Dr. Michelle Desierto
Abstract
Primary Fallopian Tube Carcinoma (PFTC) is a rare tumour, accounts for about 0.14% to 1.8% of all genital malignancies. In routine practice, a case of tubal carcinoma is usually presented as a cystic adnexal mass that resembles epithelial ovarian cancer histologically and clinically. Diagnosis is difficult preoperatively and usually first identified by the pathologist. This case was a 59-year-old postmenopausal woman presented with irregular vaginal bleeding, intermittent vaginal discharge and tolerable lower abdominal pain. She has no medical co-morbidity with stable vital signs. Her initial ultrasound showed a bulky uterus with 4mm endometrial thickness, right ovary was not visualized and left ovary has hemorrhagic cyst measuring 4.4 cm x 4.2 cm with some internal echoes. Her tumour markers were normal. Office procedure of endometrial sampling reported as an inadequate sample that prompted for dilatation and curettage (D & C). This was, however complicated postoperatively by severe abdominal pain and minimal vaginal bleeding. Surgical evaluation was done wherein a CT-scan of the abdomen showed an evidence of focal mesenteric fat stranding noted just adjacent to the urinary bladder with associated fatty attenuation within it suggestive of possible omental infraction or a focal panniculitis. It also showed a left hydro/ pyo/hematosalpinx apart from a left ovarian cyst 4.3 x 5.2 cm in size. Furthermore, proctosigmoidoscopy was done which negative for any pathology. Patient condition deteriorated and subsequently underwent emergency laparotomy with the surgical team. Intraoperative showed minimal hemoperitoneum with filmy to dense adhesion of colon to the right adnexal just above the right angular end of the uterus. Left adnexa showed dilated hemorrhagic tubal structure with cystic lesion in the ovary. Adhesiolysis done which showed incidental findings of a pinpoint right cornual to midline uterine perforation but the integrity of the ileocecal area was preserved, serosal cecal tissue biopsy sent for histopathology. Total abdominal hysterectomy with bilateral salpingoophorectomy was done and specimens were all sent for histopathology. Histopathological reported an Intratubal high grade papillary serous carcinoma (Stage 1 A, pT1a) of the left tube with vascular invasion, carcinoma-in-situ in adjacent tubal epithelium, and pyosalpinx with perforation. The patient was referred to oncologist for chemotherapy. Currently, the patient is in good condition. Limited reported case as well as misdiagnosis incites the author to report and impart the clinicopathologic features of the rare occurrence of this primary tubal carcinoma and its management.