Fallopian tube cancer incidentally diagnosed during laparoscopy for metastatic adenocarcinoma of unknown primary lesion

Abstract

Keywords: fallopian tube cancer laparoscopy metastatic adenocarcinoma unknown primary cancer a b s t r a c t Primary fallopian tube cancer is a rare gynecological malignancy. We report a case of fallopian tube cancer that was incidentally diagnosed during laparoscopy for metastatic adenocarcinoma of unknown primary lesion. A 60-year-old woman had two intraperitoneal calcific masses, which a biopsy revealed to be a metastatic malignancy with an unknown primary site. She was asymptomatic, and the primary site was not identified in imaging evaluations such as transvaginal ultrasonography. A diagnostic laparoscopy was performed and revealed papillary tumor-like lesions in the right fallopian tube. The laparoscopy was immediately converted to laparotomy. Total hysterectomy, bilateral salpingo-oophorectomy, and an omentectomy were also performed. The histopathologic diagnosis was primary serous adenocarcinoma of the fallopian tube. The patient received adjuvant chemotherapy. At 8 months postoperatively, there were no signs of recurrence. In this patient, the diagnostic laparoscopy was more useful for detecting the primary small-volume fallopian tube cancer, compared with ultrasonography, computed tomography (CT), magnetic resonance imaging, and positron emission tomographyecomputed tomography (PET-CT). Laparoscopy may be a tool for revealing an obscure primary lesion in the abdominal cavity.

Practical Means of Preoperative Diagnostics of Primary Fallopian Tube Cancer

“…Literature data mainly suggests CA-125, but reports of its diagnostic accuracy are very contradictory [2,3,8]. According to many separate observations and our data, levels of CA-125 are usually normal or dubious in the early stages of PFTC, especially if concomitant chronic diseases are present [4,11,23]. After radical surgery or chemotherapy, level of CA-125 normalizes, and increases again in cancer reactivation [8,11].…”

“…Literature data suggest that magnetic resonance imaging (MRI) and positron emission tomography (PET) are often used for PFTC diagnostics [1,22,23]. According to some authors these methods not only visualize a tumor and its structure, but unlike USS, allow to recognize fine details of contrast, of hydrophilic and chemical specifics of tissues, to identify tumor infiltrates, their borders and metastases in regional lymph nodes [23][24][25]. There are even suggestions to include MRI into FIGO guidelines as a compulsory diagnostic procedure for PFTC [24].…”

“…the odds of finding PFTC in general laparoscopic practice is 1 per 3687 laparoscopies or 0.028% [4]. Literature search showed only case reports on diagnostic laparoscopy in PFTC, without detailed elaboration of diagnostic specifics [23,27,28]. Considering prolonged 'closed nature' of PFTC and masked progression as hydro-or hematosalpinx, there are very low chances of recognizing on laparoscopy without histopathological analysis a primary fallopian tube cancer without peritoneal spread.…”

Problems of primary fallopian tube cancer diagnostics during and after surgery

“…Лапароскопію слід віднести до субопераційних методів діагностики, про що, зокрема, йдеться в роботі M. Sun et al (2019) стосовно 16 діагностичних лапароскопій при РМТ [6]. Крім того, іншими авторами описані 8 поодиноких спостережень застосування лапароскопії для діагностики цієї пухлини [2,9,[15][16][17][18][19][20]. В одному з цих повідомлень РМТ виявився випадковою знахідкою при втручанні з метою стерилізації, а в 7 хворих лапароскопія була застосована як уточнююче дослідження після виявлення іншими методами незрозумілих придаткових утворень або метастазів пухлини без виявленого первинного осередку.…”

“…Судячи з числа публікацій (9 наукових робіт з 2002 по 2020 рр. ), лапароскопія ще не посіла належного місця в діагностиці РМТ [2,6,9,[15][16][17][18][19][20]. Як метод субопераційної діагностики після розробки семіотики початкових форм РМТ на фоні гідро-гематосальпінксів вона повинна зіграти важливу роль у діагностиці ранніх стадій цього захворювання, особливо в групі хворих з незрозумілими утвореннями придатків матки, виявленими променевими методами.…”