••• Chapter 47^ Fallopian Tube Neoplasms^465
❍ What tumor marker is useful in the follow-up of tubal serous carcinomas?
CA-125.
❍ What is the standard treatment of tubal carcinoma?
The standard method of treatment is similar to that used for ovarian cancer. Treatment of tubal carcinoma consists
of total abdominal hysterectomy, bilateral salpingo-oophorectomy, with comprehensive surgical staging if there is
no evidence of metastatic disease. Aggressive cytoreductive surgery, followed by chemotherapy, is performed for
advanced disease.
❍ What is the role of cytoreductive surgery?
Cytoreductive surgery has been demonstrated to have a beneficial effect in the treatment of fallopian tube
carcinomas in a similar fashion to that of ovarian malignancies. Patients with a residual tumor mass of <1 cm have
a significantly higher survival rate than do patients with larger residual tumors following primary surgery.
❍ What are the most effective chemotherapeutic agents against tubal carcinoma?
A combination of Taxol and a platinum-based chemotherapeutic agent is currently used.
❍ Name the two most common metastatic tumors that involve the fallopian tube.
Ovarian and endometrial carcinomas. Peritoneal spread often involves the serosal surface and lymphatic spread
from adjacent primary sites may involve the mucosa or muscularis.
❍ What are the histologic criteria often employed in the diagnosis of a primary tubal carcinoma?
(1) Grossly, the main bulk of tumor is confined to the fallopian tube and arises from the endosalpinx.
(2) Microscopically, the epithelium of the tubal mucosa is involved and shows a papillary pattern.
(3) A transition between benign and malignant tubal epithelium is identifiable.
(4) The ovaries and endometrium are either normal or contain less tumor than the tubes.
❍ A tubal lesion consisting primarily of trophoblastic proliferation in addition to hydropic villi represents
what type of fallopian tube tumor?
Ectopic molar pregnancy. Responsible for approximately 1 in 5000 ectopic pregnancies, they clinically present in
a similar fashion to other ectopic gestations, but histologically demonstrate the appearance of either a complete or
partial mole.
❍ Describe the methods of spread of tubal carcinomas.
Tubal carcinomas spread in much the same manner as epithelial ovarian malignancies with transcoelomic
exfoliation of cells that implant throughout the peritoneal cavity. Lymphovascular spread to the pelvic and
para-aortic nodes is also common.
❍ Although transcoelomic exfoliation was initially suggested as the primary mechanism of spread of tubal
carcinomas, why is this theory suspect?
Typically, the gross appearance of a fallopian tube carcinoma is that of a hydrosalpinx, with a sealed distal end and
a dilated tube.