Fallopian tube carcinoma is a very rare malignancy and we report a case of stage IIC primary fallopian tube cancer

Panpalia, Madhavi

Roychowdhury, Joydeb

English

Cognitive Sciences ePrint Archive

Peer Reviewed, Open Access, Free
Published Quarterly
Mangalore, South India
ISSN 0972-5997
Volume 6, Issue 4; Oct-Dec 2007
A Rare Case Of Fallopian Tube Cancer
Authors
Joydeb Roychowdhury,
Associate Professor, Dept. Of Gynaecology & Obstetrics, NRS Medical College, 138, AJC Bose Road, 
Kolkata-70014, West Bengal 
Madhavi Panpalia,
Clinical Assistant, Jaslok Hospital, Mumbai
Address For Correspondence
Joydeb Roychowdhury
Associate Professor,
Dept. Of Gynaecology & Obstetrics,
NRS Medical College,
138, AJC Bose Road,
Kolkata-70014, West Bengal
E-mail: rcjoydeb@gmail.com
Citation
Roychowdhury J, Panpalia M. A Rare Case Of Fallopian Tube Cancer. Online J Health Allied Scs.  
2007;4:5
URL
http://www.ojhas.org/issue24/2007-4-5.htm
Open Access Archives
http://cogprints.org/view/subjects/OJHAS.html
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http://ojhas.org 1
OJHAS  Vol 6 Issue 4(5) Roychowdhury J, Panpalia M. A Rare Case Of Fallopian Tube Cancer. 
 Case Report
Submitted Jun 26, 2007; Suggested revision Dec 17, 2007; Resubmitted Dec 20, 2007; Accepted: Jan 17, 2008; 
Published: Jan 24, 2008
Abstract:
Fallopian tube carcinoma is a very rare malignancy 
and we report a case of stage IIC primary fallopian 
tube  cancer.
Key Words: Fallopian tube, Primary carcinoma
Introduction:
Cancer of the fallopian tube accounts for only 1 to 2 
percent  of  all  gynecologic  cancers.(1)  Primary 
adenocarcinoma  of  the  fallopian  tube  is  usually 
unilateral  and  is  extremely  rare.  About  1,500  to 
2,000  cases  of  fallopian  tube  cancer  have  been 
reported  worldwide.  Approximately  300  to  400 
women are diagnosed with the condition annually in 
the United States. It is more common for cancer to 
spread,  or  metastasize,  from  other  parts  of  the 
body, such as the ovaries or endometrial, than for 
cancer to actually originate in the fallopian tubes.
Fallopian tube cancer  typically  affects  women be-
tween the ages of 50 and 60, although it can occur 
at any age. It is more common in Caucasian women 
who have had few or no children. Because this can-
cer is so rare, little is known about what causes it. 
However, researchers are investigating whether ge-
netics  play  a  role.  There  is  evidence  that  women 
who have inherited the gene linked to breast  and 
ovarian  cancer,  called  BRCA1,  are  also  at  an  in-
creased risk of developing fallopian tube cancer.
The  symptoms  of  fallopian  tube  cancer  also  may 
mimic those of other gynecological problems. Some 
of the more common symptoms of the disease are 
a)  abnormal  vaginal  bleeding,  especially  after 
menopause b) abdominal pain or a feeling of pres-
sure in the abdomen c) abnormal vaginal discharge 
that is white, clear or pinkish d) a pelvic mass at the 
time of  diagnosis,  which is  present  in  up to two-
thirds of patients.
Case Report:
A 48 years old lady, mother of one child, was admit-
ted at NRS Medical College, Kolkata on 13.02.2005 
with acute pain and a mass in the lower abdomen 
for 5 days. She was a resident of Purbasthali, in Bur-
dhwan  district.  Her  menstrual  history  was  normal 
and she was referred by a consultant with a diagno-
sis of a acute torsion of ovarian tumour. On exami-
nation,  the patient  was  haemodyanamically  stable, 
pulse  rate  86/min,  blood  pressure  126/84  mmHg, 
had mild pallor and normal breasts. Abdomen was 
soft.  There was  an ill-defined,  tender  mass  in  the 
lower abdomen, partly cystic and partly solid in feel, 
variegated surface and of the size of 6″X6″ with re-
stricted mobility. The pain subsided on conservative 
treatment with antibiotics, anti-inflammatory drugs, 
sedation  and  analgesics.  On  further  investigations, 
hemoglobin was 8gm%, and other routine blood bio-
chemistry  were  normal.  Ultra  sound  examination 
showed a pelvic mass of possible ovarian origin aris-
ing from the left side. The other ovary and uterus 
appeared normal and healthy. Upper abdomen did 
not reveal any evidence of metastasis.
Photo of postoperative specimen of fallopian tubal cancerous mass along with normal uterus and ovaries
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OJHAS  Vol 6 Issue 4(5) Roychowdhury J, Panpalia M. A Rare Case Of Fallopian Tube Cancer. 
Laparotomy was done on 18.02.05 after stabilizing 
the  patient  with  2  units  of  pre-operative  blood 
transfusion.  On  opening  the  abdomen,  a  hugely 
distended  growth  was  seen  to  arise  from  left 
fallopian tube. The growth appeared haemorrhagic, 
adherent  to  the  gut,  omentum and  the  posterior 
surface  of  the  uterus.  The  peritoneal  fluid  after 
saline  wash  was  collected  for  cytology.  Liver, 
undersurface  of  the  diaphragm,  paracolic  gutters, 
peritoneum,  gut,  omentum  and  para-aortic  space 
were explored and found free of any metastasis. The 
pouch-of-douglas  (POD)  when  approached  was 
found to have metastatic deposits. Total abdominal 
hysterectomy with bilateral salpingo-oophorectomy 
