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Advisor(s)
Abstract(s)
O tumor maligno primário da trompa de Falópio é uma entidade ginecológica rara e que
acomete, principalmente, mulheres no período pós-menopausa. A metastização mamária de
tumores malignos extramamários é outra entidade rara. Na literatura, foram descritos muito
poucos casos de metástases mamárias originadas de tumor maligno primitivo da trompa, sendo
esta associação considerada, por isso, também ela muito rara.
É apresentado um caso clínico de metastização mamária de um adenocarcinoma seroso
primitivo da trompa de Falópio, numa mulher de 61 anos. Na sequência de uma ida à urgência
do Centro Hospitalar Universitário da Cova da Beira e posterior estudo, a paciente foi
submetida, em 2007, a laparotomia exploradora de estadiamento por suspeita de neoplasia
maligna do ovário. Realizou histerectomia total, anexectomia esquerda (trompa e ovário),
anexectomia direita (trompa e ovário) e excisão de metástases peritoniais. O diagnóstico
histológico foi de adenocarcinoma seroso primitivo da trompa de Falópio esquerda, classificado
no estadio IV. Realizou 6 ciclos de quimioterapia paliativa com Paclitaxel e Carboplatina. Ficou
assintomática e com imagiologia sem sinais de doença residual e cancer antigen 125 (Ca-125)
normal. Em setembro de 2008, teve recidiva da doença tendo efetuado 3 ciclos de
quimioterapia com Carboplatina e Ciclofosfamida. Ficou em vigilância clínica, assintomática,
embora com doença residual.
Em 2009, foi detetado um nódulo e edema da mama direita e diagnosticada a metastização
mamária através de microbiopsia ecoguiada e biopsia cutânea da pele suspeita de infiltração
tumoral. Houve um agravamento progressivo do estado geral e, devido às suas comorbilidades,
a doente foi considerada sem possibilidade de tratamento específico, sendo encaminhada para
os cuidados paliativos.
A partir deste caso clínico, fez-se uma revisão da literatura sobre tumores malignos primários
da trompa de Falópio e caracterização de metástases mamárias de tumores extramamários.
Realizou-se, também, uma análise dos casos descritos na literatura sobre metástases mamárias
originadas de tumor maligno primário da trompa, concluindo-se da mesma, a necessidade de
considerar esta entidade, apesar de rara, no diagnóstico diferencial de uma lesão mamária,
numa paciente com história pessoal de tumor da trompa. Assim, mesmo em situação de tumor
avançado da trompa, é necessário fazer observação mamária e pedir exames adequados, pois
o diagnóstico e tratamento precoces são fundamentais para melhorar o prognóstico desta
patologia.
The primary malignant fallopian tube tumor is a rare gynecological entity that mainly affects postmenopausal women. Breast metastasis of extramammary malignant tumors is another rare entity. Very few cases of mammary metastases originating from primitive malignant tube tumor have been described in the literature, and this association is therefore considered very rare. In this paper, we present a clinical case of mammary metastasis of a primitive fallopian serous adenocarcinoma in a 61-year-old woman. Following an emergency visit to Centro Hospitalar Universitário da Cova da Beira and further study, the patient underwent staging exploratory laparotomy in 2007 for suspected ovarian malignancy. She underwent total hysterectomy, left annexectomy (fallopian tube and ovary), right annexectomy (fallopian tube and ovary) and excision of peritoneal metastases. The histological diagnosis was early serous adenocarcinoma of the left fallopian tube, classified as stage IV. She underwent 6 cycles of palliative chemotherapy with paclitaxel and carboplatin. She was asymptomatic, imaging had no signs of residual disease and cancer antigen 125 (Ca-125) value was normal. In September 2008, the patient relapsed and underwent 3 cycles of chemotherapy with carboplatin and cyclophosphamide. She was asymptomatic, under clinical surveillance, although with residual disease. In 2009, a right breast lump and edema was detected, and breast metastasis was diagnosed through echogenous microbiopsy and skin biopsy of suspected tumor infiltration. There was a progressive worsening of the general condition and, due to her comorbidities, the patient was considered without possibility of specific treatment, being referred to palliative care. From this case report, a literature review was performed on primary malignant tumors of the fallopian tube and characterization of mammary metastases from extramammary tumors. An analysis of the cases described in the literature on mammary metastases originating from primary malignant tumors of the tube was also concluded, and the need to consider this entity, although rare, in the differential diagnosis of a breast lesion in a patient with a personal history of tube tumor. Thus, even in cases of advanced tumors of the tube, it is necessary to perform breast observation and to request adequate exams, because early diagnosis and treatment are fundamental to improve the prognosis of this pathology.
The primary malignant fallopian tube tumor is a rare gynecological entity that mainly affects postmenopausal women. Breast metastasis of extramammary malignant tumors is another rare entity. Very few cases of mammary metastases originating from primitive malignant tube tumor have been described in the literature, and this association is therefore considered very rare. In this paper, we present a clinical case of mammary metastasis of a primitive fallopian serous adenocarcinoma in a 61-year-old woman. Following an emergency visit to Centro Hospitalar Universitário da Cova da Beira and further study, the patient underwent staging exploratory laparotomy in 2007 for suspected ovarian malignancy. She underwent total hysterectomy, left annexectomy (fallopian tube and ovary), right annexectomy (fallopian tube and ovary) and excision of peritoneal metastases. The histological diagnosis was early serous adenocarcinoma of the left fallopian tube, classified as stage IV. She underwent 6 cycles of palliative chemotherapy with paclitaxel and carboplatin. She was asymptomatic, imaging had no signs of residual disease and cancer antigen 125 (Ca-125) value was normal. In September 2008, the patient relapsed and underwent 3 cycles of chemotherapy with carboplatin and cyclophosphamide. She was asymptomatic, under clinical surveillance, although with residual disease. In 2009, a right breast lump and edema was detected, and breast metastasis was diagnosed through echogenous microbiopsy and skin biopsy of suspected tumor infiltration. There was a progressive worsening of the general condition and, due to her comorbidities, the patient was considered without possibility of specific treatment, being referred to palliative care. From this case report, a literature review was performed on primary malignant tumors of the fallopian tube and characterization of mammary metastases from extramammary tumors. An analysis of the cases described in the literature on mammary metastases originating from primary malignant tumors of the tube was also concluded, and the need to consider this entity, although rare, in the differential diagnosis of a breast lesion in a patient with a personal history of tube tumor. Thus, even in cases of advanced tumors of the tube, it is necessary to perform breast observation and to request adequate exams, because early diagnosis and treatment are fundamental to improve the prognosis of this pathology.
Description
Keywords
Carcinoma Carcinoma da Trompa de Falópio Metástases Mamárias Trompas de Falópio Tumor Primário