Malignant Lesions of the Fallopian Tube and Broad Ligament


Background: In 1847, Renaud first described fallopian tube malignancy. In 1888, Orthmann submitted the first genuine case report.

The broad ligament is a double fold of peritoneum, which is formed by the reflection of the peritoneum off the pelvic floor and the lateral pelvic wall. Most tumors are benign cysts, but malignant tumors are categorized as either primary or secondary.

Primary malignancies of the broad ligament

Müllerian origin - Serous, papillary, cystadenocarcinoma, endometrioid carcinoma (CA), clear cell CA
Urothelium transitional cell CA
Mesenchymal sarcoma, histiocytoma

Secondary malignancies of the broad ligament - Metastatic from endometrial, cervical, and ovarian CA

A primary malignancy is diagnosed by its location within or on the surface of the broad ligament and by complete separation of the tumor from the uterus and ovaries.


Pathophysiology: Fallopian tube malignancy usually starts as a dysplasia or carcinoma in situ. Ideally, transition to adenocarcinoma is observed.

The etiology of malignancies of the broad ligament is unknown, although it is associated with endometriosis.


Mortality/Morbidity: On average, the 5-year survival rate was 51%: Stage I (65%), Stage II (50-60%), and Stages III and IV (10-20%).

Age: The rate rises with age but peaks at 60-66 years.



Physical: Physical examination findings are not specific; a pelvic mass usually is present, with or without ascites.

Causes: The exact etiology is unknown. Infertility and chronic salpingitis were believed to lead to an increase in incidence, but this theory is not proven, although malignancy has been associated with tuberculous salpingitis.

Similar to ovarian malignancy, BRCA germline mutation and p53 mutation are associated with fallopian tube malignancy.


Other Problems to be Considered:

Benign fallopian tube disease salpingitis (eg, tuberculosis salpingitis)
Benign ovarian disease
Ovarian tumor of low malignant potential
Malignant epithelial ovarian tumors
Broad ligament tumors


Lab Studies:

Imaging Studies:

Histologic Findings:
Serous CA - 50%
Endometrioid CA - 25%
Transitional cell CA - 11.7%
Undifferentiated CA - 7.8%
Mixed CA - 3.9%
Clear cell CA - 1.9%

Staging: Although the fallopian tubes are derived from the same embryonic structure as the uterus, histologically and clinically, malignant lesions of the fallopian tubes behave like ovarian tumors. Unlike ovarian tumors, 50% of fallopian tube tumors are Stage I and II, whereas usually, more than 50% of ovarian malignancies are in stage III and IV.


Medical Care: Medical care depends on frozen section and pathology results, as follows:

Surgical Care: Surgical care includes (1) total abdominal hysterectomy (TAH) with (2) bilateral salpingo-oophorectomy (BSO), (3) omentectomy and peritoneal washing, and (4) selective pelvic and paraaortic lymphadenectomy.


Further Outpatient Care:



Medical/Legal Pitfalls: