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Cesarean scar pregnancy is a rare form of the ectopic pregnancy and its consequences may be fatal. Its treatment is based on the hysterectomy or conservative choices. Conservative modalities may be listed as surgical (low uterine segment excision with laparotomy or laparoscopy, hysteroscopy, curettage), medical [systemic or local use of methotrexate, local potassium chloride (KCI) injection] and minimally invasive interventions (selective uterine artery embolization). A cesarean scar pregnancy was tried to treat with low dose methotrexate regiment in a woman who had two cesareans previously. While this regiment was unsuccessful it was switched to the high dose methotrexate and uterine artery embolization. The bleeding during the destruction of the gestational sac was controlled with curettage and cervical balloon tamponade. Preservation of the uterus and the life of the woman are related to the early diagnosis and treatment. A combination of the many ways may be necessary in the treatment ofthe cesarean scar pregnancy. The collaboration of the ß-hCG levels as well as the progesteron levels and the presence of the cardiac activity may be more useful in the prediction of treatment success of the low dose methotrexate regiment. Copyright © 2010 by Türkiye Klinikleri.

Fallopian tube cancer is a rare event and its extraperitoneal metastasis is even rarely seen. The most part ofthe knowledge about the fallopian tube cancer is derived from the epithelial ovarian carcinoma which has a very close similarity on clinical behavior. Disease usually disseminates to the peritoneal surfaces of the abdominal organs by exfoliation of the tumor cells in the peritoneal cavity. It is believed that the lymphogenic or hematogenous ways are the causes of extraperitoneal metastasis. We reported a review of the cases of fallopian tube cancer with extraperitoneal spreading. The majority of the patients were treated with combination of surgery and chemotherapy. On the other hand, the early reports state that the patients were treated with radiotherapy and intraperitoneal chemotherapy. Lymph node is the most common site for extraperitoneal dissemination. Lungs and central nervous system are usually involved synchronously. Central nervous system involvement is usually diagnosed while evaluating a neurological symptom. In this situation it is possible to emphasize that the central nervous system involvement is more common with asymptomatic patients. Bone, liver, spleen, skin, pleura, pericardium and breast are the other sites of extraperitoneal metastasis. The time interval for extraperitoneal recurrence was 37.5 ± 21.2 (7-74) months. The survival after the diagnosis of extraperitoneal metastasis 21.8 ± 21.0 (0, 5-72) is months. In some patients while extraperitoneal dissemination is detected, the peritoneal spread was absent. Although it is believed that when an extraperitoneal metastasis happened the prognosis is extremely poor, some patients may have a longer survival. Copyright © 2010 by Türkiye Klinikleri.