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Primary choriocarcinoma of the Fallopian tube
International Journal of Gynecology and Obstetrics 79 (2002) 37–38
Brief communication
Primary choriocarcinoma of the Fallopian tube N. Vimala, S. Kumar*, V. Dadhwal Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India Received 30 January 2002; received in revised form 14 May 2002; accepted 15 May 2002 Keywords: Fallopian tube; Choriocarcinoma; Chemotherapy
Carcinoma of the Fallopian tube is a rare genital malignancy accounting for 0.3–1.1% of all gynecological cancers w1x. Primary choriocarcinoma of the Fallopian tube is even rarer; as of 1981, only 100 cases had been reported in the world literature w2x. We report a case of primary choriocarcinoma of the Fallopian tube treated successfully with surgery and methotrexate chemotherapy. A 28-year-old woman, para 1, presented to us with a history of 2 months’ irregular vaginal bleeding. Before this she had amenorrhea for 6 weeks but her previous cycles were regular. Her general physical examination was normal. A pelvic examination revealed a uterus of normal size with a non-tender right adnexal mass. Sonography showed a mixed echogenic mass in the right adnexa and free fluid in the cul-de-sac. Her urine pregnancy test was positive and her serum beta human chorionic gonadotropin (hCG) levels were 100 000 mIUyml. Clinically, a diagnosis of ectopic pregnancy was made and laparotomy was undertaken immediately. There were 200 ml of blood in the peritoneal cavity and a solid mass of 8=8 cm was found in the ampullary portion of right Fallopian tube. The uterus, the left fallopian tube, and both ovaries appeared normal. A right salpingectomy was performed. The postoperative course *Corresponding author. Fax: q91-11-686-2663. E-mail address: [email protected] (S. Kumar).
was uneventful and the patient was discharged from the hospital 48 h after surgery. Histopathological examination of the salpingectomy specimen revealed an invasion of the myosalpinx by syncytial and cytotrophoblastic cells without evidence of villous formation. Hence, a diagnosis of primary choriocarcinoma of Fallopian tube was made (Fig. 1). Chemotherapy was planned but patient was then lost to follow-up. She reported three months later with persisting amenorrhea following surgery. On clinical examination an irregular mass arising from the pelvis was felt in the left iliac fossa. Ultrasound examination revealed a mixed echogenic mass of 12=12 cm in the cul-de-sac, along with bilateral ovarian cysts measuring 5=5 cm. Serum hCG levels were 622440 mIUyml. She was administered single-agent chemotherapy using methotrexate 1 mgykg intravenously on days 1, 3, 5 and 7 alternating with folinic acid 0.1 mgykg intramuscularly on days 2, 4, 6 and 8 of the cycle. The chemotherapy cycle was repeated every 2 weeks. She received nine cycles of chemotherapy, following which a complete resolution of pelvic mass was achieved. Serum hCG levels measured at weekly intervals showed a declining trend after the second cycle and fell to 128 mIUyml after the ninth; hCG became negative 4 weeks after discontinuation of chemotherapy. The patient is presently
0020-7292/02/$ - see front matter 䊚 2002 International Federation of Gynecology and Obstetrics. Published by Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 0 2 0 - 7 2 9 2 Ž 0 2 . 0 0 1 4 5 - 5
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N. Vimala et al. / International Journal of Gynecology and Obstetrics 79 (2002) 37–38
Fig. 1. Cross-section of a Fallopian tube showing an invasive growth pattern in an early choriocarcinoma. Top: Sheets of trophoblasts are seen invading the muscularis.
regularly followed and in remission 18 months after treatment. Carcinoma of the Fallopian tube is a rare malignancy. Histologically, the majority of malignancies are adenocarcinomas; less commonly, endometroid carcinomas, transitional cell carcinomas, or fibrocarcinomas are encountered. Choriocacinoma of the Fallopian tube is extremely rare. In a review of 2100 cases of gestational trophoblastic disease
(GTD) at New England Trophoblastic Disease Centre, 16 patients (0.76%) with GTD affecting Fallopian tubes were identified w3x. At the time of initial presentation, symptoms are usually similar to those of an ectopic pregnancy, i.e. amenorrhea, vaginal bleeding, and vascular instability along with increased hCG titers. The diagnosis is usually made on histological examination of a surgically resected specimen. Chemotherapy using single or multiple drugs is required in most patients following surgical treatment. Serial hCG titers provide a useful guide for the number of required chemotherapy cycles and assessment of response to treatment. References w1x Nordin AJ. Primary carcinoma of the Fallopian tube, a 20-year literature review. Obstet Gynecol Surv 1994;49:349 –361. w2x Ober WB, Maier RC. Gestational choriocarcinoma of the Fallopian tube. Diagn Gynecol Obstet 1981;3:213. w3x Muto M, Lage JM, Berkowitz RS, Goldstein DP, Brenstein MR. Gestational trophoblastic disease of the Fallopian tube. J Reprod Med 1991;164:611 –616.
