic method to identify fallopian tube obstruction at the interstitial portion and may alos serve as a therapeutic approach in some of these patients.     

Tumor cell seeding caused by hysteroscopy?

154 patients suffering from endometrial carcinoma who underwent CO2-hysteroscopy pretherapeutically, were examined as to whether hysteroscopy lead to tumour cell spread to the peritoneal cavity and worsened the prognosis of the patients. For that purpose, both fallopian tubes of 118 women were investigated thoroughly by histology for intratubarian spread of tumourous cells. Only in one of the 118 patients a single tumour cell complex was detected inside the ampullar part of a fallopian tube. Comparing the investigated patients with data from the literature in terms of five-year survival rates and frequency of relapses, our collective showed the same outcome as those from the literature. These results prove, that the prognosis of endometrial carcinoma is not worsened by CO2-hysteroscopy.     

Haemorrhagic hydrops of the gallbladder

Primary carcinoma of the fallopian tube is uncommon; optimal primary treatment is still not well defined, and little information is available about the efficacy of cisplatin-based combination chemotherapy. Thirty-eight patients with fallopian tube carcinoma were treated with cyclophosphamide (500 mg/m2), Adriamycin (50 mg/m2), and cisplatin (50 mg/m2) (CAP). Thirty-two patients received the combination chemotherapy as first-line treatment after cytoreductive surgery, whereas six subjects were treated for recurrent disease. The patients received a median of six cycles of therapy (range, four to nine). At the initiation of chemotherapy, 24 patients had measurable lesions. In this group of patients, 15 had a clinical complete response (CR), four had a partial response (PR), three had stable disease (SD), and two had progressive disease (PD) after chemotherapy. The overall clinical response rate (CR + PR) was 80%. Ten of the 14 CR patients who were submitted to second-look operation (SLO) were found free of disease, in pathologic complete response (pCR). Three pCR patients relapsed, and two of them died despite second-line treatment. Nine patients achieving PR, SD, and PD after first-line chemotherapy were further treated (five with chemotherapy, two with radiotherapy, two with progesteron), but none responded to second-line treatment and all died (median survival, 9 months). Fourteen patients without gross residual disease after cytoreductive surgery had no measurable lesions and were not evaluable for response. Seven of them had negative SLO and remain disease free. Three patients (two stage III and one stage II) who refused SLO relapsed 14, 16, and 26 months after completion of chemotherapy. The median survival for the entire group was 38 months, and the 5-year survival rate was 35%. The toxicity of the regimen was moderate. The CAP regimen appears to be active in primary fallopian tube carcinoma and yields response rates comparable to those reported for epithelial ovarian cancer.     

Isolated tortion of the fallopian tube. Report on a recurrent tortion of a hematosalpinx due to genital tuberculosis (author's transl)

A case of recurrent contralateral isolated tortion of tubercle hematosalpinx four years after the first event is reported. The clinical picture and the pathogenesis of the isolated tortion of the fallopian tube is discussed. This disease is considered to be rare and the etiology of isolated tortion of the tube is largely unknown. As shown in this case, tortion of the tube can occur in cases of genital tuberculosis. Since acute bleeding into the fallopian tube may be pathognomonic for tortion this factor should be considered when the findings at laparotomy are interpreted. Tortion of a hematosalpinx requires additional diagnostic measures to detect the underlying disease.     

Leiomyomas of the fallopian tube. A case report

Both heterotopic pregnancies and primary neoplasms of the fallopian tube are rare occurrences. A patient presented with early pregnancy, abdominal pain and ultrasound findings of an intrauterine gestation and a fallopian tube mass. Laparotomy revealed a primary leiomyoma of the fallopian tube.     

Respiratory complications in patients with severe burns

The rising emphasis on conservative surgical treatment of the fallopian tube has generated a greater demand for methods of reparative surgery. Thus far, the use of surrogate tubes and allotransplantation of the fallopian tube hae not fulfilled the requirements for success. A case of homotransplantation of the human fallopian tube is presented. At surgery, a midsegment anastomosis was performed by grafting the good portion of the left tube to a viable segment of the right tube. The arteries and veins were then anastomosed with 9-0 silk and a single-layer closure; an operating microscope was used. Patency was documented with chromotubation, and bleeding was controlled with microcautery. Decadron and Phenergan were placed in the patient's abdomen along with 150 ml of saline. She was given systemic Decadron, Phenergan, and antibiotics pre- and postoperatively. Three months after surgery hysterography revealed a viable-appearing fallopian tube. The patient subsequently aborted an 8-week intrauterine gestation. Fallopian tube homotransplantation has a role in the treatment of infertility, but the patient population for which this procedure is applicable is limited.     

