The patient was a 32-year-old woman with an irregular menstrual cycle and a previous menstrual period lasting 8 days (from November 29, 2002). Amenorrhea and pain in the lower left abdominal region prompted the patient to consult a neighborhood gynecologist. Although the result of a pregnancy test was positive, transvaginal ultrasonography did not reveal a gestational sac (GS) in the uterus. However, a cystic tumor containing a solid, fetus-like mass was observed in the left uterine appendage. Atypical genital bleeding was absent. Based on these findings, an ectopic pregnancy was suspected and the patient was referred to Iwate University Hospital the following day. The patient had been pregnant three times, two involved spontaneous abortions and one resulted in delivery. The patient's medical and family history did not present cause for concern. Pregnancy test results were positive, and transvaginal ultrasonography did not reveal any symptoms normally associated with pregnancy, such as the occurrence of a GS in the uterus. However, a 28-mm cystic tumor (Fig. 1), containing a 6.5-mm, solid mass (Fig. 2), was observed in the left uterine appendage. Both side ovaries were observed by transvaginal ultrasonography. Urinary and blood human chorionic gonadotropin (hCG) levels were <1000 IU/L and 189 IU/L, respectively. Based on these test results, the patient was diagnosed with an ectopic pregnancy in the left uterine appendage; in response to the persistent pain in the lower left abdominal region, the patient was admitted for emergent laparoscopy. Swelling of the left fallopian tube ampulla was confirmed during surgery (Fig. 3), and with a diagnosis of ampullary tubal pregnancy, linear salpingostomy and evisceration were performed. A 20-mm, fetus-like, solid tumor was observed inside the cystic tumor (Fig. 4). Postoperatively, the patient recovered well and was discharged 5 days after surgery. Since chorionic villi were not seen macroscopically in the resected mass, we carefully checked up the level of hCG value. However, 7 days after surgery, urinary (1800 IU/L) and blood (2289 IU/L) levels of hCG were elevated compared to preoperative values. Furthermore, transvaginal ultrasonography, performed 16 days after surgery revealed a 25-mm GS in the uterus as well as fetal heartbeats. Histopathological observations of the excised tumor confirmed adenofibroma of the left fallopian tube. At the insistence of the patient and her spouse, the pregnancy continued to term and a 3394 g baby girl was vaginally delivered at 39 weeks gestation. The baby was born healthy, with mother and infant discharged 6 days after delivery. The infant's post discharge condition was satisfactory.
The tumor was firm, with a cauliflower-like surface. Microscopically, it was papillary in appearance and composed of fibrous tissue containing scattered glands. Chorionic villi were not seen macroscopically in the resected mass. (Fig. 4).