Benign tumors of the fallopian tubes are slow—growing non-invasive volumetric formations originating from the epithelial, muscular, serous tubar membranes or surrounding tissues. Usually they are not clinically manifested. With volumetric neoplasia, complaints of discomfort, pain in the lower abdomen, signs of compression of surrounding organs, infertility are possible. They are diagnosed by gynecological examination, ultrasound, CT, MRI of pelvic organs, hysterosalpingography, ultrasonography, laparoscopy. They are treated surgically with laparoscopic or laparotomic adnexectomy, tubectomy, extirpation or supravaginal amputation of the uterus and appendages.
D28.2 Benign tumors of the fallopian tubes and ligaments
Benign tumors of the fallopian tubes are a rare gynecological pathology, detected mainly in postmenopause. According to the observations of specialists in the field of oncology, obstetrics and gynecology, benign tubal formations occupy up to 0.5-3% in the structure of neoplasia of the female genitals. However, taking into account the asymptomatic course, low progrediency and small size, their prevalence in the population may be higher. The most common benign neoplasms are adenomatoid tumors 1-2 cm in size and teratomas. The relevance of timely diagnosis of BTFT is due to the risk of their malignancy with spread to the ovaries, peritoneum, large omentum.
Due to the low prevalence of true BTFT, their etiology, unlike tumor-like formations (endometrioid cysts, adenomatous epithelial proliferation in chronic nonspecific and tuberculous inflammatory processes, hydrosalpinx, pyosalpinx), has not been practically studied. Several hypotheses of the origin of benign neoplasms of the fallopian tubes are being developed, although, most likely, the neoprocess is polyetiological. Possible causes of tumor growth are:
- Inflammatory diseases. In most chronic specific and nonspecific salpingitis, adnexitis, epithelial cells are initially affected. Prolonged infectious-inflammatory reaction affects the metabolism of epithelial cells and can cause epithelial hyperplasia.
- Violation of embryogenesis. Dysembriogenetic processes are considered as the leading cause of the formation of mature teratomas (dermoid cysts) of the fallopian tubes. Their probable basis is a violation of the differentiation of germ leaves or abnormal induction at one of the stages of embryo development.
- The effect of mutagenic factors. Tumor transformation of normal tubal tissues can occur under the influence of industrial poisons (primarily aromatic carbohydrates), physical influences (UV rays, ionizing radiation). Viruses may damage the genetic material.
- Insufficient immunity. Abnormal cellular elements are eliminated by immune cells and humoral factors. Loss of control over the growth of mutated cells of various membranes of the fallopian tubes is observed with a decrease in immunity caused by stress, taking immunosuppressants, HIV infection.
The mechanism of development of benign tumors of the fallopian tubes has not been definitively established. The basis of neogenesis is the loss of control over the division, growth, differentiation of cellular elements. Under the influence of provoking factors, the DNA of the cell is damaged, the mechanisms of apoptosis (genetically determined death) are disrupted. In conditions of insufficient immunity, abnormal cells continue to divide, which is accompanied by focal hyperplasia of the corresponding tissues, however, with a benign process, signs of cellular atypia are not detected and there is no invasive growth of volume formation.
Tissue damage in the early stages of embryogenesis usually leads to the development of mature teratomas that have the appearance of a sactosalpinx. When epithelial cells are involved in the process, papillary adenomas and papillomas localized in the abdominal part of the fallopian tube are most often formed, polyps occur less often. Hyperplasia of muscle and connective tissue fibers is accompanied by the growth of leiomyomas, fibromyomas, fibroids located at the uterine end of the tube or in the broad uterine ligament. Other types of tissues with the formation of adenomatoid tumors, lipomas, lymphangiomas, chondromes, neurilemmas are also involved in the neoprocess.
Usually, true BTFT, not complicated by the inflammatory process, are asymptomatic and are detected accidentally during a routine examination or laparotomy for another disease. Due to the small size and slow growth of most benign tubal neoplasias, they do not exert pressure on the surrounding tissues and do not cause pain. In rare cases, with large teratomas, a woman experiences heaviness, discomfort, pain in the lower abdomen on the appropriate side. There are signs of compression of the pelvic organs: frequent urge to urinate, defecation, constipation, flatulence, difficulty passing urine, a feeling of pressure on the rectum. The only complaint of a patient of reproductive age may be the inability to get pregnant with regular sexual activity without protection.
