Malignant Lesions of the Fallopian Tube and Broad Ligament

Updated: Jan 14, 2015
  • Author: Hetal B Gor, MD, FACOG; Chief Editor: Warner K Huh, MD  more...
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Overview

Background

In 1847, Renaud first described fallopian tube malignancy. In 1888, Orthmann submitted the first genuine case report. [1]

The broad ligament is a double fold of peritoneum, which is formed by the reflection of the peritoneum off the pelvic floor and the lateral pelvic wall. Most tumors are benign cysts, but malignant tumors are categorized as either primary or secondary.

Primary malignancies of the broad ligament include those of müllerian origin (ie, serous carcinoma, papillary carcinoma, cystadenocarcinoma, endometrioid carcinoma, clear cell carcinoma), urothelium transitional cell carcinoma, mesenchymal sarcoma or histiocytoma, and pheochromocytoma. Some researchers suggest that some primary fallopian tube cancers are misdiagnosed as primary ovarian cancers; however, an experienced pathologist can help to differentiate that.

Secondary malignancies of the broad ligament include metastatic cancers from endometrial, cervical, and ovarian carcinoma.

A primary malignancy is diagnosed based on its location within or on the surface of the broad ligament and by virtue of the complete separation of the tumor from the uterus and ovaries.

See also Fallopian Tube Disorders and Broad Ligament Disorders.

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Pathophysiology

Fallopian tube malignancy usually starts as a dysplasia or carcinoma in situ. Typically, transition to adenocarcinoma is observed.

Gilks et al indicate that most cases of incidental nonuterine high-grade carcinomas (HGSCs) arise in the fallopian tube fimbria. [2] In their report, 16 of 21 cases that were incidental microscopic, non-mass-forming serous tubal intraepithelial carcinoma or HGSCs had lesions confined to the fallopian tube (unilateral, 14 cases; bilateral, 2 cases). All 16 had serous tubal intraepithelial carcinoma, and 8 of 16 had invasive HGSC into the underlying lamina propria. In 5 of 21 cases, fallopian tube mucosal and ovarian involvement was found, including 2 cases that also had microscopic peritoneal involvement. [2]

The etiology of malignancies of the broad ligament is unknown, although they are associated with endometriosis.

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Epidemiology

Frequency

United States

Fallopian tube carcinomas comprise 1% of all gynecologic cancers. The average annual incidence is 3.6 cases per million women.

Mortality/Morbidity

On average, the 5-year survival rate is 51%; the rate for stage I disease is 65%, stage II disease is 50-60%, and stage III and stage IV disease is 10-20%.

Race

These lesions are more common in whites.

Age

Incidence increases with age but peaks at 60-66 years.

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