The Interest of Endoscopy in the Diagnosis of Fallopian Tubes Diseases at the Yaoundé Gyneco-Obstetric and Pediatric Hospital (Ygoph)

Introduction: Fallopian diseases are often implicated in female infertility. Several radiological and surgical explorations have been proposed in order to evaluate the severity of lesions found in utero-adnexal pathology. Among tools that are used to investigate such pathologies, we have ultrasound, hysterosalpingography and endoscopy. But, in many developing countries like Cameroon, the usage of endoscopy in gynecology is not yet known by many practicians. The objective of our study was to show the interest of endoscopy in the diagnosis of fallopian tube pathologies. Methodology: We conducted a cross-sectional and descriptive study from March 1st, 2017 to May 31st, 2017 at the Gyneco-Obstetrics and Pediatric department of our Hospital. We included all women who presented infertility and underwent ultrasound, hysterosalpingography (HSG) and endoscopy at the Yaoundé Gyneco-obstetrics Hospital. We analyzed epidemiological parameters, clinics, ultrasound, hysterosalpingography and endoscopic finding. We used Cohen’s Kappa test to determine the correlation between HSG/endoscopy and ultrasound/endoscopy in the diagnosis of fallopian tube pathologies. The threshold was significant for a K-value > 0.20. Results: We got a sample of 156 women;the mean age was 32.6 ± 4.5 years. The Secondary infertility dominated in 66.7% of cases;31.1% of women presented a past medical history of sexually transmitted infections and 41.7% did abortions before. Endoscopic lesions were dominated by a fallopian obstruction in 54.5% of cases, 8.3% of adhesions, 33.9% of women presented uterine myomas, 37.8% of ovarian cysts and 1.3% of pelvic endometriosis. The K-values between HSG and endoscopy for distal and proximal tube obstructions were significant with respective thresholds of 0.25 and 0.30. The K-value between ultrasound and endoscopy was not significant with a threshold of 0.015 for the tubal hydrosalpinx. Conclusion: Endoscopy assessment appears as the most efficient tool to investigate fallopian tube diseases.

Ultrastructural Observation of Fallopian Tubes in Patients with Pelvic Congestion Syndrome after Oviductal Ligation

The morphological basis of bilateral lower abdominal pain was studied by means of ultrastructural observation in patients with pelvic congestion syndrome after oviductal ligation. Fallopian tubes of 14 cases were collected during operation. Of them, 10 patients suffered from pelvic congestion syndrome, 4 cases were normal used as control, the 8 small segments from the tubal isthmus were removed during ligation. The essential changes of the fallopian tubes in patients with this syndrome were the marked swelling of the C-type unmyelinated nerve fibers, the decrease in density of axoplasm and in number of microtubules and microfilaments. The Schwann's cells were swollen as well. Furthermore, the mitochondria revealed mild to moderate swelling, their cristae decreased and shortened. However, the changes of the endings of efferent nerve fibers were not obvious.The ultrastructural changes of C-type unmyelinated nerve fibers except the endings of efferent nerve fibers were closely related to the bilateral lower abdominal pain in patients with this syndrome.

High-grade serous carcinoma of the fallopian tube in a young woman with chromosomal 4q abnormality:A case report

BACKGROUND Few studies have reported an association between an increased risk of acquiring cancers and survival in patients with 4q deletion syndrome.This study presents a rare association between chromosome 4q abnormalities and fallopian tube highgrade serous carcinoma(HGSC)in a young woman.CASE SUMMARY A 35-year-old woman presented with acute dull abdominal pain and a known chromosomal abnormality involving 4q13.3 duplication and 4q23q24 deletion.Upon arrival at the emergency room,her abdomen appeared ovoid and distended with palpable shifting dullness.Ascites were identified through abdominal ultrasound,and computed tomography revealed an omentum cake and an enlarged bilateral adnexa.Blood tests showed elevated CA-125 levels.Paracentesis was conducted,and immunohistochemistry indicated that the cancer cells favored an ovarian origin,making us suspect ovarian cancer.The patient underwent debulking surgery,which led to a diagnosis of stage IIIC HGSC of the fallopian tube.Subsequently,the patient received adjuvant chemotherapy with carboplatin and paclitaxel,resulting in stable current condition.CONCLUSION This study demonstrates a rare correlation between a chromosome 4q abnormality and HGSC.UBE2D3 may affect crucial cancer-related pathways,including P53,BRCA,cyclin D,and tyrosine kinase receptors,thereby possibly contributing to cancer development.In addition,ADH1 and DDIT4 may be potential influencers of both carcinogenic and therapeutic responses.

