Elsevier

Gynecologic Oncology

Volume 97, Issue 1, April 2005, Pages 263-265
Gynecologic Oncology

Case Report
Borderline endometrioid tumor arising in a paratubal cyst: a case report

https://doi.org/10.1016/j.ygyno.2004.12.032Get rights and content

Abstract

Background

Paratubal cysts, generally known as hydatid cysts of Morgagni, are small round cysts attached by a pedicle to the fimbriated end of the tube. The following represents the first reported case of an endometrioid tumor of low malignant potential arising in a paratubal cyst.

Case report

A 45-year-old nulliparous female was referred with a complex right adnexal mass on pelvic sonogram. She underwent laparoscopic bilateral ovarian cystectomy and partial right salpingectomy (for a 3-cm torsed paratubal cyst). All frozen-section diagnoses were benign; however, final pathology revealed a borderline tumor of low malignant potential of endometrioid type in the right paratubal cyst. The patient underwent extensive counseling regarding management options and decided to have a laparoscopic right salpingo-oophorectomy. Final pathologic analysis revealed no evidence of persistent borderline tumor.

Conclusion

Paratubal cysts are very difficult to diagnose with sonography; therefore, their management should be approached as any other adnexal mass. Laparoscopic surgery is an option in the management of adnexal masses; however, rupture or puncture of masses should be avoided when possible to prevent potential tumor dissemination in the event of a malignancy.

Introduction

Paratubal cysts are common incidental findings. Rarely are they large enough to be clinically significant [1]. Low malignant potential, also called borderline, tumors display pathological features intermediate between benign and invasive epithelial lesions. Although these tumors show various degrees of epithelial proliferation, they lack the destructive stromal invasion of a carcinoma [2], [3].

Ovarian tumors of low malignant potential tend to occur in younger patients and at an earlier stage of disease than their invasive counterparts. It has been reported that only 15–20% of borderline ovarian tumors present with stage III or IV disease [3]. A review of the histologic features of 1063 cases of borderline ovarian tumors revealed 50% serous histology, 46% mucinous, and the remaining 4% mixed, clear cell, or Brenner tumors [3]. Tumors of low malignant potential of the ovary are fairly common, accounting for 5–20% of all ovarian epithelial neoplasms [3], [4], [5].

Tumors of low malignant potential of fallopian tube origin are rare, as are primary invasive carcinomas arising from a paratubal cyst. An extensive review of the literature reveals that there are no previously reported cases of borderline endometrioid tumors arising in paratubal cysts. We report the first case which was diagnosed and managed laparoscopically.

Section snippets

Case report

A 45-year-old nulliparous female was referred with a 1-year history of a complex right adnexal mass. Sonographic evaluation over the 1-year period showed a persistent 5-cm septated right adnexal mass with an 8-mm papillary solid tissue projection. After referral, evaluation, and extensive counseling, the decision was made to proceed with laparoscopic evaluation.

At laparoscopy, a 3-cm torsed right paratubal cyst (Fig. 1) was noted, along with a 2-cm right ovarian cyst. On the left side, there

Discussion

Fallopian tube carcinoma is an uncommon entity, and para fallopian tube malignant tumors are even rarer. Paratubal cysts, generally known as hydatid cysts of Morgagni, are small, round cysts attached by a pedicle to the fimbriated end of the tube [6]. They are usually of mullerian (paramesonephric) origin, thin walled with clear content lined by a single layer of tubal-type ciliated epithelium [1], [6], [7]. Some paratubal cysts are of mesothelial origin and are lined by flattened cells with

References (12)

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    In the literature (see Table 1), the median age for presenting this type of cyst is 31,1 so they are rare in the adolescent period. Paratubal borderline tumors are extremely rare, reported only as case reports in the literature.1,3,4 In some cases, preoperative ultrasonographic findings of papillary protrusions suspected of malignancy and intraoperative frozen sections of the cyst are performed and thus tumors are diagnosed earlier.5

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    In a study by Savelli and colleagues,13 3% of complex paratubal/paraovarian cysts were serous papillary borderline tumors, whereas all of the unilocular, simple paratubal/paraovarian cysts were found to be benign on histology.7 Isolated case reports have described endometrioid and transitional cell carcinomas arising from paraovarian/paratubal cysts.14,15 Typically, these cysts are asymptomatic yet infrequently may cause pain and torsion.

  • Paratubal borderline serous tumors

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    Since our case consisted of a cyst attached to the tube and independent of the lumen, it may be better regarded as a paratubal lesion. While an endometrioid borderline tumor arising in a paratubal cyst is reported [9], to our knowledge, this is the first report in the literature of a paratubal serous LMP. Hence, this may be analogous to primary peritoneal LMPs in other locations or tubal borderline tumors.

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