Clin Endosc.  2014 Sep;47(5):464-468. 10.5946/ce.2014.47.5.464.

Primary Fallopian Tube Carcinoma Diagnosed with Endoscopic Ultrasound Elastography with Fine Needle Biopsy

• Kim EB
• Lee TH
• Kim JS
• Choi IH

• KMID: 2165382
• DOI: http://doi.org/10.5946/ce.2014.47.5.464

Abstract

Primary fallopian tube carcinoma (PFTC) is a rare gynecological cancer that is very difficult to diagnose preoperatively. Here, we report the case of a 66-year-old female patient with PFTC that was diagnosed preoperatively on the basis of the characteristic features on endoscopic ultrasound (EUS) elastography and fine needle biopsy (FNB). EUS showed a sausage-shaped hypoechoic mass, 8 cm in size, with irregular margins and heterogeneous internal echoes extending to both adnexa. EUS elastography revealed that the mass had a blue color pattern, representing hard stiffness, and a heterogeneous green/red color pattern distributed outside the tumor, representing intermediate stiffness. Histopathologic analysis of the FNB and operative specimens confirmed the diagnosis of fallopian tube carcinoma. This is the first reported case of a combined EUS elastography and FNB of an adnexal mass leading to a preoperative diagnosis of fallopian tube carcinoma.

Keyword

Fallopian tube neoplasms; Endosonography; Elasticity imaging techniques; Biopsy, fine-needle

MeSH Terms

Aged
Biopsy, Fine-Needle*
Diagnosis
Elasticity Imaging Techniques*
Endosonography
Fallopian Tube Neoplasms
Fallopian Tubes*
Female
Humans
Ultrasonography*

Figure

• 

  Fig. 1 Computed tomography (CT) and magnetic resonance imaging (MRI) of the adnexal mass. (A) An about 8-cm, heterogeneous enhancing mass with irregular shape, involving from the uterine cervix to the uterine fundus, was detected by using CT. (B) The mass at cul-de-sac (white arrow) has directly invaded to the rectum on MRI.

• 

  Fig. 2 Endoscopic ultrasound elastography of the adnexal mass. (A) A sausage-shaped hypoechoic mass, 8 cm in size, with irregular margins and heterogeneous internal echoes extending to both adnexa and that had obliterated the lumen of both fallopian tubes was detected. (B) The mass had invaded the right side of the uterine body, making it difficult to delineate the borderline between the lesion and the uterus. (C) Elastographic image of the left side of the dual image showing the blue color pattern (representing hard stiffness) of the mass and heterogeneous green/red coloration (representing intermediate stiffness) outside the tumor.

• 

  Fig. 3 Histopathologic analyses of needle biopsy and operative tissue specimens. (A) The ProCore needle biopsy specimen revealed papillary growing tumor cells with hyperchromatic nuclei and frequent mitoses, suggestive of primary or metastatic papillary adenocarcinoma of the pelvic cavity (H&E stain, ×100). (B) The operative specimen revealed a tumor occupying the lumen of the right residual fallopian tube that had extended to the pelvic cavity (H&E stain, ×12.5). (C) Operative specimen showing the tumor arising from the luminal epithelium with a papillary growth pattern (H&E stain, ×100). (D) Operative specimen showing that the tumor consisted of a fibrovascular core lined by a single layer of tumor cells with occasional pleomorphic cells and frequent atypical mitosis (H&E stain, ×200). These findings are similar to those of the endoscopic ultrasound-guided biopsy.

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