Primary ovarian cancer combined with primary fallopian tube cancer:A case report

BACKGROUND Low grade serous carcinoma of the ovary(LGSOC)is a rare type of epithelial ovarian cancer with a low incidence rate.The origin of ovarian cancer has always been a hot topic in gynecological oncology research,and some scholars believe that the origin of ovarian malignant tumors is the fallopian tubes.Primary fallopian tube cancer is the lowest incidence of malignant tumors in the female reproductive system.There are only a few reports in the literature,but the mortality rate is very high.But in clinical practice,fallopian tube cancer is very common,but in most cases,it is classified as ovarian cancer.CASE SUMMARY We report a 54 years old postmenopausal woman who was hospitalized with a lower abdominal mass and underwent surgical treatment.The final pathological confirmation was low-grade serous carcinoma of the right ovary and low-grade serous carcinoma of the left fallopian tube.No special treatment was performed after the surgery,and the patient was instructed to undergo regular follow-up without any signs of disease progression.CONCLUSION The prognosis of LGSOC is relatively good,over 80%of patients still experience disease recurrence.

Expression and Change of B Cell Activation Factor of the TNF Family(BAFF) Gene between Human Normal and Inflamed Fallopian Tubes

Objective To investigate the expression of B cell activation factor of the TNF family （BAFF） gene between human normal and inflamed fallopian tubes. Methods Tissue samples of human normal fallopian tube （n=20） and inflamed fallopian tube （n=20） were collected. The expression of BAFF gene was determined by the real- time reverse transcription polymerase chain reaction （RT-PCR） and immunohistochemistry. Results BAFF immunostaining appeared on the cellular membrane and in the cytoplasm of tubal epithelial cells. Both BAFF protein and mRNA in normal fallopian tubes had lower levels than those in inflamed fallopian tubes （P〈0.01）. Conclusion BAFF protein and mRNA are present in human tubal tissues. BAFF gene in human inflamed fallopian tube would have a high expression.

Endometriosis-associated endometrioid adenocarcinoma of the fallopian tube synchronized with endometrial adenocarcinoma:A case report

BACKGROUND Endometriosis is a common gynecological disorder that affects women of reproductive age.It is characterized by a cancer-like invasion of the extra-uterine endometrium and exhibits a strong association with ovarian clear cell cancer and endometrioid cancer.Endometriosis-associated fallopian tube endometrioid adenocarcinoma synchronized with endometrial adenocarcinoma was rarely reported.CASE SUMMARY A 49-year-old woman was referred to our hospital complaining about abnormal vaginal bleeding for three years following unsatisfactory medication.Intraop-erative frozen sections unexpectedly unveiled an endometrioid cancer of the left fallopian tube with superficial invasion surrounded by diffuse endometriosis synchronized with endometrioid endometrial cancer.CONCLUSION It was difficult to make a differential diagnosis when confronted with incidental findings of fallopian tube cancer lesions synchronized with endometrial cancer.The key differential diagnosis of primary endometriosis-associated endometrioid adenocarcinoma of the fallopian tube from endometrial adenocarcinoma invol-vement relies on the pathological identification of malignant transformation in fallopian tube endometriosis disease.

