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'''Uterine tubes''', | [[Image:Normal Fallopian Tube, Human (2760475010).jpg|thumb|Cross section of a Fallopian tube with decidualization. [[H&E stain]]. (WC/euthman)]] | ||
'''Uterine tubes''', also known as the '''Fallopian tubes''', serve as a connection between the [[ovary|ovaries]] and the [[uterus]]. It is where fertilization usually takes place. | |||
This was ignored in the past... current thinking is that it may be the real culprit in what is often labeled as "ovarian cancer".<ref name=pmid19574767>{{Cite journal | last1 = Hirst | first1 = JE. | last2 = Gard | first2 = GB. | last3 = McIllroy | first3 = K. | last4 = Nevell | first4 = D. | last5 = Field | first5 = M. | title = High rates of occult fallopian tube cancer diagnosed at prophylactic bilateral salpingo-oophorectomy. | journal = Int J Gynecol Cancer | volume = 19 | issue = 5 | pages = 826-9 | month = Jul | year = 2009 | doi = 10.1111/IGC.0b013e3181a1b5dc | PMID = 19574767 }}</ref> | This was ignored in the past... current thinking is that it may be the real culprit in what is often labeled as "[[ovarian cancer]]".<ref name=pmid19574767>{{Cite journal | last1 = Hirst | first1 = JE. | last2 = Gard | first2 = GB. | last3 = McIllroy | first3 = K. | last4 = Nevell | first4 = D. | last5 = Field | first5 = M. | title = High rates of occult fallopian tube cancer diagnosed at prophylactic bilateral salpingo-oophorectomy. | journal = Int J Gynecol Cancer | volume = 19 | issue = 5 | pages = 826-9 | month = Jul | year = 2009 | doi = 10.1111/IGC.0b013e3181a1b5dc | PMID = 19574767 }}</ref> | ||
=Normal uterine tube= | |||
Architecture: | |||
*Finger-like projections into the lumen. | *Finger-like projections into the lumen. | ||
* | |||
* | Cells: | ||
#Ciliated cell. | |||
#*Columnar. | |||
#*Eosinophilic cytoplasm. | |||
#Non-ciliated cell ([[AKA]] Peg cell). | |||
#*Nucleus more luminal. | |||
#**Nuclei stick-out like a golf tee. | |||
#Secretory cells. (???) | |||
#*Basal cells, fried egg-like. | |||
See also: | |||
*[[Walthard cell rest]]. | |||
===Images=== | |||
www: | |||
*[http://faculty.une.edu/com/abell/histo/ampovidw.jpg Fallopian tube (une.edu)].<ref>URL: [http://faculty.une.edu/com/abell/histo/histolab3f.htm http://faculty.une.edu/com/abell/histo/histolab3f.htm]. Accessed on: 18 October 2011.</ref> | |||
*[http://medpics.ucsd.edu/index.cfm?curpage=image&course=hist&mode=browse&lesson=37&img=669 Fallopian tube (medpics.ucsd.edu)]. | |||
*[http://www.ouhsc.edu/histology/Glass%20slides/18_09.jpg Uterine tube - cells (ouhsc.edu)]. | |||
*[http://www.ouhsc.edu/histology/Glass%20slides/18_10.jpg Uterine tube - wall (ouhsc.edu)]. | |||
=Overview= | |||
===Benign lesions=== | |||
*[[Paratubal cyst]]. | |||
*[[Salpingitis isthmica nodosa]]. | |||
*[[Endometriosis]]. | |||
===Benign neoplasm=== | |||
*[[Adenomatoid tumour]]. | |||
===Pre-malignant=== | |||
*[[Serous tubal intraepithelial carcinoma]] (STIC). | |||
===Malignant diagnoses=== | |||
*Serous carcinoma. | |||
*Endometrioid adenocarcinoma.<ref name=pmid8946874>{{Cite journal | last1 = Navani | first1 = SS. | last2 = Alvarado-Cabrero | first2 = I. | last3 = Young | first3 = RH. | last4 = Scully | first4 = RE. | title = Endometrioid carcinoma of the fallopian tube: a clinicopathologic analysis of 26 cases. | journal = Gynecol Oncol | volume = 63 | issue = 3 | pages = 371-8 | month = Dec | year = 1996 | doi = 10.1006/gyno.1996.0338 | PMID = 8946874 }}</ref> | |||
=Ditzels= | |||
{{Main|Ditzels}} | |||
==Paratubal cyst== | |||
