Gestational choriocarcinoma of the fallopian tube

Review of a world literature of 93 reported cases of choriocarcinoma primary in the fallopian tube yields 58 acceptable cases, to which 18 are added from the files of the Armed Forces Institute of Pathology. Patients ranged from 16 to 56 years old, with a mean age of 33. About 66% presented with acute symptoms consistent with banal ectopic pregnancy. The remainder usually presented with a gradually expanding adnexal mass clinically indistinguishable from an ovarian tumor. Grossly, the tumor is usually a hemorrhagic friable mass, occasionally containing spongy tissue resembling placenta. Smaller tubal choriocarcinomas are difficult to distinguish on gross inspection from common ectopic pregnancy, ruptured or not. Histopathological features and distribution of metastases are similar to gestational choriocarcinoma arising in the uterus. Chorionic villi were found in two cases, an uncommon observation in primary uterine choriocarcinoma. Of 47 acceptable cases treated prior to modern chemotherapy, 41 died, a mortality of 87%. Of 16 cases treated with modern chemotherapy, 15 survive, a salvage of 94%. Five cases in the world literature, plus three in the present series, were cured by unilateral salpingectomy or salpingo-oophorectomy alone.