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Serous borderline tumor of the fallopian tube presented as hematosalpinx: a case report
© Krasevic et al; licensee BioMed Central Ltd. 2005
Received: 14 June 2005
Accepted: 07 October 2005
Published: 07 October 2005
Compared with their ovarian counterparts, serous borderline tumors of the fallopian tube are uncommon, with limited experience about their clinical behaviour. We present a case of serous borderline tumor of the fallopian tube with unusual presentation and summarise all the published cases to date.
A case of serous borderline tumor of the fallopian tube in a 34-year old patient is presented, incidentally found during routine gynecologic examination. At laparoscopy the tumor was unusualy presented as hematosalpinx and was treated by salpingectomy. Cell-cycle analysis of the tumor tissue revealed a diploid DNA content and a low S-phase fraction. There was no evidence of the disease during the follow-up period of 4.6 years.
The current case and review of the literature suggest salpingectomy as the optimal treatment for patients with serous borderline tumor of the fallopian tube.
Compared with their ovarian counterparts, serous borderline tumors (SBTs) of the fallopian tube are uncommon, with limited experience about their clinical behaviour.
Herein we report a case of SBT of the fallopian tube in a young woman that was unusualy presented as hematosalpinx during the laparoscopic operation.
A 34-year old multigravida was found to have right adnexal mass on her routine gynecologic examination. Her previous medical history was uneventfull and Pap smear was normal. Transvaginal ultrasonography identified a cystic mass adjacent to the right ovary. Serum CA 125 was 5.1 U/ml (reference range: < 35 U/ml). At laparoscopy a dilated fallopian tube with bluish discoloration was found. The contralateral fallopian tube, ovaries and uterus were unremarkable. Exploration of the abdomino-pelvic cavity revealed smooth and shiny peritoneal surphace. Obtained peritoneal and pelvic washing were negative. Fine needle aspiration of dilated part of the fallopian tube revealed a 4 ml of bloody content. Cytological findings were consistent with hematosalpinx. Right salpingectomy was performed without using endoscopic bag. The patient was followed up by means of ultrasonography and serum CA 125 for 4.6 years. During this period she had no evidence of the disease.
Serous borderline tumors of the fallopian tube: clinical and pathological features of 7 cases.
Case no. (reference no.)
lower-guadrant pain, coul-de-sac mass
4 cm, cystic with papillations
18 mo, WED
IF during an early pregnancy
2.5 cm, cystic with papillations
WED after unspecified time
borderline papillary serous tumor
abdominal pain, elevated CA 125
salpingo-oophorectomy, ovarian biopsy, partial omentectomy
protruding from the fimbria
6 cm, solid polipoid mass with cauliflower-like surface
6 yr, WED
borderline serous tumor
IF during an elective operation
1.7 cm, cystic with papillations
2.4 yr, well
serous tumor of low malignant potential
IF on routine gynecologic examination
13 cm, cystic with papillations
serous tumor of low malignant potential
lower quadrant pain
5 cm, cystic with papillations
7. (current case)
serous tumor of borderline malignancy
IF on routine gynecologic examination
4.4 cm, cystic with papillations
4.6 yr, WED
SBTs were treated exclusively by surgery, most of them by unilateral salpingectomy. Complete staging/restaging was performed only in one case , where except salpingo-oophorectomy, contralateral ovarian biopsy, partial omentectomy and appendectomy were performed. Peritoneal and pelvic washing were obtained and multiple pelvic lymph nodes were sampled. Ten months later, contralateral ovary due to adenofibroma was removed and peritoneal and pelvic washing were obtained. The patient was without evidence of the disease during the follow-up period of 6 years.
Seidman and Kurman  reviewed 97 reports that included 4,129 patients with ovarian SBTs. They concluded that surgical-pathological stage and type of extraovarian disease (invasive versus noninvasive implants) were the most powerful prognostic indicators for these tumors. Survival rate for stage I SBTs was almost 100 % (99.5 %). Survival for advanced stage SBTs with noninvasive and invasive implants were 95.3 % and 66 % respectively.
In order to predict the behaviour of the SBT in current case, similary to the ovarian tumors, DNA ploidy was determined. In our case the tumor was diploid with low S-phase fraction of 6.3 %. DNA ploidy was found to be important prognostic factor in 321 patients with ovarian borderline tumors (BTs) . Aneuploidy was associated with older age, more advanced disease and non-serous histologic type as well. However, although aneuploidy correlated with higher stage in a study of 42 ovarian BTs, ploidy/DNA index could not predict which borderline tumors would behave in a more aggressive fashion . Analysis of 49 advanced stage ovarian SBTs revealed no correlation between DNA content and frequency of tumor recurrence . No death occurred in a subset of patients with aneuploid tumors. The patients with aneuploid tumors were more likely to have received adjuvant chemotherapy, that could affect the results.
Four additional cases of BTs of the fallopian tube were reported. Three had mucinous type of epithelium [11–13] and one was endometrioid borderline tumour . The mean age of patients with mucinous borderline tumors (MBT) was 54 years. Presented symptoms included constipation  and pelvic mass [11, 13]. MBT was bilateral in one case . Two cases were associated with pseudomyxoma peritonei [11, 12]. Follow-up informations were not available in these cases.
The unique case of borderline endometrioid tumor was reported by Alvaredo-Cabrero et al in a serie of 20 cases of tumors of the fimbriated end of the fallopian tube . The tumor was borderline adenofibroma and contained large number of endometrioid-type glands with focal villoglandular pattern separated by a fibromatous stroma. No follow-up information was available.
In conclusion, confinement to the tube as well as normal DNA content of the tumor may indicate a benign clinical behaviour of the SBTs of fallopian tube, suggesting unilateral salpingectomy as the optimal treatment for these young patients. However, long term follow-up and more cases are needed to make definitive conclusions.
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