Hamra Imen, Halouani Ahmed, Sebri Hajer, Triki Amel, Ben Amor Anissa
Department of Obstetrics and Gynecology, Mongi Slim University Hospital, La Marsa, Tunis, Tunisia.
Int J Surg Case Rep. 2024 Jul;120:109796. doi: 10.1016/j.ijscr.2024.109796. Epub 2024 May 23.
Fallopian tube cancer is a rare tumor, representing between 0.3 and 1.8 % of all malignant tumors in the gynecological sphere. Due to the proximity of the uterus and ovary, the diagnosis of primary fallopian tube cancer is very difficult to establish and relies on very strict criteria. The endometrioid form is exceptional and of controversial etiopathogenesis. Only a few cases have been previously reported. Diagnosis most often occurs incidentally during histological examination. This case presents a distinctive aspect with the rare occurrence of endometrioid-type fallopian tube cancer, notably associated with endometriosis, and initially misdiagnosed as an infected endometrioma. It underscores the diagnostic complexities encountered in identifying primary fallopian tube cancer.
We present the case of a 49-year-old patient, followed for chronic pelvic pain associated with menorrhagia. Imaging revealed a myomatous and adenomyotic uterus, a right ovarian endometrioma, and a left multicystic ovarian formation with thick walls, measuring 135 mm, requiring histological verification. She underwent an exploratory laparotomy. During the procedure, extensive retro- and supravaginal adhesive tissue involving the uterus, both adnexa, and the digestive tract was found. Careful adhesiolysis was performed. The left adnexa harbored a formation suggestive of an infected endometrioma. A total hysterectomy with bilateral adnexectomy and peritoneal washing was performed. The postoperative course was uneventful. Histopathological examination revealed an endometrioid carcinoma of the left fallopian tube, classified as pT1a according to FIGO guidelines.
Tubal cancer is a rare cancer of unknown etiology, underestimated, and sometimes confused with ovarian pathology. Preoperative diagnosis is difficult because the clinical presentation is polymorphic and imaging is nonspecific. The endometrioid form is exceptional and of controversial etiopathogenesis. Treatment mirrors that of malignant epithelial ovarian tumors, with prognosis depending on FIGO stage and histological type.
Due to its unpredictable nature, fallopian tube cancer should not be overlooked as a differential diagnosis for any adnexal mass.
输卵管癌是一种罕见肿瘤，占妇科所有恶性肿瘤的0.3%至1.8%。由于子宫和卵巢位置相邻，原发性输卵管癌的诊断很难确立，且依赖非常严格的标准。子宫内膜样型极为罕见，其病因发病机制存在争议。此前仅有少数病例报道。诊断大多在组织学检查时偶然发现。本病例呈现出独特之处，即罕见的子宫内膜样型输卵管癌，尤其与子宫内膜异位症相关，最初被误诊为感染性子宫内膜瘤。它凸显了原发性输卵管癌诊断中遇到的复杂性。
我们报告一例49岁患者，因慢性盆腔疼痛伴月经过多前来就诊。影像学检查显示子宫存在肌瘤和腺肌病，右侧卵巢有一个子宫内膜瘤，左侧有一个壁厚135毫米的多囊卵巢结构，需要进行组织学验证。她接受了剖腹探查术。术中发现广泛的阴道后和阴道上粘连组织，累及子宫、双侧附件和消化道。进行了仔细的粘连松解术。左侧附件有一个疑似感染性子宫内膜瘤的结构。实施了全子宫切除加双侧附件切除及腹腔冲洗术。术后病程顺利。组织病理学检查显示左侧输卵管为子宫内膜样癌，根据国际妇产科联盟（FIGO）指南分类为pT1a。
输卵管癌是一种病因不明的罕见癌症，常被低估，有时与卵巢病变混淆。术前诊断困难，因为临床表现多样，影像学检查不具特异性。子宫内膜样型极为罕见，其病因发病机制存在争议。治疗与恶性上皮性卵巢肿瘤相似，预后取决于FIGO分期和组织学类型。
由于其不可预测性，输卵管癌作为任何附件包块的鉴别诊断不应被忽视。
