466 Obstetrics and Gynecology Board Review •••
❍ How does depth of invasion relate to survival in fallopian tube carcinomas?
In a retrospective review, depth of invasion was inversely related to survival. Intramucosal lesions were associated
with a crude 5-year survival of 91%, lesions with muscular wall involvement were associated with a 53% survival,
and lesions penetrating the serosa were associated with a 25% or less 5-year survival.
❍ Describe the lymphatic drainage of the fallopian tube and its importance in predicting survival.
The primary lymphatic drainage of the fallopian tube is via the para-aortic lymph nodes. Pelvic or para-aortic
lymph node involvement has been found in 10% to 35% of patients at the time of their initial operation, in about
33% of patients at the time of surgery for recurrent disease, and in 75% of patients at autopsy. Survival of patients
with positive retroperitoneal or inguinal lymph node involvement (stage IIIC) is lower than that of patients with
earlier stages. Finally, the presence of lymphovascular space involvement in early tubal carcinomas is associated
with a 5-year survival of only 29% compared with 83% for tumors without identifiable lymphatic or vascular
invasion.
❍ What is the prognosis for primary malignant mixed mesodermal tumors of the fallopian tube?
The overall 5-year survival is 15%, with a mean survival of 17 months.
❍ What percentage of tubal carcinomas involve the ovary at the time of diagnosis?
Approximately 13% of tubal carcinomas involve the ovary at the time of diagnosis, usually as a result of direct
extension.
❍ What percentage of fallopian tube cancers will cause an abnormal cervical cytology specimen?
Although some series report positive cervical cytology to be as common as 40% to 60%, most series show that only
about 10% of patients with tubal carcinomas will have abnormal Papanicolaou smears.
❍ What is the lifetime risk of fallopian tube cancer in women with a BRCA mutation?
0.6% to 3%.
❍ What percentage of women with a fallopian tube cancer have a mutation in the BRCA1 or BRCA2 gene?
30%.
❍ Which sites do fallopian tube cancers tend to recur?
Retroperitoneal lymph nodes and extraperitoneal sites.
❍ What is hydrops tubae profluens?
A sudden emptying of accumulated fluid in the distended fallopian tube that causes a profuse watery
serosanguinous discharge associated with a decrease in the size of a pelvic mass.
❍ Why has the fallopian tube been implicated as the possible origin for pelvic serous carcinomas?
The presence of a serous tubal intraepithelial carcinoma (TIC) in the fimbria was initially identified in BRCA
mutation carriers following risk-reducing salpingo-oophorectomy. Subsequent studies have also identified a
coexistent TIC in all forms of pelvic serous carcinomas suggesting its role in the development of ovarian, fallopian
tube, and primary peritoneal cancers.