LETTER TO EDITOR
Year : 2009 | Volume
: 52 | Issue : 4 | Page : 596--598
Primary fallopian tube adenocarcinoma with brain and lung metastasis
Krishnamurthy Jayashree, Choudary Anubuti, Sunila, Manjunath Gundappa
Department of Pathology, JSS Medical College, Mysore, India
Department of Pathology, JSS Medical College, Mysore
|How to cite this article:|
Jayashree K, Anubuti C, Sunila, Gundappa M. Primary fallopian tube adenocarcinoma with brain and lung metastasis.Indian J Pathol Microbiol 2009;52:596-598
|How to cite this URL:|
Jayashree K, Anubuti C, Sunila, Gundappa M. Primary fallopian tube adenocarcinoma with brain and lung metastasis. Indian J Pathol Microbiol [serial online] 2009 [cited 2020 May 31 ];52:596-598
Available from: http://www.ijpmonline.org/text.asp?2009/52/4/596/56148
Primary fallopian tube carcinoma is a rare gynecological cancer  with reported incidence being 0.3%.  The literature search reveals a few cases of fallopian tube carcinoma presenting with brain metastasis. The present case of fallopian tube carcinoma had metastasis not only to the brain but also to the lungs.
Fifty-eight years old woman presented with headache since three months. The initial investigations revealed no abnormality. Patient had no relief with symptomatic treatment. Further, over a period of two months the patient developed disarticulation and dysphagia. On examination, the patient was found to have 12 th cranial nerve palsy. On reinvestigating, computed tomography (CT) of head and neck revealed multiple metastatic lesions in the base of skull [Figure 1], and thickening of nasopharynx. CT thorax showed a metastatic deposit in the lingulae of left lung [Figure 2], and CT abdomen and pelvis revealed a right uterine adnexal mass [Figure 3]. In order to confirm the site of the primary lesion, a nasopharyngeal biopsy and an exploratory laparotomy were done. On laparotomy, the uterus, both ovaries, and the left fallopian tube were found to be normal. The right fallopian tube was dilated. To evaluate the underlying pathology, right salphingectomy was done.
The laproscopically excised right salphingectomy specimen grossly consisted of tubular grey white bits of tissue which measured 3 Χ 4 Χ 1 cm 3 . The cut section showed papillary processes. The entire tissue was routinely processed and the hematoxylin and eosin (HandE) stained sections were studied. Microscopically, the sections showed a malignant tumor composed of cells arranged in papillary and glandular patterns [Figure 4]. The cells lining the papillae showed stratification, pleomorphism, and nuclear atypia. The tumor cells were seen infiltrating the underlying stroma [Figure 5]. The features were diagnostic of papillary adenocarcinoma.
The specimen of nasopharyngeal biopsy consisted of irregular tiny grey white bits of tissue and showed features of chronic inflammatory lesion.
Primary fallopian tube carcinoma is a rare but extremely aggressive cancer.  It represents less than 1% of all gynaecological malignancies. The incidence ranges from 0.142-1.8%, with reported incidence being 0.3%. 
Central nervous system (CNS) involvement by gynaecological tumors is considered as an uncommon event.  Cormio et al.,  in their study found that 6.4% cases of tubal carcinomas developed brain metastases.
The median age at the time of diagnosis of central nervous system metastases was 61 years.  In the present case the patient was 58 years old.
The clinical triad of tubal carcinoma is vaginal bleeding, watery discharge, and lower abdominal pain or a pelvic mass. But all these features are present in only 6% of the cases.  In most cases, it is known to be insidious and asymptomatic.  The present case also had no symptoms referring to the primary site. Only a directed work-up after noting the metastatic deposits in the brain and the lungs by CT scan revealed a right uterine adenxal mass. On laparoscopy the right uterine adenxal mass was found to be the dilated right fallopian tube.
Tubal carcinoma usually originates in the ampulla and its pattern of growth can be nodular, papillary, infiltrative, or massive.  These tumors are relatively confined to the tube and may have no alteration in shape or size of the tube, or it may feature diffuse swelling, a sausage shape resembling hydro, hemato, or pyosalpinx; an unbuttoning pattern of solid tumor mushrooming out of the tubal ostium, or a true tumor that is either solid or partly solid and cystic.  Histopathological examination reveals features of papillary adenocarcinoma extending into the submucosa and muscularis,  as was seen in the present case.
Metastasis to the tubes is a bilateral process in 80% of the cases,  and ovarian or endometrial cancer is often the primary lesion.  To make a diagnosis of primary tubal carcinoma, primary tumors of the ovaries and the uteruses must be excluded.  In the present case CT scan and laparotomy findings revealed no growth in the uterus or ovaries.
Primary fallopian tube carcinoma can be a possible occult primary in those patients who present with neurogenic signs and symptoms due to cerebral metastasis.
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