Correspondence
An unusual case of cavernous haemangioma of the fallopian tube ABSTRACT Fallopian tubes are one of the uncommon sites for neoplastic lesions in the female genital tract. Haemangiomas of the fallopian tubes are rare benign neoplasms that are documented as isolated case reports only. We present a rare case of incidentally detected cavernous haemangioma of the fallopian tube in a post menopausal female who underwent hysterectomy and bilateral salphingoopherectomy for dysfunctional uterine bleeding. KEY WORDS: Benign, cavernous haemangioma, fallopian tube
INTRODUCTION Neoplasms of the fallopian tube are uncommon tumors of the female genital tract. The most common benign epithelial tumor of the fallopian tube is the endometrioid polyp, which occur in the interstitial portion.[1] Though hemangiomas of the vulva are not uncommon entities in the female genital tract, it rarely occurs in the female pelvic organs. Hemangiomas of the fallopian tubes are rare neoplasms with only seven cases reported in the English Literature.[2‑4] We present an unusual case of cavernous hemangioma of the fallopian tube that was incidentally detected in a postmenopausal female who underwent hysterectomy and bilateral salphingoopherectomy for dysfunctional uterine bleeding after failed medical management. CASE HISTORY A 50‑year‑old postmenopausal female woman presented with a history of dysmenorrhoea of one‑year duration. Her last childbirth was 13 years back when she underwent emergency lower‑segment caesarean section. On pelvic examination, the cervix was healthy and fornices were free. Ultrasonography showed increased endometrial thickness. No fibroid was seen. There was a 3 × 3 cm size cystic lesion in the left side of the pelvis. Both the ovaries and fallopian tubes were normal. She was managed with hormonal therapy without any benefit. In view of this, she underwent vaginal hysterectomy with bilateral salphingoopherectomy.
On gross examination, uterus, cervix, both ovaries, and right fallopian tube were normal. Left fallopian tube measured 3.2 × 1.5 × 1.5 cm in size, with an attached nodule arising from the outer wall in ampullary region, measuring 3 × 2 × 1.5 cm in size. Cut surface of the nodule appeared congested and contained both solid and cystic areas [Figure 1a].
Prabal Deb, Vikram Singh, Vibha Dutta, Krishan Kapoor1 Departments of Pathology, Armed Forces Medical College, 1Obstetrics and Gynaecology, Command Hospital, Pune, India For correspondence: Dr. Prabal Deb, Armed Forces Medical College, Pune, India. E‑mail: debprabal@ gmail.com
H and E, sections from the cervix showed chronic cervicitis and squamous metaplasia, while the endomyometrium showed evidence of adenomyosis. Sections from the left fallopian tube nodule showed enlarged papillary fronds lined by the ciliated pseudostratified columnar epithelium, with the subepithelial tissue containing numerous vascular channels of varying ectasia [Figure 1b and c] with thickened wall confirmed by CD34‑immunopositivity [Figure 1d]. No evidence of necrosis, hemorrhage, inflammation, or dysplasia was noted. Based on the gross and histomorphological features, a diagnosis of cavernous hemangioma of the fallopian tube was given. DISCUSSION Fallopian tubes are rare sites for neoplastic lesions in the female genital tract. Cavernous hemangiomas of the fallopian tube are benign vascular tumors characterized by the presence of thick‑walled cavernous blood vessels. Trauma, inflammation and erosion are the usual predisposing factors for cavernous hemangioma, which were absent in the present case. Very few available case reports document the clinical presentation and behavior of this neoplasm, with most being detected
Journal of Cancer Research and Therapeutics - April-June 2014 - Volume 10 - Issue 2
Access this article online Website: www.cancerjournal.net DOI: 10.4103/0973-1482.136658 PMID: *** Quick Response Code:
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Deb, et al.: Fallopian tube haemangioma
female reproductive tract. They most commonly appear in postmenopausal women, usually in the 6th decade of life, which is similar to the index case.[6] Microscopically, most are benign with an occasional case documenting cellular pleomorphism and nuclear hyperchromasia. a
b
c
d
To conclude, even though hemangiomas are rare and incidental findings, they have to be differentiated from other tumors of fallopian tube like serous tumors of low malignant potential borderline papillary serous tumor and malignancies, as the prognosis and management of the patients are variable. Rupture of an undetected fallopian tube hemangioma can lead to hemoperitoneum with fatal consequences, and misinterpretation of this benign entity in a young patient may lead to radical surgery with subsequent loss of fertility.
