A 27-year-old, nulliparous (0-0-0-0), married woman was referred to our institution with a huge pelvic mass and left flank pain. She had no history of surgical or medical disease. Transvaginal ultrasonography revealed a 16 cm right adnexal cyst with intramural nodules and thickened cyst wall (). Abdomino-pelvic computed tomography (CT) scan showed a 16 cm cystic mass with enhancing solid intramural nodules in the pelvic cavity (). The CT scan showed no evidence of ascites, peritoneal seeding, omental cake, or pelvic or para-aortic lymph node involvement. It looked like an epithelial ovarian cancer because the CT scan showed delayed enhancement. Her serum cancer antigen 125 (CA-125) concentration was 19.3 U/mL (reference value, <35 U/mL), and the results of other preoperative work-up tests were unremarkable.\nWe performed an exploratory laparotomy through a low midline abdominal incision, which revealed a 16 cm right paratubal cyst completely differentiated from the right ovary and fallopian tube. Paratubal cystectomy was performed without rupture of the cyst. Frozen section analysis of the specimen showed that it was a paratubal serous borderline tumor. Exploration of the entire peritoneal cavity showed no evidence of intraperitoneal tumor spread. Her fallopian tubes, ovaries and uterus were not involved. Washing cytology and multiple peritoneal biopsies were taken. Because the patient and her husband had a strong desire to preserve fertility, her uterus and both adnexae were preserved.\nGrossly, the tumor had a homogeneous, purplish white inner surface and multiple papillary projections up to 2.1 cm in greatest dimension (). The external surface of the tumor was homogeneously purplish white and smooth, with multifocal hemorrhage. However, there was no evidence of surface involvement. The final pathology results were identical to the frozen biopsy results indicating that the mass was a paratubal serous borderline tumor (). The results of the peritoneal washing cytology and multiple biopsies were negative.\nHer postoperative course was uneventful and she was discharged 5 days after surgery. Regular check-ups at the outpatient clinic include serum CA-125 measurements, transvaginal ultrasonography, and/or abdomino-pelvic CT. She delivered a healthy baby at term 13 months after surgery. Twenty months after surgery, she is doing well, without evidence of disease.
The patient, a 41-year-old woman with a non-relevant past medical history, concluded her fourth pregnancy by cesarean delivery owing to macrosomic product (July 2013). Tubal ligation was performed on postoperative day one by the Kroener fimbriectomy method, which coursed uneventfully and without any remarkable findings. The specimens obtained were sent for routine histopathological assessment, and the patient was discharged after full recovery. To date she is healthy and without any complaints.\nBoth distal tubes and fimbriae were identified; the large tube was bulky with a nodular appearance (3.5×2×1.3 cm) (). Transverse sections taken from this dilated duct revealed an overfilled lumen with a caramel-like substance surrounding an ill-defined peripheral spot, which, when seen under a magnifying glass, showed a fractal pattern similar to a snowflake (). Histologically, this hazy frame was sketched by a slender stalk with progressively branching papillae lined by columnar non-ciliated cells with plump eosinophilic cytoplasm showing focal pseudostratification and budding (, ). The nuclei of these cells were centrally located, enlarged, and rounded or oval. The nuclei displayed a variable appearance, either dense and hyperchromatic, or vesicular with a prominent nucleolus, and sometimes having coarse chromatin, membrane foldings, pseudoinclusions or grooves. Mitotic activity was not identified.\nDespite the presence of luminal extracellular mucin, several subnuclear mucin-filled vacuoles were also identified, occasionally expanding into cyst-like structures (). Periodic acid– Schiff and Alcian blue stains highlighted the extracellular and intracellular mucin, while the intracytoplasmic vacuoles were stained with Mayer’s mucicarmine (–).\nImmunoperoxidase stains demonstrated an intensely positive reaction for cytokeratin cocktail (CK AE1/AE3) in the membrane and cytoplasm () of cells, as well as for epithelial membrane antigen (EMA) with weak cytoplasmic expression and luminal border reinforcement (). Detection of progesterone receptors (PR) was markedly positive in 95% of cells, while estrogen receptors (ER) and androgen receptors were moderately and weakly positive in 70% and 10% of cells, respectively (–). The proliferation index labeled with Ki-67 was rated in approximately 3% of cells (). Surprisingly, cyclin D1 staining was observed in nearly 90% of cells (). No reaction was detected toward a variety of factors, including carcinoembryonic antigen (CEA), human chorionic gonadotropin, human epidermal growth factor receptor 2 (HER2/Neu), or B-cell lymphoma 2 protein (Bcl-2).\nAccordingly, the proliferation was diagnosed as a metaplastic papillary tumor of the Fallopian tube, with a note to the clinician about the benign behavior of the alteration.