Uterine tubes

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Uterine tubes, also known as the Fallopian tubes, serve as a connection between the 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".[1]

Normal uterine tube

Architecture:

  • Finger-like projections into the lumen.

Cells:

  1. Ciliated cell.
    • Columnar.
    • Eosinophilic cytoplasm.
  2. Non-ciliated cell (AKA Peg cell).
    • Nucleus more luminal.
      • Nuclei stick-out like a golf tee.
  3. Secretory cells.

Images:

Overview

Benign lesions

Benign neoplasm

Pre-malignant

Malignant diagnoses

  • Serous carcinoma.
  • Endometrioid adenocarcinoma.[3]

Ditzels

Main article: Ditzels

Paratubal cyst

General

  • Very common.
  • May lead to ovarian torsion if very large.[4]

Gross

  • Thin walled-cyst with serous fluid.

Microscopic

Features:

  • Simple cyst with ciliated (tubal) epithelium.

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PARATUBAL CYST, RIGHT, EXCISION:
- BENIGN SIMPLE CYST.

No epithelium

PARATUBAL CYST, LEFT, EXCISION:
- BENIGN FIBROUS TISSUE COMPATIBLE WITH CYST WALL.

Tubal ligation

  • Abbreviated TL.

General

  • Done to control fertility.

Microscopic

See normal uterine tube.

DDx:

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Left then right

A. FALLOPIAN TUBE, LEFT, TUBAL LIGATION:
- FALLOPIAN TUBE WITHIN NORMAL LIMITS.

B. FALLOPIAN TUBE, RIGHT, TUBAL LIGATION:
- FALLOPIAN TUBE WITHIN NORMAL LIMITS.

Right then left

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.

A. FALLOPIAN TUBE, RIGHT, TUBAL LIGATION:
- FALLOPIAN TUBE WITHIN NORMAL LIMITS.

B. FALLOPIAN TUBE, LEFT, TUBAL LIGATION:
- FALLOPIAN TUBE WITHIN NORMAL LIMITS.

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:

Stains

If organisms are seen on routine stains:

  • Gram stain +ve/-ve.

Granulomatous inflammation:

Adenofibroma

General

  • Rare.[5]
    • More frequently seen than in the past -- presumably as pathologists are looking more closely at the Fallopian tube.
  • Cannot be disguished from ovarian adenofibroma.[5]

Gross

  • Solid, nodular.

Microscopic

Features:[5]

  • Stroma + glandular elements.
    • Glandular elements: secretory cells and ciliated cells.

IHC

Features:

  • Stroma:[5]
    • CD10 +ve.
    • Inhibin +ve.

Salpingitis isthmica nodosa

  • Abbreviated SIN.
  • AKA adenosalpingitis,[6] and diverticulosis of the Fallopian tubes.[7]

General

Diagnosis (clinical):

  • Hysterosalpingography.[10]
    • Finding: diverticula.

Notes:

Microscopic

Features:[11]

  • Nodular thickening of the tunica muscularis of the isthmic portion.
  • Cystically dilated glands.
  • +/-Complete obliteration of tubal lumen.

Images:

Adenomatoid tumour

See: Adenomatoid tumours (uterine tumours).

General

  • Relatively common tumour of the fallopian tube.[12]

Microscopic

See: Adenomatoid tumours (uterine tumours).

Serous tubal intraepithelial carcinoma

  • Abbreviated STIC.[13]
  • AKA tubal intraepithelial carcinoma.

General

Gross

  • Not apparent on gross.
  • Usually at the fimbriated end of the tube.

Microscopic

Features:[15]

  • Discrete papillary growth - low power.
  • Formal criteria - need 3 or more:
    1. Atypical chromatin pattern.
    2. Nuclear enlargement.
    3. Nuclear pleomorphism.
    4. Nuclear moulding.
    5. Loss of nuclear polarity or epithelial stratification.

