Case Of Fallopian Tube Cancer Research Articles

“A Concealed Malignancy” A Case Series on Primary Fallopian Tube Carcinoma

Background: As rare as it is, primary fallopian tube carcinoma presents with a varied range of nonspecific signs and symptoms making its preoperative diagnosis a clinical challenge. It is often missed and is usually recognized later by histopathology. This paper aims to present four cases of fallopian tube cancer managed in our institution in a 5-year period with varied presentation and to discuss updates in diagnosis, management and prognosis in the light of recent literature. Methods and Results: All of the four cases were of different age group, presented differently and were diagnosed preoperatively to be of another etiology. The first case, 44 year old, initially presented with recurrent vaginal discharge. The patient then presented with supraclavicular nodes to be of metastatic origin. The second case, 58 year old, presented with vaginal spotting and on imaging, a pelvic mass that may represent ovarian new growth. The third and fourth case, 71 and 66 year old respectively, presented with a history of gradually enlarging abdominal mass with an imaging showing an adnexal mass. Intraoperatively, the first and third case revealed a fallopian tube that was thinned out and dilated to a granular and friable tissue. The second case had a right fallopian tube that cannot be grossly identified but an adnexal mass was noted. The fourth case showed a left fallopian tube that was converted to a tan irregular mass. Histopathology revelaed all of these cases as high grade fallopian tube serous carcinoma. Conclusion: To raise suspicion in the diagnosis of this rare carcinoma preoperatively should be given more importance so that a prompt investigation would be made and catching this disease in an early stage would be achieved. This paper showcased the varied presentation of this disease so as to avoid preoperative misdiagnosis and have a better head start on proper management.

Added value of regional 18F-FDG PET/MRI-assisted whole-body 18F-FDG PET/CT in malignant ascites with unknown primary origin

BackgroundComparing to PET/CT, integrative PET/MRI imaging provides superior soft tissue resolution. This study aims to evaluate the added value of regional delayed 18F-FDG PET/MRI-assisted whole-body 18F-FDG PET/CT in diagnosing malignant ascites patients.ResultsThe final diagnosis included 22 patients with ovarian cancer (n = 11), peritoneal cancer (n = 3), colon cancer (n = 2), liver cancer (n = 2), pancreatic cancer (n = 2), gastric cancer (n = 1), and fallopian tube cancer (n = 1). The diagnosis of the primary tumor using whole-body PET/CT was correct in 11 cases. Regional PET/MRI-assisted whole-body PET/CT diagnosis was correct in 18 cases, including 6 more cases of ovarian cancer and 1 more case of fallopian tube cancer. Among 4 cases that were not diagnosed correctly, 1 case had the primary tumor outside of the PET/MRI scan area, 2 cases were peritoneal cancer, and 1 case was colon cancer. The diagnostic accuracy of regional PET/MRI-assisted whole-body PET/CT was higher than PET/CT alone (81.8% vs. 50.0%, κ 2 = 5.14, p = 0.023). The primary tumor conspicuity score of PET/MRI was higher than PET/CT (3.67 ± 0.66 vs. 2.76 ± 0.94, P < 0.01). In the same scan area, more metastases were detected in PET/MRI than in PET/CT (156 vs. 86 in total, and 7.43 ± 5.17 vs. 4.10 ± 1.92 per patient, t = 3.89, P < 0.01). Lesion-to-background ratio in PET/MRI was higher than that in PET/CT (10.76 ± 5.16 vs. 6.56 ± 3.45, t = 13.02, P < 0.01).ConclusionComparing to whole-body PET/CT alone, additional delayed regional PET/MRI with high soft tissue resolution is helpful in diagnosing the location of the primary tumor and identifying more metastases in patients with malignant ascites. Yet larger sample size in multicenter and prospective clinical researches is still needed.

Hereditary breast and ovarian cancer triggered by occult fallopian tube cancer: a case report

BackgroundAt the time of benign gynecological surgery, a prophylactic salpingo-oophorectomy or salpingectomy is increasingly being performed concurrently to reduce the risk of future ovarian and fallopian tube cancer. We herein describe a case of hereditary breast and ovarian cancer syndrome in which a hysterectomy and bilateral adnexectomy were performed with a preoperative diagnosis of benign tumor. A detailed pathological examination revealed occult fallopian tube cancer, and additional staging surgery provided an accurate pathology diagnosis.Case presentationA 72-year-old Japanese woman with a past history of breast cancer underwent a hysterectomy and bilateral oophoro-salpingectomy for the preoperative diagnosis of uterine myoma and a right para-ovarian cyst. In the detailed pathological examination, high-grade serous carcinoma of the right fallopian tube was detected incidentally, and a subsequent staging laparotomy confirmed single para-aortic lymph node metastasis. Furthermore, a mutation in germline BRCA2 was detected postoperatively, and the patient was finally diagnosed with hereditary breast and ovarian cancer syndrome. She was diagnosed with fallopian tube cancer International Federation of Gynecology and Obstetrics Stage IIIA1(i) and started on adjuvant therapy (six courses of paclitaxel and carboplatin followed by maintenance therapy with olaparib), and 18 months after surgery, she was free of disease.ConclusionThis is a case of fallopian tube cancer that was diagnosed incidentally and then accurately staged with additional advanced staging surgery. Even in the absence of grossly malignant findings, a detailed pathological search of the fallopian tubes and accurate staging surgery are important to make the necessary treatment decisions for the patient.

