Obstetrics and Gynecology - A. M. Gromova 2000

Malignant neoplasms of the female reproductive organs
Fallopian tube cancer

Malignant neoplasms of the fallopian tubes account for 0.5% to 1.4% of all female genital malignancies and can be either primary or secondary, resulting from the spread of a tumor process from the Uterus or Ovary. Histologically, they comprise carcinomas, choriocarcinomas, and sarcomas.

Malignant transformation in the fallopian tubes typically develops against the Background of chronic, frequently recurring inflammatory processes of the uterine appendages.

The Clinical presentation of malignant fallopian tube tumors is non-specific, which is why pre-operative Diagnosis is rare. Patients typically complain of a dull or cramping lower abdominal pain on the affected side. Occasionally, bloody, purulent-bloody, or watery discharge may occur.

Bimanual pelvic examination reveals a non-tender, mobile, elastic, or nodular mass on the side of the affected tube.

To confirm the diagnosis, hysterosalpingography and bicontrast radiopelviography are performed, which typically reveal fallopian tube thickening, filling defects, and amputation of the distal tubal segment. Cytological evaluation involves analyzing uterine cavity aspirates and tubal discharge, as well as Touch imprints of the tumor obtained during surgery (express Diagnostics). Lymphography is performed to assess tumor dissemination. Fallopian tube Cancer predominantly metastasizes to the lumbar, pelvic, and parametrial Lymph Nodes.

Treatment for malignant fallopian tube tumors is surgical, followed by Radiation therapy and Chemotherapy. Surgical intervention involves total Hysterectomy with bilateral salpingo-oophorectomy and omentectomy.

Fallopian tube Choriocarcinoma develops either following a Tubal Pregnancy (primary) or secondary to the spread of uterine disease. A history of Hydatidiform Mole is sometimes present. A hallmark of choriocarcinoma is rapid growth accompanied by tissue necrosis, meaning symptoms of intraperitoneal Hemorrhage may be the primary clinical manifestation. Due to predominantly hematogenous dissemination, the tumor rapidly metastasizes to the Brain, Lungs, and Liver. Management consists of supracervical hysterectomy with removal of the affected Ovaries and fallopian tubes, combined with chemotherapy.

Grossly, fallopian tube Sarcoma resembles a polypoid tumor. Occasionally, fluid accumulates within the affected tube, making it resemble a hydrosalpinx with serous-hemorrhagic contents. The tumor metastasizes early to the ovaries, omentum, lungs, and liver. The clinical manifestations of fallopian tube sarcoma closely mimic those of tubal carcinoma. The definitive diagnosis is established intraoperatively and confirmed by histological examination. Patients with fallopian tube sarcoma undergo combined treatment involving total hysterectomy with bilateral salpingo-oophorectomy and greater omentectomy, followed by adjuvant radiation therapy and chemotherapy.