Primary fallopian tube carcinoma and ectopic pregnancy: A rare co-occurrence

Abstract

Primary fallopian tube carcinoma is a rare gynecologic malignancy; conversely, tubal ectopic pregnancy is relatively common. Tubal carcinoma can be identified accidentally during surgery performed for ectopic pregnancy [1] .S urgery is not a routine procedure to screen for rare tubal carcinomas during ectopic pregnancy, although both medical conditions have well-established guidelines. Suitable diagnostic strategies are based on case studies and not on high-grade evidence. We present a case of primary fallopian tube carcinoma coinciding with an ectopic pregnancy in the same fallopian tube. A 35-year-old woman presented with lower abdominal pain associated with 52 days of amenorrhea. Her medical history revealed one live birth and one spontaneous abortion in the first trimester. On examination, her vital signs were stable (pulse 100 beats/minute; blood pressure 113/77 mmHg). A physical examination revealed right lower quadrant tenderness without rebound. A bimanual examination was remarkable for a right adnexal mass with cervical tenderness. Transvaginal ultrasonography showed a complex right adnexal mass of 8.7 � 6.6 � 6.0 cm 3 in size, with an anechoic area of fluid in the pelvic cavity. Her human chorionic gonadotropin level was 17,072.5 IU/L and hemoglobin was 70 g/L. Electrolyte (Na þ ,K þ ,a nd HCO 3e ) and liver function tests (bilirubin and alanine and aspartate aminotransferases) were normal. A provisional diagnosis of right tubal pregnancy was made and confirmed by subsequent laparoscopy. There was 1000 mL of blood and clots in the pelvic cavity. The ampullary segment of the right fallopian tube showed a dilated segment of 5 � 3 � 2c m 3 in size, with extrusion through the mucosa and active bleeding. The uterus, ovaries, and left tube appeared normal. A total right salpingectomy was performed to avoid a recurrent tubal pregnancy. The specimen was sent for pathologic examination and the final pathologic analysis confirmed the existence of a tubal pregnancy (Fig. 1A). A serous papillary carcinoma (well differentiated) was an incidental finding in the same fallopian tube (Fig. 1B and C). The tubal mucosa was involved and exhibited a papillary pattern. The tubal wall was not involved. As the patient declined to undergo a second operation and her husband supported her in this decision, we elected not to perform further surgery. The patient was discharged. Primary fallopian tube carcinoma is an uncommon malignancy, accounting for approximately 1% of female genital cancers [2]. Primary fallopian tube carcinoma most frequently occurs in women between 50 years and 69 years of age, with a median age of 55 years [3]. Primary fallopian tube carcinoma, which occasionally occurs in women of reproductive age, coinciding with an ectopic pregnancy in the same fallopian tube is extremely rare. Few reports have described such cooccurrence [1]. The difference is that fallopian tube carcinoma was observed by laparotomy in the previous report, whereas it was demonstrated by diagnostic laparoscopy in the case described here. Approximately 4% of primary fallopian tube carcinomas are diagnosed pre-operatively [3]. More often, primary fallopian tube carcinoma is first appreciated by a pathologist on histopathologic examination. In most cases, surgery is performed for suspicion of a benign or malignant ovarian tumor rather than tubal carcinoma, until pathology clarifies the correct diagnosis [4]. The case presented here suggests that the diagnosis of primary fallopian tube carcinoma may also be established when performing surgery for an ectopic pregnancy.