Benign or non-neoplastic conditions
Common incidental findings
Called hydatids of Morgani if large and near fimbriae or broad ligament
Gross: attached to fimbriated end of tube by a pedicle, thin walled, clear content
Gross images: image1
Micro: usually tubal-type lining, may have plica
Presence of hemosiderin-laden macrophages within plical stroma
Associated with surgery for sterilization, chronic pain or benign masses, Archives 2002;126:951
Micro images: figure2
Benign lesion of intermediate trophoblast; remnant of placental implantation site
Rarely in fallopian tube
Positive stains: cytokeratin, placental alkaline phosphatase, human placental lactogen, focal human chorionic gonadotropin, EMA
Reference: Hum Path 1996;27:1243
Dilation of proximal tube, attenuation of plica with pseudopolyp formation and chronic inflammation, plical thickening in distal tube
80% associated with vaginal hysterectomy
Case report of prolapse into urinary bladder, resembling carcinoma, Archives 1983;107:613
Gross: resembles granulation tissue, visible at vaginal apex
Young women, mean 26 years
85% bilateral
Pathogenesis is analogous to uterine adenomyosis
Associated with infertility in 50%; may lead to ectopic pregnancy
Also associated with glandular inclusions in lymph nodes, AJSP 1981;5:353
Gross: well-delimited yellow-white nodular enlargement of isthmus
Micro: regularly spaced, cystically dilated glands surrounded by hypertrophied muscle (actually diverticula that communicate with tubal lumen); no stromal response, but may be accompanied by salpingitis; occasional glands surrounded by endometrial-type stroma; no atypia
DD: carcinoma (irregular distribution of glands, atypia, stromal response)
Usually due to inflammation or tumor, occasionally no known abnormality
Often accompanies torsion of adjacent ovary with moderate sized cyst
Occurs in women of all ages
May resolve or tube may become necrotic and calcified with autoamputation of tube and ovary
2/3 involve right tube
Gross: swollen, dusky
May represent mesothelial hyperplasia
Gross: white/yellow nodules or cysts up to 2 mm, resemble granulomas
Micro: well-circumscribed, small, glistening, round collections of flat/cuboidal cells, resembling urothelium, on tubal serosa; minimal atypia, no/rare mitotic figures; cells have prominent nuclear groove, 1-2 small nucleoli; may see inspissated eosinophilic secretion or mucin within lumina
DD: serosal tumor implants
Tumors
Most common benign tumor of fallopian tube, aka benign mesothelioma
Similar to paratesticular tumor
Gross: usually incidental tumor of myosalpinx (muscle layer), 2 cm or less; circumscribed, gray-white-yellow, firm; usually unilateral
Micro: tubular / glandular spaces of various sizes composed of flattened cells resembling endothelium or large cells with eosinophilic cytoplasm; may have vacuoles; may have mucinous secretions or infiltrative-like margins; often smooth muscle hyperplasia; cells also in clusters or small cords; rare mitotic figures; minimal atypia; often lymphocytic follicles
Negative stains: CEA
DD: lymphangioma, adenomyoma (more prominent smooth muscle), carcinoma (not circumscribed, invasive, atypia, mitotic activity)
Rare cases, mostly mucinous tumors, which may represent spread of appendiceal mucinous cystic tumor
Case report of borderline papillary serous tumor in 31 year old woman, AJSP 1996;20:30
Rare, 0.3 to 1.0% of genital tract malignancies
Mean age 57 years, rarely teenagers; usually incorrect preoperative diagnosis
High stage with pelvic extension or positive peritoneal cytology
To call primary in fallopian tube, should arise from mucosa (endosalpinx), have tubal histologic pattern, involve the lumen, uterus and ovaries must be normal or have foci of malignancy that resemble metastases or independent primaries; if tubal wall is involved, should detect a transition between benign and malignant tubal epithelium
5 year survival: Stage 1 - 77%, Stage 3 - 20%; usually recur intra-abdominally
Associated with BRCA1 and BRCA2 mutations; for patients with known mutation or family history of breast or ovarian cancer, should submit entire fallopian tube and ovary for microscopic examination, AJSP 2002;26:171, AJSP 2001;25:1283
50% serous, 25% endometrioid, 20% transitional or undifferentiated
Symptoms: vaginal bleeding or discharge (2/3), pain, adnexal mass (triad in 50%); endometrial smear positive in 10%
Gross: enlarged tube, with solid or papillary tumor filling the lumen; tumors occasionally are primary in the fimbriae; 80-97% unilateral; hemorrhage, necrosis and cysts common
Micro: invasive papillary adenocarcinoma; may resemble ovarian serous adenocarcinoma with complex papillary architecture
Endometrioid tumors may be non-invasive, have squamous metaplasia, be associated with endometriosis, contain spindled epithelial cells; may have small, closely packed cells with numerous glandular spaces of varying sizes, containing PAS+ dense colloid-like secretion, resembling female adnexal tumor of probably wolffian origin (but usually intraluminal, typical endometrioid carcinoma elsewhere, more mitotic activity and atypia, mucin present)
Carcinoma in situ
Rare without invasive carcinoma
May be preceded with tubal intraepithelial neoplasia at distal fibrimia; associated with BRCA+ patients, who often have p53 signatures in fimbrial epithelium in prophylactic TAH/BSO specimens that represents serous carcinoma in-situ (Curr Opin Obstet Gynecol 2007;19:3, Clin Med Res 2007;5:35, Am J Surg Pathol 2007;31:161)
