1、Primary fallopian tube carcinoma（PFTC）原發(fā)性輸卵管癌蘇歡歡2015-08Epidemiology PFTC is one of the rarest malignancies of the female genital tract, accounting for 0.14-1.8% of all gynaecological malignancies（婦科惡性腫瘤）. occurring predominantly in post-menopausal women at a mean age of 55 years, with women of highe

2、r social classes and education being at greater risk.Clinical presentation aetiology（病因學） hormonal（激素）, reproductive（生殖的）, genetic factors may play a role, along with the presence of chronic inflammation of the pelvis.Clinical presentation Characteristic symptoms (Laztkos triad, seen in only 15% of

3、patients) colicky(疝氣樣) abdominal or pelvic pain adnexal(附件的) mass relieved by intermittent, profuse(大量的), serosanguineous vaginal discharge(陰道排液)Clinical presentation Hydrops tube profluens(輸卵管積水)：seen in only 5% of patients The age of presentation is commonly between 40 and 60 years, with a mean ag

4、e of 55 years.Clinical presentation The pre-operative diagnosis of PFTC is rarely performed, with clinical signs and symptoms pointing towards the more frequently occurring ovarian cancer or pelvic inflammatory disease. Elevated CA-125 levels are indicative of poor prognosis, and can be used during

5、follow-up, as a marker of disease recurrencePathological diagnosis Serous carcinoma(漿液性癌) of the fallopian tube is the most common histological type The second most common type of tumour is the endometrioid carcinoma(子宮內膜樣癌), followed by undifferentiated, clear cell, mucinous, and transitional carin

6、omas.Pathological diagnosis diagnosis criteria of PFTC the main tumour arises from the endosalpinx(輸卵管內膜) the histological pattern reproduces the epithelium of the tubal mucosa the transition from benign to malignant tubal epithelium is demonstrable the ovaries or endometrium are either normal or co

7、ntain a tumour that is smaller than the tumour in the tubePathological diagnosis Dissemination(播散) of PFTC implantation of cells throughout the abdominal cavity through continuity adjacent organs transluminal migration（經(jīng)腔轉移） haematogenous lymphatic spread distant metastasesTreatment surgical approac

8、h total abdominal hysterectomy(子宮切除術) bilateral salpingo-oophorectomy（輸卵管-卵巢切除術） infra-colic omentectomy（結腸以下網(wǎng)膜切除術）, appendicectomy, peritoneal washings, peritoneal biopsies. Routine pelvic and para-aortic lymphadenectomyTreatment Postoperatively, chemotherapy plays an important role in the manageme

9、nt of early-stage PFTC Hormonal therapies may be of value in the future, given the sensitivity and response of the fallopian tube epithelium to hormonal fluctuationsPrognosis The main prognostic factors identified for increased survival include stage, age, and residual tumour after surgery, serous s

10、ubtype, and elevated pre-treatment CA-125. The 5-year survival rate of PFTC ranges between 22-57%.Imaging PFTC The characteristic appearance of PFTC direct signs: relative small, tubular-shaped (or sausage-shaped臘腸樣) manss inhomogenous signal, low signal intensity on T1WI, isointensity to slight hyp

11、erintensity on T2WI, high signal in DWI mild to moderate enhancement indirect signs: hydrosalpinx（輸卵管積水） or intra-uterine fluidAnatomy of the fallopian tubes on MRI The normal fallopian tubes are usually not visualized on pelvic MRI. In the presence of intraperitoneal fluid, they may be seen as pair

12、ed thin structures, extending from the ovaries to the uterine cornua, in the superior edge of the broad ligament.Anatomy of the fallopian tubes on MRI 10-12cm divided into four portions intramural/interstitial on the medial end the isthmus the ampulla the infundibulum at the lateral fimbriated endAn

13、atomy of the fallopian tubes on MRITubular/sausage-shaped mass A 52-year-old woman with a primary fallopian tube carcinoma on the left side. Sagittal turbo SE T2WI with fat saturation (a) shows a sausage-like solid mass (arrow) with slightly hyperintense signal and moderate enhancement on contrast-e

14、nhanced FLASH 2D T1WI with fat saturation (b).A 62-year-old woman with a primary fallopian tube carcinoma on the left side. Axial SE T1WI (a), turbo SE T2WI with fat saturation (b), and contrast-enhanced FLASH 2D T1WI with fat saturation (c)An 81-year-old woman with a primary fallopian tube carcinoma on the right side. MRI for differentiating primary fallopian tube carcinoma from epithelial ovarian cancer Significant differences between PFT