*Also known as ''Hydatid cyst of Morgagni'' and ''Hydatid of Morgagni''. | |||
===General=== | |||
*Very common. | |||
*May lead to ovarian torsion if very large.<ref name=pmid22840942>{{Cite journal | last1 = Thakore | first1 = SS. | last2 = Chun | first2 = MJ. | last3 = Fitzpatrick | first3 = K. | title = Recurrent ovarian torsion due to paratubal cysts in an adolescent female. | journal = J Pediatr Adolesc Gynecol | volume = 25 | issue = 4 | pages = e85-7 | month = Aug | year = 2012 | doi = 10.1016/j.jpag.2011.10.012 | PMID = 22840942 }} | |||
</ref> | |||
*Associated with [[obesity]].<ref>{{Cite journal | last1 = Muolokwu | first1 = E. | last2 = Sanchez | first2 = J. | last3 = Bercaw | first3 = JL. | last4 = Sangi-Haghpeykar | first4 = H. | last5 = Banszek | first5 = T. | last6 = Brandt | first6 = ML. | last7 = Dietrich | first7 = JE. | title = Paratubal cysts, obesity, and hyperandrogenism. | journal = J Pediatr Surg | volume = 46 | issue = 11 | pages = 2164-7 | month = Nov | year = 2011 | doi = 10.1016/j.jpedsurg.2011.07.011 | PMID = 22075351 }}</ref> | |||
===Gross=== | |||
*Thin walled-cyst with serous fluid. | |||
===Microscopic=== | |||
Features: | |||
*Simple cyst with ciliated (tubal) epithelium. | |||
===Sign out=== | |||
<pre> | |||
PARATUBAL CYST, RIGHT, EXCISION: | |||
- BENIGN SIMPLE CYST. | |||
</pre> | |||
====No epithelium==== | |||
<pre> | |||
PARATUBAL CYST, LEFT, EXCISION: | |||
- BENIGN FIBROUS TISSUE COMPATIBLE WITH CYST WALL. | |||
</pre> | |||
==Tubal ligation== | |||
*Abbreviated ''TL''. | |||
===General=== | |||
*Done to control fertility. | |||
===Microscopic=== | |||
See ''normal uterine tube''. | |||
DDx: | |||
*[[Salpingitis]] - inflammatory cells. | |||
*[[Serous carcinoma]] - nuclear atypia (marked), nuclear pleomorphism, prominent nucleoli. | |||
*[[Tubal intraepithelial carcinoma]] - discrete papillary growth, loss of nuclear polarity, nuclear atypia. | |||
*[[Endometriosis]]. | |||
===Sign out=== | |||
====Left then right==== | |||
<pre> | |||
A. Fallopian Tube, Left, Tubal Ligation: | |||
- Fallopian tube within normal limits, consistent with complete cross sections. | |||
B. Fallopian Tube, Right, Tubal Ligation: | |||
- Fallopian tube within normal limits, consistent with complete cross sections. | |||
</pre> | |||
<pre> | |||
A. FALLOPIAN TUBE, LEFT, TUBAL LIGATION: | |||
- FALLOPIAN TUBE WITHIN NORMAL LIMITS, CONSISTENT WITH COMPLETE CROSS SECTIONS. | |||
B. FALLOPIAN TUBE, RIGHT, TUBAL LIGATION: | |||
- FALLOPIAN TUBE WITHIN NORMAL LIMITS, CONSISTENT WITH COMPLETE CROSS SECTIONS. | |||
</pre> | |||
<pre> | |||
A. FALLOPIAN TUBE, LEFT, TUBAL LIGATION: | |||
- FALLOPIAN TUBE WITHIN NORMAL LIMITS. | |||
B. FALLOPIAN TUBE, RIGHT, TUBAL LIGATION: | |||
- FALLOPIAN TUBE WITHIN NORMAL LIMITS. | |||
</pre> | |||
====Right then left==== | |||
<pre> | |||
A. Fallopian Tube, Right, Tubal Ligation: | |||
- Fallopian tube within normal limits, consistent with complete cross sections. | |||
B. Fallopian Tube, Left, Tubal Ligation: | |||
- Fallopian tube within normal limits, consistent with complete cross sections. | |||
</pre> | |||
<pre> | |||
A. FALLOPIAN TUBE, RIGHT, TUBAL LIGATION: | |||
- FALLOPIAN TUBE WITHIN NORMAL LIMITS, CONSISTENT WITH COMPLETE CROSS SECTIONS. | |||
B. FALLOPIAN TUBE, LEFT, TUBAL LIGATION: | |||
- FALLOPIAN TUBE WITHIN NORMAL LIMITS, CONSISTENT WITH COMPLETE CROSS SECTIONS. | |||
</pre> | |||
<pre> | |||
A. FALLOPIAN TUBE, RIGHT, TUBAL LIGATION: | |||
- FALLOPIAN TUBE WITHIN NORMAL LIMITS. | |||
B. FALLOPIAN TUBE, LEFT, TUBAL LIGATION: | |||
- FALLOPIAN TUBE WITHIN NORMAL LIMITS. | |||
</pre> | |||
