閉経後骨盤内膿瘍を契機に、審査腹腔鏡手術で診断しえた卵管癌の一例

抄録

Background: Fallopian tube carcinoma is a rare malignancy, representing approximately 1％ of all female genital cancers. The typical clinical manifestations include watery discharge, pelvic pain, and a palpable pelvic mass. However, many cases are asymptomatic or present with nonspecific symptoms, leading to a low rate of preoperative diagnosis. In this case, pathological evaluation of specimens obtained via diagnostic laparoscopy proved instrumental in establishing the diagnosis.

Case: A 66-year-old female with a history of an abdominal left linear salpingostomy for ectopic pregnancy was referred to our hospital for the management of a right adnexal mass. MRI and CT imaging suggested a pelvic abscess. Diagnostic laparoscopy revealed purulent ascites and an abscess adhered to the pouch of Douglas. Both ovaries and fallopian tubes appeared grossly normal. The mass and bilateral adnexa were resected, and histopathological examination revealed high-grade serous carcinoma of the right fallopian tube accompanied by serous tubal intraepithelial carcinoma. The patient was subsequently started on neo-adjuvant chemotherapy.

Conclusion: Fallopian tube carcinoma is a rare and aggressive malignancy difficult to diagnose preoperatively. Pelvic abscesses are atypical in postmenopausal women and can occasionally be associated with underlying malignancies. In such cases, even if the adnexa appear grossly normal, bilateral adnexectomy should be considered.