Protocol for the Examination of Specimens From Patients With Carcinoma of the Fallopian Tube

This protocol is intended to assist pathologists in providing clinically useful and relevant information as a result of the examination of surgical specimens. Use of this protocol is intended to be entirely voluntary. If equally valid protocols or similar documents are applicable, the pathologist is, of course, free to follow those authorities. Indeed, the ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of the individual circumstances presented by a specific patient or specimen.It should be understood that adherence to this protocol will not guarantee a successful result. Nevertheless, pathologists are urged to familiarize themselves with this document. Should a physician choose to deviate from the protocol owing to the circumstances of a particular patient or specimen, the physician is advised to make a contemporaneous written notation of the reason for the procedure followed.The College recognizes that this document may be used by hospitals, attorneys, managed care organizations, insurance carriers, and other payers. However, the document was developed solely as a tool to assist pathologists in the diagnostic process by providing information that reflects the state of relevant medical knowledge at the time the protocol was first published. It was not developed for credentialing, litigation, or reimbursement purposes. The College cautions that any uses of the protocol for these purposes involve considerations that are beyond the scope of this document.The occurrence of a gush of cholesterol-rich, clear fluid per vaginam accompanied by abdominal pain and reduction in the size of an abdominal mass is suggestive of but not specific for carcinoma of the fallopian tube.The World Health Organization Histologic Classification of Carcinoma of the Fallopian Tube is as follows.No specific grading system for tubal cancers is recommended. For the sake of uniformity, however, it is suggested that 4 grades be used, with grade 4 (undifferentiated) applied to tumors with no differentiation or minimal differentation that is discernible in only rare tiny foci.The TNM Staging System for fallopian tubes endorsed by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) and the parallel system formulated by the International Federation of Gynecology and Obstetrics (FIGO) are recommended.1,2* By AJCC/UICC convention, the designation “T” of the TNM classificaiton refers exclusively to the first resection of a primary tumor. The prefix symbol “p” refers to the pathologic classification of the TNM (pTNM), as opposed to the clinical classification. Pathologic classification is based on gross and microscopic examination. Therefore, pT entails a resection of the primary tumor or biopsy adequate to evaluate the highest pT category; pN entails removal of nodes adequate to validate lymph node metastasis; and pM implies microscopic examination of distant lesions.† “Mucosa” presumably refers to the epithelium since the mucosa contains both epithelium and lamina propria.Although most investigators have not commented on the possible prognostic significance of the status of the fimbriated end, in one series of cases of tubal carcinoma,3 closure of the fimbriated end was an important factor in improvement of the survival rate.F: Selection of Specimens for Microscopic Examination.When a tumor involves both the fallopian tube and the ovary, it may be difficult to determine the primary site of the tumor in some cases. Typically, the primary tumor predominates and obviously originates from one or the other organ. Occasionally, however, the tube and ovary are fused to form a solid or cystic mass with destruction of most or all landmarks. In such cases, the tumor is almost always assumed to be a primary ovarian cancer because its frequency is much greater than that of tubal cancer. Microscopic examination may be helpful because most tubal cancers resemble serous carcinomas of the ovary, with tubal carcinomas of other cell types being relatively rare. Finding what appears to be in situ carcinoma in the tube adjacent to the main tumor mass is not always a reliable criterion for origin in the tube since carcinoma that has extended into the tube from elsewhere can grow along its mucosal surface and simulate closely carcinoma in situ.Severe salpingitis, including tuberculous salpingitis, can be associated with pseudocarcinomatous changes in the tube.4 Carcinoma is rarely associated with severe salpingitis. Therefore, the presence of severe salpingitis should alert the pathologist to the possibility of a pseudocarcinomatous change. Endometriosis may be present in the background of endometrioid carcinoma of the tube.5,6Contributors: the College of American Pathologists Cancer Committee; David M. Gershenson, MD; Arthur L. Herbst, MD; and Jaime E. Wheeler, MD.