Primary mesonephric adenocarcinoma of the fallopian tube:A case report

BACKGROUND Mesonephric adenocarcinoma(MNAC)is an extremely rare malignancy in the female genital tract.Only a few cases have been reported in the literature,and most of them occurred in the cervix,with extremely rare cases in the uterine body and ovary.MNAC has never been reported to arise in the fallopian tube.CASE SUMMARY A 45-year-old woman was referred to our institution with a history of abdominal pain.Ultrasound revealed a cystic and solid mass in left adnexal region.The patient underwent complete staging surgery when intraoperative pathological examination demonstrated that the mass was malignant.The final histological and immunohistochemical results confirmed the diagnosis of MNAC originating from the fallopian tube.Then she received four cycles of combination chemotherapy with carboplatin plus paclitaxel.The tumor recurred with hepatic metastases 4 mo after initial surgery,and second resection of the tumors in the liver plus partial hepatectomy was performed.She was supplemented with five courses of a new combination chemotherapy with gemcitabine plus carboplatin,and there was no evidence of recurrence within the 22-mo follow-up period after the second surgery.CONCLUSION MNAC originating from the fallopian tube is an extremely rare and high malignancy with a poor prognosis.It can be very aggressive,even at early stage.Little is known about the clinical characteristics,pathological diagnosis,prognosis,and optimal management strategy of MNAC originating from the fallopian tube.Herein we report the first case of primary MNAC deriving from the fallopian tube.

FALLOPIAN TUBE PROLAPSE FOLLOWING HYSTERECTOMY

Objective To investigate the clinical diagnosis, treatment, and prevention of fallopian tube prolapse (FTP) after hysterectomy.Methods A total of 7949 patients received hysterectomy from January 1983 to August 2005 in Peking Union Medical College Hospital, and 9 cases (including 1 case from other hospital) of FTP after hysterectomy were involved during this period.All of them were diagnosed according to pathological results and were followed up.The symptoms, diagnosis, and treatment of the FTP patients were analyzed retrospectively.Results The incidence of FTP after hysterectomy was 0.1% (8/7949), with the incidence of FTP after trans- abdominal hysterectomy being 0.06% (4/6229), after trans-vaginal hysterectomy being 0.5% (4/780), after laparoscopic assistant vaginal hysterectomy being 0 (0/940).There was no symptom in 3 cases.The pelvic examination revealed the typical prolapsed fimbrial end of a fallopian tube in 3 cases and the other 6 cases revealed red granulation tissue.All of them were excised vaginally and cauterized.The results were proved by pathological examination.No recurrence was reported during follow-up.Conclusions FTP is a rare complication after hysterectomy.The prognosis is well after proper diagnosis and treatment.Fixation of accessories onto the pelvic wall and complete peritonealization at the time of hysterectomy are the most important methods to prevent FTP after hysterectomy.

Combination of docetaxel-carboplatin for adjuvant chemotherapy of epithelial ovarian,primary peritoneal and fallopian tube cancers:a meta-analysis

Objective： The aim of this study was to compare the efficacies and safeties of the combination of docetaxel- carboplatin with the combination of non docetaxel-carboplatin as first-line chemotherapy for advanced epithelial ovarian, pri- mary peritoneal or fallopian tube cancers. Methods： Relevant articles were identified from MEDLINE （1993-2010）, EMBASE （1980-2010）, MEDION, the Cochrane library, Science Citation Index Expanded databases, hand searching of reference lists from primary articles and reviews, conference abstracts and contact with experts in the field. The review included 5 relevant primary studies （1430 women）. Data was extracted for study characteristics and quality. Bivariate random-effect model meta- analysis was used to estimate diagnostic accuracy of the various index tests. A quantitative meta-analysis was carried out by two reviewers based on the inclusion criteria from all available studies. Results： The frequency of the subgroup analysis of toxicity showed that toxicity action of combination of docetaxel-carboplatin was more severe than that of non docetaxel- carboplatin group （OR = 1.33, 95% CI = 1.13-1.56, P = 0.0005）, whereas that of clinical responses was equivalent in com- parison combination of docetaxel-carboplatin with combination of paclitaxel-carboplatin or docetaxel-cisplatin （OR = 1.0, 95% CI = 0.87-1.16, P = 0.95）. There were heterogeneity （X2 = 79.36, P 〈 0.00001） and inconsistency （83.6%） in toxicity analysis among the trials, while neither heterogeneity （x2 = 3.21, P = 0.99） nor inconsistency （F = 0%） in clinical responses among the trials. Conclusion： The safety of combination of docetaxel-carboplatin is less than that of combination of paclitaxel- carboplatin or docetaxel-cisplatin. However, the clinical responses of combination of docetaxel-carboplatin are comparable with combination of paclitaxel-carboplatin or docetaxel-cisplatin.

