Totally Laparoscopic Resection of Primary Fallopian Tube Adenocarcinoma

Guillermo Peralta, Denisse Lorena Sepúlveda, MD, Zanndor del Real-Romo, MD, Roberto Alatorre, MD, Jose Antonio Diaz-Elizondo, MD. Instituto Tecnologico de Estudios Superiores de Monterrey

Primary carcinoma of the fallopian tube is a rare disease that shares similar clinical and histological features of epithelial ovarian tumor. These tumors has an extremely low incidence of 0.3 to 1%, especially malignant tumors. Most cases are diagnosed in women over 50 years.

Female patient in the seventh decade of life, with abdominal pain of three months duration. She had history of hysterectomy, apparently secondary to uterine fibroids. The patient reported pain in the right iliac fossa and hypogastrium, stabbing, cramping without irradiation. USG reports mixed mass that appears to be composed of residual ovarian stroma, coupled with expansion of the tube and probable small follicles or ovarian cysts. Its outline is well defined with respect to the neighboring fat imaging appearance seems to correspond to a benign structure. CT was achieved suggesting right hydrosalpinx. CA -125 was increased. Laparoscopic lysis of adhesions and right salpiooforectomy was performed. Patology reported fallopian tube adenocarcinoma.

Orthmann described the first reported case in 1888 is considered to be a clinical triad of hydrosalpinx, pelvic pain and a pelvic mass. The clinical diagnosis is very difficult due to a higher index of suspicion of endometrial carcinoma in postmenopausal patients with vaginal bleeding. The finding of a complex or solid adnexal mass with worrisome features for malignancy usually require surgery for definitive histological diagnosis. The marker CA 125 is elevated in many patients. The treatment involves a combination of surgical excision and chemotherapy. The case presented here was challenge in the diagnosis and is one of the few cases reported in Latin America.

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