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Background
These structures form a link between the ovaries and the uterus. Although uncommon, malignancies may arise in this small organ. More commonly, the fallopian tube is involved by conditions such as endometriosis and infections such as chlamydia, leading to adhesions and scarring and subsequent infertility. It is also the most common site of ectopic pregnancies, hence the term tubal pregnancy.
Fallopian Tube Carcinoma
OUTLINE
Pathogenesis Laboratory/Radiologic/Other Diagnostic Testing Gross Appearance and Clinical Variants Histopathological Features and Variants Commonly Used Terms Internet Links
PATHOGENESIS CHARACTERIZATION INTERLEUKIN 8
Interleukin-8 in the human fallopian tube.Palter SF, Mulayim N, Senturk L, Arici A.
Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
J Clin Endocrinol Metab 2001 Jun;86(6):2660-7 Abstract quote The human fallopian tube is a dynamic structure that undergoes cyclic variation in its functional epithelium. This epithelium contains both secretory and ciliated cells. The mechanisms regulating the growth and function of the tubal epithelium are not fully understood. Interleukin-8 (IL-8) is one potential local regulatory factor.
We therefore characterized the IL-8 system, which includes IL-8, its receptors A and B, and its degradative enzyme aminopeptidase N, in the human fallopian tube by immunohistochemistry. Immunohistochemistry was performed on isthmic, ampullary, and fimbrial fallopian tubal segments obtained from women undergoing gynecological surgical procedures for benign conditions (n = 52). IL-8 was found in the human fallopian tube predominantly in the epithelial cells. It was present in greater amounts in the distal compared with the proximal tube. IL-8 receptors A and B localized in the tube in similar patterns.
The degradative enzyme aminopeptidase N is found in tubal stromal tissue at the epithelial stromal border and perivascularly and may limit the systemic effects of epithelial IL-8. The IL-8 system seems to be an active component of tubal physiology.
PLACENTAL PROTEIN 14
Human fallopian tube contains placental protein 14.Julkunen M, Wahlstrom T, Seppala M
Am J Obstet Gynecol 1986 May;154(5):1076-9 Abstract quote Radioimmunoassay and immunoperoxidase staining were used to study the tissue content and localization of an endometrial protein, placental protein 14, in the human fallopian tube.
Placental protein 14 immunoreactivity was found in saline extracts from all fallopian tubes tested (n = 14). In the fimbrial part the placental protein 14 content was higher in the secretory than in the proliferative phase (p less than 0.01). No difference was found in the placental protein 14 content between the isthmic, ampullar, and fimbrial parts of the tube. Immunoperoxidase staining localized placental protein 14 to the ciliated and secretory epithelial cells of the mucosa in all parts of the tube regardless of the phase of menstrual cycle.
The occurrence of the same protein in the endometrium and fallopian tube is compatible with the common embryonic origin from the mullerian duct of these tissues.
VASCULAR ENDOTHELIAL GROWTH FACTOR
Vascular endothelial growth factor localization in human ovary and fallopian tubes: possible role in reproductive function and ovarian cyst formation.Gordon JD, Mesiano S, Zaloudek CJ, Jaffe RB.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco 94143-0132, USA.
J Clin Endocrinol Metab 1996 Jan;81(1):353-9 Abstract quote Vascular endothelial growth factor (VEGF) is a potent angiogenic factor that also increases vascular permeability. We hypothesized that VEGF plays a role in the regulation of cyclic ovarian angiogenesis in women, and that its ability to increase vascular permeability may be an important factor in the production of fallopian tube effluent and fluid formation in ovarian cysts.
To examine these hypotheses, we assessed VEGF expression in ovaries and fallopian tubes from premenopausal (n = 10) and postmenopausal (n = 4) women. Immunohistochemical analysis for VEGF was performed using a rabbit polyclonal antibody directed against human VEGF. In normal ovaries from premenopausal women, VEGF within healthy follicles was localized to the thecal cell layer, with minimal VEGF peptide detected in the granulosa cell layer. VEGF was not expressed in atretic follicles or a degenerating corpus luteum. However, intense VEGF immunostaining was observed within the highly vascularized corpora lutea in all specimens examined. In normal ovaries from postmenopausal women, VEGF was detected only in epithelial inclusion cysts and a serous cystadenoma.
