Images in Gynecologic Surgery
Primary Tubal Carcinoma Pietro Litta, MD, PhD*, Anna Codroma, MD, Angela Borghero, MD, Shara Borgato, MD, Lorena Conte, MD, and Mauro Cassaro, MD From the Department of Woman and Child Health (Drs. Litta, Codroma, Borghero, Borgato, and Conte), Padua University School of Medicine, Padua, Italy, and Department of Medicine (Dr. Cassaro), Unit of Pathological Anatomy, Padua University School of Medicine, Padua, Italy.
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Fig. 1
Fig. 2
Ultrasound image of a mass of the left adnexa.
Primary carcinoma of the distal left fallopian tube.
In November 2011, 63 year old woman, in menopause since the age of 51, who has never taken hormonal therapy, contacted the Gynecology unit of the Department
Corresponding author: Pietro Litta, MD, PhD, Department of Woman and Child Health, Padua University School of Medicine, Padua, Italy. E-mail: [email protected] Submitted August 7, 2012. Accepted for publication October 18, 2012. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2012 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2012.10.011
of Woman and Child Health, University of Padua, because of abnormal uterine bleeding. A transvaginal ultrasound showed a solid mass in the left adnexa, (20 x 37 mm) (Fig. 1). Because of a suspect early ovarian cancer the patient underwent thoracic and abdominal tomography, hysteroscopy and colposcopy. The surgical procedure started with a laparoscopy but was immediately converted to a laparotomy. In the distal left fallopian tube there was a smooth surface 3 cm lesion (Fig. 2). Disseminated malignant nodules were observed on the Douglas
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Journal of Minimally Invasive Gynecology, Vol 20, No 6, November/December 2013
Fig. 3
Fig. 4
H&H staining of tubal wall.
H&H staining of ovarian stroma.
peritoneum, posterior broad ligament, left ovary, infracolic omentum and right hemidiaphragm (diameter 0.2–2 cm). The patient underwent radical hysterectomy, type A according to Morrow-Querleu classification, pelviclomboaortic lymphadenectomy, omentectomy, Douglasectomy and wide excision of the right diaphragmatic dome peritoneum [1]. Histological examination showed tubal wall deeply involved by a poor differentiated neoplasia arranged in solid nests and with stromal desmoplasia (Fig. 3) while ovaric stroma presented smaller foci (Fig. 4). All lymph nodes were negative. In most studies ovarian carcinomas were shown to originate from the ovarian surface epitelium (OSE) [2]. But nowadays prophylactic salpingo-oophorectomies from women with BRCA mutations have pointed to the fallopian tube as being a frequent site of early pelvic serous carcinoma (tubal intraepithelial carcinoma) [3]. Therefore the tube
has a role in the pathogenesis of ovarian and/or peritoneal serous carcinomas [4,5]. References 1. Litta P, Fracas M, Pozzan C, Merlin F, Saccardi C, Sacco G, Mannici D. Laparoscopic management of early stage endometrial cancer. Eur J Gynaecol Oncol. 2003;24(1):41–44. 2. Lee Y, Miron A, Drapkin R, Nucci MR, Medeiros F, Saleemuddin A, Garber J, Birch C, Mou H, Gordon RW, Cramer DW, McKeon FD, Crum CP. A candidate precursor to serous carcinoma that originates in the distal fallopian tube. J Pathol. 2007 Jan;211(1):26–35. 3. Crum CP, McKeon FD, Xian W. BRCA, the oviduct, and the space and time continuum of pelvic serous carcinogenesis. Int J Gynecol Cancer. 2012 May;22(Suppl 1):S29–S34. 4. Chambers SK, Martinez JD. The significance of p53 isoform expression in serous ovarian cancer. Future Oncol. 2012 Jun;8(6):683–686. 5. Kurman RJ, Shih I-M. The Origin and Pathogenesis of Epithelial Ovarian Cancer- a Proposed Unifying Theory. Am J Surg Pathol. 2010 March; 34(3):433–443.
