204 T. Lo et al.

/ International Journal of Gynecology and Obstetrics 130 (2015) 200206

remove the cyst intact with no risk of spillage. The technique reported
here allows drainage and removal of the cyst through a signicantly
smaller incision, giving a better cosmetic result while protecting the
patient from the potential spread of malignancy that a ruptured cyst
could cause.
This technique would be suitable for large benign lesions and could
be used with a smaller abdominal incision (e.g. a Pfannenstiel incision)
to reduce the risk of adhesions in the future when compared with
a midline incision [3]. It would not be recommended when malignancy
is strongly suspected. A staging laparotomy would be needed in
these cases.
Conict of interest
The authors have no conicts of interest.
References
[1] Cho SM, Byun JY, Rha SE, Jung SE, Park GS, Kim BK, et al. CT and MRI ndings of
cystadenobromas of the ovary. Eur Radiol 2004;14(5):798804.
[2] Fatum M, Rojansky N, Shushan A. Papillary serous cystadenobroma of the ovaryis
it really so rare? Int J Gynecol Obstet 2001;75(1):856.
[3] Ashrania M, Vazirichimeh Z, Dastjerdi MV, Moiini A. Adhesion formation in patients
with previous laparotomies. J Am Assoc Gynecol Laparosc 1996;3(4 Supplement):S2.

http://dx.doi.org/10.1016/j.ijgo.2015.03.031
0020-7292/ 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Magnetic resonance imaging features of fallopian tube carcinoma

Xin-feng Mao a,b, Chun-hong Hu a,, Su Hu a, Yue-ming Zhu b, Yu-ying Zhao b, Jian Shen b
a
Imaging Center, The First Afliated Hospital of Soochow University, Suzhou, China
b
Department of Radiology, Huzhou Central Hospital, Huzhou, China

a r t i c l e i n f o imaging with fast spin echo sequence were 600/8.8 (repetition time/
echo time). T2-weighted images were obtained using a single-shot
Article history: fast spin echo technique with parameters of 2800/81 (repetition time/
Received 8 October 2014 echo time). The T1- and T2-weighted images were acquired with a sec-
Received in revised form 20 January 2015 tion thickness of 5 mm and a matrix of 288 256. Diffusion-weighted
Accepted 26 March 2015
images used an axial spin-echo echo-planar sequence with a b value
Keywords:
of 700 s/mm2. The contrast agent was gadolinium, with a dose of
Diagnosis 1520 mL and injection rate of 1.52.0 mL/s. All the images were obtain-
Fallopian tube carcinoma ed in the axial, sagittal, and coronal planes.
Magnetic resonance imaging (MRI)

Table 1
Magnetic resonance imaging results (n = 9).
Primary fallopian tube carcinoma (FTC) is considered a rare gyneco-
logic malignancy that accounts for 0.14%1.8% of all gynecologic cancers Characteristics Valuesa
[1]. FTC occurs on the highly differentiated epithelium of the Mllerian Location
duct and has an unknown etiology. Because of its rarity and nonspecic Left lateral 5 (56)
clinical presentation, preoperative diagnosis of FTC is difcult, and many Right lateral 3 (33)
patients with FTC undergo laparotomy as a result of a presumed diagno- Bilateral 1 (11)
Shape
sis of ovarian carcinoma [2]. The diagnosis of FTC is based on histological Plug-like 2 (22)
examination, and specic criteria have to be met [3]. A way to rapidly Honeycomb-like 2 (22)
and accurately diagnose FTC is urgently needed. Bead-like 3 (33)
A retrospective analysis was performed to determine the magnetic Sausage-like 3 (33)
Size, cm 1.0 0.9 0.98.8 7.2 7.1
resonance imaging (MRI) features in patients with FTC and summarize
Margins
these MRI features to enable differential diagnosis of FTC. Patients were Well dened 6 (67)
included when they had been referred to the First Afliated Hospital of Poorly dened 3 (33)
Soochow University, Suzhou, China between February 1, 2003, and Signal features
September 30, 2012, and had been diagnosed with FTC after surgery Iso- or hypo-intensity on T1WI 9 (100)
Hyperintensity on T2WI 9 (100)
and pathologic analysis. The study was approved by the Institutional Hyperintensity on DWI 9 (100)
Review Board of the First Afliated Hospital of Soochow University, Enhancement of solid and cystic masses
Suzhou, China. Written informed consent was obtained from all the pa- Hyperdensity 9 (100)
tients for future use of their data for analysis. Change of surrounding areas
Cystic-solid adnexal mass 9 (100)
MRI had been performed up to 3 weeks before surgery, using a 1.5 T
Internal structure
GE Signa Excite scanner (GE Medical Systems, Milwaukee, WI, USA) and Papillary projections 4 (44)
phased-array multicoils. The imaging parameters in T1-weighted Cylindrical soft tissue shadow 2 (22)
Irregular soft tissue shadow 3 (33)
Fluid-uid levels 2 (22)

Corresponding author at: Imaging Center, The First Afliated Hospital of Soochow Abbreviations: T1WI, T1-weighted image; T2WI, T2-weighted image; DWI, diffusion
University, 188 Shizi St, Suzhou, 215006, China. Tel./fax: +86 512 65228072. weighted image.
a
E-mail address: hchsuda5305@126.com (C. Hu). Values are given as number (percentage) or range.
 T. Lo et al. / International Journal of Gynecology and Obstetrics 130 (2015) 200206 205

Fig. 1. Magnetic resonance imaging of a patient aged 48 years with primary fallopian tube carcinoma on the left side. (a) T2-weighted imaging with fat saturation showed a left adnexal
cystic lesion (arrow) and papillary projections inside the fallopian tube, with a slightly hyperintense signal. (b) Contrast-enhanced T1-weighted imaging with fat saturation showed a
substantial lesion and cystic wall enhancement (arrow).

