Department of Pathology, University of Tokyo Hospital, Tokyo, Japan.
Int J Gynecol Pathol. 2010 May;29(3):273-7. doi: 10.1097/PGP.0b013e3181c30301.
Primary adenocarcinoma of the fallopian tube is an uncommon female genital tract tumor. In situ or minimally invasive tubal cancer often poses a diagnostic challenge because of the absence of specific clinical and radiological findings. Here, we report a rare case of bilateral microscopic fallopian tube cancer that initially presented with malignant findings in an endometrial cytologic smear. The patient was a 57-year-old postmenopausal woman. An endometrial smear performed during a routine checkup revealed clusters of malignant cells. During the clinical diagnosis of endometrial cancer, she underwent bilateral salpingo-oophorectomy, total hysterectomy, and partial omentectomy. Histologically, no carcinoma was found in the uterus or ovaries. In toto sectioning of the fallopian tubes and their fimbriated ends revealed minute foci of serous adenocarcinoma in the left tubal mucosa and right fimbria. In situ adenocarcinoma components were present in both lesions. Microinvasive carcinoma was observed in the right fimbria. Although there was no macroscopic dissemination in the peritoneum at the time of surgery, positive intraoperative peritoneal cytology suggests that the patient was at risk of developing peritoneal serous carcinoma if not treated. Clinicians and pathologists should consider the possibility of early tubal cancer when there is no clinically detectable pelvic mass, and malignant cells appear in endometrial cytology specimens.
原发性输卵管腺癌是一种罕见的女性生殖道肿瘤。原位或微侵袭性输卵管癌由于缺乏特定的临床和影像学表现，常常构成诊断挑战。在此，我们报告一例罕见的双侧输卵管微小癌病例，其最初在子宫内膜细胞学涂片上呈现恶性表现。患者为 57 岁绝经后女性。常规检查行子宫内膜涂片时发现成堆的恶性细胞。在子宫内膜癌的临床诊断过程中，她接受了双侧输卵管卵巢切除术、全子宫切除术和部分网膜切除术。组织学上，子宫或卵巢均未发现癌。输卵管及其伞端的全段切片显示左侧输卵管黏膜和右侧输卵管伞部有微小的浆液性腺癌灶。两个病变均存在原位腺癌成分。右侧输卵管伞部可见微浸润癌。尽管手术时腹膜无肉眼可见的播散，但术中腹膜细胞学阳性提示如果不治疗，患者有发生腹膜浆液性癌的风险。当临床上无法检测到盆腔肿块且子宫内膜细胞学标本出现恶性细胞时，临床医生和病理医生应考虑早期输卵管癌的可能性。
