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| CytoJournal 2005,
2:20 |
Primary fallopian tubal transitional cell carcinoma with exfoliation of malignant cells in cervical Pap smear
Nalini Gupta1, Radhika Srinivasan1, Raje Nijhawan1, Lakhbir Kaur Dhaliwal2
1 Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| Date of Submission | 19-Jun-2005 |
| Date of Acceptance | 09-Dec-2005 |
| Date of Web Publication | 09-Dec-2005 |
Correspondence Address:
Raje Nijhawan
Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh
India
© 2005 Gupta et al; licensee Cytopathology Foundation Inc.This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.PMID: 16336674
How to cite this article:
Gupta N, Srinivasan R, Nijhawan R, Dhaliwal LK. Primary fallopian tubal transitional cell carcinoma with exfoliation of malignant cells in cervical Pap smear. CytoJournal 2005;2:20 |
How to cite this URL:
Gupta N, Srinivasan R, Nijhawan R, Dhaliwal LK. Primary fallopian tubal transitional cell carcinoma with exfoliation of malignant cells in cervical Pap smear. CytoJournal [serial online] 2005 [cited 2012 May 16];2:20. Available from: http://www.cytojournal.com/text.asp?2005/2/1/20/41250 |
Only 0.2 - 0.5% of primary female genital malignancies are tubal, and histologically most of these are adenocarcinomas. Primary transitional cell carcinoma (TCC) accounts for about 10% of primary tubal carcinomas. [1] Primary TCC of the Fallopian tube More Details with exfoliation of malignant cells in cervical Pap smear More Details has not been described in the literature previously.
A 52-year- old lady presented with episodic spotting per vaginum. On general physical examination, the only significant finding was a 1.5 cm, firm, mobile, left supraclavicular lymph node. Fine needle aspiration (FNAC) from the left supraclavicular lymph node showed a metastatic carcinoma. The patient was investigated for detection of the primary malignancy. She was referred to the gynecologist, who took a cervical Pap smear. The Pap smear revealed mainly clusters as well as scattered cells showing moderate pleomorphism [Figure 1]. The cells had moderate amount of cytoplasm, coarsely clumped granular chromatin and inconspicuous nucleoli. It was reported as positive for squamous cell carcinoma by the cytopathologist, who also advised colposcopy and biopsy confirmation. Colposcopical examination of the cervix was performed which showed no significant abnormality. A cervical biopsy and endocervical curettage were done. On microscopic examination, the endocervical curettage showed an occasional cluster of malignant cells entangled in mucus. The endocervical curettage was reported as suspicious of malignancy. The cervical biopsy was unremarkable. A repeat Pap smear also showed malignant cells as described previously. In view of the persistently positive Pap smear report, a total abdominal hysterectomy with bilateral salpingo-oophrectomy was carried out and the specimen was sent for histopathological examination.
Grossly, the cervix, endo- myometrium, bilateral ovaries and left fallopian tube were unremarkable. The right fallopian tube showed a nodule measuring about 2.5 × 2 × 2 cm occluding its fimbrial end. The cut section of this nodule was gray-white. Microscopically, a tumor was identified in the right fallopian tube. In one focus, a clump of tumor cells was seen in its lumen. The tumor showed large areas of necrosis. The tumor cells were arranged predominantly in ribbons, trabeculae and sheets [Figure 2]. Histologicaly, this tumor pattern was that of a transitional cell carcinoma. The cells had "coffee bean" like nuclei and prominent nucleoli. There was no evidence of keratinisation. Mitosis was increased and the tumor was seen infiltrating transmurally. In addition, a small serosal tumor deposit was seen in the uterus.
Primary transitional cell carcinoma (TCC) of the fallopian tube is rare. The typical signs and symptoms of invasive tubal carcinoma include vaginal bleeding, clear or serosanguinous vaginal discharge, pelvic pain and a pelvic mass. The cervical Pap smear has shown exfoliated malignant cells rarely in cases of adenocarcinoma of fallopian tube. [1-5] Grossly, the tubal lumen is usually filled and dilated by papillary or solid and necrotic tumor. Tumor at the fimbriated end, with ready access to the peritoneal cavity, may also warrant individual staging. The morphology of TCC in fallopian tube is similar to TCC of urinary bladder. To the best of our knowledge, there are less than twenty cases reported of primary TCC in the fallopian tube in the English literature[6-8]. Primary TCC of fallopian tube showing exfoliated malignant cells in cervical Pap smear has not been described in the literature previously. Therefore, if the cervical Pap smear is positive for malignant cells and the cervical biopsy is negative, the patient should be investigated for a malignancy higher up in the gynecological tract. If endometrial curettage also does not reveal malignancy, the possibility of a tubal malignancy must be excluded by appropriate investigations.[Figure 3]
| » References | |  |
| 1. | Kim JW, Cho EM, Kim YT, Han JH: A case of primary transitional cell carcinoma of the fallopian tube. J Obstet Gynaecol Res 1999, 25: 321-6.  |
| 2. | Johnston GA Jr: Primary malignancy of the fallopian tube: a clinical review of 13 cases. J Surg Oncol 1983, 24: 304-9. |
| 3. | Safret A, Bosch B, Bannwart F, Rinderknecht B, Hafner HU: Carcinoma in situ of the fallopian tube presenting as a positive Pap smear. Acta Cytologica 2004, 48 (3) : 462-4. |
| 4. | Rahimpanah F, Reid R: Fallopian tube carcinoma detected by ThinPrep cytology smear. Med J Aust 2000, 172: 38. |
| 5. | Warshal DP, Burgelson ER, Aikins JK, Rocereto TF: Post- hysterectomy fallopian tube carcinoma presenting with a positive Papanicolaou smear. Obstet Gynecol 1999, 94: 834-6. |
| 6. | Koshiyama M, Konishi I, Yoshida M, Wang DP, Mandai M, Mori T, Fujii S: Transitinal cell carcinoma of the fallopian tube: a light and electron microscopic study. Int J Gynecol Pathol 1994, 13: 175-80. |
| 7. | Takeuchi S, Hirano H, Ichio T, Taniguchi H, Toyoda N: A case report: rare case of primary transitional cell carcinoma of the fallopian tube. J Obstet Gynaecol Res 1999, 25: 29-32. |
| 8. | Rabczynski J, Kochman A, Hudziec P: Primary transitional cell carcinoma of the fallopian tube. Przegl Lek 1998, 55: 572-5. |
[Figure 1], [Figure 2], [Figure 3]
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