Primary Fallopian Tube Cancer May Mimic Endometrial Malignancy

Abstract

for approximately 0.14–1.8% of female genital malignancies [1]. Fallopian tube carcinoma most frequently occurs in women between the ages of 40 and 60 years. The most common histologic type is serous type, and the staging system is similar to that of epithelial ovarian carcinomas. We describe a woman who complained of postmenopausal vaginal bleeding and had been previously diagnosed with serous papillary adenocarcinoma of the endometrium; however, the final results revealed primary fallopian tube carcinoma. A 52-year-old postmenopausal woman, gravida 2, para 2, presented with postmenopausal vaginal bleeding. She sought help at a hospital where the endometrial biopsy initially revealed no evidence of malignancy. She received medical treatment, but the vaginal bleeding persisted. A fractional endometrial biopsy was performed, and adenocarcinoma of the endometrium of the papillary serous type was noted. Immunohistochemical studies revealed strong positive reactivity of p53 protein. The endocervical specimen was negative for malignancy. She visited our gynecology department for help, and a high level of CA-125 (200.7 unit/mL) was found. The pelvic magnetic resonance imaging was performed before the operation, and there was no evidence of abnormal thickening or nodularity in the endometrium and no significant lymphadenopathy in the pelvis (Figure 1A). Two small fibroid tumors (15 and 10 mm in size) were present in the myometrium. Early-stage endometrial malignancy without tumor mass was suspected before the operation. We performed staging laparotomy including extrafascial total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and paraaortic lymph node dissection, infracolic omentectomy, and peritoneal cytology. No gross lesions of the bivalved uterus were noted. We also found that the left fallopian tube was engorged with intact contour and papillary contents (Figure 1B). Primary fallopian tube carcinoma was suspected. The pathologic results confirmed the diagnosis of stage Ic serous papillary adenocarcinoma of the fallopian tube (Figure 2). Adjuvant chemotherapy with a regimen of cyclophosphamide and carboplatin was administered. The patient withstood six courses of chemotherapy well, and the level of CA-125 decreased to within the normal range. She was well followed up at our outpatient department. The most common presentation of primary fallopian tube carcinoma is vaginal bleeding and discharge