Primary fallopian tube carcinoma has an incidence of 0.1-1.8% of all female genital malignancies. Serous papillary adenocarcinoma is the most common histological subtype (70-80%), followed by endometrioid adenocarcinoma and transitional cell carcinoma. Primary squamous cell carcinoma arising from the fallopian tube is extremely rare, with about ten clinical cases reported in the literature, making the characteristics and prognosis of this subtype not well clarified.
We are reporting a case of bilateral squamous cell carcinoma of the fallopian tube associated with cervical intraepithelial neoplasia.
A 62 year-old woman presented with history of relapse of cervical intraepithelial neoplasia 3 (CIN3) treated with conization in 2016.
In May 2017 she reported mild vaginal bleeding, without other symptoms. The Papanicolaou Test showed CIN3 and HPV16 infection. Clinical examination and vaginal US didn’t releave any pelvic lesion. The thoracic-abdominal CT scan and pelvic MRI were negative.
In June 2017 a total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. The histological examination confirmed the presence of CIN3 with HPV16 infection and revealed a high grade bilateral invasive squamous cell carcinoma of the fallopian tube with central necrosis and infiltration of the tubal wall and peritubal soft tissues.Presence of vascular invasion. The endometrium presented a small lesion of intrepithelial squamous cell neoplasia. Parametrium and ovaries were negative for neoplastic infiltration (FIGO stage II). On IHC stains high weight keratins and p63 were positive; WT1 was negative.
She received adjuvant chemotherapy with platinum and taxane for 6 cycles.
Primary squamous cell carcinoma of the fallopian tube is a very rare entity and its aetiology, clinical features and prognosis are not well known.
It is important to distinguish primary carcinoma of fallopian tube from metastatic carcinoma secondary from the ovary, uterus or gastrointestinal tract which more commonly involves the fallopian tube. It can be associated with simultaneous ovarian involvement, cervical intraepithelial neoplasia or with HPV infection. The median age of presentation is between 55-60 years. Preoperative diagnosis is very difficult. In our case there was no evidence of disease based on radiological exams. Presenting symptoms may include vaginal spotting or bleeding; abdominal pain or pelvic discomfort.
The current recommendation for surgery is a total abdominal hysterectomy, bilateral salpingo- oophorectomy, omentectomy and lymphadenectomy and the chemotherapy treatment approach is similar to that for ovarian serous carcinoma.