原発性卵管癌の診断に腹腔鏡手術が有用であった1症例

Abstract

Primary carcinoma of the fallopian tube is a rare tumor, accounting for only between 0.3% and 1% of all gynecological malignancies. Its symptoms include abnormal vaginal bleeding, vaginal discharge, lower abdominal pain, and pelvic mass. The nonspecific nature of these symptoms makes preoperative diagnosis difficult. We report a case of primary carcinoma of the fallopian tube suspected in a combined positron emission tomography and computed tomography (PET-CT) study during follow-up for gastric cancer, and diagnosed by using laparoscopy. A 57-year-old woman (gravida 0) with a history of gastric and thyroid cancers presented to our department with a possible left adnexal mass. Internal examination and ultrasonography revealed an enlarged uterus with multiple myomas and a solid mass in the left adnexa, 25×13 mm in size. Magnetic resonance imaging was subsequently performed, and the tumor was enhanced on gadolinium-enhanced T1-weighted imaging and showed high signal intensity on diffusion-weighted imaging. PET-CT revealed no distal metastases. We suspected a metastatic or primary malignant adnexal tumor. After providing informed consent, the patient underwent a laparoscopic surgery. In the distal left fallopian tube, a 3-cm lesion with a smooth surface was found. Disseminated malignant nodules were not observed, and the peritoneal washing cytological examination result was negative. Only salpingo-oophorectomies were performed because of the fact that metastatic tumors are difficult to distinguish from primary fallopian tube carcinomas during surgery. The histopathological diagnosis was high-grade carcinoma of the left fallopian tube, and staging laparotomy was performed later. The patient had no recurrence at 12 months after the surgery. Laparoscopic surgery may be useful in distinguishing metastatic tumors from primary malignant adnexal tumors.