Fallopian Tube Neoplasia and Mimics

A Case Report of an Adenomatoid Tumor of the Fallopian Tube: The Histopathologic Challenges and a Review of the Literature

Background: Adenomatoid tumor (AT) is a rare benign neoplasm of mesothelial origin, which mainly occurs in the male and female genital tracts. The most common site for AT occurrence in women is the uterus, which makes the presentation in the fallopian tube(s) a rarity with an incidence of approximately 0.5%. The reported extragenital sites include serosal surfaces, adrenal glands, and visceral organs, are even less common. Macroscopically, ATs present as white-grayish or yellowish irregular yet circumscribed firm nodules, often containing cystic components. Owing to a vast array of histomorphological growth patterns, ATs tend to mimic malignancy and trigger overresection. Such clinical situations have been described by several studies for the ovaries, uterus, and fallopian tubes, underlining the importance of differential diagnosis in order to avoid superfluous treatment. Methods: Herein, we report a presentation of an AT at the oviductal lumen, detected incidentally during prophylactic bilateral salpingo-oophorectomy in a 67-year-old patient with a BRCA1 mutation. Results: Immunohistochemical staining revealed a positive expression for calretinin, WT1, and cytokeratin 7, and negative expression for both PAX8 and CD34, thus confirming the diagnosis of AT and excluding tubal malignancy. Conclusions: This report, with a concise review of the global literature on tubal AT, brings attention to the solitary and asymptomatic nature of the tumor. With a clear diagnosis, no surgical radicality is necessary.

Endometrioid tubal intraepithelial neoplasia (E-TIN): case report & literature review

An endometrioid carcinogenic pathway of the fallopian tube with possible potential precursors including type II SCOUTs (secretory cell outgrowths) and E-TIN (endometrioid tubal intraepithelial neoplasia) has been recently documented. We report an incidental focus of E-TIN identified in a hysterectomy specimen for Grade 1 endometrioid type endometrial carcinoma. The lesion was present at the fimbriated end of left fallopian tube involving 1 plica. It comprised crowded glandular proliferation with a pseudostratified columnar lining. The cells displayed elongated nuclei with no remarkable nuclear atypia.Immunohistochemistry showed patchy loss of PAX 2 expression with multifocal aberrant nuclear and cytoplasmic staining for B-catenin. p53 was wild-type and ER was positive.In view of the co-existing endometrioid type endometrial carcinoma, a possible metastatic spread to the fallopian tube was considered. However, morphologically no obvious nuclear atypia noted, and no associated inflammatory response or desmoplastic stromal reaction identified within the tubal lesion. And on immunostaining, the endometrial tumour was distinct from the tubal lesion. For instance, PTEN was negative/lost in the endometrial tumour but retained in the tubal lesion and B-catenin was membranous in the endometrial tumour but aberrant with multifocal nuclear and cytoplasmic overexpression in the tubal lesion. WT1 was negative in the endometrial tumour but positively expressed by the tubal lesion. All the above findings favoured the possibility of the tubal lesion as being independent of the endometrial primary. In conclusion, we describe an incidental B-catenin aberrant endometrioid type proliferation of the fallopian tube/E-TIN, to raise awareness of such lesions.

Adenomatoid tumor of the fallopian tube: A case report and a review of the literature

INTRODUCTION

Adenomatoid tumor is a rare, benign condition, more common in males, that affects the epididymis, spermatic cord and testicular tunics, whereas in females, the uterus and fallopian tubes. This solitary tumor is commonly appearing as an incidental finding. The diverse morphological characteristics of these tumors pose challenges in differential diagnoses.

PRESENTATION OF CASE

We report a case of a 33-year-old woman with a multilocular solid mass identified in a routine gynecological check-up. The cyst was removed laparoscopically, and histology analysis reported an adenomatoid tumor of the fallopian tube. Patient recovered without any additional treatment and within 2 years delivered a healthy offspring. Extensive literature search was conducted in Pubmed, Embase and Google Scholar for the identification of all relevant case reports or case series of adenomatoid tumors of the fallopian tubes.

