Background

In 1847, Renaud first described fallopian tube malignancy. In 1888, Orthmann submitted the first genuine case report.^[1]

The broad ligament is a double fold of peritoneum, which is formed by the reflection of the peritoneum off the pelvic floor and the lateral pelvic wall. Most tumors are benign cysts, but malignant tumors are categorized as either primary or secondary.

Primary malignancies of the broad ligament include those of müllerian origin (ie, serous carcinoma, papillary carcinoma, cystadenocarcinoma, endometrioid carcinoma, clear cell carcinoma), urothelium transitional cell carcinoma, mesenchymal sarcoma or histiocytoma, and pheochromocytoma. Some researchers suggest that some primary fallopian tube cancers are misdiagnosed as primary ovarian cancers; however, an experienced pathologist can help to differentiate that.

Secondary malignancies of the broad ligament include metastatic cancers from endometrial, cervical, and ovarian carcinoma.

A primary malignancy is diagnosed based on its location within or on the surface of the broad ligament and by virtue of the complete separation of the tumor from the uterus and ovaries.

Pathophysiology

Fallopian tube malignancy usually starts as a dysplasia or carcinoma in situ. Typically, transition to adenocarcinoma is observed.

Gilks et al indicate that most cases of incidental nonuterine high-grade carcinomas (HGSCs) arise in the fallopian tube fimbria.^[2]In their report, 16 of 21 cases that were incidental microscopic, non-mass-forming serous tubal intraepithelial carcinoma or HGSCs had lesions confined to the fallopian tube (unilateral, 14 cases; bilateral, 2 cases).^[3]All 16 had serous tubal intraepithelial carcinoma, and 8 of 16 had invasive HGSC into the underlying lamina propria. In 5 of 21 cases, fallopian tube mucosal and ovarian involvement was found, including 2 cases that also had microscopic peritoneal involvement.^[2]

The etiology of malignancies of the broad ligament is unknown, although they are associated with endometriosis.

Frequency

United States

Fallopian tube carcinomas comprise 1% of all gynecologic cancers. The average annual incidence is 3.6 cases per million women.

Mortality/Morbidity

On average, the 5-year survival rate is 51%; the rate for stage I disease is 65%, stage II disease is 50-60%, and stage III and stage IV disease is 10-20%.

Race

These lesions are more common in whites.

Age

Incidence increases with age but peaks at 60-66 years.

Clinical Presentation

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Gilks CB, Irving J, Kobel M, et al. Incidental Nonuterine High-grade Serous Carcinomas Arise in the Fallopian Tube in Most Cases: Further Evidence for the Tubal Origin of High-grade Serous Carcinomas. Am J Surg Pathol. 2014 Dec 16. [QxMD MEDLINE Link].
Chay WY, McCluggage WG, Lee CH, Köbel M, Irving J, Millar J, et al. Outcomes of Incidental Fallopian Tube High-Grade Serous Carcinoma and Serous Tubal Intraepithelial Carcinoma in Women at Low Risk of Hereditary Breast and Ovarian Cancer. Int J Gynecol Cancer. 2016 Mar. 26 (3):431-6. [QxMD MEDLINE Link].
Romaniuk A, Gyryavenko N, Lyndin M, Piddubnyi A, Sikora V, Korobchanska A. Primary cancer of the fallopian tubes: histological and immunohistochemical features. Folia Med Cracov. 2016. 56 (4):71-80. [QxMD MEDLINE Link].
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Author

Hetal B Gor, MD, FACOG Obstetrician/Gynecologist, Private Practice

Hetal B Gor, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

John Paulson, MD Clinical Professor of Obstetrics/Gynecology, Eastern Virginia Medical School; Professor of Clinical Obstetrics/Gynecology, Medical College of Virginia; Associate Director, Residency Program, Riverside Health System

John Paulson, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, International College of Surgeons US Section

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michel E Rivlin, MD Former Professor, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, Royal College of Surgeons of Edinburgh, Royal College of Obstetricians and Gynaecologists

Disclosure: Nothing to disclose.

Chief Editor

Warner K Huh, MD Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Senior Scientist, Comprehensive Cancer Center, University of Alabama School of Medicine

Warner K Huh, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Surgeons, Massachusetts Medical Society, Society of Gynecologic Oncology, American Society of Clinical Oncology

Disclosure: I have received consulting fees for: Merck; THEVAX.

Additional Contributors

Karen Loeb Lifford, MD Director of General Gynecology, Associate Program Director, Department of Obstetrics and Gynecology, Instructor, Brigham and Women's Hospital, Harvard Medical School

Karen Loeb Lifford, MD is a member of the following medical societies: Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa

Disclosure: Nothing to disclose.