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.

Cross section of a Fallopian tube with decidualization. H&E stain. (WC/euthman)

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. (???)
    • Basal cells, fried egg-like.

See also:

Images

www:

Overview

Benign lesions

Benign neoplasm

Pre-malignant

Malignant diagnoses

  • Serous carcinoma.
  • Endometrioid adenocarcinoma.[3]

Ditzels

Main article: 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.[4]
  • Associated with obesity.[5]

Gross

  • Thin walled-cyst with serous fluid.

Microscopic

Features:

  • Simple cyst with ciliated (tubal) epithelium.

Sign out

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:

Sign out

Left then right

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.

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.

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, 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.

Both in one container

Submitted as "Fallopian Tubes Right and Left", Tubal Ligation:
     - Pieces of Fallopian tube within normal limits, consistent with 
       complete cross sections.

Submitted as "Fallopian Tubes Right and Left", Partial Excision: 
     - Pieces of Fallopian tube within normal limits, consistent with 
       complete cross sections and fibril ends.
Incomplete cross sections at microscopy
Submitted as "Right and Left Fallopian Tubes", Tubal Ligation: 
     - Fallopian tubes within normal limits, incomplete cross sections 
       seen at microscopy; clinical correlation is suggested.
Mild inflammation
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.

Surgical resection of previous tubal ligation

LEFT FALLOPIAN TUBE AND OVARY, LEFT SALPINGO-OOPHORECTOMY:
- FALLOPIAN TUBE WITH PARATUBAL CYSTS AND FOCAL FIBROSIS.
- OVARY WITHIN NORMAL LIMITS.

Tubes with fimbria

Submitted as "Right and Left Fallopian Tube Segments", Excision:
     - Fallopian tubes with fimbria within normal limits; complete cross sections seen.

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

  • Salpingitis - low mag. (WC)

  • Salpingitis - high mag. (WC)

  • Granulomatous salpingitis - intermed mag. (WC)

  • Granulomatous salpingitis - high mag. (WC)

Stains

If organisms are seen on routine stains:

  • Gram stain +ve/-ve.

Granulomatous inflammation:

Ectopic pregnancy

Main article: Ectopic pregnancy

Adenofibroma

General

  • Rare.[6]
    • More frequently seen than in the past -- presumably as pathologists are looking more closely at the Fallopian tube.
  • Cannot be disguished from ovarian adenofibroma.[6]

Gross

  • Solid, nodular.

Microscopic

Features:[6]

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

IHC

Features:

  • Stroma:[6]
    • CD10 +ve.
    • Inhibin +ve.

Salpingitis isthmica nodosa

  • Abbreviated SIN.
  • AKA adenosalpingitis,[7] and diverticulosis of the Fallopian tubes.[8]

General

Diagnosis (clinical):

  • Hysterosalpingography.[11]
    • Finding: diverticula.

Notes:

Microscopic

Features:[12]

  • 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.[13]

Microscopic

See: Adenomatoid tumours (uterine tumours).

Serous tubal intraepithelial carcinoma

  • Abbreviated STIC.[14]
  • AKA tubal intraepithelial carcinoma.
Main article: Serous tubal intraepithelial carcinoma

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. ↑ Muolokwu, E.; Sanchez, J.; Bercaw, JL.; Sangi-Haghpeykar, H.; Banszek, T.; Brandt, ML.; Dietrich, JE. (Nov 2011). "Paratubal cysts, obesity, and hyperandrogenism.". J Pediatr Surg 46 (11): 2164-7. doi:10.1016/j.jpedsurg.2011.07.011. PMID 22075351.
  6. ↑ 6.0 6.1 6.2 6.3 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.
  7. ↑ Stedman's Medical Dictionary. 27th Ed. Lippincott Williams & Wilkins.
  8. ↑ URL: http://www.medcyclopaedia.com/library/topics/volume_iv_2/s/salpingitis_isthmica_nodosa.aspx. Accessed on: 28 July 2010.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ URL: http://radiology.rsna.org/content/154/3/597.abstract. Accessed on: 28 July 2010.
  12. ↑ 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.
  13. ↑ Christensen C (1990). "Adenomatoid tumors of the uterus". Eur. J. Gynaecol. Oncol. 11 (2): 85–9. PMID 2199199.
  14. ↑ 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.
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