54P Fallopian tube cancer and ovarian cancer: A real-world comparison of epidemiological patterns, clinical outcomes, and mutational landscape

Fallopian tube cancer is a rare tumor which accounts for only 1% of all gynaecological cancers. It is closely related and generally treated with a similar approach to ovarian cancer. We used the publicly available databases to provide a description of epidemiological patterns, clinical outcomes, and mutational landscape of fallopian tube cancer and compare it with that of ovarian cancer. We extracted clinical and epidemiological data of fallopian tube and ovarian cancers from the SEER database [13 reg; Nov 2020 Submission]. The average annual percentage change (AAPC) of incidence rates was calculated using The NIH’s Joinpoint Regression Program. Sequencing data were obtained through The American Association of Cancer Research (AACR) project GENIE database. We included 4,240 cases of fallopian tube cancer and 74,837 cases of ovarian cancer diagnosed between 1992 and 2018. The overall incidence of fallopian tube cancer was 0.39 [95% CI, 0.38-0.40], whereas the overall incidence of ovarian cancer was 6.97 [95% CI, 6.92-7.02]. Between 1992 and 2018, there was a significant increase in the incidence of fallopian tube cancer (AAPC = 6.1% 95% CI, [4.6, 7.9], p<0.001) and a decrease in the incidence of Ovarian cancer (AAPC = -1.7% 95% CI, [-2, -1.4], p<0.001). The median overall survival of fallopian tube cancer was significantly higher than ovarian cancer (80 months vs 43 months, P<0.001). A presentation with stage IV disease was significantly less frequent in fallopian tube cancer compared to ovarian cancer (50% vs 70%, P<0.001). In 166 patients with fallopian tube cancer and 5,303 patients with ovarian cancer in GENIE, the most frequently mutated genes were TP53, SPTA1, LRP1B, FAT3, and NF1; and TP53, CSMD3, DNAH9, ARID1A, and PDE4DIP; for fallopian tube cancer and ovarian cancer respectively. Fallopian tube cancer is a distinct disease entity different in genetic, epidemiological, and clinical characteristics from ovarian cancer. Cases with fallopian tube cancer are less likely to present with distant metastasis and have longer overall survival compared to cases with ovarian cancer. The most frequently mutated genes of both cancers are different.

Clinical analysis of 23 cases with simultaneous double primary gynecological malignant tumors

Objective: To investigate the clinicopathological features, diagnosis, treatment and prognosis of simultaneous double primary gynecological malignant tumors. Methods: A total of 23 patients with simultaneous double primary malignant tumors of female reproductive system primarily treated in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 1, 2010 to December 31, 2020 were retrospectively collected. The age, symptoms, tumor stage, tumor type, treatment and prognosis of patients were collected and followed up. Results: (1) The number of patients with gynecological tumors in our hospital increased year by year in the past 11 years. A total of 8 987 patients with gynecological malignant tumors were firstly diagnosed and cured in our hospital, including 3 474 cases of cervical cancer, 3 484 cases of endometrial cancer, 1 329 cases of ovarian malignancies, 171 cases of fallopian tube cancer, 182 cases of uterine sarcoma, 42 cases of vaginal cancer, 192 cases of vulvar cancer, 110 cases of trophoblastic tumor and 3 cases of other gynecological malignancies. The top three cancers were endometrial cancer, cervical cancer and ovarian malignancies. (2) There were 23 patients identified with simultaneous double primary gynecological tumors in the past 11 years, accounting for 0.26% (23/8 987) of female malignant tumors. There were 3 cases of cervical cancer complicated with endometrial cancer, 3 cases of cervical cancer complicated with ovarian cancer, 16 cases of endometrial cancer combined with ovarian cancer, and 1 patient with endometrial cancer combined with fallopian tube cancer. (3) All 23 patients underwent surgical treatment. According to the first diagnosis of the tumor, the surgical methods included cervical cancer radical surgery, endometrial cancer staging surgery and ovarian cancer cytoreductive surgery. After operation, radiotherapy and chemotherapy were supplemented according to the results of pathological examination and tumor staging. (4) The age of 23 patients ranged from 28 to 66 years, with an average age of (49.4±9.7) years. All patients had vaginal bleeding or conscious pelvic mass as their main clinical manifestation. The clinical stage was found in 7 patients (30%, 7/23) with advanced gynecological cancer (stage Ⅲ-Ⅳ), and 16 patients (70%, 16/23) with early stage gynecological cancer (stage Ⅰ-Ⅱ). According to the nonspecific tumor markers, 13 patients (57%, 13/23) had elevated CA125 and CA199. (5) Among the 23 patients, 1 case was uncontrolled and 3 cases recurred during the follow-up period, and the sites of uncontrolled or recurred were all located in the abdominopelvic cavity. Three cases died. Among the 3 patients who died, 1 patient was an uncontrolled patient, whose tumor type was cervical adenosquamous cell carcinoma combined with ovarian clear cell adenocarcinoma. The overall survival time was 19 months with postoperative supplementary radiotherapy and chemotherapy. There were 2 recurrent patients, and the tumor types were endometrioid carcinoma complicated with high-grade serous ovarian carcinoma and ovarian endometrioid carcinoma, respectively. After surgery, all patients received supplementary chemotherapy and recurred 60 and 21 months after surgery, respectively, and the overall survival time was 78 and 28 months, respectively. Another patient recurred 43 months after surgery, and survived with tumor for 14 months after recurrence. The remaining 19 patients were tumor-free and were still being followed up. Conclusions: There are no specific markers for simultaneous double primary gynecological malignant tumors. The most common clinical symptoms are vaginal bleeding or pelvic mass. The treatment principle of simultaneous double primary gynecological malignant tumor is the same as that of single gynecological malignant tumor, but need to be taken into account the characteristics of two tumors. Surgery is the main treatment method, and radiotherapy and chemotherapy play an important auxiliary role. The prognosis of simultaneous double primary gynecological malignancies is related to the late stage of the two malignancies.