Brief communication
Primary choriocarcinoma of the Fallopian tube N. Vimala, S. Kumar*, V. Dadhwal Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India Received 30 January 2002; received in revised form 14 May 2002; accepted 15 May 2002 Keywords: Fallopian tube; Choriocarcinoma; Chemotherapy
Carcinoma of the Fallopian tube is a rare genital malignancy accounting for 0.3–1.1% of all gynecological cancers w1x. Primary choriocarcinoma of the Fallopian tube is even rarer; as of 1981, only 100 cases had been reported in the world literature w2x. We report a case of primary choriocarcinoma of the Fallopian tube treated successfully with surgery and methotrexate chemotherapy. A 28-year-old woman, para 1, presented to us with a history of 2 months’ irregular vaginal bleeding. Before this she had amenorrhea for 6 weeks but her previous cycles were regular. Her general physical examination was normal. A pelvic examination revealed a uterus of normal size with a non-tender right adnexal mass. Sonography showed a mixed echogenic mass in the right adnexa and free fluid in the cul-de-sac. Her urine pregnancy test was positive and her serum beta human chorionic gonadotropin (hCG) levels were 100 000 mIUyml. Clinically, a diagnosis of ectopic pregnancy was made and laparotomy was undertaken immediately. There were 200 ml of blood in the peritoneal cavity and a solid mass of 8=8 cm was found in the ampullary portion of right Fallopian tube. The uterus, the left fallopian tube, and both ovaries appeared normal. A right salpingectomy was performed. The postoperative course *Corresponding author. Fax: q91-11-686-2663. E-mail address: [email protected] (S. Kumar).
was uneventful and the patient was discharged from the hospital 48 h after surgery. Histopathological examination of the salpingectomy specimen revealed an invasion of the myosalpinx by syncytial and cytotrophoblastic cells without evidence of villous formation. Hence, a diagnosis of primary choriocarcinoma of Fallopian tube was made (Fig. 1). Chemotherapy was planned but patient was then lost to follow-up. She reported three months later with persisting amenorrhea following surgery. On clinical examination an irregular mass arising from the pelvis was felt in the left iliac fossa. Ultrasound examination revealed a mixed echogenic mass of 12=12 cm in the cul-de-sac, along with bilateral ovarian cysts measuring 5=5 cm. Serum hCG levels were 622440 mIUyml. She was administered single-agent chemotherapy using methotrexate 1 mgykg intravenously on days 1, 3, 5 and 7 alternating with folinic acid 0.1 mgykg intramuscularly on days 2, 4, 6 and 8 of the cycle. The chemotherapy cycle was repeated every 2 weeks. She received nine cycles of chemotherapy, following which a complete resolution of pelvic mass was achieved. Serum hCG levels measured at weekly intervals showed a declining trend after the second cycle and fell to 128 mIUyml after the ninth; hCG became negative 4 weeks after discontinuation of chemotherapy. The patient is presently
0020-7292/02/$ - see front matter 䊚 2002 International Federation of Gynecology and Obstetrics. Published by Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 0 2 0 - 7 2 9 2 Ž 0 2 . 0 0 1 4 5 - 5
38
N. Vimala et al. / International Journal of Gynecology and Obstetrics 79 (2002) 37–38
Fig. 1. Cross-section of a Fallopian tube showing an invasive growth pattern in an early choriocarcinoma. Top: Sheets of trophoblasts are seen invading the muscularis.
regularly followed and in remission 18 months after treatment. Carcinoma of the Fallopian tube is a rare malignancy. Histologically, the majority of malignancies are adenocarcinomas; less commonly, endometroid carcinomas, transitional cell carcinomas, or fibrocarcinomas are encountered. Choriocacinoma of the Fallopian tube is extremely rare. In a review of 2100 cases of gestational trophoblastic disease
(GTD) at New England Trophoblastic Disease Centre, 16 patients (0.76%) with GTD affecting Fallopian tubes were identified w3x. At the time of initial presentation, symptoms are usually similar to those of an ectopic pregnancy, i.e. amenorrhea, vaginal bleeding, and vascular instability along with increased hCG titers. The diagnosis is usually made on histological examination of a surgically resected specimen. Chemotherapy using single or multiple drugs is required in most patients following surgical treatment. Serial hCG titers provide a useful guide for the number of required chemotherapy cycles and assessment of response to treatment. References w1x Nordin AJ. Primary carcinoma of the Fallopian tube, a 20-year literature review. Obstet Gynecol Surv 1994;49:349 –361. w2x Ober WB, Maier RC. Gestational choriocarcinoma of the Fallopian tube. Diagn Gynecol Obstet 1981;3:213. w3x Muto M, Lage JM, Berkowitz RS, Goldstein DP, Brenstein MR. Gestational trophoblastic disease of the Fallopian tube. J Reprod Med 1991;164:611 –616.