DISCUSSION

Literature search revealed other 49 cases of adenomatoid tumors in fallopian tube published. The mean age of patients was 45,6 years (ranged from 29 to 72 years) and the mean diameter of the tumor was 10 mm.

CONCLUSION

Laparoscopic removal of such a rare, benign tumor is effective and safe.

The Incidental Diagnosis of Adenomatoid Tumour on Fallopian Tubes Submitted for Tubal Ligation at a Tertiary Laboratory in Northern Pretoria, South Africa

Introduction

Adenomatoid tumours are the most common benign mesothelial neoplasms of the fallopian tube. They are usually diagnosed incidentally in specimens submitted for bilateral tubal ligation and can be mistake for vascular or epithelial lesions.

Materials and methods

A retrospective analysis of cases with adenomatoid tumour of the fallopian submitted for tubal ligation from 2012 to 2020. The clinicopathological characteristic data was retrieved from the laboratory information system.

Results

A total of 11 cases with adenomatoid tumour of the fallopian tubes submitted for tubal ligation were identified in women with average age of 30.9 years. In all the cases, only 1 fallopian tube was affected. Grossly, the fallopian tubes did not show any discernible tumour. Immunohistochemical stains confirmed the diagnosis of adenomatoid tumours in all the cases.

Conclusion

Adenomatoid tumours in fallopian tubes are infrequent, and pathologists shouldn't overlook them especially in unsuspicious instances. As frequent as adenomatoid tumour of the fallopian tubes are uncommon, pathologists show be aware of as their misdiagnosis could lead mismanagement of patient with far reaching complication.

Clinicopathological Characteristics of Microscopic Tubal Intraepithelial Metastases from Adenocarcinoma and Small Cell Neuroendocrine Carcinoma of the Uterine Cervix

BACKGROUND/AIM

Some metastatic tumors that involve the fallopian tube show intraepithelial spread, mimicking primary tubal neoplasm and representing a potential diagnostic pitfall. In this study, we aimed to investigate the clinicopathological characteristics of tubal intraepithelial metastasis (IEM) from cervical carcinoma.

PATIENTS AND METHODS

We analyzed the clinical features, histological features, and immunophenotypes of IEMs in five patients with cervical carcinoma.

RESULTS

This study included usual-type (1/5), mucinous-type (1/5), and gastric-type (2/5) endocervical adenocarcinomas and small cell neuroendocrine carcinoma (1/5) cases. None of the patients had ovarian metastasis, but metastatic tumor cells spread along the tubal mucosal surface and partially replaced the lining epithelium. Histological features of metastatic tumors closely resembled those of the primary tumors in all cases.

CONCLUSION

Tubal IEM can mimic various tubal lesions including serous tubal intraepithelial carcinoma. Morphological consistency between the primary and metastatic tumors and immunostaining help guide the differential diagnosis of challenging intraepithelial lesions of the fallopian tube.

Endometrioid Tubal Intraepithelial Neoplasia (E-TIN) of the Fallopian Tube: A Case Series

Although serous tubal intraepithelial carcinoma has been well described in the distal fallopian tube as precancers of pelvic high-grade serous carcinoma, endometrioid precancers have drawn less attention. Recently, endometrioid precursor lesions have been identified and reported to have a specific immunophenotype (PAX2-, ALDH1+, diffuse nuclear beta-catenin), as well as an association with both uterine and ovarian endometrioid carcinomas. These have been referred to as endometrioid (or type II) secretory cell outgrowths. A subset of endometrioid secretory cell outgrowths show architectural complexity resembling hyperplasia of the endometrium and have been referred to as endometrioid tubal intraepithelial neoplasia. We report 4 cases of endometrioid tubal intraepithelial neoplasia with clinical correlation and morphologic differential diagnosis.

Serous Tubal Intraepithelial Carcinoma-Like and Pagetoid Tubal Metastasis of an Ovarian Large Cell Neuroendocrine Carcinoma: Peculiar Metastatic Growth Patterns of a Rare Tumor

A large cell neuroendocrine carcinoma of the ovary is presented because of tubal metastases with peculiar growth patterns: pagetoid and serous tubal intraepithelial carcinoma-like. The possibility that a tubal intraepithelial carcinoma could represent a metastasis should be considered by pathologists.