以外阴淋巴水肿为首发表现的输卵管癌一例

以外阴淋巴水肿为首发表现的输卵管癌一例

Thresholds and timing of pre-operative thrombocytosis and ovarian cancer survival: analysis of laboratory measures from electronic medical records.

BackgroundThrombocytosis has been associated with poor ovarian cancer prognosis. However, comparisons of thresholds to define thrombocytosis and evaluation of relevant timing of platelet measurement has not been previously conducted.MethodsWe selected Tumor Registry confirmed ovarian, primary peritoneal, and fallopian tube cancer cases diagnosed between 1995–2013 from the Vanderbilt University Medical Center. Laboratory measured platelet values from electronic medical records (EMR) were used to determine thrombocytosis at three thresholds: a platelet count greater than 350, 400, or 450 × 109/liter. Timing was evaluated with 5 intervals: on the date of diagnosis, and up to 1, 2, 4, and 8 weeks prior to the date of diagnosis. Cox regression was used to calculate hazard ratios (HR) and confidence intervals (CI) for association with overall survival; adjustment included age, stage, grade, and histologic subtype of disease.ResultsPre-diagnosis platelet measures were available for 136, 241, 280, 297, and 304 cases in the five intervals. The prevalence of thrombocytosis decreased with increasing thresholds and was generally consistent across the five time intervals, ranging from 44.8–53.2 %, 31.6–39.4 %, and 19.9–26.1 % across the three thresholds. Associations with higher grade and stage of disease gained significance as the threshold increased. With the exception of the lowest threshold on the date of diagnosis (HR350: 1.55, 95 % CI: 0.97–2.47), all other survival associations were significant, with the highest reaching twice the risk of death for thrombocytosis on the date of diagnosis (HR400: 2.01, 95 % CI: 1.25–3.23).ConclusionsOur EMR approach yielded associations comparable to published findings from medical record abstraction approaches. In addition, our results indicate that lower thrombocytosis thresholds and platelet measures up to 8 weeks before diagnosis may inform ovarian cancer characteristics and prognosis.

Abstract 3404: Thrombocytosis and epithelial ovarian cancer survival: relevant time frame of platelet count measurement and diagnostic threshold for thrombocytosis

