primary fallopian tube carcinoma

Primary

fallopian tube carcinoma • Primary fallopian tube carcinoma - Ganzer Fall bei Radiopaedia

Radswiki T, Primary fallopian tube carcinoma. Case study, Radiopaedia.org (Accessed on 24 Jan 2023) https://doi.org/10.53347/rID-11817 • CC by-nc-sa 3.0 (modified)

Primary

fallopian tube carcinoma: review of MR imaging findings. Serous PFTC in a 63-year-old female, presenting with pelvic pain. a Axial T2WI through the pelvis, showing “sausage”-shaped mass (asterisk). Incomplete folds (red arrow) and the “waist” sign (white arrows), are in favour of a fallopian tube mass; b Sagittal T2WI with the same solid mass (asterisk), inside a structure with well-defined walls (white arrowhead), the “waist” sign (white arrows), incomplete folds (red arrow), and the “synechiae” sign (red arrowhead) with strands of tissue floating in the fluid-filled fallopian tube; c Coronal T2WI, with the “sausage”-shaped mass (asterisk) folded upon itself, as depicted by the portions of wall visible inside the mass (red arrow), which approximates the “spoke-wheel” sign, usually better depicted when the mass is predominantly cystic. Once again, the “synechiae” sign can be observed (red arrowhead); d T1WI, fat-saturated, post-contrast image, showing the enhancement of the solid portions of the mass. Courtesy of Dra. Rosana Santos

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Primary

fallopian tube carcinoma: review of MR imaging findings. Serous PFTC in a 78-year-old female, presenting with postmenopausal bleeding and pelvic pain. a Sagittal T2WI showing a solid mass (asterisk) with well-defined walls (white arrow), incomplete folds (red arrow), and an incidental cystic lesion corresponding to a cystadenofibroma (blue arrowhead); b Axial T2WI showing the ovarian cystadenofibroma, posterior to the mass (blue arrowhead); c Axial DWI with the same solid mass showing restriction to diffusion; d Axial T1WI, fat-saturated, contrast-enhanced image, showing contrast uptake by the mass, with central necrosis

insightsimaging.springeropen.com •

Primary

fallopian tube carcinoma: review of MR imaging findings. Serous PFTC in a 58-year-old female, presenting with postmenopausal bleeding. a Axial T2WI showing a left hydrosalpinx with well-defined walls (arrowhead), mural nodules (asterisk), the “beak sign” (dashed arrow), and an enlarged left obturator lymph node (blue arrow); b Coronal T2WI showing the same mural nodules (asterisk) inside the fluid-distended left fallopian tube, in transverse section

insightsimaging.springeropen.com •

Primary

fallopian tube carcinoma: review of MR imaging findings. Serous PFTC in a 64-year-old female, presenting with abdominal pain. a Sagittal T2WI showing a “sausage”-shaped solid mass, folded upon itself as shown by the portion of Fallopian tube wall on the centre of the mass (arrowhead), and again the “beak” sign is depicted (dashed arrow); b Sagittal T2WI where the mass can still be seen (asterisk), together with an important sign in PFTC: hydrometra (red dashed arrow)

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Radiopaedia • CC-by-nc-sa 3.0 • de

Primary fallopian tube carcinoma (PFTC) is an extremely rare malignancy that arises from the fallopian tube. They account for ~1 (0.2-1.1)% all gynecological malignancies (least common of all gynecological malignancies ).

Epidemiology

The estimated incidence is at ~3-4 per million women . It typically present in post menopausal females (peaks at 6-7 decades).

Clinical presentation

Most patients are asymptomatic or tend to present with non specific or insiduous symptoms. The symptoms complex comprising of an intermittent profuse serosanguineous vaginal discharge, colicky lower abdomino-pelvic pain relieved by the vaginal discharge, and an adnexal mass can be present in ~15% of and is termed the Latzko triad .

Pathology

Most primary fallopian tube cancers arise from ampulla with endoluminal growth that leads to obstruction and distension of the fallopian tube (hydrosalpinx), which explains why the majority of these patients are rarely asymptomatic in contrast with those with ovarian cancer.

Tumors can be bilateral in 20% of the cases, mainly in advanced disease.

The pattern of growth can be nodular, papillary, infiltrative, or mass forming.

Recognized histological types include:

papillary serous adenocarcinoma of fallopian tube
- most common histological sub type
- can be histologically identical to a serous cystadenocarcinoma of the ovary.
endometrioid carcinoma of the fallopian tube
transitional cell carcinoma of the fallopian tube

Location

The tumor usually originates in the ampulla of the Fallopian tube. Bilateral involvement can in been is ~20% of cases .

Markers

Serum CA-125 levels often elevated

Radiographic features

Advanced tumors are difficult to differentiate from ovarian tumors on imaging. The presence of a hydrosalpinx can be a useful feature.

Ultrasound

While being non specific, it may be sonographically identified as a complex cystic mass involving the fallopian tube with papillary projections .

MRI

While signal characteristics are not specific, they generally are as follows

T1
- solid tumor portion is usually of low signal
- if there is an associated simple serous fluid containing hydrosalpinx this may be low signal
- if there is an associated simple hemorrhagic fluid containing hydrosalpinx this may be high signal
T2
- solid tumor component is often homogeneously or heterogeneously low or of intermediate signal
- if there is an associated simple serous fluid containing hydrosalpinx this may be of high signal
T1 C+ (Gd): solid portion often demonstrates enhancement

Staging

See: staging of primary fallopian tube carcinoma

Treatment and prognosis

Compared with ovarian carcinoma, fallopian tube cancer more tends to present at an earlier stage but has a worse prognosis, stage for stage . The reposted better overall survival therefore may be on the basis of earlier stage at presentation . Treatment generally consists of surgical debulking followed by chemotherapy.

Differential diagnosis

For a mass involving the fallopian tube, differential considerations would be:

tubal ectopic pregnancy: women of childbearing age and BHCG evelated
primary ovarian cancers (especially ovarian epithelial tumors) with involvement of the fallopian tubes
infective of inflammatory conditions
- pelvic inflammatory disease +/- pyosalpinx