Introduction: The fallopian tubes were first described in 16th centuary and named after anatomist Gabriele Falloppio. In surgical histopathology, the fallopian tubes are one of the most encountered specimens and these tubes are mainly removed for lesions in other gynecological organs.As they are distinguished from adenomyosis by their sharp demarcation from surrounding normal tissues and from leiomyomas by the presence of endometrial glands and stroma(10). As Hemangioma are tumors of vascular origin and they are mostly observed in soft tissue and skin. Vascular tumor of pelvic organs are very rare and they are detected incidentally. Capillary hemangioma of fallopian tube is a very rare neoplasm. Rupture of this hemangioma can be lethal (11). As it is a benign sporadic vascular tumor , only 16 documented cases available in literature(12). Due to potential for these lesions to manifest as surgical emergencies, it is very important for surgeons to recognize these lesions immediately and appropriately managedAs they are distinguished from adenomyosis by their sharp demarcation from surrounding normal tissues and from leiomyomas by the presence of endometrial glands and stroma(10). As Hemangioma are tumors of vascular origin and they are mostly observed in soft tissue and skin. Vascular tumor of pelvic organs are very rare and they are detected incidentally. Capillary hemangioma of fallopian tube is a very rare neoplasm. Rupture of this hemangioma can be lethal(11). As it is a benign sporadic vascular tumor , only 16 documented cases available in literature(12). Due to potential for these lesions to manifest as surgical emergencies, it is very important for surgeons to recognize these lesions immediately and appropriately managed.
The fallopian tubes were first described in 16th centuary and named after anatomist Gabriele Falloppio. In surgical histopathology, the fallopian tubes are one of the most encountered specimens and these tubes are mainly removed for lesions in other gynecological organs(1). The fallopian tube is key of conduit of ova and fertilization and it consists of interstitial portions, isthmus, ampulla, infundibulum and opens as finger like projections towards ovary(2). Various lesions like inflammation and tumor may occur in fallopian tube. Inflammation that are caused by pyogenic organisms like gonococcus and chlamydia. By these infections, lumen gets filled with purulent exudate and which leaks out in to ovary and leads to salpingo-oophoritis. Various tumors are benign tumors which are found in fallopian tube like adenofibroma, adenomyoma, mesothelioma, lymphangioma and mesonephroma(3). Other conditions like xanthogranulomatous salpingitis and torsion of fallopian tube and ovary are usually secondary to inflammation and tumor(4). The significance of pathogenetic changes in fallopian tube have an important role on infertility. In this , salpingitis is responsible for many causes of infertility(5). The average length of fallopian tube is 11 cm and it affects mainly 11% of reproductive females and lead to increase chances of ectopic pregnancies(6). The present study is conducted to report case series of 5 cases, rare and incidental lesions of fallopian tube to determine relationship with uterine and ovarian pathology.
First case:- ADENOMYOMA : A 30 year old lady (P3L3) presented to gynecology out patient department with a history of increasing polymenorrhagia and dysmenorrhea for the last 2 years. There was no history of discharge per vaginum given by the patient and she did not have urinary and bowel complaints. So patient was subjected for endometrial biopsy elsewhere, and reported as proliferative endometrium. General condition of patient was normal except for mild pallor. There was no thyromegaly and no mass palpable per abdomen. On Bimanual Examination, Uterus was anteverted and no mass palpable in the fornices. Patient was diagnosed with abnormal uterine bleeding with Right Tubo-ovarian mass and Left side tube and ovary are normal. Grossly, we received a salpingectomy specimen measuring 3 cm in length with attached soft tissue mass measuring 3x2.5x2 cm. Cut section, mass shows grey white with focal tan areas and cut section of fallopian tube, lumen is identified. On Microscopic examination, Fallopian tube shows features of chronic salpingitis with endometriosis and attached soft tissue mass shows Adenomyoma of fallopian tube.
