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Uterine tubes (view source)

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'''Uterine tubes''', aka '''Fallopian tubes''', serve as a connection the [[ovary]] and [[uterus]].  It is where fertilization usually takes place.
[[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==
=Normal uterine tube=
Architecture:
*Finger-like projections into the lumen.
*Finger-like projections into the lumen.
*Cilia.
 
*Have ''peg cells''...
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==
===General===
===General===
*Rare<ref name=pmid18580316>{{Cite journal  | last1 = Bossuyt | first1 = V. | last2 = Medeiros | first2 = F. | last3 = Drapkin | first3 = R. | last4 = Folkins | first4 = AK. | last5 = Crum | first5 = CP. | last6 = Nucci | first6 = MR. | title = Adenofibroma of the fimbria: a common entity that is indistinguishable from ovarian adenofibroma. | journal = Int J Gynecol Pathol | volume = 27 | issue = 3 | pages = 390-7 | month = Jul | year = 2008 | doi = 10.1097/PGP.0b013e3181639a82 | PMID = 18580316 }}</ref>... but more frequently seen than in the past (as pathologists are looking more closely at the Fallopian tube).
*Rare.<ref name=pmid18580316>{{Cite journal  | last1 = Bossuyt | first1 = V. | last2 = Medeiros | first2 = F. | last3 = Drapkin | first3 = R. | last4 = Folkins | first4 = AK. | last5 = Crum | first5 = CP. | last6 = Nucci | first6 = MR. | title = Adenofibroma of the fimbria: a common entity that is indistinguishable from ovarian adenofibroma. | journal = Int J Gynecol Pathol | volume = 27 | issue = 3 | pages = 390-7 | month = Jul | year = 2008 | doi = 10.1097/PGP.0b013e3181639a82 | PMID = 18580316 }}</ref>
**More frequently seen than in the past -- presumably as pathologists are looking more closely at the Fallopian tube.
*Cannot be disguished from ovarian adenofibroma.<ref name=pmid18580316/>
*Cannot be disguished from ovarian adenofibroma.<ref name=pmid18580316/>


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===Microscopic===
===Microscopic===
Features:<ref name=pmid18580316/>
*Stroma + glandular elements.
*Stroma + glandular elements.
**Glandular elements: secretory cells and ciliated cells.<ref name=pmid18580316/>
**Glandular elements: secretory cells and ciliated cells.


===IHC===
===IHC===
Stroma<ref name=pmid18580316/>  
Features:
*CD10.
*Stroma:<ref name=pmid18580316/>  
*Inhibin positive.
**CD10 +ve.
**Inhibin +ve.
 
==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===
*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>
 
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===
Features:<ref name=pmid19679986>{{Cite journal  | last1 = Chawla | first1 = N. | last2 = Kudesia | first2 = S. | last3 = Azad | first3 = S. | last4 = Singhal | first4 = M. | last5 = Rai | first5 = SM. | title = Salpingitis isthmica nodosa. | journal = Indian J Pathol Microbiol | volume = 52 | issue = 3 | pages = 434-5 | month =  | year =  | doi = 10.4103/0377-4929.55019 | PMID = 19679986 }}</ref>
*Nodular thickening of the tunica muscularis of the isthmic portion.
*Cystically dilated glands.
*+/-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==
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==
=See also=
*[[Gynecologic pathology]].
*[[Gynecologic pathology]].
*[[Ovary]].
*[[Ovary]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gynecologic pathology]]
[[Category:Gynecologic pathology]]
[[Category:Uterine tubes]]
Michael
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