Images:

IHC

Features:[13]

  • p53 +ve.
  • Ki-67 +ve.
  • p16 +ve.[15]

See also

References

  1. ↑ Hirst, JE.; Gard, GB.; McIllroy, K.; Nevell, D.; Field, M. (Jul 2009). "High rates of occult fallopian tube cancer diagnosed at prophylactic bilateral salpingo-oophorectomy.". Int J Gynecol Cancer 19 (5): 826-9. doi:10.1111/IGC.0b013e3181a1b5dc. PMID 19574767.
  2. ↑ URL: http://faculty.une.edu/com/abell/histo/histolab3f.htm. Accessed on: 18 October 2011.
  3. ↑ Navani, SS.; Alvarado-Cabrero, I.; Young, RH.; Scully, RE. (Dec 1996). "Endometrioid carcinoma of the fallopian tube: a clinicopathologic analysis of 26 cases.". Gynecol Oncol 63 (3): 371-8. doi:10.1006/gyno.1996.0338. PMID 8946874.
  4. ↑ Thakore, SS.; Chun, MJ.; Fitzpatrick, K. (Aug 2012). "Recurrent ovarian torsion due to paratubal cysts in an adolescent female.". J Pediatr Adolesc Gynecol 25 (4): e85-7. doi:10.1016/j.jpag.2011.10.012. PMID 22840942.
  5. ↑ 5.0 5.1 5.2 5.3 Bossuyt, V.; Medeiros, F.; Drapkin, R.; Folkins, AK.; Crum, CP.; Nucci, MR. (Jul 2008). "Adenofibroma of the fimbria: a common entity that is indistinguishable from ovarian adenofibroma.". Int J Gynecol Pathol 27 (3): 390-7. doi:10.1097/PGP.0b013e3181639a82. PMID 18580316.
  6. ↑ Stedman's Medical Dictionary. 27th Ed. Lippincott Williams & Wilkins.
  7. ↑ URL: http://www.medcyclopaedia.com/library/topics/volume_iv_2/s/salpingitis_isthmica_nodosa.aspx. Accessed on: 28 July 2010.
  8. ↑ Jenkins, CS.; Williams, SR.; Schmidt, GE. (Oct 1993). "Salpingitis isthmica nodosa: a review of the literature, discussion of clinical significance, and consideration of patient management.". Fertil Steril 60 (4): 599-607. PMID 8405510.
  9. ↑ Skibsted, L.; Sperling, L.; Hansen, U.; Hertz, J. (Jul 1991). "Salpingitis isthmica nodosa in female infertility and tubal diseases.". Hum Reprod 6 (6): 828-31. PMID 1757522.
  10. ↑ URL: http://radiology.rsna.org/content/154/3/597.abstract. Accessed on: 28 July 2010.
  11. ↑ Chawla, N.; Kudesia, S.; Azad, S.; Singhal, M.; Rai, SM.. "Salpingitis isthmica nodosa.". Indian J Pathol Microbiol 52 (3): 434-5. doi:10.4103/0377-4929.55019. PMID 19679986.
  12. ↑ Christensen C (1990). "Adenomatoid tumors of the uterus". Eur. J. Gynaecol. Oncol. 11 (2): 85–9. PMID 2199199.
  13. ↑ 13.0 13.1 Visvanathan, K.; Vang, R.; Shaw, P.; Gross, A.; Soslow, R.; Parkash, V.; Shih, IeM.; Kurman, RJ. (Dec 2011). "Diagnosis of serous tubal intraepithelial carcinoma based on morphologic and immunohistochemical features: a reproducibility study.". Am J Surg Pathol 35 (12): 1766-75. doi:10.1097/PAS.0b013e31822f58bc. PMID 21989347.
  14. ↑ Lee, Y.; Miron, A.; Drapkin, R.; Nucci, MR.; Medeiros, F.; Saleemuddin, A.; Garber, J.; Birch, C. et al. (Jan 2007). "A candidate precursor to serous carcinoma that originates in the distal fallopian tube.". J Pathol 211 (1): 26-35. doi:10.1002/path.2091. PMID 17117391.
  15. ↑ 15.0 15.1 15.2 Sehdev, AS.; Kurman, RJ.; Kuhn, E.; Shih, IeM. (Jun 2010). "Serous tubal intraepithelial carcinoma upregulates markers associated with high-grade serous carcinomas including Rsf-1 (HBXAP), cyclin E and fatty acid synthase.". Mod Pathol 23 (6): 844-55. doi:10.1038/modpathol.2010.60. PMID 20228782.
  16. ↑ 16.0 16.1 16.2 Kurman, RJ.; Shih, IeM. (Jul 2011). "Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer--shifting the paradigm.". Hum Pathol 42 (7): 918-31. doi:10.1016/j.humpath.2011.03.003. PMID 21683865.
  17. ↑ Gross, AL.; Kurman, RJ.; Vang, R.; Shih, IeM.; Visvanathan, K. (2010). "Precursor lesions of high-grade serous ovarian carcinoma: morphological and molecular characteristics.". J Oncol 2010: 126295. doi:10.1155/2010/126295. PMID 20445756.
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