Abstract INTRODUCTION: Ovarian cancer is rapidly progressive and lethal disease. Thrombocytosis has been associated with poor prognosis; mechanisms underlying this association include paracrine signaling between platelets and cancer cells, resulting in tumor cell proliferation. However, the relevant timing of platelet measurement in relation to diagnostic operation and a threshold to define thrombocytosis as a prognostic indicator have not been evaluated. METHODS: Tumor Registry confirmed epithelial ovarian and fallopian tube cancer cases with pre-diagnosis platelet counts were identified from the Synthetic Derivative, a de-identified mirror of electronic medical records from the Vanderbilt University Medical Center. Thrombocytosis was defined with two thresholds: platelet count greater than 400 or 450 × 109/L. The relevant time frame of platelet measurement was evaluated within 5 time intervals: on the date of diagnosis, and 1, 2, 4, and 8 weeks before and including the date of diagnosis. Prognostic significance was evaluated using Cox proportional hazards regression to calculate hazard ratios (HR) and confidence intervals (CI); adjustment included age, stage, grade, and histologic subtype of disease. RESULTS: Measured platelet values were available for 136, 241, 280, 297, and 304 cases within the five time intervals. The prevalence of thrombocytosis was 31.6, 39.4, 38.2, 38.1, and 37.5% for 400 × 109/L, and 19.9, 26.1, 25.7, 24.9, and 25.0% for 450 × 109/L across the five intervals, respectively. Thrombocytosis was significantly associated with higher stage and grade, regardless of threshold used. In both unadjusted and multivariable adjusted analysis, thrombocytosis was significantly associated with worse survival. Associations were similar across thresholds and time frames, but were generally larger on the date of diagnosis (HR(400): 1.96, 95% CI 1.23-3.13; HR(450): 1.90, 95% CI: 1.12-3.23), and smaller as time to diagnosis increased up to 8 weeks (HR(400): 1.54, 95% CI: 1.14-2.09; HR(450): 1.55, 95% CI: 1.11-2.15). CONCLUSIONS: Depending upon the threshold used and the timing of measurement, thrombocytosis was identified in 20-40% of epithelial ovarian cancer cases. Regardless of threshold or timing, preoperative thrombocytosis was associated with more aggressive disease characteristics and was an independent negative prognostic factor. These preliminary results support use of a lower thrombocytosis threshold and indicate that platelet count measurements collected up to 8 week preoperatively may be used to inform ovarian cancer prognosis. Citation Format: Gabriella D. Cozzi, Jacob M. Samuel, Jason T. Fromal, Spencer Keene, Marta A. Crispens, Dineo Khabele, Alicia C. Beeghly-Fadiel. Thrombocytosis and epithelial ovarian cancer survival: relevant time frame of platelet count measurement and diagnostic threshold for thrombocytosis. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3404.

Abstract C19: Assessing metformin use and ovarian cancer survival from electronic medical records

Abstract Background: Ovarian cancer is a rare disease with a poor prognosis. Type 2 Diabetes Mellitus (T2D) is associated with increased cancer risk and mortality. Metformin is a common first-line treatment for T2D that has been shown to have multiple anti-cancer effects. Repurposing metformin for ovarian cancer treatment is attractive, but associations between T2D, metformin use, and ovarian cancer survival have been evaluated in only a few studies to date. Methods: Electronic medical record (EMR) data was abstracted for tumor registry confirmed ovarian and fallopian tube cancer cases from the Vanderbilt University Medical Center; MedEx was used to determine metformin use. Associations with T2D or metformin were evaluated with chi-square tests or Student's t-tests. Associations with overall survival were evaluated using Cox proportional hazards regression to compute Hazard Ratios (HR) and corresponding 95% Confidence Intervals (CI). Associations with and without adjustment for age, race, stage of disease, and histologic subtype were modeled. Kaplan-Meir functions were used to visualize survival functions; differences were evaluated via the log-rank test. For 50 subjects, we used natural language processing assisted manual review to assess metformin use; a Kappa coefficient was used to compare this to MedEx captured use. Results: EMR data was available for 414 Tumor Registry confirmed cases; of these, 372 (89.9%) were invasive epithelial ovarian cancers. Of the 372 cases, 332 were non T2D ovarian cancer cases of which 47 (14.2%) were from minority population(s) (non-Caucasian). There were a total of 40 T2D ovarian cancer cases of which 7 (17.5%) were from minority population(s). There were more high stage (III &amp; IV) cancers among T2D than non-T2D OC cases (P=0.032). T2D cases on metformin were taller and weighed more than T2D cases without metformin use (P=0.034 and P=0.044, respectively). Associations with overall survival were suggestive but non-significant for T2D (HR: 0.72, 95% CI: 0.47-1.08) and metformin use, either compared to T2D cases without metformin use (HR: 0.56, 95% CI: 0.23-1.39) or compared to all ovarian cancer cases (HR: 0.53, 95% CI: 0.27-1.05). MedEx captured and manually curated metformin use was highly concordant (Kappa=0.96). Conclusions: We found that ovarian cancer cases with metformin use had marginally better overall survival than both T2D cases not taking metformin and all ovarian cancer cases. While not significant, these associations indicate that metformin may have utility clinically repurposed as a treatment for ovarian cancer. Finally, high agreement between MedEx captured and natural language processing assisted manually curated metformin use indicates that MedEx captured metformin use can be used in larger EMR studies. Citation Format: Leshaun Clayton, Spencer Keene, Samantha P. Stansel, Min Jiang, Melinda Aldrich, Hua Xu, Jeremy Warner, Joshua Denny, Dineo Khabele, Alicia Beeghly-Fadiel. Assessing metformin use and ovarian cancer survival from electronic medical records. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C19.

Abstract B35: Ovarian cancer incidence projections in the United States: Expected increases through 2030.

