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Fallopian Tube Carcinoma | Radiology Key

Fallopian Tube Carcinoma



Fallopian Tube Carcinoma


Akram M. Shaaban, MBBCh






































































































(T) Primary Tumor


Adapted from 7th edition AJCC Staging Forms.


TNM


FIGO


Definitions


TX


Primary tumor cannot be assessed


T0


No evidence of primary tumor


Tis1


0


Carcinoma in situ (limited to tubal mucosa)


T1


I


Tumor limited to the fallopian tube(s)



T1a


IA


Tumor limited to 1 tube, without penetrating the serosal surface; no ascites



T1b


IB


Tumor limited to both tubes, without penetrating the serosal surface; no ascites



T1c


IC


Tumor limited to 1 or both tubes with extension onto or through the tubal serosa, or
with malignant cells in ascites or peritoneal washings


T2


II


Tumor involves 1 or both fallopian tubes with pelvic extension



T2a


IIA


Extension &/or metastasis of uterus &/or ovaries



T2b


IIB


Extension to other pelvic structures



T2c


IIC


Pelvic extension with malignant cells in ascites or peritoneal washings


T3


III


Tumor involves 1 or both fallopian tubes, with peritoneal implants outside the pelvis



T3a


IIIA


Microscopic peritoneal metastasis outside the pelvis



T3b


IIIB


Macroscopic peritoneal metastasis outside the pelvis ≤ 2 cm in greatest dimension



T3c


IIIC


Peritoneal metastasis > 2 cm in diameter


(N) Regional Lymph Nodes


NX


Regional lymph nodes cannot be assessed


N0


No regional lymph node metastasis


N1


IIIC


Regional lymph node metastasis


(M) Distant Metastasis


M0


No distant metastasis


M1


IV


Distant metastasis


1 FIGO no longer includes stage 0 (Tis). Note: Liver capsule metastasis is T3/stage III; liver parenchymal metastasis is M1/stage IV; pleural effusion must have positive cytology for M1/stage IV.








































































AJCC Stages/Prognostic Groups


Adapted from 7th edition AJCC Staging Forms.


Stage


T


N


M


0


Tis


N0


M0


IA


T1a


N0


M0


IB


T1b


N0


M0


IC


T1c


N0


M0


IIA


T2a


N0


M0


IIB


T2b


N0


M0


IIC


T2c


N0


M0


IIIA


T3a


N0


M0


IIIB


T3b


N0


M0


IIIC


T3c


N0


M0



Any T


N1


M0


IV


Any T


Any N


M1








Low-power magnification of H&E stained full section of carcinoma in situ and fallopian tube shows the lumen lined by endosalpingeal epithelial cells forming papillae image. (Original magnification 20x.)






High-power magnification of the epithelial cells with carcinoma in situ shows loss of polarity with papillary formation image that lack stromal cores. Note the cellular atypia of the lining cells and the mitotic figure image. The basement membrane is intact. (Original magnification 400x.)






Low-power magnification shows tumor limited to the fallopian tube (T1a). H&E stain shows tumor cells within the wall of the fallopian tube. The left side clear space represents the luminal aspect of the fallopian tube with the lining epithelium. The tumor image is limited to the wall of the fallopian tube. (Original magnification 40x.)






Intermediate-power magnification depicts a close-up on the sheets of tumor cells image that do not extend to the serosal aspect (inked black, top) of the tube. (Original magnification 100x.)







H&E stain from the wall of a fallopian tube demonstrates tumor image invading through the wall of the tube. Note the surface epithelium on the luminal side image. (Original magnification 100x.)






H&E section of tumor with pelvic extension to the surface of the ovary (T2a) displays tumor nodules image visible on the surface of the ovary image. (Original magnification 40x.)






Intermediate-power magnification shows tumor nodule image on the surface of the ovary. Note the stroma composed of whorls of plump spindle cells of fibroblastic type that is characteristic of the ovary image. (Original magnification 100x.)






H&E stain demonstrates peritoneal tumor implants outside the pelvis (T3). (Original magnification 400x.)







Graphic of the uterus as viewed from above shows T1a disease: Tumor is limited to 1 fallopian tube image, without penetrating the serosal surface, and there is no ascites.






Graphic of the uterus as viewed from above shows T1b disease: Tumor is limited to both fallopian tubes image, without penetrating the serosal surface, and there is no ascites.






Two graphics of the uterus as viewed from above show T1c disease: Tumor is limited to 1 or both fallopian tubes, with extension onto or through the tubal serosa image, shown on the left, and with malignant cells in ascites or peritoneal washings on the right.






Graphic of the uterus as viewed from above shows T2a disease: Tumor involving 1 or both fallopian tubes image, with pelvic extension to the uterus image &/or ovaries image.