Fig. 2. Magnetic resonance imaging of a patient aged 59 years with primary fallopian tube carcinoma on the left side. (a) T2-weighted imaging with fat saturation showed a left adnexal
cystic lesion and cylindrical soft tissue shadow (arrow) shaped as an embolism along the cystic lesion, with a slightly hyperintense signal. (b) Diffusion weighted imaging showed a
hyperintense signal (arrow).

Fig. 3. Magnetic resonance imaging of a patient aged 54 years with primary fallopian tube carcinoma on the right side. (a) T2-weighted imaging with fat saturation showed a right adnexal
cystic lesion (arrow), irregular shaped parenchyma, a dilated fallopian tube with a sausage-like appearance, and severe pelvic effusion. (b) Irregular soft tissue shadow (arrow) was
observed in uterus and rectum. Metastatic cancer was conrmed after surgery.
206 T. Lo et al. / International Journal of Gynecology and Obstetrics 130 (2015) 200206

Fig. 4. Magnetic resonance imaging of a patient aged 63 years with primary fallopian tube carcinoma on the left side. (a) Contrast-enhanced T1-weighted imaging with fat saturation
showed an irregularly shaped left adnexal cystic lesion (arrow) and obvious parenchyma enhancement. (b) T2-weighted imaging with fat saturation showed uid-uid levels inside
the cystic lesion (arrow).

The patients then underwent laparoscopy or laparotomy. The tumor
was staged according to the International Federation of Gynecology and
Obstetrics 2013 staging system.
A total of nine patients were identied; two underwent laparoscopy
and the other seven underwent laparotomy. The age of the patients
ranged from 4872 years (mean 60 years). Seven (78%) women were
postmenopausal. According to the physical examination results before
referral, 2 (22%) patients had abnormal vaginal discharge, 3 (33%) ab-
normal vaginal bleeding, and 4 (44%) a palpable pelvic mass.
Table 1 summarizes the features noted on MRI. Of the nine cases,
four had papillary projections adhering to the cystic wall inside the cys-
tic lesion (Fig. 1) with well dened margins. Two had a cylindrical soft
tissue shadow with the appearance of an embolism along the cystic
lesion (Fig. 2), and a well dened margin could be observed between le-
sion and peripheral tissues. Three had a combination of a cystic lesion
and irregular soft tissue shadow, with a mixed signal shadow and poorly
dened margins. One presented with irregular soft tissue shadow in the
pelvic cavity with severe pelvic effusion (Fig. 3). Two of the cystic le-
sions showed uid-uid levels inside cystic lesion (Fig. 4).
As in a previous report [4], the most common appearance of FTC in
the present study was a relatively small, sausage-like, solid unilateral
mass with low-signal intensity on T1-weighted images and high-
signal intensity on T2-weighted images. By contrast, the typical presen-
tation of ovarian cancer is an irregular, solid, cystic mass, or a cystic mass
with multiple papillary mural nodules [5].
Overall, FTC is a possible diagnosis among postmenopausal women
with unusual vaginal discharge or bleeding. Additionally, it should
be considered when MRI shows a solid, cystic adnexal mass with a
sausage-like appearance and papillary protrusions or cylindrical soft
tissue shadow; when T1-weighted images show hypo- or iso-intensity
signals, T2-weighted images show slightly hyperintensity signals,
diffusion-weighted images show hyperintensity signals; or a uid-
uid level can be seen in the dilated fallopian tube lumen with unevenly
distributed cystic wall and thickened wall enhancement. Finally, pre-
sentation with pelvic metastasis is a strong indication of the risk of FTC.
In conclusion, the classic features of FTC on MRI seem to be a solid,
cystic adnexal mass with papillary projection or cylindrical soft tissue
shadow within a sausage-like dilated fallopian tube. Conclusions con-
ducted from the present study could be limited by the small number
of patients assessed. However, the present study does support the use
of MRI in the diagnosis of FTC.
Conict of interest
The authors have no conicts of interest.
References
[1] Oliveira C, Duarte H, Bartosch C, Fernandes D. Small fallopian tube carcinoma with ex-
tensive upper abdominal dissemination: a case report. J Med Case Rep 2013;7:252.
[2] Haratz-Rubinstein N, Russell B, Gal D. Sonographic diagnosis of Fallopian tube carci-
noma. Ultrasound Obstet Gynecol 2004;24(1):868.
[3] Sedlis A. Carcinoma of the fallopian tube. Surg Clin North Am 1978;58(1):1219.
[4] Kim MY, Rha SE, Oh SN, Jung SE, Lee YJ, Kim YS, et al. MR Imaging ndings of
hydrosalpinx: a comprehensive review. Radiographics 2009;29(2):495507.
[5] Bazot M, Dara E, Nassar-Slaba J, Lafont C, Thomassin-Naggara I. Value of magnetic
resonance imaging for the diagnosis of ovarian tumors: a review. J Comput Assist
Tomogr 2008;32(5):71223.

http://dx.doi.org/10.1016/j.ijgo.2015.02.018
0020-7292/ 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.