====Both in one container==== | |||
<pre> | |||
Submitted as "Fallopian Tubes Right and Left", Tubal Ligation: | |||
- Pieces of Fallopian tube within normal limits, consistent with | |||
complete cross sections. | |||
</pre> | |||
<pre> | |||
Submitted as "Fallopian Tubes Right and Left", Partial Excision: | |||
- Pieces of Fallopian tube within normal limits, consistent with | |||
complete cross sections and fibril ends. | |||
</pre> | |||
=====Incomplete cross sections at microscopy===== | |||
<pre> | |||
Submitted as "Right and Left Fallopian Tubes", Tubal Ligation: | |||
- Fallopian tubes within normal limits, incomplete cross sections | |||
seen at microscopy; clinical correlation is suggested. | |||
</pre> | |||
=====Mild inflammation===== | |||
<pre> | |||
Submitted as "Fallopian Tubes Right and Left", Tubal Ligation: | |||
- Pieces of Fallopian tube with mild inflammation otherwise within | |||
normal limits, consistent with complete cross sections. | |||
</pre> | |||
====Surgical resection of previous tubal ligation==== | |||
<pre> | |||
LEFT FALLOPIAN TUBE AND OVARY, LEFT SALPINGO-OOPHORECTOMY: | |||
- FALLOPIAN TUBE WITH PARATUBAL CYSTS AND FOCAL FIBROSIS. | |||
- OVARY WITHIN NORMAL LIMITS. | |||
</pre> | |||
====Tubes with fimbria==== | |||
<pre> | |||
Submitted as "Right and Left Fallopian Tube Segments", Excision: | |||
- Fallopian tubes with fimbria within normal limits; complete cross sections seen. | |||
</pre> | |||
=Specific diagnoses= | |||
==Salpingitis== | |||
:Also ''suppurative salpingitis''. | |||
:Also ''granulomatous salpingitis''. | |||
===General=== | |||
*Benign. | |||
*May be part of ''pelvic inflammatory disease''. | |||
===Microscopic=== | |||
Features: | |||
*Inflammatory cells: | |||
**Neutrophils = acute. | |||
**Lymphocytes and plasma cells = chronic. | |||
*+/-[[Granulomas]]; known as ''granulomatous salpingitis''. | |||
*+/-Clusters of neutrophils = abscess; known as ''suppurative salpingitis''. | |||
====Images==== | |||
<gallery> | |||
File:Salpingitis_-_low_mag.jpg | Salpingitis - low mag. (WC) | |||
File:Salpingitis_-_high_mag.jpg | Salpingitis - high mag. (WC) | |||
File:Granulomatous_salpingitis_-_intermed_mag.jpg | Granulomatous salpingitis - intermed mag. (WC) | |||
File:Granulomatous_salpingitis_-_high_mag.jpg | Granulomatous salpingitis - high mag. (WC) | |||
</gallery> | |||
===Stains=== | |||
If organisms are seen on routine stains: | |||
*Gram stain +ve/-ve. | |||
Granulomatous inflammation: | |||
*[[Ziehl-Neelsen stain]] +ve/-ve. | |||
*[[GMS stain]] +ve/-ve. | |||
*[[PASD stain]] +ve/-ve. | |||
==Ectopic pregnancy== | |||
{{Main|Ectopic pregnancy}} | |||
==Adenofibroma== | ==Adenofibroma== | ||
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==Salpingitis isthmica nodosa== | ==Salpingitis isthmica nodosa== | ||
*Abbreviated ''SIN''. | |||
*[[AKA]] ''adenosalpingitis'',<ref>Stedman's Medical Dictionary. 27th Ed. Lippincott Williams & Wilkins.</ref> and ''diverticulosis of the Fallopian tubes''.<ref>URL: [http://www.medcyclopaedia.com/library/topics/volume_iv_2/s/salpingitis_isthmica_nodosa.aspx http://www.medcyclopaedia.com/library/topics/volume_iv_2/s/salpingitis_isthmica_nodosa.aspx]. Accessed on: 28 July 2010.</ref> | |||
===General=== | ===General=== | ||
*Associated with infertility and [[ectopic pregnancy]].<ref name=pmid8405510>{{Cite journal | last1 = Jenkins | first1 = CS. | last2 = Williams | first2 = SR. | last3 = Schmidt | first3 = GE. | title = Salpingitis isthmica nodosa: a review of the literature, discussion of clinical significance, and consideration of patient management. | journal = Fertil Steril | volume = 60 | issue = 4 | pages = 599-607 | month = Oct | year = 1993 | doi = | PMID = 8405510 }}</ref> | |||
