MM complicated with primary fallopian tube cancer is extremely rare in clinic. Taking "multiple myeloma", "primary fallopian tube cancer" and "ovarian cancer" as key words, we systematically searched four electronic databases: PubMed, SCI-Web of Science Citation Index, FMRS Foreign Language Medical Information Retrieval Platform and SciFinder Database, and found no similar case reports. After screening, a total of 21 documents were selected to form this review.
This case history is a stunning demonstration of the coexistence of solid and liquid malignancies. Multiple myeloma combined with fallopian tube carcinoma is very rare in clinical practice. Evaluation of patients with multiple myeloma usually includes serological tests and imaging studies [4]. The determination of serum albumin and β-2 microglobulin in blood is of great value for the staging of diseases [5]. However, the final diagnosis of multiple myeloma requires bone marrow biopsy [6]. As a malignant tumor of the blood system, the treatment of multiple myeloma is constantly developing. In the early 1960s, Mefaran and prednisone combined therapy became a major treatment method. With the deepening of research, thalidomide, bortezomib and lenalidomide became the main therapeutic drugs [10]. At present, new combination therapy, a new generation of targeted drugs, immunotherapy and autologous stem cell transplantation (ASCT) have been added to its therapeutic methods. In recent years, researchers have found that the development of these therapeutic methods is effective in improving the survival rate of most patients with multiple myeloma, but the survival rate of elderly patients has not been significantly improved[11].
In 2014, the FIGO’s Committee for Gynecologic Oncology put ovarian cancer, fallopian tube cancer and peritoneal cancer into the same system. Because there are few reliable literatures about fallopian tube cancer, the diagnosis method of fallopian tube cancer refers to the relevant literatures about ovarian cancer [7]. The symptoms are not obvious, and most of patients have reached the advanced stage when they are discovered[8]. The screening of early ovarian cancer is mainly the examination of blood tumor markers and ultrasound images [9]. Carbohydrate antigen 125 (CA125) is a commonly used tumor marker, but its sensitivity and specificity are low [7, 8]. Transvaginal ultrasonography is the gold standard imaging method for observing adnexa and uterus [6]. Imaging examination of CT and magnetic resonance imaging (MRI) can help to better understand the degree of disease development of patients [7]. In recent years, it has been found that most high-grade ovarian serous carcinoma (HGSC) originates from serous fallopian tube intraepithelial carcinoma (STIC) lesions at the distal end of the fallopian tube[12, 13].
When pelvic mass is found in patients with multiple myeloma, attention should be paid to the possibility of a second primary tumor in addition to the presentation of multiple myeloma metastasis. Patients may have symptoms associated with both malignancies at the same time, and a definitive diagnosis depends on the final pathological findings.
Surgery and chemotherapy are the main methods for the treatment of primary fallopian tube and ovarian cancer. The primary surgery for carcinoma of fallopian tube and ovarian includes total staging surgery and tumor cell reduction. Studies have shown that tumor cell reduction combined with Hyperthermic intraperitoneal chemotherapy (HIPEC) can improve patient survival outcomes [14]. However, most patients still need postoperative supplementary chemotherapy, and some patients develop platinum resistance after multiple chemotherapy, so molecular targeted therapy is also a better approach for this part of patients. PARP (poly-ADP-ribose polymerase) inhibitors and anti-vascular endothelial growth factor (anti-VEGF) monoclonal antibodies are the two most potent ovarian cancer targeting drugs currently approved[15]. Patients with advanced carcinoma of fallopian tube and ovarian need a comprehensive assessment of their physical condition and a personalized choice of treatment. Some studies have shown that the preoperative status of patients has a certain impact on the risk of postoperative complications of advanced cancer tumor cell reduction [16]. Even if complete resection of the lesion is achieved, the initial disease burden is still an important prognostic indicator [17]. In our medical records, the patient had primary fallopian tube cancer that had metastasized to the ovaries, invaded the rectum, and reduced tumor cells was the standard surgical procedure. However, due to the patient's previous history of multiple myeloma, poor physical condition, older age, difficulties in perioperative period, and postoperative quality of life problems, only bilateral appendages were removed.
The perioperative management of MM patients with advanced primary fallopian tube cancer is a great challenge for clinicians. Patients with MM have an increased susceptibility to infection, especially in the elderly and in immunocompromised patients, where infection is a major cause of death [18]. Stage III multiple myeloma with decreased hemoglobin (hemoglobin<90g/L) and elevated C-reactionprotein were independent risk factors for infection, and these factors were significantly associated with poor prognosis [19]. Therefore, the risk of infection should be fully assessed before operation, anemia and leukocyte reduction should be corrected, antibiotics should be prophylactically applied before operation, aseptic operation should be strictly performed during operation, blood routine and C-reactionprotein should be actively monitored after operation, and the temperature of the patient should be paid attention to. In addition, kidney function is a key concern in this group of patients, and kidney damage is one of the main features of MM, and kidney damage is associated with decreased overall survival and increased risk of early death in multiple myeloma patients [20]. Therefore, the patient should pay attention to renal function and urine volume after surgery, and adjust the fluid volume in time. At the genetic level, studies have shown that up to 15% of patients with high-grade serous ovarian cancer, tubal cancer or peritoneal cancer have breast cancer susceptibility genes(BRCA), and the lifetime risk of ovarian cancer is 18–56% for BRCA 1 mutation carriers and 14–27% for BRCA2 carriers [11, 12]. Moreover, the research shows that the disease of MM is closely related to genes [4–6]. Therefore, it is recommended that patients and their children have genetic testing, and corresponding preventive measures should be given according to the test results [21]. For women with increased genetic risk, bilateral tubal oophorectomy with reduced risk can be considered [7].