Fallopian tube:Its role in infertility and gynecological oncology

Disorders of the fallopian tube play a very important role in both infertility and gynaecological oncology. Tubal factor infertility is considered among the leading causes of female factor infertility. Many tubal disorders are related to infertility including congenital anomalies, acute and chronic inflammatory diseases, endometriosis and other pathologies that result in partial or total fallopian tube obstruction. In the field of gynaecological oncology, ovarian surface epithelial tumors remain one of the most fatal malignancies in women worldwide carrying the worst prognosis among female genital malignancies. For decades, the cell of origin of epithelial tumors has remained controversial and was largely believed to be surface ovarian epithelium. Recently several studies suggested that there is a major role of the fallopian tube in the development of ovarian surface epithelial tumors, mainly high grade serous carcinoma and other tumour types. In this article we review the role of the fallopian tube in both infertility and gynaecological oncology.

A CLINICAL REPORT OF REFRACTOTY CARCINOMA OFOVARY AND FALLOPIAN TUBE TREATED WITH TAXOL

From September 1993 through March 1994, 30 cases of refractory carcinoma of the ovary and Fallopian tube were treated with Taxol. Complete response was seen in 4 and partial response in 8 cases with a response rate of 40 %. The average length of remission was 5 months in CR and 3.9 months in PR. The major toxic side effect was decrease in total white cell count and in neutrophil count. Apart from flushing of face during Taxol infusion in 6 patients, no other allergic reaction was observed. Gastrointestinal, neurologic, liver and renal toxicities were mild. Taxol is a drug of choice in the treatment of patients with cancer of the ovary and Fallopian tube who are resistant to conventional chemotherapy.

Diagnostic and Therapeutic Radiological Intervention for Fallopian Tube Obstruction

Presented in this paper are results of diagnostic and therapeutic radiological intervention for 110 cases of fallopian tube obstruction. Unilateral or bilateral recanalization was achieved in 89 cases, with a success rate being 80. 91%.Among the 89 patients, patency was achieved by first step treatment(regularHSG) in 40 cases (46%) and recanalization was successeful in 49 patients(54%) by sencond and/or third step (selective salpingography plus guide wire). Inthe 49 cases, 96 occluded tubes were involved, including 89 tubes with proximalobstruction (interstitia-isthmus portion) and 7 tubes with medial-distal obstruction (isthmus-ampulla portion). The success rates for proximal and medial-distalobstruction were 92. 2% and 7. 8% respectively. Follow-up results of 45 casesrevealed that the tubes of remained patent in 30 cases; 40 became pregnant, among them, 9 gave normal birth of babies; occlusion re-developed in only onecase. The authors believe that this radiological intervention can avoid false positive findings frequently occurring with use of regular HSG, thereby enhancing diagnostic accuracy. The selective salpingography could directly increase the intratubal hydrostatic pressure , remove the debris and amiliorate the inflammatoryadhersion in the fallopian tubes; selective salpingography plus guide wire recanalization can recanalize the tubes with proximal obstruction with satisfactory results. We recommend the method for the pre-treatment of 'test tube baby' procedure.

A Rare Case of Intrauterine Adhesion Caused by Intrauterine Fallopian Tube Incarceration

Hysteroscopy is widely used for the detection and treatment of intrauterine adhesion.Such technique,however,sometimes has limitations and even second damages.We report a rare case of severe intrauterine adhesion caused by uterine perforation with a fallopian tube incarceration.A 24-year-old woman underwent severe intrauterine adhesion and secondary infertility caused by fallopian tube incaceration into the uterine cavity after postpartum curettage.First hysteroscopy created a false passage through the previous uterine perforation,entered into the cavity of incarcerated fallopian tube,and led to iatrogenic hydrosalpinx.Secondary hysteroscopy combined with laparoscopy revealed a connection between the right tubal lumen and the uterine cavity by the false passage,released the adhesion,and reconstructed the uterine cavity.Early recognition of uterine perforation or tissue incarcerarion is significant in preventing further damage.

