Primary High-Grade Serous Carcinoma of the Fallopian Tube Initially Misdiagnosed as Ovarian Carcinoma: A Case Report |Chapter 9| Medical Science: Recent Advances and Applications Vol. 11

 

Background: Historically, primary fallopian tube carcinoma has been reported to constitute only about 0.3% of all female genital tract malignancies. However, literature suggests that its actual incidence may be higher, as many cases are often classified as ovarian cancer. Preoperative diagnosis is difficult and challenging due to the absence of specific symptoms. Clinically, fallopian tube carcinoma resembles epithelial ovarian cancer, and histologically, it is also similar; hence, its evaluation and treatment are essentially the same.

 

Objective: As primary fallopian tube carcinoma (PFTC) is a rare gynecologic malignancy that poses a diagnostic dilemma and is often misdiagnosed as ovarian carcinoma, we report a case of primary high-grade serous adenocarcinoma of the fallopian tube. This case highlights its role in the differential diagnosis of adnexal masses and emphasizing the diagnostic challenges and the importance of intraoperative evaluation, appropriate treatment and follow-up.

 

Case Summary: A 48-year-old woman presented with watery vaginal discharge, and on bimanual examination, a firm, non-tender mass in the left fornix measuring 6 × 6 cm separately from the uterus. Radiological imaging suggested an ovarian tumour, and serum CA-125 was markedly elevated at 2586 U/ml. The patient underwent staging laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, and pelvic as well as para-aortic lymphadenectomy. Intraoperatively, a solid, polypoidal growth measuring 5 × 5 × 7 cm was identified arising from the fimbrial end of the left fallopian tube. Approximately 100 ml of hemorrhagic peritoneal fluid was noted in the pelvis,  and two para-aortic lymph nodes were enlarged, measuring up to 1.5 × 1 cm. Histopathological examination confirmed a poorly differentiated serous adenocarcinoma of the left fallopian tube, classified as histologic grade III and nuclear grade II, and staged as pathological stage IC2.

 

Outcome: Postoperatively, the patient received adjuvant chemotherapy with paclitaxel and carboplatin. She was monitored regularly over five years with physical examinations, CA-125 testing, and imaging studies, during which no symptoms or signs of recurrence were observed.

 

 

Author(s) Details

Gayam S.
Department of Obstetrics and Gynaecology, Vijay Marie Hospital, Hyderabad, India.

 

Babu C.
Department of Surgical Oncology, Apollo Hospital, Hyderabad, India.

 

V.V.S. L.
Department of Obstetrics and Gynaecology, Vijay Marie Hospital, Hyderabad, India.

 

Maddali S.
Histopathology & Cytology Laboratory, Hyderabad, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/msraa/v11/6258

A Radiologist’s Analysis in Comparing the Diagnostic Efficacy of CT and MRI for Staging of Paediatric Renal Tumours— A Report from a Tertiary Care Hospital | Chapter 12 | Medical Research and Its Applications Vol. 3

 

Background and Objective: Approximately 7% of all paediatric malignant tumors are renal tumors [1]. Most of these are Wilms tumors or nephroblastomas. Less than 10% of primary renal neoplasms and less than 1% of all paediatric cancers are non-Wilms tumors, which include renal cell carcinoma (RCC), clear cell sarcoma, malignant rhabdoid tumour, malignant cystic nephroma, mesoblastic nephroma, and renal medullary carcinoma [2]. This is a very diverse set of malignancies, with each having a unique prognosis, treatment regimen, and relationship to genetic predispositions. In order to treat these uncommon tumors, diagnosis and staging is crucial. Even while every tumour exhibits unique radiologic characteristics, there is a significant amount of overlap. As a result, imaging like computed tomography and magnetic resonance imaging may be crucial for making the right diagnosis and prescribing the right course of action. However, the two modalities have different advantages and disadvantages in the staging of renal tumours. The objective of the study is to compare the diagnostic performance of CT and MRI for the local staging of paediatric renal tumours.

Materials and Methods: The study population was derived from our hospital Medical College Kolkata and Hospital. Baseline abdominal imaging was performed with both CT and MRI.A retrospective review was done with 50 renal tumour cases selected and planned for nephrectomy over a study period of one year from October 2022 to November 2023. Each case was evaluated for capsular penetration, lymph node metastasis, tumour thrombus, preoperative tumour rupture, and synchronous contralateral lesions. The surgical and pathological findings were the reference gold standard.

Results: The sensitivity of CT and MRI for detecting capsular penetration was 70% and 60%, respectively (P=0.73), while specificity was 84.3% and 84% (P=1.0). The sensitivity of CT and MRI for detecting lymph node metastasis was 80% and 53% (P=0.22), and specificity was 88% and 92% (P=1.0). Synchronous contralateral lesions were identified by CT in 5/12 cases and by MRI in 8/12 cases.

Conclusion: CT and MRI have similar diagnostic performance for detection of lymph node metastasis and capsular penetration. MRI was more accurate in detecting contralateral synchronous lesions. Hence either modality can be used for initial loco–regional staging of paediatric renal tumours.

 

Author(s)details:-

 

Debarpita Datta
Department of Radiodiagnosis, Medical College Kolkata and Hospital, Kolkata, India.

 

Debashis Dakshit
Department of Radiodiagnosis, Medical College Kolkata and Hospital, Kolkata, India.

 

Arup Maity
Department of Radiodiagnosis, Medical College Kolkata and Hospital, Kolkata, India.

 

Please See the book here :-  https://doi.org/10.9734/bpi/mria/v3/449