A volumetric formation that narrows the lumen of the fallopian tube can disrupt the normal progress of a fertilized egg and provoke the development of an ectopic pregnancy. With complete obturation, benign tumors are complicated by tubal infertility, sactosalpinx. Epithelial neoplasms on the leg, located in the ampullary section, sometimes twist, which leads to tissue necrosis and the development of an acute abdominal clinic. Malignancy of tumors, especially of epithelial origin, is not excluded. Moreover, according to some oncogynecologists, most papillomas and adenomas of the fallopian tubes are highly differentiated adenocarcinomas, which is indirectly confirmed by the development of ascites in such neoplasms.
The diagnosis of benign volumetric formations of the fallopian tubes is complicated by the low severity or absence of clinical symptoms and low alertness of medical workers about this pathology. Preliminary diagnosis is carried out with the help of physical and instrumental studies, the final one is based on pathohistological data. The recommended survey methods are:
- Gynecological examination. During the examination on the chair, the tumor can be palpated in the appendage area in the form of a voluminous elastic formation with a smooth surface that is not soldered to the surrounding tissues. Neoplasia of small sizes is often not detected by palpation.
- Sonography. Ultrasound of the pelvic organs allows you to assess the size, structure, and features of the tumor surface. To improve the accuracy of diagnosis, tomography (CT, MRI), hysterosalpingography, ultrasonography of the fallopian tubes are additionally prescribed.
- Diagnostic operation. Visual examination of appendages in the framework of laparoscopy provides a more accurate determination of the localization of the tumor process and its connection with the fallopian tubes. If necessary, a biopsy is performed during the examination to study the structure of the tumor.
The establishment of a final diagnosis is usually possible only after a histological analysis of the removed neoplasm. BTFT is differentiated with benign ovarian tumors, fallopian tube cancer, endometrioid polyps, isthmic nodose salpingitis, hydrosalpinx, pyosalpinx, tubovarial abscess, tuberculosis of appendages. According to the indications, the patient is consulted by a phthisiologist, oncologist, infectious disease specialist.
Non-drug and conservative methods of therapy for true BTFT have not been proposed. Patients of reproductive age, if possible, retain the function of the affected tube, providing dynamic monitoring of the development of neoplasia and treatment of tubal infertility. Detection of the tumor process during perimenopause is usually an indication for surgical removal of the neoplasm. The operation is performed as soon as possible in the presence of large tumors that cause compression of neighboring organs, rapidly growing formations, complicated course. The amount of intervention depends on the type of tumor, age and reproductive plans of the woman. Patients with neoplasia of the fallopian tubes can be performed:
- Endoscopic removal of appendages. Laparoscopic adnexectomy on the side of the lesion with histological rapid diagnosis is the operation of choice in menopausal age. Since the final differentiation between ovarian and tubar benign tumors is difficult even at the intraoperative stage, performing the intervention in this volume provides a radical cure and allows timely detection of malignancy. In deep postmenopause, in the presence of severe extragenital pathology and the detection of a neoplasm of the tube, tubectomy is permissible.
- Laparotomic removal of appendages. Classical abdominal adnexectomy is recommended for patients with a twisted leg of tubar benign formation. Laparotomy is also justified if a tumor lesion of the tube is suspected in the presence of post-inflammatory changes that make it difficult to perform endoscopic intervention and differential diagnosis with ovarian tumors. Through the cavity access, it is easier to expand the scope of intervention for histological detection of a malignized tumor. In postmenopause, more radical operations are indicated — supravaginal amputation or extirpation of the uterus with appendages.
Prognosis and prevention
If a benign tumor is detected in a timely manner and the operation is performed in the recommended volume, the outcome of the disease is favorable. Due to insufficient knowledge of the etiology and pathogenesis, the primary prevention of DOM has not been developed in detail. Adequate therapy of inflammatory diseases of the female genital organs, barrier methods of contraception, refusal of sexual relations with casual partners play a likely role in preventing the tumor process. Secondary prevention involves regular checkups with an obstetrician-gynecologist and ultrasound screening every six months after the age of 40.