Abstract Background: Several reports have shown that age-standardized ovarian cancer rates are decreasing in recent years in the United States. While these reported rates are useful to compare trends across certain groups, they do not always accurately convey the burden of ovarian cancer, nor do they provide information on the actual numbers of ovarian cases diagnosed each year. Since age is the greatest risk factor for ovarian cancer, and the older population of the Unites States is growing, the accurate assessment of future ovarian cancer trends is important in order to plan for clinical care needs and allocate resources effectively. Objective: To assess future trends in the United States ovarian cancer burden by projecting the number of new cases of ovarian and fallopian tube cancer cases diagnosed through the year 2030. Methods: We used observed incidence data from 1982-2011 from the SEER program, and population projections based on the 2010 US Census to predict ovarian and fallopian tube cancer cases and rates through 2030. Cases of both ovarian and fallopian tube cancers were included to account for misclassification that often occurs between the two cancer sites and also because some ovarian cases are thought to originate in the fallopian tube. Predictions were made using age-period-cohort regression models implemented in the Nordpred software. Results: The number of ovarian cancer cases is estimated to increase from 23,215 in 2012 to 27,666 in 2030, for a 19.2% total increase in new cases of ovarian cancer in 2030. Fallopian tube cancer cases are expected to increase from 1,621 in 2012 to 3,686 in 2030. Together, 31,352 cases of ovarian and fallopian tube cancers are projected to be diagnosed in 2030, for an overall expected increase of 26.2% for these cancers. Discussion: Given the expected increase in cancer cases, prioritizing resources for ovarian cancer control is warranted. Continued training and outreach of gynecologic oncologists to ensure ovarian cancer patients receive optimal treatment is necessary. Systems changes that ensure referral and accessibility to gynecologic oncologists are also needed. Additional research into genetic and other factors that predispose individuals to ovarian cancer, and the continued characterization of symptoms may help to identify cases earlier, potentially resulting in more treatment options for ovarian cancer patients. Citation Format: Sherri L. Stewart, Trevor D. Thompson, Hannah K. Weir, Sun Hee Rim. Ovarian cancer incidence projections in the United States: Expected increases through 2030. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: Exploiting Vulnerabilities; Oct 17-20, 2015; Orlando, FL. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(2 Suppl):Abstract nr B35.

Abstract B17: Type 2 diabetes, metformin, and ovarian cancer survival: An analysis of tumor registry and electronic medical record data.

Abstract Background: Type 2 Diabetes Mellitus (T2D) is associated with increased cancer risk and higher cancer mortality. Metformin, a common T2D treatment, is associated with improved survival for several cancers. With a five year survival of 42%, repurposing metformin to improve ovarian cancer prognosis is attractive. However, only a few studies to date have evaluated associations between T2D, metformin use, and ovarian cancer survival. Methods: We evaluated tumor registry confirmed ovarian and fallopian tube cancer cases from the Vanderbilt University Medical Center. Metformin use was determined from electronic medical records (EMR) using MedEx. For validation, natural language processing EMR review was conducted for 50 subjects. Cox proportional hazards regression was used to evaluate associations with overall survival and calculate Hazard Ratios (HR) and corresponding 95% Confidence Intervals (CI); models included adjustment for age, stage, histologic subtype, and body-mass index (BMI). Results: Tumor registry data and EMR was available for 372 invasive epithelial ovarian cancer cases. Forty (10.8%) had T2D, and 20 had metformin use (5.4%). MedEx and EMR reviewed metformin use was highly concordant (Kappa=0.96). Associations with overall survival were suggestive but non-significant for T2D (HR: 0.80, 95% CI: 0.51-1.25) and metformin use, either among only T2D cases (HR: 0.73, 95% CI: 0.29-1.84) or among all ovarian cancer cases (HR: 0.61, 95% CI: 0.31-1.21). Two or more years of metformin use was significantly associated with better survival compared to cases without metformin use (HR: 0.28, 95% CI: 0.09-0.89). Exploratory analyses suggested better survival among serous cases and worse survival among non-serous cases for both T2D and metformin, but associations were not significant. Analyses to address survival time bias yielded results comparable to our primary findings. Conclusions: Ovarian cancer cases with metformin use had marginally better overall survival. While not significant, these associations indicate that metformin may have utility repurposed as a treatment for ovarian cancer. Larger studies are needed to determine if associations differ by histology, and if metformin may be beneficial to all ovarian cancer subtypes. Citation Format: Spencer Keene, Samantha P. Stansel, Leshaun Clayton, Min Jiang, Melinda Aldrich, Hua Xu, Jeremy Warner, Joshua Denny, Dineo Khabele, Alicia Beeghly-Fadiel. Type 2 diabetes, metformin, and ovarian cancer survival: An analysis of tumor registry and electronic medical record data. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: Exploiting Vulnerabilities; Oct 17-20, 2015; Orlando, FL. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(2 Suppl):Abstract nr B17.

