FALLOPIAN TUBE DISEASE
Normal fallopian tubes cannot be palpated and usually are not con-sidered in the differential diagnosis of adnexal disease in the asymp-tomatic patient. Common problems involving the fallopiantubes include ectopic pregnancy, salpingitis/hydrosalpinx/ tubo-ovarian abscess, and endometriosis (which can pre-sent as masses or be symptomatic).
Paraovarian cysts develop in the mesosalpinx from vesti-gial Wolffian duct structures, tubal epithelium, and peri-toneum inclusions. These are differentiated from paratubal cysts, which are found near the fimbriated end of the fal-lopian tube, are common, and are called hydatid cystsof Morgagni. Both are usually small and symptomatic,although, rarely, they can reach large proportions.
Primary fallopian tube carcinoma is usually an adenocar-cinoma, although other cell types, including adenosqua-mous carcinoma and sarcoma, are rarely reported. About two-thirds of patients with this rare gynecologic cancer (<1% of gynecologic cancers) are postmenopausal. Grossly, these tumors are often rather large, resembling a hydro-salpinx, and unilateral. Microscopically, most are typical papillary serous cystadenocarcinomas of the ovary. The symptoms of this tumor are so slight that the tumor is often advanced before a problem is recognized. The most common complaint associated with fallopian tube carci-noma is postmenopausal bleeding, followed by abnormal vaginal discharge. Profuse serosanguineous discharge, called hydrotubae profluens, is sometimes considered diagnosticof this tumor; however, other findings are watery vaginal discharge, pain, and pelvic mass. Staging is surgical, similar to that for ovarian carcinoma (Table 46.2); progression is similar to that of ovarian carcinoma, with intraperitoneal metastases and ascites. Because the fallopian tubes are richly permeated with lymphatic channels, para-aortic and pelvic lymph node spread often occurs. Seventy percent of fallopian tube cancers present as stage I or II disease. The overall 5-year survival rate is 35% to 45%, with stage I having the most favorable rate. Too few data are available to ascertain whether adjunctive therapy is useful, and this management must be made on a case-by-case basis; how-ever, initial management with staging and debulking is the same as for ovarian cancer treatment.
Carcinoma metastatic to the fallopian tube, com-ing mainly from the uterus and ovary, is far more com-mon than primary fallopian tube carcinoma. Other rare tumors of the fallopian tube include malignant mixed müllerian tumors, primary choriocarcinoma, fibroma, and adenomatoid tumors.