eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Oncology

Malignant Lesions of the Fallopian Tube and Broad Ligament

Author: John Paulson, MD, Professor of Clinical Obstetrics/Gynecology, Eastern Virginia Medical School; Clinical Professor of Obstetrics/Gynecology, Medical College of Virginia; Associate Director, Residency Program, Riverside Health System
Coauthor(s): Hetal B Gor, MD, FACOG, Consulting Staff, Private Practice, Bergen County, New Jersey
Contributor Information and Disclosures

Updated: Oct 9, 2008

Introduction

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.

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 eMedicine articles Fallopian Tube Disorders and Broad Ligament Disorders.

Pathophysiology

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

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

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%.

Age

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

Clinical

History

  • Malignant lesions of the fallopian tube
    • Patients may present with pelvic pain, a pelvic mass, postmenopausal bleeding, and serosanguineous vaginal discharge.
    • The classic description of hydrops tubae profluens, which is characterized by colicky lower abdominal pain relieved by a profuse, serous, watery, yellow, intermittent, vaginal discharge, usually is not found.
  • Malignant lesions of the broad ligament
    • A clinical history of vague abdominal pain may be present. Upon examination or with abdominal exploration, an adnexal mass is found.
    • Rarely, it can manifest as an acute abdominal emergency, simulating appendicitis.

Physical

  • Physical examination findings are not specific; a pelvic mass usually is present, with or without ascites.
  • Diagnostic criteria include the following:
    • Grossly, the main tumor should be in the fallopian tube.
    • Histologically, the tubal mucosa should be involved, with a papillary pattern.
    • The tubal wall, if involved, and a transition from benign to malignant tubal epithelium should be identified.
    • The lesion is a more advanced stage of tubal tumor than the other tumors.

Causes

  • The exact etiology is unknown.
    • Infertility and chronic salpingitis were believed to lead to an increase in incidence, but this theory has not been proven. However, malignancy has been associated with tuberculous salpingitis.
    • Similar to ovarian malignancy, a BRCA germline mutation and TP53 mutation are associated with fallopian tube malignancy.

More on Malignant Lesions of the Fallopian Tube and Broad Ligament

Overview: Malignant Lesions of the Fallopian Tube and Broad Ligament
Differential Diagnoses & Workup: Malignant Lesions of the Fallopian Tube and Broad Ligament
Treatment & Medication: Malignant Lesions of the Fallopian Tube and Broad Ligament
Follow-up: Malignant Lesions of the Fallopian Tube and Broad Ligament
References
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References

  1. Orthmann EG. Primareskarzinom in Einertuberkulosen. Ztschr Geburtsh Gynaek. 1888;15:212.

  2. Kalir T, Rahaman J, Hagopian G, Demopoulos R, Cohen C, Burstein DE. Immunohistochemical detection of glucose transporter GLUT1 in benign and malignant fallopian tube epithelia, with comparison to ovarian carcinomas. Arch Pathol Lab Med. May 2005;129(5):651-4. [Medline].

  3. Alvarado-Cabrero I, Young RH, Vamvakas EC. Carcinoma of the fallopian tube: a clinicopathological study of 105 cases with observations on staging and prognostic factors. Gynecol Oncol. Mar 1999;72(3):367-79. [Medline].

  4. Aslani M, Scully RE. Primary carcinoma of the broad ligament. Report of four cases and review of the literature. Cancer. Oct 1 1989;64(7):1540-5. [Medline].

  5. Ben-Hur H, Dgani R, Ben-Arie A. Diagnostic dilemmas and current therapy of Fallopian tube cancer. Eur J Gynaecol Oncol. 1999;20(2):108-9. [Medline].

  6. Berek J, Hacker N, eds. Practical Gynecologic Oncology. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2000:546.

  7. Danforth DN, Scott JR. Diseases of the ovary and fallopian tubes. In: Danforth DN, Scott JR, Di Saia PJ, Hammond CB, Spellacy WN, eds. Danforth's Obstetrics & Gynecology. 8th ed. Philadelphia, Pa: Lippincott Raven; 1999:889.