Second Case:- CAPILLARY HEMANGIOMA: A 49 year old female presented to gynecology department with complaint of dysmenorrhea for 2 years. On general examination patient was anemic and her routine investigations revealed decreased hemoglobin, red blood cell count, hematocrit and RBC indices. WBC count and platelet counts were normal in range and peripheral blood film shows features of microcytic hypochromic anemia. Patient was a known case of endometroid carcinoma of ovary but Total abdominal hysterectomy was not feasible because of dense adhesions in pelvis. We received right salpingo-oophorectomy along with omentum specimen in histopathology . On Gross examination, in salpingoophorectomy specimen, ovary measures 2.5x2x1cm. On cut section, it was unremarkable and fallopian tube measures 2.5 cm in length and on cut section, lumen identified. Microscopy, omentum shows Metastatic carcinomatous deposits , right ovary is involved by tumor and in right fallopian tube capillary hemangioma and paratubal cyst is seen which was an incidental finding.
Third Case:- XANTHOGRANULOMATOUS SALPINGITIS: A 45 year old female presented to gynecology department with history of bilateral groin pain since 6 months and pain is gradually increased over a period of 2 weeks. She and her husband were not using any contraceptive and she was infertile for 2 years and they did not seek any professional help. As we received a hysterectomy specimen with bilateral attached adnexa in our histopathology department in which Uterus with cervix measures 8x8x4 cm and on cut section of uterus, endometrium measures 0.1 to 0.2 cm and myometrium measures 2x2.5 cm. Trabeculations also noted. Cut section of cervix , multiple Nabothian cysts are identified ranging from 0.2 to 0.3 cm. Right ovary measures 2.5x2x1 cm and on cut section multiple cysts identified ranging in size from 0.2 to 0.3 cm. Right fallopian tube measures 2.5 cm in length and cut section, lumen identified. Left ovary measures 2.5x2x2cm and one paratubal cyst was identified on cut section. Left fallopian tube measures 2.5 cm in length and lumen was identified on cut section. On microscopic examination, Right fallopian tube showed hematosalpinx with foreign body giant cell reaction and paratubal cyst and left fallopian tube showed xanthogranulomatous salpingitis with paratubal cyst.
Fourth Case:- SALPINGITIS ISTHMICA NODOSA: A 34 year old female came to gynecology OPD with history of 2 year of subfertility. She was P2L2A1 with previous 2 normal vaginal deliveries and had history of MTP kit intake . We received bilateral tubectomy specimen in histopathology department . On Gross examination we received parts of two fallopian tubes each measuring 1 and 1.3 cm respectively. On cut section, lumen identified . On Microscopic examination, Sections examined from first fallopian tubal tissue show unremarkable morphology and sections examined from second fallopian tubal tissue show morphology of Salpingitis Isthmica Nodosa.
Fifth case:- CYSTADENOFIBROMA: A 70 year old postmenopausal female presented to gynecology department with history of dull aching pain since 3 months
On examination, abdomen was soft , per vaginally mobile, non tender cystic mass of 5x4cm was noted. On Gross examination, we received a hysterectomy specimen with bilateral attached adnexa measuring6.5x4x5cm. Cut section uterus- endometrium measures 0.1 cm and myometrium measures 0.5 cm. Cut section cervix- Unremarkable. Right ovary measures 2x1.5x1cm. Cut section- Unremarkable. Right Fallopian tube measures 4 cm in length. Cut section- lumen identified. Left ovary measures 3x1.5x1 cm. Cut section- Unremarkable. Left fallopian tube measures 4 cm in length. Cut section- lumen identified. On microscopic examination, Endometrium shows senile cystic atrophic, Cervix shows chronic cervicitis with Nabothian cyst. Bilateral ovaries are unremarkable. Right fallopian tube shows congestion but left fallopian tube shows Cystadenofibroma.
Fig. 1: Adenomyoma of fallopian tube( H&Ex10).