Fallopian tube cancer incidentally diagnosed during laparoscopy for metastatic adenocarcinoma of unknown primary lesion

Abstract Primary fallopian tube cancer is a rare gynecological malignancy. We report a case of fallopian tube cancer that was incidentally diagnosed during laparoscopy for metastatic adenocarcinoma of unknown primary lesion. A 60-year-old woman had two intraperitoneal calcific masses, which a biopsy revealed to be a metastatic malignancy with an unknown primary site. She was asymptomatic, and the primary site was not identified in imaging evaluations such as transvaginal ultrasonography. A diagnostic laparoscopy was performed and revealed papillary tumor-like lesions in the right fallopian tube. The laparoscopy was immediately converted to laparotomy. Total hysterectomy, bilateral salpingo-oophorectomy, and an omentectomy were also performed. The histopathologic diagnosis was primary serous adenocarcinoma of the fallopian tube. The patient received adjuvant chemotherapy. At 8 months postoperatively, there were no signs of recurrence. In this patient, the diagnostic laparoscopy was more useful for detecting the primary small-volume fallopian tube cancer, compared with ultrasonography, computed tomography (CT), magnetic resonance imaging, and positron emission tomography–computed tomography (PET-CT). Laparoscopy may be a tool for revealing an obscure primary lesion in the abdominal cavity.

A Rare Case of Tubal Malignancy with Atypical Features

Fallopian tube malignancy is the rarest among genital malignancies ranging to 0.3% *1. There are no specific symptoms related to fallopian tube malignancy, therefore the diagnosis mainly depends on imaging & histopathology. We are reporting a case of fallopian tube cancer in a 40 year multiparous lady who presented with vague lower abdominal pain and no other symptoms suggestive of genital malignancies. Therefore women presenting with symptoms like abdominal pain , white discharge per vaginum should be subjected to thorough clinical examination & relevant investigations to arrive at a proper diagnosis at the earliest time possible, to give better prognosis to the patient.

When, how and why BRCA1 and BRCA2 genetic testing is offered to patients who do not meet standard criteria

Various BRCA1 and BRCA2 mutation probability prediction models exist which can be used to determine equitable access to publicly funded genetic testing. In January 2009 two of these models were introduced in three New South Wales genetic services. From this time, the criteria below were used to determine eligibility for publicly funded BRCA1 and BRCA2 mutation analysis. Individual diagnosed with breast or ovarian cancer with one or more of the following: • Combined Manchester score of 15 or higher • Combined BOADICEA score of 10% or higher • Synchronous or metachronous breast and ovarian cancer • Serous fallopian tube cancer Cases not fulfilling the above criteria could be offered testing following discussion and approval at a combined monthly meeting of clinical staff. This was instigated because staff thought that some clinical scenarios would not easily fit into the BOADICEA or Manchester models and yet should be considered for testing. We have audited all 77 cases discussed at the meetings between January 2009 and December 2010. Some cases discussed did in fact meet the testing criteria above. In 41 cases the decision was made to offer publicly funded BRCA1 and BRCA2 mutation analysis. Reasons cases were considered for ‘off-criteria’ testing and bought to the meeting for discussion included: • Very early age of diagnosis • Pathological subtype • Limited family structure • Non-Western European ancestry • Affected with prostate or pancreatic cancer • Ashkenazi Jewish ancestry but no BRCA1 or BRCA2 founder mutation identified We will present an analysis of the 77 cases including case and family history, pathology, BOADICEA score, Manchester score, outcome of discussion, and genetic test results. We will also consider the cost-effectiveness of ‘off-criteria’ testing.

Hereditary Breast-Ovarian Cancer Team of the University Medical Centre Groningen (UMCG) - a Report