Primary Bilateral Adenocarcinoma of the Fallopian Tube: A Case Report

Primary fallopian tube carcinoma is an uncommon malignancy that accounts for 0.14% to 1.8% of gynecological cancers. The clinical symptom is not specific and preoperative diagnosis is easy to miss or delay because of a lack of specific symptoms. We reported a case of bilateral adenocarcinoma of the Fallopian tubes, was occurred in a 51-year-old postmenopausal woman and diagnosed with bilateral salpingectomy for suspicious of suppurative salpingitis. The diagnosis is not always suspected preoperatively. They are assimilated to salpingitis in the early stage, or to ovarian tumors in the advanced stage. The diagnosis is made postoperatively, after an anatomopathological examination. Its etiology is still poorly understood.

The sperm-interacting proteome in the bovine isthmus and ampulla during the periovulatory period

Background Spermatozoa interact with oviduct secretions before fertilization in vivo but the molecular players of this dialog and underlying dynamics remain largely unknown.Our objectives were to identify an exhaustive list of sperm-interacting proteins(SIPs)in the bovine oviduct fluid and to evaluate the impact of the oviduct anatomical region(isthmus vs.ampulla)and time relative to ovulation(pre-ovulatory vs.post-ovulatory)on SIPs number and abundance.Methods Pools of oviduct fluid(OF)from the pre-ovulatory ampulla,pre-ovulatory isthmus,post-ovulatory ampulla,and post-ovulatory isthmus in the side of ovulation were collected from the slaughterhouse.Frozen-thawed bull sperm were incubated with OF or phosphate-buffered saline(control)for 60 min at 38.5℃.After protein extraction and digestion,sperm and OF samples were analyzed by nanoLC-MS/MS and label-free protein quantification.Results A quantitative comparison between proteins identified in sperm and OF samples(2333 and 2471 proteins,respectively)allowed for the identification of 245 SIPs.The highest number(187)were found in the pre-ovulatory isthmus,i.e.,time and place of the sperm reservoir.In total,41 SIPs(17%)were differentially abundant between stages in a given region or between regions at a given stage and 76 SIPs(31%)were identified in only one region×stage condition.Functional analysis of SIPs predicted roles in cell response to stress,regulation of cell motility,fertilization,and early embryo development.Conclusion This study provides a comprehensive list of SIPs in the bovine oviduct and evidences dynamic spatiotemporal changes in sperm-oviduct interactions around ovulation time.Moreover,these data provide protein candidates to improve sperm conservation and in vitro fertilization media.

An update on hormonal regulation of early embryo-fallopian tube interactions: insights for improvements of assisted reproductive technology outcomes

Human fallopian tubes(FTs)play important roles in the whole reproductive process.FTs are the site for the final maturation of gametes,fertilization,transport of preimplantation embryos,and early embryonic development before entering the uterus.All these functions are critical in the establishment of a successful pregnancy.When the embryo is in transit through the FT,the FT microenvironment changes through endocrine,paracrine,autocrine,and juxtacrine mechanisms which involve various hormones and bioactive substances mainly from the neighboring cells.Therefore,the interactions between the embryo and the FT may be the earliest embryo-maternal communications that are essential for the establishment of pregnancy.This review critically discusses the evidence of various hormonal and bioactive mediated control of the microenvironment in the FTs during the earliest embryo-maternal communications.Moreover,we highlight existing gaps in the knowledge and the importance of exploring more of the physiology of FTs which will hold the key to producing high-quality embryos for patients seekingin vitro fertilization(IVF)treatments.

Diagnosis and treatment of tubal endometriosis in women undergoing laparoscopy:A case series from a single hospital

BACKGROUND Tubal endometriosis(TEM)is a category of pelvic endometriosis(EM)that is characterized by ectopic endometrial glands and/or stroma within any part of the fallopian tube.The fallopian tubes may be a partial source of ovarian endometriosis(OEM).TEM is difficult to diagnose during surgery and is usually detected by pathology after surgery.AIM To provide a clinical basis for the diagnosis and treatment of TEM.METHODS In this study,the data of 30 patients who underwent laparoscopic salpingectomy due to various gynecological diseases and had pathological confirmation of TEM at our hospital were retrospectively analyzed,and the clinical basis for the diagnosis and treatment of TEM was evaluated.RESULTS Among 1982 surgical patients,30 met the study criteria.Among those,6 patients had a history of infertility,12 patients had a history of artificial abortion,13 patients had a history of cesarean section,1 patient had a history of tubal ligation,4 patients had an intrauterine device,and 22 patients had hydrosalpinx.Sixteen patients(53.33%)conceived naturally and gave birth to healthy babies.Pathology showed that only 2 patients had TEM without any other gynecological diseases,while the others all had simultaneous diseases,including 26 patients with EM at other pelvic sites.CONCLUSION The final diagnosis of TEM depends on pathological examination since there are no specific clinical characteristics.The rate of TEM combined with EM(especially OEM)was higher than that of other gynecological diseases,which indicates that TEM is related to OEM.