Micro: flat or minimally papillary lesions, not grossly noted, cells have obvious malignant nuclear features
Micro images: intraepithelial carcinoma; p53 staining
DD: metastases to fallopian tube
Common
Female adnexal tumor of probable wolffian origin
Rare, ~ 40 cases reported
Mean age 47, range 15 to 72 years
Nonspecific symptoms or incidental mass
Usually benign, no known features predictive of malignancy
Malignant case in 81 year old woman, Archives 1994;118:310
Gross: solid tumor within or hanging from broad ligament or fallopian tube by a pedicle; mean 8 cm, rounded with bosselated external surface; solid or cystic cut surface; gray-white, tan or yellow, firm to rubbery; hemorrhage or necrosis is rare
Micro: diffuse, trabecular, tubular or sieve like patterns; cells are cuboidal to columnar with minimal cytoplasm; rarely abundant pale cytoplasm; nuclei small, round/oval, pale; may have prominent hyalinized stroma or fibrous bands that creates lobular appearance; sheets of tumor cells may have a spindly appearance
Positive stains: AE1/AE3
Negative stains: EMA, CEA, S100, B72.3
EM: thick peritubular basal lamina, no/minimal cilia; Golgi apparatus, secretory granules and glycogen favor Wolffian origin
Tubes often affected by disseminated lymphoma, although less common than ovarian involvement
No cases of primary tubal lymphoma reported
Malignant mixed mullerian tumor
Rare, < 70 cases reported
Similar age and clinical presentation as primary tubal carcinoma
p53 positive in one study of two tumors, Mod Path 1994;7:619
Gross: large, polypoid mass protruding into lumen
Micro: similar to MMMT of uterus; homologous and heterologous stromal component may be present
DD: endometrioid carcinoma with spindle cells, immature teratoma
Reference: Archives 1987;111:386
Tubal involvement often by ovarian borderline tumors and carcinomas, cervical and endometrial carcinoma (invasive or in-situ) and pseudomyxoma peritonei
Metastases from extra-genital site are rare
Micro images: figure3
Rare, associated with mucinous lesions elsewhere in female genital tract and Peutz-Jeghers syndrome
Mucinous metaplasia and neoplasia of fallopian tube may indicate multifocal mucinous neoplasia, AJSP 1994;18:1205
Micro images: figure5
Papillary cystadenoma of mesosalpinx
Associated with von Hippel Lindau disease
Similar to ovarian counterpart
Rare, ~ 50 cases reported, almost all benign and cystic
Case report of struma salpingis associated with struma ovarii, AJSP 1993;17:1187
Gross: usually attached by a pedicle to tubal mucosa; 0.7 to 2.0 cm
Micro: usually cystic and mature
Widespread intra-abdominal disease is common, so multiple biopsies of commonly involved sites are required for staging
Primary tumor (T) and FIGO stage in ( )
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
Tis: Carcinoma in situ (limited to tubal mucosa)
T1 (I): Tumor limited to fallopian tube(s)
T1a (IA): Tumor limited to one tube, without penetrating the serosal surface; no ascites
T1b (IB): Tumor limited to both tubes, without penetrating the serosal surface; no ascites
T1c (IC): Tumor limited to one or both tubes, with extension onto or through the tubal serosa, or with malignant cells in ascites or peritoneal washings
T2 (II): Tumor involves one or both fallopian tubes with pelvic extension
T2a (IIA): Extension or metastasis to the uterus or ovaries
T2b (IIB): Extension to other pelvic structures
T2c (IIC): Pelvic extension with malignant cells in ascites or peritoneal washings
T3 (III): Tumor involves one or both fallopian tubes, with peritoneal implants outside the pelvis
T3a (IIIA): Microscopic peritoneal metastasis outside the pelvis
T3b (IIIB): Macroscopic peritoneal metastasis outside the pelvis 2 cm or less in greatest dimension
T3c (IIIC): Peritoneal metastasis outside the pelvis and more than 2 cm in diameter
Notes
- Liver capsule metastasis is T3/Stage III
- Liver parenchymal metastasis is M1/Stage IV
- Pleural effusion must have positive cytology for M1/Stage IV
Regional lymph nodes (N) and FIGO stage in ( )
NX: Regional lymph nodes cannot be assessed
N0: No regional lymph node metastasis
N1 (IIIC): Regional lymph node metastasis
Distant Metastasis (M) and FIGO stage in ( )
M0: No distant metastasis
M1 (IV): Distant metastasis (excludes metastasis within the peritoneal cavity)
Stage grouping
Stage 0: T1s N0 M0
Stage I: T1 N0 M0
Stage IA: T1a N0 M0
Stage IB: T1b N0 M0
Stage IC: T1c N0 M0
Stage II: T2 N0 M0
Stage IIA: T2a N0 M0
Stage IIB: T2b N0 M0
Stage IIC: T2c N0 M0
Stage III: T3 N0 M0
Stage IIIA: T3a N0 M0
Stage IIIB: T3b N0 M0
Stage IIIC: T3c N0 M0 or any T N1 M0
Stage IV: M1
Notes:
FIGO no longer includes Stage 0 (Tis)
Histologic type
Grade
Size
Depth of invasion (i.e. layers of tube involved)
Location in segment of tube
Extension to adjacent tissue
Angiolymphatic invasion
Resection margins
Pathologic findings for other tissue submitted
Additional findings (salpingitis, endometriosis)
Reference: Archives 1999;123:33
Broad ligament tumors
3 cases reported, ages 13, 45, 47 years, sizes 1.0, 9.5, 13 cm
Resemble ependymoma of central nervous system
Positive stains: GFAP
Most common soft tissue tumor of broad ligament
Most common sarcoma of broad ligament
Associated with von Hippel-Lindau disease
Tumors often bilateral
Mean age 33 years
Gross: unilateral, unilocular cysts up to 13 cm
Micro: resemble ovarian counterparts, with ovarian-type stroma; no ova, no ovarian follicles
End of Fallopian Tubes chapter