It’s a malignant cancer found in the fallopian tubes linked to Serous Carcinoma (more rare and aggressive form) commonly found in the Uterus or Ovaries. The uterus and ovaries have a knack for receiving metastatic spread from one another that it becomes a problem to determine which came first. 

<center>![stem2.jpg](https://files.peakd.com/file/peakd-hive/adamada.stem/AK576G1h5qK7eznPjxZebGZfkJdfhPHV3Js5qJuMVfeQu4sJomBcyoWsAfC4wBt.jpg)</center>

<center>Fallopian Tube Wall at 100x magnification</center>

For reference of what a [normal fallopian tube](https://histologyblog.com/2013/07/13/histoquarterly-fallopian-tube/) looks like on histologic section. 

I previously shared this case with a shot at the [ovary](https://peakd.com/hive-163521/@adamada.stem/enlarged-specimens-for-the-week). It just got complicated but not too complicated enough. The dilemma was trying to identify which one came first as during presentation the patient was already diagnosed with Endometrial Carcinoma and Ovarian Carcinoma.

<center>![stem1.jpg](https://files.peakd.com/file/peakd-hive/adamada.stem/23w2uCrxwPzG2AEmSkpf6BfW7RJ3csnyAmt1kej8EdSiigtxg3YaoBUghH7j8GTAmqsLo.jpg)</center>
<center>Fallopian tube plicae at 400x magnification, the lining with heavy blue to purple enveloping the pink stroma is the epithelium</center>


Examining the slides of the endometrium showed the endometrioid type carcinoma which was also the same features for what was found in the ovaries. But the problem arised when reviewing the fallopian tubes. 


<center>![stem4.jpg](https://files.peakd.com/file/peakd-hive/adamada.stem/23tmWNcLaBE5nFebuRimCnHZKafqAnaxQTHaxRC5rts3R3m3cEnCpSzfVd4LnoH7msj9h.jpg)</center>

<center>Endometrial Cancer on 400x magnification</center>


The lack of cilia the cells, the hyperchromasia (more blue than usual), the pleomorphism (bizarre forms and increased nuclei to cytoplasm ration), and the loss of polarity made this case a Serous Tubal Intraepithelial Carcinoma.

So how does this even change the prognosis? Well it would make me rethink whether I’m actually dealing with an endometrioid type vs a serous type which is more worse due to how more aggressive this type is (both of them are but the other one is just worse). And when I review the morphology of the endometrium, it has some semblance to other areas that could suggest a serous form. 

In the grand scheme of things, the impact of getting this specifics right is the end prognosis for the patient as treatment plans get altered based on what the empirical data suggests for each prognosis. 

Think about it this way, supposed a patient is diagnosed with Small Cell Lung Carcinoma, that’s equivalent to a death sentence within months. Now if they got diagnosed with a large cell neuroendocrine carcinoma of the lungs or whatever else goes, they can expect by what the data suggests, to have more time if they undergo treatment. The burden of telling it how it is goes to the clinician.

This is how a Pathologist indirectly impacts the decision making for other parties. If the prognosis is bad and the patient is already old and see no benefit for treatment, then they would probably opt not to be aggressive about the treatment plan compared to hearing a better prognosis. We don’t really see this in action but only get told second hand. 

If you made it this far reading, thank you for your time.

Posted with [STEMGeeks](https://stemgeeks.net)