and  infra-colic  omentectomy  was  done  after 
releasing  all  adhesions.  The metastatic  deposits  in 
the  POD  was  removed  partially  with  as  much 
debulking as possible because of its friable nature 
and gross adhesions. The patient had an uneventful 
postoperative period. The histopathology report of 
the mass confirmed papillary adenocarcinoma of the 
left  fallopian  tube,  the  nodule  in  POD  revealed 
metastases and peritoneal wash had malignant cells. 
The patient was referred for chemotherapy but did 
not  turn  up.  She  returned  after  7  months  with 
bleeding  per  vagina  from  a  metastatic  growth  at 
vaginal  vault.  The mass regressed with 6 cycles  of 
chemotherapy with cisplatin and cyclophosphamide. 
The patient remains asymptomatic and is still under 
follow-up. 
Discussion:
Cancer of the fallopian tube may be either primary 
or secondary. Most tumours involving the fallopian 
tube  are  metastatic  (80%),  mainly  from  ovarian 
cancer  as  well  as  from  endometrial  and 
gastrointestinal  tumours.(2)  Primary 
adenocarcinoma  of  fallopian  tube  is  usually 
unilateral.  The  fallopian  tube  cancer  is  extremely 
rare  and  comprises  only  0.3-0.5%  of  all 
gynaecological  malignancies.  The  aetiolgy  of  the 
disease remains unknown. Many of the patients are 
nulliparous  and infertile.  Fallopian tube carcinoma 
may  remain  asymptomatic  in  early  stage  of  the 
disease.  The  usual  presenting  symptom  is 
perimenopausal  or  postmenopausal  bleeding  per 
vagina  seen  in  about  50%  of  the  patients.  The 
patient may also complain of continuous watery or 
amber  coloured  vaginal  discharge  and  lower 
abdominal pain.
The most common finding on physical examination 
is  a palpable pelvic  or abdominal  mass that  occa-
sionally has a characteristic sausage shape. The triad 
of pain, menorrhagia and leucorrhoea with an ad-
nexal mass are considered pathognomonic of tubal 
cancer. Ascites is rarely present. Preoperative diag-
nosis  of fallopian tube carcinoma is  seldom made 
prior to surgery. It is suspected in fewer than 5% of 
cases  preoperatively.  Primary  ovarian  neoplasm  is 
the most common preoperative diagnosis made in 
these patients.
Ultrasound, both abdominal and vaginal, is accurate 
to  diagnose  fallopian  tube  pathology  when  it 
demonstrates a cystic and solid mass in the adnexal 
region in the presence of an identifiable separate ip-
silateral ovary. Computed tomography may be help-
ful  for  localising distant  spread to other  intra  ab-
dominal or retro peritoneal structures. The Interna-
tional  Federation  of  Gynaecology  and  Obstetrics 
(FIGO) has formulated a surgico-pathological staging 
system and is essentially based on tumour penetra-
tion through the layers of tube.
The definitive  treatment is  exploratory  laparotomy 
to confirm the diagnosis, and staging the disease, to 
remove the primary tumour along with total abdom-
inal hysterectomy and bilateral salpingo-ophorecto-
my  and  resection  of  pelvic  metastases.  It  appears 
that cisplatinum based chemotherapy improve long 
term survival in patients with advanced disease as in 
this  case.  Its  benefit  as  adjuvant therapy for  early 
stage disease has not been defined. The role of sec-
ond  look  surgery  is  controversial.  The  prognostic 
factor that directly correlates with survival is stage 
of the disease at the time of surgery.
Conclusion:
Fallopian tube cancer is a very rare type of virulent 
genital  cancer  which  is  difficult  to  diagnose  early 
and carries a poor prognosis. Thus pre-operative di-
agnosis of fallopian tube carcinoma is seldom made 
and most of the time the diagnosis is made on the 
operating table. This case was a stage IIC primary fal-
lopian tube cancer.  The 5-year survival  of stage II 
disease reported in one report of FIGO published in 
19983 were 52%. Chemotherapy with cisplatin con-
taining regime improve the long-term survival.
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OJHAS  Vol 6 Issue 4(5) Roychowdhury J, Panpalia M. A Rare Case Of Fallopian Tube Cancer. 
References:
1. Smith M. SGO: Fallopian Tube Carcinoma 
Similar  to  Ovarian  Cancer.  March,  2007. 
Available  at  http://www.medpagetoday.-
com/OBGYN/SGO/tb/5193 2007 
2. Pardeshi  SP,  Kulkarni  MM,  Hishikar  VA. 
Journal  of  postgraduate  medicine  
1996;42:59-61
3. Hanton EM, Malkasian GR, Dahlin DC. Pri-
mary carcinoma of the fallopian tube. Am J  
Obstet Gynecol 1966;94:832.
4. Carcinoma  of  the  fallopian  tube:  Overall 
survival,  FIGO  report:  J  Epidemiol  Biostat 
1998;3:99
http://ojhas.org 4
OJHAS  Vol 6 Issue 4(5) Roychowdhury J, Panpalia M. A Rare Case Of Fallopian Tube Cancer. 


Carcinoma of the fallopian tube: Overall survival, FIGO report:

Primary carcinoma of the fallopian tube.

SGO: Fallopian Tube Carcinoma Similar to Ovarian Cancer.

A Rare Case Of Fallopian Tube Cancer

CogPrints Cognitive Sciences Eprint Archive

Joydeb Roychowdhury

Madhavi Panpalia

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A Rare Case Of Fallopian Tube Cancer

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