Year : 2015 | Volume
: 58 | Issue : 4 | Page : 519--520
Malignancy of fallopian tube
Department of Pathology, Rohilkhand Medical College Hospital, Bareilly, Uttar Pradesh, India
Dr. Ranjan Agrawal
Department of Pathology, Rohilkhand Medical College Hospital, Pilibhit Bypass Road, Bareilly, Uttar Pradesh
|How to cite this article:|
Agrawal R. Malignancy of fallopian tube.Indian J Pathol Microbiol 2015;58:519-520
|How to cite this URL:|
Agrawal R. Malignancy of fallopian tube. Indian J Pathol Microbiol [serial online] 2015 [cited 2019 Dec 10 ];58:519-520
Available from: http://www.ijpmonline.org/text.asp?2015/58/4/519/168858
Soft tissue sarcomas constitute 1% of all adult malignancies. Rhabdomyosarcoma (RMS) is a high-grade sarcoma that predominantly affects children, and rarely, the adult population. Its incidence is approximately 3% of soft tissue sarcomas in adults. The genitourinary tract is commonly involved especially urinary bladder, prostate, paratesticular region, vagina, uterus, cervix, and ovary. RMSs have three major histologic variants: Embryonal, alveolar, and anaplastic (Formerly termed pleomorphic). Embryonal RMS (ERMS) usually affects children in theirfirst 5 years of life but is the most common type of RMS at all ages. ERMS tends to occur in head and neck, bladder, vagina, prostate, and testicles. Alveolar RMS (ARMS) accounts for approximately 31% of all RMS and tends to arise at a slightly older age than the other subtypes, with a peak incidence of 10–25 years of age. It has a predilection for the deep soft tissues of the extremities, although it may also occur in the head and neck, trunk, perinuem, pelvis and retroperitoneum. ARMS has a faster growth rate than ERMS and usually requires more intense treatment. Anaplastic RMS is an uncommon type that occurs mostly in adults.
Primary fallopian tube carcinoma (PFTC) is an uncommon tumor that histologically and clinically resembles epithelial ovarian cancer., PFTC accounts for approximately 0.14–1.8% of female genital malignancies. They frequently occur between the fourth and sixth decade of life with a mean age of 55 years. Symptoms are very vague, with a usual triad of intermittent profuse serosanguinous vaginal discharge, colicky pain relieved by discharge andabdominal or pelvic mass in only 15% of all patients. Bilateral tubal involvement by carcinoma has been reported in 10–27% of cases.
Reports of ectopic β-human chorionic gonadotropin, renin or alpha-fetoprotein production from fallopian tube carcinomas have been published. Furthermore, in more than 80% cases the expression of CA-125 has been reported. With some limitations, CA-125 may thus be considered as a suitable tumor marker for use in cancers of the fallopian tube. Fallopian tube carcinomas can cause paraneoplastic symptoms such as cerebellar degeneration with anti-Yo antibodies.
Sarcomas of the fallopian tube are exceedingly rare malignancies, occurring in postmenopausal women and are considered to be most lethal of all gynecological malignancies with high metastatic potential, frequent recurrences, and poor prognosis. The reported pathological types include malignant mixed Müllerian (mesodermal) tumors or carcinosarcomas, leiomyosarcomas, RMSs, liposarcomas, and synovial sarcomas. The least common site for malignant Müllerian mixed tumors (carcinosarcoma and metaplastic carcinoma) is the fallopian tube accounting for only 4% of all cases. The literature review revealed only one case of adenosarcoma and 37 cases of leiomyosarcoma. RMS of the fallopian tube may occur as a component of a heterologous malignant mixed mullerian tumor (heterologous carcinosarcoma), or as a heterologous component of a mullerian adenosarcoma, or an immature teratoma. RMSs arising from adjacent organs have never been reported to involve the fallopian tubes. Pure tubal RMS has been reported in only three cases, of which histologically one was embryonal and two pleomorphic types.
ARMS is characterized by distinctive cytogenetic abnormalities that allow its distinction from other RMS subtypes, as well as other round cell tumors. Most of the tumors have a t(2;13) (q35;q14) translocation which results in the generation of two derivative chromosomes: A shortened chromosome 13 and an elongated chromosome 2. The breakpoints occur within the PAX3 gene on chromosome 2 and the FKHR gene (also termed FOXO1a) on chromosome 13, and an FKHR-PAX3 fusion gene on chromosome 2. Both these genes encode transcription factors that regulate the expression of specific target genes. The PAX-FKHR fusion appears to be more sensitive and specific than the FKHR-PAX3 fusion in determining this tumor.
Adult RMS although rare, are more likely to have a faster growth rate and tend to occur in sites that are difficult to treat. Histologic subtype has been found to be an important independent prognostic factor besides the primary site, clinical group, and tumor size. Studies have shown that the 5-year survival rates for botryoid and spindle cell subtypes of ERMS are superior (95% and 88%); respectively; classic embryoral RMS has an intermediate prognosis (66%); and the alveolar subtype has a poor prognosis, with a 54% survival rate.
As compared to epithelial ovarian cancers, fallopian tube carcinomas show a higher rate of retroperitoneal and distant metastases. Para-aortic lymph node metastases have been detected in 33% of patients while 6.4% cases have been reported to develop brain metastases. Surgical removal is the first line of treatment with special focus placed on para-aortic and pelvic lymphadenectomy keeping in view the higher rate of lymph node metastases.
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