Ectopic Tubal Molar Pregnancy: A Case Report

Background: Molar pregnancy is a rare condition;its ectopic form is even rarer occurring in 1.5 per 1,000,000 pregnancies. Aim: We report a case of ectopic molar pregnancy located in the fallopian tube and draw attention to the importance of systematic histological examination in any ectopic pregnancy. Case report: A 32-year-old primigravida woman presented with metrorrhagia in a context of about 2 months of amenorrhea. An ectopic pregnancy was diagnosed by ultrasonography. A Laparotomy was performed and a ruptured left ampullary ectopic pregnancy was found, and a total left salpingectomy was performed. The pathologic examination and the histological examination show an aspect of a partial molar ectopic tubal pregnancy. Conclusion: Ectopic molar pregnancy is a rare entity, its diagnosis requires histological confirmation. Beta-HCG monitoring is the essential tool for monitoring the postoperative evolution.

The Expression and Change of the β_3 Integrin Subunit and Fibronectin in Normal Human Oviductal Tissue and Tubal Ectopic Pregnant Tissue

Objective To investigate the expression and change of the β3 integrin subunit and fibronectin in normal human oviductal tissue during various phases of the menstrual cycle and tubal ectopic pregnant tissueMethods Samples of normal ( n=29 ) and pregnant fallopian tube ( n=22 ) tissues were obtained from women who had normal cycle and history of normal pregnancy. Normal oviductal tissue samples were divided into 4 groups based on their menstrual cycle. Both expression and distribution of the β3 subunit and fibronectin were determined with the immunohistochemical method and the image analysis.Results The β3 subunit was expressed in the cytoplasm of ciliated cells. The expression level of the β3 subunit was higher after ovulation than that before ovulation in isthmus epithelium (P<0.001), and declined significantly after ovulation in ampullae epithelium (P<0.001). In umbrella epithelium within 4 days after ovulation, the expression level of the β3 subunit was observed at rather higher level among other phases (P <0.001). The ciliated and secretory cells of the epithelium except for where the pregnancy occurred in tubal pregnancy expressed the β3 subunit, and no significant relationship was found between the normal tubal tissue of the secretory phase and tubal ectopic pregnant tissue (P>0.05). Fibronectin was expressed in the basement membrane of human oviductal epithelium and matrix. The expression level of fibronectin was higher in the hyperplastic phase than that in the secretory one (P<0.001). And it was lower in normal tubal tissue of the secretory phase than that in tubal ectopic pregnant tissue (P<0.001).Conclusion Theβ3 integrin subunit was expressed in the ciliated cells of human oviductal epithelium, and fibronectin was expressed in the basement membrane of human oviductal epithelium and matrix. Their expression and change in oviductal tissue is based on different phases of menstrual cycle. The β3 subunit could not related to the occurrence of tubal ectopic pregnancy. Fibronectin could be the potential molecular basis for the tubal ectopic pregnancy.

Ectopic Adrenal Gland in Mesosalpinx:A Case Report and Literature Review

A case of ectopic adrenal gland tissue in mesosalpinx is reported.A 52-year-old patient was admitted to the hospital for irregular vaginal bleeding for 2 months.Ultrasound scan showed multiple hypoechoic masses in the myometrium of the anterior wall of uterus with regular shape and clear boundary.Laparoscopic hysterectomy and bilateral adnexectomy were performed.In the course of pathological diagnosis,we accidentally found ectopic adrenal gland tissue in the left mesosalpinx.We believe this is worthy of reporting since this case is rare.