Figure 1: (a-d) Gross appearance of excised left fallopian tube, measuring 3 × 2 × 1.5 cm in size with both solid and cystic areas (a); Photomicrograph of fallopian tube hemangioma containing vascular channels of varying ectasia (b) H and E, ×100, (c) H and E, ×400; which were CD34-immunopositive (d) CD34 ×200
incidentally, while few presenting with acute abdomen due to hemoperitoneum following massive hemorrhage from the ruptured tumor.[2,3] Emrahimi and Okagaki[5] reported a case of fallopian tube hemangioma that was incidentally detected during laparotomy in a case of endometrial carcinoma. The patient had received full course of chemotherapy 6 weeks prior to surgery and authors had concluded that radiation was probably the incriminating factor. Malignant neoplasms of the fallopian tube are rare, accounting for 0.18‑1.6% of all malignant neoplasms of the
364
REFERENCES 1. de la Fuente AA. Benign mixed Müllerian tumour – Adenofibroma of the fallopian tube. Histopathology 1982;6:661‑6. 2. Gowri R, Soundararaghavana S, Oumachigui A, Iyengar KR. Fallopian tube haemangioma. J Obstet Gynecol Ind 2004;54:85‑6. 3. Joglekar VM. Haemangioma of the fallopian tube. Br J Obstet Gynecol 1979;86:823‑825. 4. Wojnar A, Drożdż K, Dzięgiel P. Cavernous haemangioma of the oviduct. Pol J Pathol 2010;61:103‑4. 5. Ebrahimi T, Okagaki T. Hemangioma of the fallopian tube. Am J Obstet Gynecol 1973;115:864‑5. 6. Haratz‑Rubinstein N, Fromberg E, Lederman S. Sonographic diagnosis of a serous tumor of low malignant potential of the fallopian tube. J Ultrasound Med 2004;23:869‑72. Cite this article as: Deb P, Singh V, Dutta V, Kapoor K. An unusual case of cavernous haemangioma of the Fallopian tube. J Can Res Ther 2014;10:363-4. Source of Support: Nil, Conflict of Interest: None declared.
Journal of Cancer Research and Therapeutics - April-June 2014 - Volume 10 - Issue 2
Copyright of Journal of Cancer Research & Therapeutics is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
An unusual case of cavernous haemangioma of the fallopian tube ABSTRACT Fallopian tubes are one of the uncommon sites for neoplastic lesions in the female genital tract. Haemangiomas of the fallopian tubes are rare benign neoplasms that are documented as isolated case reports only. We present a rare case of incidentally detected cavernous haemangioma of the fallopian tube in a post menopausal female who underwent hysterectomy and bilateral salphingoopherectomy for dysfunctional uterine bleeding. KEY WORDS: Benign, cavernous haemangioma, fallopian tube
INTRODUCTION Neoplasms of the fallopian tube are uncommon tumors of the female genital tract. The most common benign epithelial tumor of the fallopian tube is the endometrioid polyp, which occur in the interstitial portion.[1] Though hemangiomas of the vulva are not uncommon entities in the female genital tract, it rarely occurs in the female pelvic organs. Hemangiomas of the fallopian tubes are rare neoplasms with only seven cases reported in the English Literature.[2‑4] We present an unusual case of cavernous hemangioma of the fallopian tube that was incidentally detected in a postmenopausal female who underwent hysterectomy and bilateral salphingoopherectomy for dysfunctional uterine bleeding after failed medical management. CASE HISTORY A 50‑year‑old postmenopausal female woman presented with a history of dysmenorrhoea of one‑year duration. Her last childbirth was 13 years back when she underwent emergency lower‑segment caesarean section. On pelvic examination, the cervix was healthy and fornices were free. Ultrasonography showed increased endometrial thickness. No fibroid was seen. There was a 3 × 3 cm size cystic lesion in the left side of the pelvis. Both the ovaries and fallopian tubes were normal. She was managed with hormonal therapy without any benefit. In view of this, she underwent vaginal hysterectomy with bilateral salphingoopherectomy.
On gross examination, uterus, cervix, both ovaries, and right fallopian tube were normal. Left fallopian tube measured 3.2 × 1.5 × 1.5 cm in size, with an attached nodule arising from the outer wall in ampullary region, measuring 3 × 2 × 1.5 cm in size. Cut surface of the nodule appeared congested and contained both solid and cystic areas [Figure 1a].