Female carriers of a germline BRCA1 or BRCA2 mutation have a cumulative lifetime ovarian cancer risk of 39-54% or 11-23%, respectively [1,2]. Preventive health strategies for these women include gynaecological screening aiming at early cancer detection and prophylactic salpingo-ophorectomy aiming at cancer risk reduction. However, it is becoming increasingly clear that (bi) annual gynaecological screening by transvaginal ultrasonography and serum CA125 estimation in women at increased risk of ovarian cancer is ineffective in detecting presymptomatic ovarian cancer [4]. In a recent publication a positive predictive value of 17% and a sensitivity of less than 50% were found for screening for ovarian cancer in a high-risk population [3]. Preventive bilateral salpingo-oophorectomy (BSO) reduces ovarian cancer risk by 96% and breast cancer risk by 50% or less, depending on the age of preventive surgery. Preventive BSO at a premenopausal age is the most effective strategy to prolong life in the case of a BRCA1 mutation [5]. In our clinic, we therefore counsel women with a BRCA1/2 gene mutation to choose preventive surgery after childbearing age. From the age of 35-40 for BRCA1 mutation carriers and from the age of 40-45 for BRCA2 mutation carriers, these women are advised to undergo a laparoscopic BSO. Counselling is provided at our multidisciplinary outpatient clinic by an experienced gynaecologist who discusses the benefits and drawbacks of the decision for or against preventive surgery with the patient and the (contra) indications for hormonal replacement therapy (HRT). Additional psychological counselling is available from the team's psychologist. In our clinic, uptake of preventive BSO is more than 70% in the total group of counselled mutation carriers and rises to more than 90% in women by the time they reach the age of 50 years. The operation is performed in a day care setting and starts with peritoneal washing for a cytologic examination to detect subclinical (extra) ovarian or tubal cancer, followed by BSO. Atraumatic tissue handling is performed by grasping the ovarian pedicles instead of the ovarian epithelium. The fallopian tube is removed from the uterine corner by bipolar coagulation and only the intramural part of the tube is left in situ. After marking one adnex, the adnexa are taken out of the body by an endobag. The tissue is sent for histopathological examination. Since the publications of case reports linking BRCA mutations to an increased risk of fallopian tube cancer as well, preventive oophorectomy is recommended to be replaced by BSO [6]. Although the rationale for removing the total fallopian tube by removing the uterus as well is clear, we could not find any evidence that a hysterectomy adds to reducing the risk of fallopian tube cancer more than a complete BSO alone. In a large clinicopathologic study of 105 cases of fallopian tube cancer, 92% were situated in the tubal portion, most often the distal part, while 8% were confined to the fimbriae [7]. Following preventive BSO, women who are younger than 45 years of age and have no history of breast cancer are counselled to use HRT, to treat vasomotor symptoms and sexual side effects of oestrogen deprivation. In the case of prescription of HRT, we prescribe tibolone, because in contrast to oestrogen/progestogen treatment, it appears to exert little stimulation of breast tissue and does not increase the mammographic breast density [8]. Women who have been treated for breast cancer, or are older than 45-50 years of age, are advised not to use HRT. In the case of severe vasomotor symptoms, non-hormonal treatment is proposed by selective serotonin reuptake inhibitors (SSRI).

254: Cerebral Recurrence of the Fallopian Tube Cancer

Study ObjectiveTo present an unusual case of fallopian tube cancer, which recurred at the brain. Diagnosis was one by endoscopic biopsy.DesignFallopian tube adenocarcinoma is a rare gynecologic cancer, and central nervous system metastasis is an extremely rare event. The treatment of this disease is known be same as that of ovarian cancer with brain metastasis.SettingWe present a case of brain metastasis in a fallopian tube cancer patient.PatientsA 46-year-old Korean woman visited the OPD with severe headache. She had undergone a surgical treatment for FIGO stage IIIc fallopian tube adenocarcinoma and adjuvant chemotherapy 4 years ago. Brain MRI revealed a solitary lesion in the left thalamus to midbrain.InterventionThe mass was removed by endoscopic surgery. Pathologic review demonstrated metastatic adenocarcinoma, same finding of primary cancer. She was treated by radiation therapy and PC combined chemotherapy.Measurements and Main ResultsShe is being regular follow-up for 12 months after multimodal treatment. She is in the disease-free state and required regular follow-up.ConclusionA cerebral recurred fallopian tube adenocarcinoma case was treated by multimodal treatment, surgery, radiation and chemotherapy. Study ObjectiveTo present an unusual case of fallopian tube cancer, which recurred at the brain. Diagnosis was one by endoscopic biopsy. To present an unusual case of fallopian tube cancer, which recurred at the brain. Diagnosis was one by endoscopic biopsy. DesignFallopian tube adenocarcinoma is a rare gynecologic cancer, and central nervous system metastasis is an extremely rare event. The treatment of this disease is known be same as that of ovarian cancer with brain metastasis. Fallopian tube adenocarcinoma is a rare gynecologic cancer, and central nervous system metastasis is an extremely rare event. The treatment of this disease is known be same as that of ovarian cancer with brain metastasis. SettingWe present a case of brain metastasis in a fallopian tube cancer patient. We present a case of brain metastasis in a fallopian tube cancer patient. PatientsA 46-year-old Korean woman visited the OPD with severe headache. She had undergone a surgical treatment for FIGO stage IIIc fallopian tube adenocarcinoma and adjuvant chemotherapy 4 years ago. Brain MRI revealed a solitary lesion in the left thalamus to midbrain. A 46-year-old Korean woman visited the OPD with severe headache. She had undergone a surgical treatment for FIGO stage IIIc fallopian tube adenocarcinoma and adjuvant chemotherapy 4 years ago. Brain MRI revealed a solitary lesion in the left thalamus to midbrain. InterventionThe mass was removed by endoscopic surgery. Pathologic review demonstrated metastatic adenocarcinoma, same finding of primary cancer. She was treated by radiation therapy and PC combined chemotherapy. The mass was removed by endoscopic surgery. Pathologic review demonstrated metastatic adenocarcinoma, same finding of primary cancer. She was treated by radiation therapy and PC combined chemotherapy. Measurements and Main ResultsShe is being regular follow-up for 12 months after multimodal treatment. She is in the disease-free state and required regular follow-up. She is being regular follow-up for 12 months after multimodal treatment. She is in the disease-free state and required regular follow-up. ConclusionA cerebral recurred fallopian tube adenocarcinoma case was treated by multimodal treatment, surgery, radiation and chemotherapy. A cerebral recurred fallopian tube adenocarcinoma case was treated by multimodal treatment, surgery, radiation and chemotherapy.