  8. Dieste MC, Lynch GR, Gordon A. Malignant fibrous histiocytoma of the broad ligament: a case report and literature review. Gynecol Oncol. Oct 1987;28(2):225-9. [Medline].

  9. Disaia PJ, Creasman WT. Fallopian tube cancer. In: Creasman WT, Doherty M, Disaia PJ, Dinh TV, Hannigan EV, eds. Clinical Gynecologic Oncology. 5th ed. St. Louis, Mo: Mosby-Year Book; 1997:375-80.

  10. Dunton CJ, Neufeld J. Complete response to topotecan of recurrent fallopian tube carcinoma. Gynecol Oncol. Jan 2000;76(1):128-9. [Medline].

  11. Fedele L, Cittadini E, Bortolozzi G. Successful in vitro fertilization and embryo transfer after limited surgical treatment for tubal adenocarcinoma. Cancer. Oct 1 1989;64(7):1546-7. [Medline].

  12. Kurjak A, Kupesic S, Jacobs I. Preoperative diagnosis of the primary fallopian tube carcinoma by three- dimensional static and power Doppler sonography. Ultrasound Obstet Gynecol. Mar 2000;15(3):246-51. [Medline].

  13. Latner AL, Turner GA. Effect of aprotinin on immunological resistance in tumour-bearing animals. Br J Cancer. May 1976;33(5):535-8. [Medline].

  14. Loverro G, Cormio G, Renzulli G. Serous papillary cystadenoma of borderline malignancy of the broad ligament. Eur J Obstet Gynecol Reprod Biol. Aug 1997;74(2):211-3. [Medline].

  15. Navani SS, Alvarado-Cabrero I, Young RH. Endometrioid carcinoma of the fallopian tube: a clinicopathologic analysis of 26 cases. Gynecol Oncol. Dec 1996;63(3):371-8. [Medline].

  16. Ricci JV. One Hundred Years of Gynecology. Philadelphia, Pa: Blackiston; 1945.

  17. Rose PG, Shrigley R, Wiesner GL. Germline BRCA2 mutation in a patient with fallopian tube carcinoma: a case report. Gynecol Oncol. May 2000;77(2):319-20. [Medline].

  18. Rosen AC, Ausch C, Hafner E. A 15-year overview of management and prognosis in primary fallopian tube carcinoma. Austrian Cooperative Study Group for Fallopian Tube Carcinoma. Eur J Cancer. Oct 1998;34(11):1725-9. [Medline].

  19. Rosen AC, Ausch C, Klein M. p53 expression in fallopian tube carcinomas. Cancer Lett. Aug 1 2000;156(1):1-7. [Medline].

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Further Reading

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Keywords

malignant lesions of the fallopian tube and broad ligament, fallopian tube malignancy, fallopian tube cancer, fallopian tube carcinoma, broad ligament malignancy, broad ligament cancer, gynecologic cancer, dysplasia, carcinoma in situ, CIS, endometriosis

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Contributor Information and Disclosures

Author

John Paulson, MD, Professor of Clinical Obstetrics/Gynecology, Eastern Virginia Medical School; Clinical Professor of Obstetrics/Gynecology, Medical College of Virginia; Associate Director, Residency Program, Riverside Health System
John Paulson, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and International College of Surgeons US Section
Disclosure: Nothing to disclose.

Coauthor(s)

Hetal B Gor, MD, FACOG, Consulting Staff, Private Practice, Bergen County, New Jersey
Hetal B Gor, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Karen Loeb Lifford, MD, Director of General Gynecology, Associate Program Director, Department of Obstetrics and Gynecology, Instructor, Brigham and Women's Hospital, Harvard Medical School
Karen Loeb Lifford, MD is a member of the following medical societies: Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michel E Rivlin, MD, Professor, Coordinator, Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator, Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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