Fallopian tube carcinoma presenting as tubo-ovarian abscess: a report of two cases with literature review

Predictive Markers of Tubo-Ovarian Abscess in Pelvic Inflammatory Disease

BACKGROUND/AIMS

The purpose of this study was to identify predictive markers for tubo-ovarian abscess (TOA) through a comparison of clinical and laboratory data in patients diagnosed with pelvic inflammatory disease (PID).

METHODS

We reviewed the medical charts of 499 females who were admitted to hospital with clinical, surgical, imaging-based diagnoses of PID between 2001 and 2011. The patients were divided into the following two groups: (1) PID with TOA and (2) PID without TOA.

RESULTS

The TOA and non-TOA groups were comprised of 69 and 430 females, respectively. Mean age, history of intrauterine device (IUD) insertion and inflammatory markers, including erythrocyte sedimentation rate, C-reactive protein (CRP) and CA-125 levels, were higher in the TOA group than the non-TOA group. Independent factors that predicted TOA were older age, IUD insertion, increased CRP and CA-125, and chlamydia infection. CA-125 was found to have the highest predictive value for TOA. TOA size was associated with increased surgical therapy compared to patients with smaller abscesses.

CONCLUSIONS

Increased age, IUD insertion, chlamydia infection, and increased CRP and CA-125 level were the independent factors predictive of TOA in acute PID. These predictive values will be expected to help decrease gynecological morbidity by early diagnosis and appropriate treatment of TOA. © 2015 S. Karger AG, Basel.

Primary fallopian tube carcinoma: correlation between magnetic resonance and diffuse weighted imaging characteristics and histopathologic findings

OBJECTIVE

The aim of this study was to investigate the magnetic resonance (MR) and diffusion-weighted (DW) imaging characteristics of primary fallopian tube carcinoma (PFTC).

METHODS

The clinical, MR, and DW imaging characteristics and pathologic findings of 23 patients with 27 tumors were studied retrospectively. The MR and DW imaging appearance of tumors including laterality, size and shape, architecture, signal intensity, apparent diffusion coefficient (ADC) value, enhancement pattern, hydrosalpinx, and intrauterine fluid collection were evaluated and correlated with pathologic findings.

RESULTS

Histopathologically, all 27 tumors were serous carcinoma with a unilateral tumor in 19 patients and bilateral tumors in 4 patients. Thirteen patients (57%) with PFTC were misdiagnosed preoperatively, 10 of which as epithelial ovarian carcinoma. The mean (SD) largest diameter was 61 (7) mm. The tumor shape was fusiform, sausagelike, or serpentine in 19 patients (70%) and nodular or irregular in 8 patients (30%). Twenty (74%) of the 27 tumors were solid, and 7 (26%) were cystic-solid. The solid components showed hypointensity to isointensity on T1-weighted imaging, and isointensity to slight hyperintensity on T2-weighted imaging. There were obvious hyperintensity on DW imaging; obvious hypointensity on ADC maps with a mean (SD) ADC value of 0.79 (0.22) × 10 mm; and mild (8/27, 30%), moderate (13/27, 48%), and marked (6/27, 22%) enhancement on contrast-enhanced imaging. Ipsilateral hydrosalpinx, intrauterine fluid collection, and ascites were found in 14 tumors (52%) and 7 (30%) and 5 (22%) patients, respectively.

CONCLUSIONS

The PFTC has some characteristic MR imaging features. The DW imaging, ADC maps, and ADC values are helpful for the detection and differentiation of PFTC from other pelvic masses.