Primary fallopian tube carcinoma: a case report of rare disease

Background: Primary fallopian tube carcinoma is considered one of the rarest cancers of the female reproductive system. Recent data indicate that most high-grade serous ovarian cancers arise from the ciliary ends of the fallopian tubes. Primary fallopian tube carcinoma has similar characteristics to ovarian cancer, including a typical course of metastasis in peritoneal, pelvic and para-aortic lymph nodes. Preoperative diagnosis of primary fallopian tube cancer is rare. Clinical signs and symptoms are non specific. Because of this, early radiological diagnosis is a relevant diagnostic problem. Often, as in our patient, the disease is asymptomatic and diagnosis is made postoperatively in women undergoing surgery. Histological examination of surgical specimens provides a definitive diagnosis. Case report: Our case concerns a 73-year-old patient presenting for a routine gynecological examination. The patient is followed up by gynecologists after endometrial polyp removal surgery. Her personal medical history reports chronic gastritis. Menopause started when she was 55. During transvaginal ultrasound, a 5.8x3.5x5.4 cm solid formation is detected near the right ovary with intense blood flow and free fluid nearby. MRI is then ordered to investigate this issue. On MRI images the mass had heterogeneous contrast enhancement on postcontrast MRI and restricted diffusion on DWI, giving it the appearance of a fallopian tube tumor. Total hysterectomy, omentectomy, removal of ileocecal and para-aortic lymph nodes, and peritoneum biopsy were performed. Postoperatively, histological examination of the surgical specimens confirmed high-grade serous carcinoma of the fallopian tube. After surgery, she was referred to an oncology center and placed under medical supervision. The patient received six cycles of chemotherapy with carboplatin and paclitaxel. CT images after chemotherapy revealed no enlarged lymph nodes, suspicious masses, or cancer recurrence. Discussions and conclusion: Primary fallopian tube cancer is a challenge. A current diagnostic issue is early radiological diagnosis. Complete surgical resection of the disease, including pelvic lymphadenectomy, followed by adequate cycles of postoperative chemotherapy is an important strategy to improve the prognosis of patients.