Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.
Int J Surg Pathol. 2023 Aug;31(5):646-650. doi: 10.1177/10668969221117980. Epub 2022 Aug 9.
Isolated metastases from non-gynecological cancers to the fallopian tube are rare. Recent literature suggests that mucosal alterations of the fallopian tube should be considered primary tubal lesions. This has led to a paradigm shift in the classification of ovarian tumors with studies proposing tubal origin for these tumors, and clinicians advocating distal salpingectomy to decrease rates of ovarian cancer. This is based on the theory that sole presence of tubal mucosal disease is evidence of tubal origin. We present two patients with isolated mucosal metastases to the fallopian tube from appendiceal tumors. Two 36- and 72-year-old women presented with adnexal masses. Both had a history of right hemicolectomy for low-grade appendiceal mucinous neoplasms. The tubes in both cases were distended with mucin. Microscopic examination showed multifocal low-grade mucinous epithelium with papillations and tufting, interspersed by normal tubal epithelium. The mucinous epithelium was diffusely positive for keratin 20 and CDX2, focally positive for keratin 7, and negative for ER and PAX8 in both cases. Ovaries showed acellular mucin pools. Based on morphology and immunohistochemical features, it is likely that these tumors are of primary appendiceal origin metastatic to fallopian tube mucosa. These cases are unique in that no other organs were involved by metastases raising the possibility of an in-situ lesion or benign tubal mucinous metaplasia. These cases bring up an important point that mucosal metastasis can occur and question the current practice of assigning primary origin of a tumor to the fallopian tube in the presence of "intraepithelial" tumor.
非妇科癌症引起的输卵管孤立转移较为罕见。最近的文献表明,输卵管黏膜改变应被视为原发性输卵管病变。这导致了卵巢肿瘤分类的范式转变,研究提出这些肿瘤的起源于输卵管,临床医生提倡行输卵管远段切除术以降低卵巢癌的发生率。这基于这样的理论,即仅存在输卵管黏膜疾病是输卵管起源的证据。我们报告了两例来源于阑尾肿瘤的输卵管黏膜孤立转移病例。两名患者分别为 36 岁和 72 岁女性,均因附件包块就诊。两人均有右半结肠切除术治疗低级别阑尾黏液性肿瘤的病史。两例输卵管均扩张,充满黏液。显微镜下检查显示,多处低级别黏液性上皮伴乳头和簇状结构,其间穿插正常输卵管上皮。黏液性上皮弥漫性 CK20 和 CDX2 阳性,局灶性 CK7 阳性,两例 ER 和 PAX8 均阴性。卵巢显示无细胞黏液池。基于形态学和免疫组织化学特征,这些肿瘤很可能是原发于阑尾的肿瘤,转移至输卵管黏膜。这些病例的独特之处在于没有其他器官受累转移,这提示可能存在原位病变或良性输卵管黏液性化生。这些病例提出了一个重要观点,即黏膜转移可能发生,并质疑在存在“上皮内”肿瘤的情况下将肿瘤的原发部位归为输卵管的现行做法。