Primary fallopian tube carcinoma (PFTC)—often mistaken for ovarian cancer—remains a diagnostic challenge for gynecologists and sonographers. “Small primary, large metastatic” pattern: Ovarian or peritoneal lesions may overshadow a small tubal primary, especially in advanced cases. ConclusionAbdominal pain and endometrial fluid are key but often overlooked signs of primary fallopian tube carcinoma. Key PointsMost PFTC cases present with abdominal pain or are asymptomatic; vaginal discharge is less common than traditionally thought. Citation:Gao L, Huang R, Yang X, Kong F, Zhao F. Clinical and ultrasound characteristics of primary fallopian tube carcinoma: a single-institution retrospective study of 280 cases.