Fallopian tube cancer in a BRCA1 mutation carrier: Rapid development and failure of screening

We report a case of fallopian tube cancer that developed in a woman with a germ-line BRCA1 mutation. The notable feature of this case was the extremely rapid growth of the cancer, which precluded early diagnosis. Preventive gynecologic surgery in BRCA1/2 mutation carriers should probably always include bilateral salpingectomy. (Am J Obstet Gynecol 2002;186:53-4.)

A Genetic Epidemiological Study of Carcinoma of the Fallopian Tube

Abstract Objective. The goal of this work was to evaluate the importance of genetic factors in the etiology of fallopian tube cancer. Methods. All pathologically confirmed cases of fallopian tube cancer diagnosed in Ontario from 1990 to 1998 were identified from the records of the Ontario Cancer Registry. Living patients were approached to provide information about their family history and to provide a blood sample for testing for mutations in BRCA1 and BRCA2. Results. A modest increase in the risk of ovarian cancer (relative risk (RR) = 2.2; 95% confidence interval (CI) = 0.4, 6.3) and of early-onset breast cancer (RR = 2.4; 95% CI=0.6, 6.1) was observed in the first-degree relatives of the fallopian cancer cases. Five of the forty-four cases were positive for a mutation in BRCA1 (11%) and two were positive for a BRCA2 mutation (5%). Five of eighteen women diagnosed at or before age 55 were positive (28%). Two of the seven mutation carriers had a strong family history of breast and ovarian cancer, and three carriers had a modest family history. Three of the forty-four cases were Jewish, and of these, two carried a founder mutation characteristic of this population. Conclusions. Fallopian tube carcinoma should be considered to be a clinical component of the hereditary breast–ovarian cancer syndrome, and may be associated with BRCA1 and BRCA2 mutations. Genetic evaluation should be offered to women who present with fallopian tube carcinoma. It is important to consider the risk of fallopian tube carcinoma when prophylactic oophorectomy is performed in high-risk women.

A Genetic Epidemiological Study of Carcinoma of the Fallopian Tube

Objective. The goal of this work was to evaluate the importance of genetic factors in the etiology of fallopian tube cancer.Methods. All pathologically confirmed cases of fallopian tube cancer diagnosed in Ontario from 1990 to 1998 were identified from the records of the Ontario Cancer Registry. Living patients were approached to provide information about their family history and to provide a blood sample for testing for mutations in BRCA1 and BRCA2.Results. A modest increase in the risk of ovarian cancer (relative risk (RR) = 2.2; 95% confidence interval (CI) = 0.4, 6.3) and of early-onset breast cancer (RR = 2.4; 95% CI = 0.6, 6.1) was observed in the first-degree relatives of the fallopian cancer cases. Five of the forty-four cases were positive for a mutation in BRCA1 (11%) and two were positive for a BRCA2 mutation (5%). Five of eighteen women diagnosed at or before age 55 were positive (28%). Two of the seven mutation carriers had a strong family history of breast and ovarian cancer, and three carriers had a modest family history. Three of the forty-four cases were Jewish, and of these, two carried a founder mutation characteristic of this population.Conclusions. Fallopian tube carcinoma should be considered to be a clinical component of the hereditary breast–ovarian cancer syndrome, and may be associated with BRCA1 and BRCA2 mutations. Genetic evaluation should be offered to women who present with fallopian tube carcinoma. It is important to consider the risk of fallopian tube carcinoma when prophylactic oophorectomy is performed in high-risk women.

Occult Cancer of the Fallopian Tube in BRCA-1 Germline Mutation Carriers at Prophylactic Oophorectomy: A Case for Recommending Hysterectomy at Surgical Prophylaxis

Objective. BRCA-1 and BRCA-2 germline mutations increase the risk of ovarian and breast cancer. Primary cancer of the fallopian tube is rare; however, recent evidence suggests that patients harboring a germline mutation conferring an increased risk of ovarian cancer may be at risk for fallopian tube cancer as well. We discuss the finding of occult fallopian tube cancer diagnosed at surgical prophylaxis in women harboring BRCA-1 mutations.Methods/Results. Two patients undergoing surgical prophylaxis to address an increase in ovarian cancer risk were discovered to harbor occult primary fallopian tube carcinoma on final pathology review. Mutational analysis confirmed the presence of a deleterious mutation in BRCA-1 in both patients.Conclusion. Currently, consensus opinions regarding ovarian cancer surgical prophylaxis in gene mutation carriers do not include hysterectomy as part of the preventative procedure. This report as well as a growing number of cases of fallopian tube cancer reported in known BRCA-1 and BRCA-2 mutation carriers has important implications for recommendations regarding surgical prophylaxis in these women.