Raised serum CA 125 preceding the diagnosis of carcinoma of the fallopian tube: two case reports

Neoplasms of the fallopian tube and broad ligament: a selective survey including historical perspective and emphasising recent developments

Recent contributions on selected aspects of the pathology of tubal and paratubal neoplasms are reviewed after a brief historical perspective. The most important, considering both frequency and clinical importance, are those pertaining to tubal carcinoma. These can be grouped as follows: (1) recognition that endometrioid carcinoma is the second most common carcinoma of the tube, after serous, and other variants of müllerian carcinoma are rare; (2) expansion of knowledge about the morphological spectrum of tubal endometrioid carcinoma; (3) modifications of the FIGO staging system; (4) heightened appreciation of the occasional origin of tubal carcinomas from the tubal fimbriae; (5) increased awareness of early carcinoma arising in patients with the BRCA mutation; (6) greater recognition of the propensity for non-tuberculous salpingitis with reactive atypia to mimic carcinoma. Brief consideration then follows of certain other tubal and paratubal neoplasms including those of the broad ligament, emphasising issues in differential diagnosis.

The clinical value of serum concentrations of cancer antigen 125 in patients with primary fallopian tube carcinoma: a multicenter study

BACKGROUND

Primary fallopian tube carcinoma (PFTC) is a rare disease, and data on the serum concentration of tumor marker cancer antigen 125 (CA 125) in patients with this disease are sparse. The authors assessed the clinical value of the serum concentration of CA 125 as a prognostic and monitoring marker in patients with surgically treated PFTC.

METHODS

In a multicenter study, the concentration of CA 125 was measured in 406 serum samples from 53 patients with PFTC. The results were correlated with clinical data.

RESULTS

The pretreatment median serum CA 125 level was 183 U/mL (range, 6.5-5440.0 U/mL) in patients with PFTC. In a univariate Cox regression model, tumor stage and serum CA 125 level were associated significantly with shortened disease free survival (P = 0.006 and P < 0.001, respectively) and with overall survival (P = 0.03 and P = 0. 001, respectively). Lymph node involvement, tumor grade, and patient age were not associated with the length of survival. A multivariate Cox regression model showed that pretreatment the serum CA 125 level was a prognostic factor of disease free and overall survival, independent of tumor stage (P = 0.005 and P = 0.01, respectively). The pretreatment serum CA 125 level was correlated with tumor stage (P < 0.001) but not with lymph node involvement (P = 0.8), histologic grade (P = 0.3), or patient age (P = 0.2). The serum CA 125 level during chemotherapy was correlated significantly with Gynecologic Oncology Group response criteria to chemotherapy (P = 0. 001). During the follow-up of patients, serum CA 125 levels reached sensitivity, specificity, positive predictive value, and negative predictive value of 92%, 90%, 67%, and 98%, respectively, for differentiating between no evidence of disease and the presence of recurrent disease. In 90% of the patients, an increase of serum CA 125 level preceded the clinical or radiologic diagnosis of recurrent disease with a median lead time of 3 months (range, 0.5-7.0 months).

CONCLUSIONS

This is the largest study to date with respect to serum CA 125 levels in patients with PFTC. The current data indicate that the pretreatment serum CA 125 level is an additional independent prognostic factor of disease free and overall survival in patients with PFTC. The serum CA 125 level adequately defines the response to chemotherapy and displays good sensitivity and specificity characteristics during the follow-up of patients with PFTC.

Unsuspected primary tubal carcinoma during operative laparoscopy

OBJECTIVE

To evaluate the possible risk of dealing with an unsuspected primary carcinoma of the fallopian tube during laparoscopic surgery.

METHODS

We performed a countrywide survey in Austria concerning laparoscopic procedures in cases of primary carcinoma of the tube. The questionnaire consisted of questions regarding the pre-, intra-, and postoperative management.

RESULTS

Of 18,435 laparoscopies in cases of an adnexal mass, 5 cases were reported, when laparoscopy was performed on an unsuspected carcinoma of the tube. Therefore, the risk of detecting this malignancy during laparoscopy after preoperative evaluation is 1 in 3687 cases (0.028%).

CONCLUSION

The risk of encountering an unsuspected primary carcinoma of the fallopian tube during laparoscopy in Austria is an extremely rare situation. In case of a malignancy, a staging or debulking laparotomy should be performed immediately or as soon as possible.

Ultrasonographic appearance of fallopian tube carcinoma

Preoperative diagnosis of tubal carcinoma is difficult and a diagnosis cannot usually be established until the time of operation. However, since prognosis is strictly related to the stage of the neoplasm, it is very important to be familiar with the clinical and imaging characteristics of primary fallopian tube carcinoma in order to make an early and accurate diagnosis. This report presents the ultrasonographic features of three cases of fallopian tube carcinoma and reviews the literature on the subject.

Preoperative and postoperative CA-125 serum levels in primary fallopian tube carcinoma

Levels of CA-125 were determined pre- and postoperatively in 13 patients with fallopian tube cancer. Values before surgery were significantly higher (Median 1220 IU/ml, 90-5000 IU/ml) compared with postoperative levels (Median 194 IU/ml, 67-880 IU/ml) (P = 0.0052). Correlation analysis with FIGO stage and grading failed to show any statistical significance, but a trend for a positive correlation with FIGO stage and preoperative values could be observed. The CA-125 antigen is expressed by fallopian tube carcinoma and should therefore be used in diagnosis and follow-up.