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Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). In case of ovarian, Fallopian tube or primitive peritoneal cancer of FIGO III-IV stages, thoraco-abdomino-pelvic CT scan with injection (grade B) is recommended. Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO III stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A)., (Copyright © 2019 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B)., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO III stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A). For BRCA mutated patient, Olaparib is recommended (grade B)., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Transvaginal ultrasound is the first-line examination allowing characterizing 80 to 90% of adnexal masses (LP1). If performed by an expert, a subjective analysis is optimal. If performed by a non-expert, combining the use of Simple Rules with subjective analysis can achieve the diagnostic performance of an expert (LP1). Whichever the chosen model (subjective analysis by an expert or combination of the Simple Rules with a subjective analysis by a non-expert), a second-line examination will have to be proposed in the complex or indeterminate cases (about 20% of the masses) (grade A). The best-performing second-line test for characterization is pelvic MRI (LP1). If read by an expert, a pathological hypothesis can or should be suggested (grade D). In case of non-expert reading, the use of the ADNEXMR score allows a reliable assessment of the positive predictive value of malignancy to guide the patient towards the best management (gradeC). For preoperative assessment and evaluation of resectability of ovarian, fallopian tube or primary peritoneal cancer, it is recommended to perform a chest abdomen and pelvis CT with contrast agent injection (LP2, grade B). In the event of a contraindication to the injection of iodinated contrast agent (severe renal insufficiency, GFR <30mL/min), an abdomen and pelvis MRI completed with a non-injected chest CT may be proposed (LP3, grade C). By analogy, the same examinations are recommended to evaluate the disease after neo-adjuvant chemotherapy (LP3, Recommendation grade C). Further studies will be required to determine whether PET-CT provides better lymph node assessment before retroperitoneal and pelvic lymphadenectomy. PET-CT may be used to eliminate lymph node involvement in the absence of suspicious lymph nodes on morphological examination (LP3, grade C). The report should specify the localizations leading to a risk of incomplete cytoreductive surgery and lesions outside the field explored during surgery., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Aim of no residual macroscopic disease has to be the objective of the gynecologist oncologist surgeon. It can require extensive surgical procedures in all the abdomen area. We report 2 rare cases of cytoreductive surgery with iliac vessels resection and use of vascular prosthesis. We discuss the opportunity of this surgery with high morbidity., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Ovarian serous carcinoma is the most threatening type of gynaecological cancer because of late diagnosis at the advanced stage of peritoneal carcinomatosis stage. Identification of precancerous lesions could be essential in our understanding of ovarian carcinogenesis and might allow the development of effective screening tools. A serous carcinogenic sequence has been recently described in the Fallopian tube whereas an ovarian preinvasive lesion--ovarian epithelial dysplasia--was previously found. In light of recent and past molecular studies, we will review and discuss these two theories.

Ovarian carcinomas are a heterogeneous group of lesions, among which serous histologic subtype is the most frequent. Ovarian and peritoneal serous carcinomas are subdivided into low- and high-grade tumors. Low-grade carcinomas derive from serous tumors of low malignant potentiel, while high-grade carcinomas were thought to derive de novo from ovarian surface epithelium. Studies from prophylactic salpingo-oophorectomy in women with BRCA mutations revealed a precursor to pelvic serous carcinomas that originates in the distal fallopian tube, called STIC (serous tubal intraepithelial carcinoma). This review reports new findings on serous carcinogenesis in the tube (SCAT). It brings an explanation in French on different terminologies used in the English literature these last years such as SCOUT (secretory cell outgrowth), p53 signature, TILT (tubal intraepithelial lesion in transition), STIC and SCAT and on the macroscopic protocol of Brigham and Women's Hospital of annexectomies specially in the setting of BRCA mutation, the SEE-FIM (sectioning and extensively examining the fimbriated end of the fallopian tube)., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Primary neuroendocrine carcinoma arises mainly in the gastrointestinal tract, lungs and pancreas, localization in the fallopian tube is exceptional with only one case being reported in literature. This second case concerns a 54-year-old patient, diagnosed at the Pierre-Zobda-Quitman hospital. Tumor histology revealed a poorly differentiated carcinoma with medium to large cells, marked atypia and high mitotic activity. Immunostaining was positive for chromogranine A, synaptophysine and CD56. Primary fallopian tube neuroendocrine carcinoma requires cross referencing of the radiological, pathological and immunohistochemical findings and discarding the differential diagnoses., (Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.)

Leiomyomas of the fallopian tube are extremely rare. They are often managed with autopsy or surgery. We report a revealed case by a voluminous-abdominal mass in a 35-year-old woman. Neither the tomodensitometry nor, even, the laparoscopy did not permit specifying the tubal origin of the tumor. The diagnosis has been finally carried to the laparotomy. An annexectomy had been achieved. The histological examination concluded to a leiomyoma without malignant-cellular atypia.