Clarithromycin, amoxycillin and H2-receptor antagonist therapy for Helicobacter pylori peptic ulcer disease in Korea

OBJECTIVE: To compare the efficacy of fallopian tube sperm perfusion utilizing a Foley catheter technique with standard IUI. DESIGN: Randomized controlled study. SETTING: The infertility units of the University Central Hospital and the Family Federation of Finland, Oulu, Finland. PATIENT(S): One hundred infertile women with unexplained factor, minimal to mild endometriosis, mild male factor, or ovarian dysfunction, undergoing 50 IUI and 50 fallopian tube sperm perfusion cycles stimulated by clomiphene citrate and hMG. INTERVENTION(S): Thirty-six hours after hCG administration, patients were randomized to either the IUI group (group 1, 50 patients and cycles) or the fallopian tube sperm perfusion group (group 2, 50 patients and cycles). Intrauterine insemination was performed using a standard method and fallopian tube sperm perfusion with a pediatric Foley catheter, which prevents the reflux of sperm suspension. MAIN OUTCOME MEASURE(S): Number of clinical pregnancies. RESULTS(S): The fallopian tube sperm perfusion method using a Foley catheter technique was easy to perform and convenient for the patients. The overall pregnancy rate per cycle was 8% for fallopian tube sperm perfusion and 20% for IUI, a difference that was not significant. CONCLUSION(S): The fallopian tube sperm perfusion method using a Foley catheter offers no advantage in comparison with the conventional IUI technique.     

Salvage mitomycin/5-fluorouracil after platinum-based therapy for women with advanced ovarian cancer and related gynecologic malignancies

PURPOSE: to determine response rates, survival, and toxicity of a regimen of mitomycin-C and 5-fluorouracil in patients previously treated with platinum-based combinations for ovarian cancer and related gynecologic malignancies. PATIENTS AND METHODS: retrospective chart review of all cases of persistent or recurrent ovarian, fallopian tube, and peritoneal carcinoma treated with mitomycin-C 7 mg/m2 followed by continuous infusion of 5-fluorouracil 600 mg/m2/day over 4 days. RESULTS: 26 patients were treated after a median of 2 prior platinum-based regimens, 22 with ovarian cancer, 3 with peritoneal cancer, and one with fallopian tube cancer. Only 2 patients completed 6 or more cycles. 2 patients had partial responses (8%); no complete responses were seen. 24 patients died a median of 3 months after the initiation of therapy, while 2 patients were alive 4 and 8 months after beginning therapy. All deaths were attributable to disease, not complications of treatment. 8 patients required dose modification or treatment delay for toxicity. Nine patients required a total of 11 unscheduled admissions. CONCLUSIONS: toxicity attributable to mitomycin-C/5-fluorouracil therapy of ovarian cancer is acceptable, but responses are few. More effective alternative should be sought.     

The Dall-Miles cable and plate system for periprosthetic femoral fractures

BACKGROUND: Spontaneous bilateral ectopic pregnancy is a rare event and difficult to diagnose preoperatively. CASE: A unique case occurred of bilateral ectopic pregnancy involving the left fallopian tube and right cornu, or interstitial segment. CONCLUSION: This case demonstrates the difficulty in diagnosing heterotopic pregnancies and in particular those pregnancies with an interstitial component and also demonstrates the limits of ultrasound and laparoscopy in making such a diagnosis.     

A simple technique for the long-term non-polarised and polarised culture of human fallopian tube epithelial cells

Fallopian tubes were obtained from 25 women undergoing abdominal hysterectomy. Pieces of fallopian tube mucosa were placed in culture flasks containing minimum essential medium in Earle's salts supplemented with fetal bovine serum. First passage was carried out after 7-10 days and subcultures in 4-5 days. For polarised cell culture, epithelial cells were seeded onto an extracellular matrix system. New epithelial cells were seen on day 2-3 of the primary culture and epithelial patches on day 7-10. Cells reached confluence in 4-5 days in subcultures. The cells could be subcultured for 7-11 passages with a life span of 42-60 days. Epithelial origins of the cells were confirmed by immunofluorescence staining with anti-cytokeratin antibody. Polarised cells showed a columnar pattern, microvilli on their apical surface and basally located nucleus whereas non-polarised cells were flat. It was concluded that the human fallopian tube epithelial cells can be cultured in vitro to create non-polarised and polarised cell layers by using a simple and reproducible technique and this system can be a potential model to study function of the fallopian tube.     