Fig. 2: Capillary Hemangioma of fallopian tube(H &EX4)
Fig. 3: Capillary Hemangioma of fallopian tube( H&EX10).
Fig. 3: Xanthogranulomatous Salpingitis of fallopian tube(H&EX 40).
Fig. 4. Saipingitis Isthmica Nodosa of fallopian tube( H & E X10).
Fig. 5. Cystadenofibroma of fallopian tube(H &E X10).
The Fallopian tubes are complex structures as they connect ovaries to endometrial cavity. It is a common specimen which is examined alone as salpingectomy specimen or bilateral tubal ligation or as a part of hysterectomy or oophorectomy operation(7). As the fallopian tubes are affected by wide spectrum of diseases ranging from salpingitis to carcinoma but there are very few studies documented in the literature which reports the histopathological spectrum of lesions of fallopian tubes. The fallopian tubes are rare site of primary disease and the most common affliction is inflammation so it is commonly part of pelvic inflammatory disease(8). As tumors of fallopian tube are rare and they occur in form of fibroma, leiomyoma, hemangioma, and special adenomatoid tumor. Adenomyoma is a rare entity and it is characterized by the presence of ectopic endometrial glands and stroma with in the myometrium. It is associated with myometrial hypertrophy which may be focal or diffuse. As over best knowledge, only two cases have been reported in English literature so far(9). As they are distinguished from adenomyosis by their sharp demarcation from surrounding normal tissues and from leiomyomas by the presence of endometrial glands and stroma(10). As Hemangioma are tumors of vascular origin and they are mostly observed in soft tissue and skin. Vascular tumor of pelvic organs are very rare and they are detected incidentally. Capillary hemangioma of fallopian tube is a very rare neoplasm. Rupture of this hemangioma can be lethal(11). As it is a benign sporadic vascular tumor , only 16 documented cases available in literature(12). Due to potential for these lesions to manifest as surgical emergencies, it is very important for surgeons to recognize these lesions immediately and appropriately managed(13). As a lesion of fallopian tube like xanthogranulomatous salpingitis is an unusual inflammatory condition of fallopian tube which is characterized by accumulation of foamy macrophages in the wall of fallopian tube and chronic inflammatory cells. To our best knowledge, a very few cases have been reported in English literature with under some different nomenclature. As it has been associated with pelvic endometriosis, it has never been demonstrated through progressive changes, beginning with mucosal endometriosis to full blown xanthogranulomatous inflammation(14). These cases are usually present as a pelvic inflammatory disease which does not respond to antibiotics or as a mass lesion mimicking as pelvic malignancy. So, it is a chronic destructive inflammatory condition that affects the fallopian tube (15). Another lesion of fallopian tube like salpingitis isthmica nodosa is a nodular swelling or diverticulum of fallopian tube. It is most commonly finding while investigating infertility or also associated with ruptured ectopic pregnancies. It is characterized by invasion of tubal epithelium through this muscle wall, forming an outpouching which can communicate with isthmic lumen(16). It has an incidence of 0.6% to 11% in healthy fertile women and strongly associated with infertility and ectopic pregnancies(17).One more benign lesion of fallopian tube is cystadenofibroma which was first diagnosed by Iwanow in 1909, who called it Papilliferum cystadenofibroma. The age of patient ranges from 19 to 73 years(18). These tumors are very rare benign tumors of female genital tract and they tumors are usually asymptomatic and found incidentally. This tumor is considered as an embryologic remnant rather than a neoplastic process (19).
In conclusion, Tumors like Adenomyoma, Capillary Hemangioma, Cystadenofibroma, Salpingitis Istmica Nodosa and Xanthogranulomatous salpingitis are rare tumors and these are incidental findings in histopathology. So, Surgical Pathologists should be careful while examining and sampling of fallopian tube so that these lesions are not missed. However, Histopathology is the gold standard for these lesions.
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