Introduction: Adult dermatomyositis is a rare inflammatory myopathy associated with typical cutaneous lesions and an increased incidence of internal malignancies, notably cancers of the female genital tract. Nevertheless, fallopian tube carcinoma is exceptionally associated with dermatomyositis., Exegesis: We report an unusual case of dermatomyositis because of cutaneous necrosis revealing a cancer of the fallopian tube., Conclusion: Predictive factors of cancer can improve prognosis of dermatomyositis due to earlier diagnosis of associated cancer. In our observation as in literature review, cutaneous necrosis lesions are highly predictive of an associated neoplasia even as rare as a fallopian tube carcinoma.

Objective: The purpose of this study is to determine the topography of pelvic and para-aortic node involvement in Fallopian tube carcinoma (PFTC). This will help us to recommend appropriate surgical treatment options to the related patients., Patients and Method: A retrospective study was performed on 19 women with PFTC who underwent a systematic bilateral pelvic and para-aortic lymphadenectomy., Results: The overall frequency of lymph node involvement was 47% (9/19). The frequency of pelvic and para-aortic metastases was 21% (4/19) and 42% (8/19) respectively. The frequency of lymph node metastases according to the stage of the disease (stage I, II and III) was : 29% (2/7), 50% (1/2) and 60% (6/10) respectively. The left para-aortic chain above the level of the inferior mesenteric artery was the site most frequently involved (75%) when para-aortic nodes were involved., Discussion and Conclusions: In patients with primary tubal carcinoma, the left para-aortic chain above the level of the inferior mesenteric artery is the most frequently involved. A complete lymphadenectomy (including all pelvic and para-aortic chains up to the level of the left renal vein) should be performed in patients with primary tubal carcinoma, even in patients with stage I disease.

Tubal carcinoma is rare and its prognosis is poor. His diagnosis before intervention is not easy because clinic is poor and complementary exams not specifics. His treatment is radical surgery by laparoscopy associated with chemotherapy. The prognosis is correlated with cancer stage and residual tumoral volume after surgery. We report a 55 years case who underwent coelioscpic annexectomy for left pyosalpinx. Definitive histology answered tubal cancer. Patient dead after three months because disseminated and parietal metastasis.

The primitive endometrioid carcinoma of the fallopian tube is exceptional. Only three cases have been reported in the literature. Its rise on tubal endometriosis like for the ovary needs to meet the strict histological criteria established by Sampson and Scott in 1953. We report one case observed on a patient aged 45 years, who needed a total hysterectomy with bilateral annexectomy for menometrorrhagias associated to uterine leiomyomas which resisted to medical treatment. The finding of a primitive intra-epithelial endometrioid carcinoma of the left fallopian tube developed on bilateral tubo-ovarian endometriosis was fortuitously found during histological examination. Our observation seems to be unique since it shows an evident filiation between the lesions of tubal endometriosis and the adjoining endometrioid carcinoma contrary to the similar unique case reported in the literature where the link between the two lesions has not been demonstrated.

A 51-year old patient consults for abdominal swelling and persistent constipation. Clinical exploration shows the presence of a left iliac fossa tumor corresponding to a papillary serous adenocarcinoma of the fallopian tube after macroscopic and microscopic examination. The diagnostic and therapeutic problems caused by this rare gynecologic tumor are discussed.

Objectives: From a review of 20 cases of primary carcinoma of the fallopian tube, we stress the various clinical aspects of the disease and discuss the possibilities of a preoperative diagnosis., Materials and Methods: A retrospective study covering the period between 1982 and 1996. An analysis of the different etiological factors mentioned in the literature, of the physical signs and symptoms of the carcinoma, of the patients' age and hormonal status as well as the role of additional investigations was conducted., Results: The average age of the patients was 62.3 years, 90% of the women had reached menopause and 15% were nullipara. A history of salpingitis was noted in 5% of the patients and another 5% had infertility problems. 20% of the patients had suffered from another carcinoma. Metrorrhagia was the most frequent clinical finding revealing the disease (55%) followed by abnormal secretions of blood stained liquid (15%). Hydrops Tubae Profluens was not observed in this series. The main complementary investigations performed were pelvic ultrasound scanning and hysterosalpingography, preoperative diagnosis was possible in 15% of cases; diagnosis was made during the operative procedure in 45% of cases and by pathologic examination in the remaining 40% of patients., Conclusion: Primary carcinoma of the fallopian tube is a rare form of cancer of unknown aetiology. Clinical signs are often unrelated and sometimes misleading; however, preoperative diagnosis is possible if one keeps in mind the existence of this carcinoma.

229 patients with ovarian cancer (224) or Fallopian tube cancers (5) are discussed. 51.3% of 115 patients of 224 had stages III and IV, 4 patients with stage IIIc had Fallopian tube cancer. 56 primary debulking operations were performed: 53 for cancer of the ovaries, 3 of the Fallopian tubes. The total number of debulking operations was 70 in 56 patients. New operations were performed in 35 patients: 14 new debulking procedures, 21 second-look operations. A new trend in extensive surgery omits the second-look operation and prefers to repeat a new debulking surgery when it is clinically necessary and acceptable.