Prabal Deb, Vikram Singh, Vibha Dutta, Krishan Kapoor1 Departments of Pathology, Armed Forces Medical College, 1Obstetrics and Gynaecology, Command Hospital, Pune, India For correspondence: Dr. Prabal Deb, Armed Forces Medical College, Pune, India. E‑mail: debprabal@ gmail.com
H and E, sections from the cervix showed chronic cervicitis and squamous metaplasia, while the endomyometrium showed evidence of adenomyosis. Sections from the left fallopian tube nodule showed enlarged papillary fronds lined by the ciliated pseudostratified columnar epithelium, with the subepithelial tissue containing numerous vascular channels of varying ectasia [Figure 1b and c] with thickened wall confirmed by CD34‑immunopositivity [Figure 1d]. No evidence of necrosis, hemorrhage, inflammation, or dysplasia was noted. Based on the gross and histomorphological features, a diagnosis of cavernous hemangioma of the fallopian tube was given. DISCUSSION Fallopian tubes are rare sites for neoplastic lesions in the female genital tract. Cavernous hemangiomas of the fallopian tube are benign vascular tumors characterized by the presence of thick‑walled cavernous blood vessels. Trauma, inflammation and erosion are the usual predisposing factors for cavernous hemangioma, which were absent in the present case. Very few available case reports document the clinical presentation and behavior of this neoplasm, with most being detected
Journal of Cancer Research and Therapeutics - April-June 2014 - Volume 10 - Issue 2
Access this article online Website: www.cancerjournal.net DOI: 10.4103/0973-1482.136658 PMID: *** Quick Response Code:
363
Deb, et al.: Fallopian tube haemangioma
female reproductive tract. They most commonly appear in postmenopausal women, usually in the 6th decade of life, which is similar to the index case.[6] Microscopically, most are benign with an occasional case documenting cellular pleomorphism and nuclear hyperchromasia. a
b
c
d
To conclude, even though hemangiomas are rare and incidental findings, they have to be differentiated from other tumors of fallopian tube like serous tumors of low malignant potential borderline papillary serous tumor and malignancies, as the prognosis and management of the patients are variable. Rupture of an undetected fallopian tube hemangioma can lead to hemoperitoneum with fatal consequences, and misinterpretation of this benign entity in a young patient may lead to radical surgery with subsequent loss of fertility.
Figure 1: (a-d) Gross appearance of excised left fallopian tube, measuring 3 × 2 × 1.5 cm in size with both solid and cystic areas (a); Photomicrograph of fallopian tube hemangioma containing vascular channels of varying ectasia (b) H and E, ×100, (c) H and E, ×400; which were CD34-immunopositive (d) CD34 ×200
incidentally, while few presenting with acute abdomen due to hemoperitoneum following massive hemorrhage from the ruptured tumor.[2,3] Emrahimi and Okagaki[5] reported a case of fallopian tube hemangioma that was incidentally detected during laparotomy in a case of endometrial carcinoma. The patient had received full course of chemotherapy 6 weeks prior to surgery and authors had concluded that radiation was probably the incriminating factor. Malignant neoplasms of the fallopian tube are rare, accounting for 0.18‑1.6% of all malignant neoplasms of the
364
REFERENCES 1. de la Fuente AA. Benign mixed Müllerian tumour – Adenofibroma of the fallopian tube. Histopathology 1982;6:661‑6. 2. Gowri R, Soundararaghavana S, Oumachigui A, Iyengar KR. Fallopian tube haemangioma. J Obstet Gynecol Ind 2004;54:85‑6. 3. Joglekar VM. Haemangioma of the fallopian tube. Br J Obstet Gynecol 1979;86:823‑825. 4. Wojnar A, Drożdż K, Dzięgiel P. Cavernous haemangioma of the oviduct. Pol J Pathol 2010;61:103‑4. 5. Ebrahimi T, Okagaki T. Hemangioma of the fallopian tube. Am J Obstet Gynecol 1973;115:864‑5. 6. Haratz‑Rubinstein N, Fromberg E, Lederman S. Sonographic diagnosis of a serous tumor of low malignant potential of the fallopian tube. J Ultrasound Med 2004;23:869‑72. Cite this article as: Deb P, Singh V, Dutta V, Kapoor K. An unusual case of cavernous haemangioma of the Fallopian tube. J Can Res Ther 2014;10:363-4. Source of Support: Nil, Conflict of Interest: None declared.
Journal of Cancer Research and Therapeutics - April-June 2014 - Volume 10 - Issue 2
Copyright of Journal of Cancer Research & Therapeutics is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