In specimens from both pre- and postmenopausal women, the luminal epithelium of the fallopian tube as well as smooth muscle cells and pericytes lining small and large blood vessels within the tube and hilum of the ovary exhibited specific staining for VEGF.
Based on these data, we suggest that during reproductive life, VEGF plays a role in the growth and maintenance of the ovarian follicle and corpus luteum by mediating angiogenesis. In addition, VEGF within the fallopian tube luminal epithelium may increase vascular permeability and modulate tubal luminal secretions. Similarly, VEGF in the epithelial lining of benign ovarian neoplasms may contribute to fluid formation in ovarian cysts.
LABORATORY/RADIOLOGIC/
OTHER TESTSCHARACTERIZATION RADIOLOGIC LABORATORY MARKERS SALPINGOSCOPY
Salpingoscopy: light microscopic and electron microscopic correlations.
Hershlag A, Seifer DB, Carcangiu ML, Patton DL, Diamond MP, DeCherney AH.
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut.
Obstet Gynecol 1991 Mar;77(3):399-405 Abstract quote In order to examine the ability of salpingoscopy to diagnose intratubal pathology, 32 fallopian tubes were evaluated salpingoscopically and histologically.
Both flexible and rigid salpingoscopes were used, and observations were documented by intratubal photography. Salpingoscopic criteria were established and each criterion assigned a numerical value. Each tube was evaluated for patency, mucosal fold architecture, erythema, adhesions, and dilatation. Based on these criteria, tubes were graded as normal or as abnormal with mild, moderate, or severe changes. Histologically, each tube was evaluated for patency, epithelial changes, vascularity, dilatation, adhesions, and active inflammation. Six tubes with significant histologic findings and two histologically normal fallopian tubes were also examined by transmission electron microscopy. In five discordant cases, histology revealed epithelial and stromal changes not detected by salpingoscopy. Fallopian tubes with severe disease were diagnosed by both methods. Transmission electron microscopy of histologically abnormal tubes showed flattening of the epithelium with markedly reduced ciliary distribution, degenerating secretory epithelial cells with large intracellular vacuoles, and swollen nuclei containing sparse chromatin.
Our results indicate that salpingoscopic observations are consistent with histologic findings when endotubal disease is severe. However, moderate pathologic changes as documented by light microscopy and transmission electron microscopy were frequently not diagnosed salpingoscopically, even with magnification.
GROSS APPEARANCE/
CLINICAL VARIANTSCHARACTERIZATION GENERAL VARIANTS
HISTOLOGICAL TYPES CHARACTERIZATION GENERAL
Deciliation in the puerperal fallopian tube.Seki K, Rawson J, Eddy CA, Smith NK, Pauerstein CJ.
Fertil Steril 1978 Jan;29(1):75-83 Abstract quote Tubal segments obtained from patients at cesarean section and at intervals during the first 5 postpartum days were examined to evaluate puerperal changes in the tubal epithelium. The specimens of tubal epithelium were examined under the scanning and transmission electron microscopes.
Ciliated cells were most densely distributed on the fimbria and in the ampulla, and were relatively sparsely distributed in the isthmus. Progressive diminution of numbers of ciliated cells and deciliated of individual cells were noted in specimens obtained during the puerperium. Nonciliated cells were in the resting stage at term pregnancy. Secretory activity returned during the puerperium.
VARIANTS
Histopathologic changes in fallopian tubes subsequent to sterilization procedures.Stock RJ.
Int J Gynecol Pathol 1983;2(1):13-27 Abstract quote Longitudinal serial and serial step sections of fallopian tubes from more than 100 patients, subsequent to tubal sterilization procedures, were examined. Thirteen of these patients had pregnancies following their sterilizations.
The histologic findings at the previous surgical sites were compatible with what would be expected for a normal healing process. Evidence for a unique tubal epithelial process, as suggested by the terms "endosalpingiosis" or "recanalization," was lacking. Likewise, the author found no evidence of tuboperitoneal fistula formation and/or the subsequent occurrence of pregnancy secondary to localized endometriosis.