The authors report the result of a study carried out on 16 cases of tubal adenocarcinoma treated between the years 1975 and 1988. This is a rare gynaecological cancer with a poor prognosis. The mean age of the patients was 57 years, 64.5% of them were menopausal. 25% had had a history of sterility. 29% were nulliparous and 37.5% had previous salpingitis. In 44% of cases the principal clinical signs were a watery discharge and a blood stained discharge. Pelvic pain occurred in 37% of the cases and CT scan showed a pelvic mass in 50% of cases. Hysterosalpingography and ultrasound were two complimentary investigations. The relatively early stage at which first signs of the condition were noted, show the stages of the disease: stage I 68.7%, stage II 25%, stage III 6.2%, stage IV 0%. Surgery above all was the basis of treatment carried out in all cases, and supplemented in 15 out of the 16 cases by added treatment (radiotherapy, chemotherapy of hormone therapy). As far as histology was concerned, well or moderately well differentiated forms were found to predominate (there were 37.5% grade I and 37.5% grade II) against only 26% for grade III. More than half of the tube wall was infiltrated in 50% of cases. The actuarial survival rate after 5 years was 33%. The authors examine the principal factors responsible for the prognosis, the tissue, the early diagnosis and the possibility of removing the tumour completely at the first operation as well as the histological grading and above all the degree of depth of infiltration of the wall of the tube.

Endosalpingosis, defined by the presence in an ectopic site of epithelium comparable to that of the tubal mucosa, is not a well-known entity. In reference to 6 cases of our department, the authors have been able to assess this lesion. Clinical manifestations and laboratory tests offer no arguments. Cytology represents a diagnostic trap. The diagnosis may only be made histologically and is very often fortuitous. This benign lesion is often the result of a metaplasic process but, considering the difficulty of the diagnosis, the treatment is often surgical (total hysterectomy with castration). The course is uneventful.

The authors report a case of primary bilateral adenocarcinoma of the fallopian tube in a woman with invasive ductal carcinoma of the breast in her antecedents. The tubal carcinoma was in situ or invasive and appeared as a bilateral hydrosalpinx, fact which often happens in the literature. Gross examination showed a tumoral mass of about 2 cm diameter at the fimbriated end of the right tube, the diagnostic of bilaterality requiring serial cuts on the left tube. The electron microscopic study showed ciliated differentiation in the neoplastic cells, bearing out the primitive nature of the proliferation.

Although endometriosis appears as a rare cause in long series of cases of extrauterine pregnancy, the study of pregnancies which survive after treatment of endometriosis show a significant increase of extrauterine pregnancy, especially in cases of proximal lesions. The authors thinks that careful anatomo-pathological examination of tubes resected because of extrauterine pregnancy undoubtedly permit a large number of endometriosis lesions to be found.

Results of a 7-year follow-up review of a patient with intratubal cancer and lumbo-aortic glands invasion are reported. The highly lympholytic character of these tumors and the existence of elective lumbo-aortic lymph node metastases suggest that surgery should include routine bilateral lumbo-aortic curettage in tubal cancer, particularly stages I and IIA. As well as providing improved assessment of degree of extension of the disease it can also avoid the frequently poorly tolerated abdominopelvic radiotherapy.

Authors on the subject of a case of fallopian tube dermoid cyst, lay an emphasis on the rarity of this pathology, its clinical polymorphism. With an unknown pathology, the treatment remains only surgical.

The authors describe 4 cases of tubal cancer reported in the gynaecology department of the University Hospital in Caen and review the international literature. If all authors are in agreement on the early symptoms (leukorrhea, haemorrhages, pelvic pain), the lack of diagnosis before the procedure, the lack of information regarding the staging and the grading, as well as the surgical and radiation treatment, there is, above all, controversy regarding the use of chemotherapy, since the low number of patients in the different series does not permit reaching a conclusion.

The authors report a case of tubal choriocarcinoma discovered by chance during an ectopic pregnancy. The literature was reviewed on this subject. The treatment vary according to the authors, but, it would seem that chemotherapy has clearly modified the prognosis. But, we must realize that, with such a rare disease, diagnosis and treatment are sometimes difficult to obtain.

The majority of the 82 cases of tubal choriocarcinoma reported in the published literature followed malignant transformation of a tubal ectopic pregnancy. The case presented was not related to ectopic pregnancy but was apparently the result of malignant changes in migrating trophoblastic elements during previous pregnancies not arriving at full term. The patient had two abortions by aspiration and had been on oral contraceptives ever since. Fifteen or so of the cases of extra-uterine choriocarcinoma published in the literature appear to have resulted from the same aetiopathogenic mechanism.

Nodular salpingitis and tubal endometriosis are dystrophic disorders (salpingioses) the clinical importance of which is mainly due to their interference with female fertility. We have studied 42 cases of women operated for tubal sterility, viz. 23 cases of nodular salpingitis (NS), 17 of endometriosis (EM) and two cases in which both lesions were present. Pre-operative x-ray and celioscopic exploration was performed in order to assess the severity of the lesions and the outlook after tubal plastic surgery. X-ray examination reveals the diverticular nature of these lesions. Both diseases may be localized in any of the tubal segments. The postoperative prognosis depends on early surgery, site of the lesion and its nature.