Post-hysterectomy fallopian tube carcinoma presenting with a positive Papanicolaou smear

Background: Fallopian tube carcinoma is a rare gynecologic malignancy. The majority of women present with vaginal bleeding and have advanced disease. Case: A 76-year-old woman presented 34 years after vaginal hysterectomy with a routine Papanicolaou smear showing adenocarcinoma. Rectovaginal examination was remarkable for thickening at the vaginal apex. Colposcopy found a pinpoint opening in this area, and a cytobrush passed through the opening confirmed adenocarcinoma. Pelvic ultrasound, computed tomography scan, and CA 125 were normal. At laparotomy, the right fallopian tube and ovary were adherent to the vaginal apex. A grade II papillary serous adenocarcinoma confined to the tube was discovered. Conclusion: According to a MEDLINE search, this is the third report detailing a unique presentation of fallopian tube carcinoma after hysterectomy and possibly the first detected with positive Papanicolaou cytology.