Primary Tubal Carcinoma Pietro Litta, MD, PhD*, Anna Codroma, MD, Angela Borghero, MD, Shara Borgato, MD, Lorena Conte, MD, and Mauro Cassaro, MD From the Department of Woman and Child Health (Drs. Litta, Codroma, Borghero, Borgato, and Conte), Padua University School of Medicine, Padua, Italy, and Department of Medicine (Dr. Cassaro), Unit of Pathological Anatomy, Padua University School of Medicine, Padua, Italy.
DISCUSS
Use your Smartphone to scan this QR code and connect to the discussion forum for this article now*
You can discuss this case report with its authors and with other AAGL members at http://www.AAGL.org/jmig-20-4-12-00397
* Download a free QR Code scanner by searching for ‘‘QR scanner’’ in your smartphone’s app store or app marketplace.
Fig. 1
Fig. 2
Ultrasound image of a mass of the left adnexa.
Primary carcinoma of the distal left fallopian tube.
In November 2011, 63 year old woman, in menopause since the age of 51, who has never taken hormonal therapy, contacted the Gynecology unit of the Department
Corresponding author: Pietro Litta, MD, PhD, Department of Woman and Child Health, Padua University School of Medicine, Padua, Italy. E-mail: [email protected] Submitted August 7, 2012. Accepted for publication October 18, 2012. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2012 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2012.10.011
of Woman and Child Health, University of Padua, because of abnormal uterine bleeding. A transvaginal ultrasound showed a solid mass in the left adnexa, (20 x 37 mm) (Fig. 1). Because of a suspect early ovarian cancer the patient underwent thoracic and abdominal tomography, hysteroscopy and colposcopy. The surgical procedure started with a laparoscopy but was immediately converted to a laparotomy. In the distal left fallopian tube there was a smooth surface 3 cm lesion (Fig. 2). Disseminated malignant nodules were observed on the Douglas
740
Journal of Minimally Invasive Gynecology, Vol 20, No 6, November/December 2013
Fig. 3
Fig. 4
H&H staining of tubal wall.
H&H staining of ovarian stroma.
peritoneum, posterior broad ligament, left ovary, infracolic omentum and right hemidiaphragm (diameter 0.2–2 cm). The patient underwent radical hysterectomy, type A according to Morrow-Querleu classification, pelviclomboaortic lymphadenectomy, omentectomy, Douglasectomy and wide excision of the right diaphragmatic dome peritoneum [1]. Histological examination showed tubal wall deeply involved by a poor differentiated neoplasia arranged in solid nests and with stromal desmoplasia (Fig. 3) while ovaric stroma presented smaller foci (Fig. 4). All lymph nodes were negative. In most studies ovarian carcinomas were shown to originate from the ovarian surface epitelium (OSE) [2]. But nowadays prophylactic salpingo-oophorectomies from women with BRCA mutations have pointed to the fallopian tube as being a frequent site of early pelvic serous carcinoma (tubal intraepithelial carcinoma) [3]. Therefore the tube
has a role in the pathogenesis of ovarian and/or peritoneal serous carcinomas [4,5]. References 1. Litta P, Fracas M, Pozzan C, Merlin F, Saccardi C, Sacco G, Mannici D. Laparoscopic management of early stage endometrial cancer. Eur J Gynaecol Oncol. 2003;24(1):41–44. 2. Lee Y, Miron A, Drapkin R, Nucci MR, Medeiros F, Saleemuddin A, Garber J, Birch C, Mou H, Gordon RW, Cramer DW, McKeon FD, Crum CP. A candidate precursor to serous carcinoma that originates in the distal fallopian tube. J Pathol. 2007 Jan;211(1):26–35. 3. Crum CP, McKeon FD, Xian W. BRCA, the oviduct, and the space and time continuum of pelvic serous carcinogenesis. Int J Gynecol Cancer. 2012 May;22(Suppl 1):S29–S34. 4. Chambers SK, Martinez JD. The significance of p53 isoform expression in serous ovarian cancer. Future Oncol. 2012 Jun;8(6):683–686. 5. Kurman RJ, Shih I-M. The Origin and Pathogenesis of Epithelial Ovarian Cancer- a Proposed Unifying Theory. Am J Surg Pathol. 2010 March; 34(3):433–443.