The histologic notations of proximal luminal dilatation, plical attenuation, chronic inflammatory infiltrates with pseudopolyp formation, and the findings of plical thickening in the distal segment of remaining tube after an interruption type of procedure seem to be associated with the length of time from the sterilization procedure. These may be factors related to the apparent reduced success rate, with time, of microsurgical reanastomotic procedures.
Histology of proximal tubal obstruction in cases of unsuccessful tubal canalization.Letterie GS, Sakas EL.
Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii.
Fertil Steril 1991 Nov;56(5):831-5 Abstract quote OBJECTIVE: To determine possible etiologies of unsuccessful fluoroscopically guided tubal canalization, we studied the histology of tubal segments in cases of failed canalization for proximal tubal obstruction. Factors contributing to cases of unsuccessful fluoroscopically guided tubal canalization remain unclear.
DESIGN: Prospective.
SETTING: Reproductive Endocrinology Clinic.
MATERIALS: Twenty-seven cornual and/or isthmic tubal segments from 15 patients who underwent proximal tubal surgery after fluoroscopically guided tubal canalization were studied. Specimens were prepared with hemotoxylin-eosin and Masson trichrome stains.
RESULTS: Histologic examination of excised cornual and isthmic tubal segments revealed abnormalities in 93% of specimens. Obliterative fibrosis (61%), chronic salpingitis (57%), and salpingitis isthmica nodosa (42%) were the most commonly found histologic tubal abnormalities. One case of complete tubal occlusion and tubal schistosomiasis was also detected.
CONCLUSIONS: These data suggest that cases of failed fluoroscopically guided tubal canalization may be secondary to severe intrinsic tubal disease and tubal occlusion and not to the technique. Fluoroscopically guided tubal canalization may provide a means of differentiating a functional obstruction amenable to conservative management from true occlusion requiring management by microsurgical techniques or in vitro fertilization.
Histologic features of surgically removed fallopian tubes.Hunt JL, Lynn AA.
Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pa (Dr Hunt); and the Consultants in Laboratory Medicine, Toledo, Ohio (Dr Lynn).
Arch Pathol Lab Med 2002 Aug;126(8):951-5 Abstract quote Context.-The fallopian tube is a common specimen in a pathology laboratory. It may be examined either alone as a salpingectomy or tubal ligation specimen, or as part of a more complex specimen from a hysterectomy and/or oophorectomy operation. Although the common histologic findings in the fallopian tube have been described previously, to our knowledge no study has documented the frequency of histologic changes in fallopian tubes removed for all reasons or associations with clinical history.
Design.-Hematoxylin-eosin-stained slides from 287 fallopian tube specimens were reviewed without knowledge of the clinical history. Three categories and associated subcategories of histologic findings were identified (listed in descending order of frequency): stromal and architectural alterations (fibrosis, intramuscular edema, cellular luminal contents, inclusion cysts, Walthard nests, pigmentosis tubae, Wolffian duct remnants, decidualized stroma, endosalpingiosis, and metastatic carcinoma), epithelial characteristics (cytologic atypia, vacuolization, metaplasia, and tufting), and inflammatory changes (intramuscular mast cells, plasma cells, neutrophils, and lymphoid follicles). Histologic findings were correlated with clinical history, surgery type, and age.
Results.-Intramuscular edema was identified in 12.5% of specimens, most frequently in postpartum women. Plical fibrosis (35.5% of specimens), epithelial atypia (7.3%), epithelial vacuolization (6.6%), and epithelial tufting/stratification (3.5%) correlated with increased patient age. Inflammatory cells were relatively common; 69% of specimens contained intramuscular mast cells, 19.9% had stromal plasma cells, 10.5% had neutrophils, and 2.1% had lymphoid follicles.
Conclusions.-This study provides data that may be valuable for surgical pathologists involved in identifying and characterizing common histologic changes in surgically removed fallopian tubes.
Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Rosai J. Ackerman's Surgical Pathology. Eight Edition. Mosby 1996.
Sternberg S. Diagnostic Surgical Pathology. Third Edition. Lipincott Williams and Wilkins 1999.
Basic Principles of Disease
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Commonly Used Terms
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Last Updated 8/22/2002
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