Fallopian tubes & broad ligament

• Chronic inflammation of fallopian tube with lymphoplasmacytic infiltrate and with or without foamy histiocytes and granulomas

• Fused fimbriae, causing blunted end (clubbed tube)
• May form significant tubo-ovarian adhesions and a conglomerated mass
• May show marked tubal dilation (hydrosalpinx)
• May show areas of hemorrhage if associated with endometriosis

AFIP images

• Chronic salpingitis (Fertil Steril 2000;74:152):
  • Usually short, thick plicae with fibrous stroma, lymphocytes, plasma cells or both in the mucosa
  • Hydrosalpinx may or may not be seen
  • Plicae may look normal or fused
  • Epithelial hyperplasia may be seen
  • Granulomas, either necrotizing or nonnecrotizing, suggest infection (especially tuberculosis), sarcoidosis or other autoimmune disease (e.g., inflammatory bowel disease)
• Pseudoxanthomatous salpingitis (Int J Gynecol Pathol 2015;34:275):
  • Abundant hemosiderin laden macrophages within fallopian tube lamina propria with associated lymphoplasmacytic infiltrate
  • Endometriosis in the tubal subserosa or ovarian tissue
• Xanthogranulomatous salpingitis:
  • Foamy histiocytes, granulomas and chronic inflammation in the fallopian tube submucosa (Int J Gynecol Pathol 2002;21:56)
  • May be associated with pelvic inflammatory disease
• Follicular salpingitis (misnomer): later stage of chronic salpingitis with fusing plicae, mimicking a pattern of thyroid follicles

Contributed by Shabnam Zarei, M.D. and Nicole D. Riddle, M.D.

• Fallopian tube, salpingectomy:
  • Chronic salpingitis, xanthogranulomatous salpingitis or pseudoxanthomatous salpingitis

• Fibrotic plica:
  • A normal physiologic change in postmenopausal women
  • Inflammatory infiltrate is absent
• Physiologic salpingitis during menses:
  • Only minimal neutrophilic infiltrate is seen
• Salpingitis isthmica nodosa:
  • Nodular thickening of fallopian tube with cystically dilated glands within muscular layer
  • No associated inflammation
• Serous tubal intraepithelial carcinoma (STIC):
  • Older women
  • Cytologic atypia and loss of ciliation
  • Abnormal (mutant) pattern of p53 expression by immunohistochemistry

Which of the following is the most common finding associated with pseudoxanthomatous salpingitis?

1. Endometriosis
2. History of prior pelvic surgery
3. Inflammatory bowel disease and diverticulosis
4. Pelvic tuberculosis

A. Endometriosis. Answer B is incorrect because prior pelvic surgery is not associated with pseudoxanthomatous salpingitis. Answer C is incorrect because inflammatory bowel disease and diverticulosis can be seen in association with pulse granuloma and chronic salpingitis. Answer D is incorrect because pelvic tuberculosis is associated with granulomatous salpingitis.

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Reference: Chronic salpingitis

Which of the following statements is true regarding the photomicrograph above?

1. Associated hydrosalpinx is uncommon
2. Rarely seen in ectopic tubal pregnancy
3. The most common inflammatory infiltrates are neutrophils and eosinophils
4. When associated with endometriosis, it has distinct gross and microscopic findings

D. When associated with endometriosis, it has distinct gross and microscopic findings. Answer A is incorrect because hydrosalpinx is common. Answer B is incorrect because this can be seen in half of ectopic tubal pregnancy. Answer C is incorrect because plasma cells and lymphocytes are usually present in the submucosa.

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Reference: Chronic salpingitis