Graphic of the uterus as viewed from above shows T2b disease: Tumor involving 1 or both fallopian tubes with extension to pelvic organs other than the uterus and ovaries. Shown here is extension to the rectum image.






Graphic of the uterus as viewed from above shows T2c disease: Pelvic extension with malignant cells in ascites or peritoneal washings.






T3a tumors involve microscopic peritoneal metastases beyond the pelvis. These cannot be visualized by imaging; rather, they are found through peritoneal biopsy at staging laparotomy.






T3b tumors feature macroscopic peritoneal metastases beyond the pelvis that are less than or equal to 2 cm in greatest dimension.







T3c tumors involve macroscopic peritoneal metastases beyond the pelvis larger than 2 cm in greatest dimension.






Fallopian tube lymphatics follow the ovarian veins to the paraaortic lymph nodes image. Lymphatic spread may also occur through the broad ligament to the pelvic lymph nodes image and along the round ligament to the inguinal lymph nodes image.
























image


METASTASES, ORGAN FREQUENCY


Liver


20.5%


Pleura


18%


Vagina


15.5%


Lung


13%


Bones


2.6%


Brain


2.6%




OVERVIEW


Classification



  • Histological types of primary fallopian tube carcinoma (PFTC) include



    • Papillary serous carcinoma (49.5-83.3%)


    • Endometrioid (8.3-50%)


    • Mixed (3.9-16.7%)


    • Clear cell (1.9%)


    • Transitional (11.7%)


PATHOLOGY


Routes of Spread



  • Pattern of spread is similar to ovarian carcinoma


  • Peritoneal spread



    • In approximately 80% of patients with advanced disease, metastases are confined to peritoneal cavity


  • Lymphatic spread



    • Lymphatic drainage of PFTC mirrors that of uterine fundus and ovaries



      • Along ovarian vessels → paraaortic nodes


      • Along broad ligament → pelvic nodes


      • Along round ligament of uterus → superficial inguinal nodes


    • Early lymphatic metastases are common



      • Incidence of positive nodes is 40-60% when there is extratubal tumor spread


  • Hematogenous spread



    • Can occur to liver, pleura, vagina, lungs, and brain


  • Transluminal spread



    • Spread to proximal part of fallopian tube and uterus


General Features



  • Genetics



    • PFTC has been described in high-risk breast-ovarian cancer families with germ-line BRCA1 and BRCA2 mutations



      • BRCA mutations were noted in 16% of invasive PFTC patients


      • Occult PFTC found in 5.6% of BRCA patients who underwent prophylactic risk-reducing salpingo-oophorectomy


      • 44% of occult malignancies found in prophylactic oophorectomy specimens are of tubal origin


      • Increasing evidence that tubal fimbriae may be preferred site of origin of adnexal cancer in carriers of BRCA gene mutations


  • Etiology



    • Etiology of PFTC is unknown



      • Hormonal, reproductive, and possibly genetic factors thought to ↑ epithelial ovarian tumors risk might also ↑ PFTC risk


      • 25-30% of cases in nulliparous women


      • 5x higher bilateral occurrence in infertile patients than in fertile patients


      • No statistically significant correlation between PFTC and age, race, weight, education level, pelvic inflammatory disease, infertility, previous hysterectomy, endometriosis, lactose intolerance, or smoking


      • Better prognosis in nulliparous women


      • High parity may be protective


      • Pregnancy and use of oral contraceptives ↓ risk significantly


  • Epidemiology & cancer incidence



    • Least common of gynecological malignancies



      • Accounts for approximately 0.3-1.8% of female genital malignancies


      • Annual incidence is 3.6-4.1 per 1,000,000 women


      • True incidence may be underestimated because of difficulty in differentiating PFTC from epithelial ovarian carcinoma, especially in advanced cases


    • In 1 series, 35% of women with PFTC had history of breast cancer


    • Most frequently occurs between 4th and 6th decades of life



      • Median age of occurrence of 55 years (range: 17-88 years)


    • Bilateral tumors reported in 10-27% of cases


  • Associated diseases, abnormalities



    • CA-125 is useful tumor marker for diagnosis, assessment of response to treatment, and detection of tumor recurrence during follow-up



      • > 80% of patients have elevated pretreatment serum CA-125 levels


      • Pretreatment serum CA-125 level is independent prognostic factor of disease-free survival and overall survival


      • Lead time (↑ CA-125 levels prior to clinical or radiological diagnosis of recurrence) is 3 months (range: 0.5-7 months)


Gross Pathology & Surgical Features

Sep 18, 2016 | Posted by in OBSTETRICS & GYNAECOLOGY IMAGING | Comments Off on Fallopian Tube Carcinoma
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