*SIN is uncommonly bilateral.<ref name=pmid1757522>{{Cite journal | last1 = Skibsted | first1 = L. | last2 = Sperling | first2 = L. | last3 = Hansen | first3 = U. | last4 = Hertz | first4 = J. | title = Salpingitis isthmica nodosa in female infertility and tubal diseases. | journal = Hum Reprod | volume = 6 | issue = 6 | pages = 828-31 | month = Jul | year = 1991 | doi = | PMID = 1757522 }}</ref> | |||
*Associated with infertility and ectopic pregnancy.<ref name=pmid8405510>{{Cite journal | last1 = Jenkins | first1 = CS. | last2 = Williams | first2 = SR. | last3 = Schmidt | first3 = GE. | title = Salpingitis isthmica nodosa: a review of the literature, discussion of clinical significance, and consideration of patient management. | journal = Fertil Steril | volume = 60 | issue = 4 | pages = 599-607 | month = Oct | year = 1993 | doi = | PMID = 8405510 }} | |||
</ref> | |||
Diagnosis (clinical): | Diagnosis (clinical): | ||
* | *Hysterosalpingography.<ref>URL: [http://radiology.rsna.org/content/154/3/597.abstract http://radiology.rsna.org/content/154/3/597.abstract]. Accessed on: 28 July 2010.</ref> | ||
**Finding: diverticula. | |||
Notes: | |||
*The male cousin of this is: ''[[vasitis nodosa]]''. | |||
===Microscopic=== | ===Microscopic=== | ||
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*Cystically dilated glands. | *Cystically dilated glands. | ||
*+/-Complete obliteration of tubal lumen. | *+/-Complete obliteration of tubal lumen. | ||
Images: | |||
*[[WC]]: | |||
**[http://commons.wikimedia.org/wiki/File:Salpingitis_isthmica_nodosa_-_very_low_mag.jpg SIN - very low mag. (WC)]. | |||
*www: | |||
**[http://www.pathologypics.com/PictView.aspx?ID=234 SIN (pathologypics.com)]. | |||
==Adenomatoid tumour== | ==Adenomatoid tumour== | ||
See: ''[[Uterine_tumours#Adenomatoid_tumour|Adenomatoid tumours (uterine tumours)]]''. | See: ''[[Uterine_tumours#Adenomatoid_tumour|Adenomatoid tumours (uterine tumours)]]''. | ||
===General=== | |||
*Relatively common tumour of the fallopian tube.<ref name=pmid2199199>{{cite journal |author=Christensen C |title=Adenomatoid tumors of the uterus |journal=Eur. J. Gynaecol. Oncol. |volume=11 |issue=2 |pages=85–9 |year=1990 |pmid=2199199 |doi= |url=}}</ref> | |||
===Microscopic=== | |||
See: ''[[Uterine_tumours#Adenomatoid_tumour|Adenomatoid tumours (uterine tumours)]]''. | |||
==Serous tubal intraepithelial carcinoma== | |||
*Abbreviated ''STIC''.<ref name=pmid21989347>{{Cite journal | last1 = Visvanathan | first1 = K. | last2 = Vang | first2 = R. | last3 = Shaw | first3 = P. | last4 = Gross | first4 = A. | last5 = Soslow | first5 = R. | last6 = Parkash | first6 = V. | last7 = Shih | first7 = IeM. | last8 = Kurman | first8 = RJ. | title = Diagnosis of serous tubal intraepithelial carcinoma based on morphologic and immunohistochemical features: a reproducibility study. | journal = Am J Surg Pathol | volume = 35 | issue = 12 | pages = 1766-75 | month = Dec | year = 2011 | doi = 10.1097/PAS.0b013e31822f58bc | PMID = 21989347 }}</ref> | |||
*[[AKA]] ''tubal intraepithelial carcinoma''. | |||
{{Main|Serous tubal intraepithelial carcinoma}} | |||
=See also= | |||
*[[Gynecologic pathology]]. | *[[Gynecologic pathology]]. | ||
*[[Ovary]]. | *[[Ovary]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gynecologic pathology]] | [[Category:Gynecologic pathology]] | ||
[[Category:Uterine tubes]] |
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