Vascular endothelial growth factor localization in human ovary and fallopian tubes: possible role in reproductive function and ovarian cyst formation

Vascular endothelial growth factor (VEGF) is a potent angiogenic factor that also increases vascular permeability. We hypothesized that VEGF plays a role in the regulation of cyclic ovarian angiogenesis in women, and that its ability to increase vascular permeability may be an important factor in the production of fallopian tube effluent and fluid formation in ovarian cysts. To examine these hypotheses, we assessed VEGF expression in ovaries and fallopian tubes from premenopausal (n = 10) and postmenopausal (n = 4) women. Immunohistochemical analysis for VEGF was performed using a rabbit polyclonal antibody directed against human VEGF. In normal ovaries from premenopausal women, VEGF within healthy follicles was localized to the thecal cell layer, with minimal VEGF peptide detected in the granulosa cell layer. VEGF was not expressed in atretic follicles or a degenerating corpus luteum. However, intense VEGF immunostaining was observed within the highly vascularized corpora lutea in all specimens examined. In normal ovaries from postmenopausal women, VEGF was detected only in epithelial inclusion cysts and a serous cystadenoma. In specimens from both pre- and postmenopausal women, the luminal epithelium of the fallopian tube as well as smooth muscle cells and pericytes lining small and large blood vessels within the tube and hilum of the ovary exhibited specific staining for VEGF. Based on these data, we suggest that during reproductive life, VEGF plays a role in the growth and maintenance of the ovarian follicle and corpus luteum by mediating angiogenesis. In addition, VEGF within the fallopian tube luminal epithelium may increase vascular permeability and modulate tubal luminal secretions. Similarly, VEGF in the epithelial lining of benign ovarian neoplasms may contribute to fluid formation in ovarian cysts.     

Threshold intrauterine perfusion pressures for intraperitoneal spill during hydrotubation and correlation with tubal adhesive disease

OBJECTIVE: To determine the minimum intrauterine perfusion pressure that will produce spill from the fallopian tubes into the peritoneal cavity and to correlate this pressure with the extent of tubal adhesive disease. DESIGN: Hydrotubation was performed at laparoscopy and intrauterine perfusion pressure was measured. The extent of peritubal and fimbrial adhesions was graded at laparoscopy. SETTING: Ambulatory surgery suites. PATIENTS: Ten patients with infertility and/or pelvic pain were enrolled in the study. Data from nine patients were analyzed. INTERVENTIONS: Measurement of intrauterine perfusion pressures. MAIN OUTCOME MEASURES: The minimum pressure that produced spill of dye from each fallopian tube and the correlation between extent of external tubal pathology and this threshold pressure. RESULTS: The median threshold pressure at which dye spilled from at least one fallopian tube was 100 mm Hg, and no spill occurred at pressures < 70 mm Hg. The threshold pressure was correlated negatively with the extent of tubal disease. CONCLUSIONS: Fluid with the same viscosity as hydrotubation dye will not spill into the peritoneal cavity through normal fallopian tubes until the intrauterine perfusion pressure exceeds 70 mm Hg. The threshold pressure is higher when tubal adhesive disease that can be visualized by laparoscopy is present.     

Twenty-one year mortality in a dialysis unit: changing effect of withdrawal from dialysis

This study was designed in order to assess whether the Iwasaki-Hayashi (IH) catheter can be fixed to the uterine cervix easily and successfully during transcervical fallopian tube recanalization (T-FTR) with fluoroscopic guidance, to try T-FTR in special cases, and to investigate the success rate. The study included 21 infertile women with tubal obstruction, diagnosed by hysterosalpingography examined at least twice to exclude tubal spasm. Using the IH catheter, which proved to be very useful, higher therapeutic efficacy could be obtained. A patient with unilateral proximal tubal obstruction became pregnant following natural fertilization in the fallopian tube which had been recanalized by T-FTR. The success rate of recanalization, the pregnancy rate and the take-home-baby rate were 95.2%/patient, 19.0 and 19.0%, respectively.