Primary carcinoma of the Fallopian tube: A surprise finding in a postpartum tubal ligation

Abstract

Primary carcinoma of the Fallopian tube is the rarest form of pelvic cancer. A disease of recent vintage it was 1st described in 1847 by Raymond and later in 1861 by Rokitansky. There are no characteristic symptoms or pathognomonic features and the correct diagnosis is rarely made preoperatively. The present case report documents the diagnosis of primary adenocarcinoma in a postpartum tubal ligation operative specimen. The patient a 26-year-old white woman gravida 2 para 1 was delivered of a normal infant at Womens Hospital and underwent immediate postpartum tubal ligation. At the time of tubal ligation a slightly dilated portion of the left tube was noted and this was included in the operative specimen. The pathologic examination revealed Grade 1 papillary adenocarcinoma (continued to the mucosa without any invasion) in the left Fallopian tube (shown in a figure). The right Fallopian tube segment was normal. She was readmitted and total abdominal hysterectomy and bilateral salpingo-oophorectomy were carried out. There was no evidence of metastic disease in the peritoneal cavity. The patient tolerated the operation well and her postoperative course was unremarkable. Gross and microscopic examination revealed bilateral Fallopian tubes with evidence of recent segmental resection. There was no residual papillary carcinoma in the tubes which were sectioned entirely. There were no histologic abnormalities in the ovaries. The uterus weighed 200 gm and exhibited proliferative endometrium and chronic cervicitis. The patient received no further therapy. She is to be followed up at 3-month intervals. A case of primary adenocarcinoma of the Fallopian tube Grade 1 is presented. Its rarity merits a report of every case. The notable feature was the unusual mode of the presentation. Since early diagnosis is important both the surgeon and the pathologist should be aware of the condition while examining the Fallopian tubes at the operating table with the laparoscope and under the microscope. A search of the literature on the subject indicates that this may be the 1st reported instance of a diagnosis of tubal carcinoma purely on the basis of routine histologic examination of the Fallopian tubes after their removal.