Difference between revisions of "Uterine tubes"

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DDx:
DDx:
*[[Salpingitis]] - inflammatory cells.
*[[Salpingitis]] - inflammatory cells.
*[[Serous carcinoma]].
*[[Serous carcinoma]] - nuclear atypia (marked), nuclear pleomorphism, prominent nucleoli.
*[[Tubal intraepithelial carcinoma]]<ref name=pmid17117391>{{Cite journal  | last1 = Lee | first1 = Y. | last2 = Miron | first2 = A. | last3 = Drapkin | first3 = R. | last4 = Nucci | first4 = MR. | last5 = Medeiros | first5 = F. | last6 = Saleemuddin | first6 = A. | last7 = Garber | first7 = J. | last8 = Birch | first8 = C. | last9 = Mou | first9 = H. | title = A candidate precursor to serous carcinoma that originates in the distal fallopian tube. | journal = J Pathol | volume = 211 | issue = 1 | pages = 26-35 | month = Jan | year = 2007 | doi = 10.1002/path.2091 | PMID = 17117391 }}</ref> - discrete papillary growth, loss of nuclear polarity, nuclear atypia.
*[[Tubal intraepithelial carcinoma]] - discrete papillary growth, loss of nuclear polarity, nuclear atypia.


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Revision as of 13:34, 15 November 2012

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.

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 cells.
    • Columnar.
    • Eosinophilic cytoplasm.
  2. Peg cells.
    • Nucleus more luminal.
      • Nuclei stick-out like a golf tee.

Images:

Ditzel

Main article: Ditzels

Tubal ligation

General

  • Done to control fertility.

Microscopic

See normal uterine tube.

DDx:

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A. FALLOPIAN TUBE, LEFT, TUBAL LIGATION:
- FALLOPIAN TUBE WITHIN NORMAL LIMITS.

A. FALLOPIAN TUBE, RIGHT, TUBAL LIGATION:
- FALLOPIAN TUBE WITHIN NORMAL LIMITS.

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:

Stains

If organisms are seen on routine stains:

  • Gram stain +ve/-ve.

Granulomatous inflammation:

Adenofibroma

General

  • Rare.[3]
    • More frequently seen than in the past -- presumably as pathologists are looking more closely at the Fallopian tube.
  • Cannot be disguished from ovarian adenofibroma.[3]

Gross

  • Solid, nodular.

Microscopic

Features:[3]

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

IHC

Features:

  • Stroma:[3]
    • CD10 +ve.
    • Inhibin +ve.

Salpingitis isthmica nodosa

  • Abbreviated SIN.
  • AKA adenosalpingitis,[4] and diverticulosis of the Fallopian tubes.[5]

General

Diagnosis (clinical):

  • Hysterosalpingography.[8]
    • Finding: diverticula.

Notes:

Microscopic

Features:[9]

  • 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.[10]

Microscopic

See: Adenomatoid tumours (uterine tumours).

Serous tubal intraepithelial carcinoma

  • Abbreviated STIC.[11]
  • AKA tubal intraepithelial carcinoma.

General

Gross

  • Not apparent on gross.
  • Usually at the fimbriated end of the tube.

Microscopic

Features:[13]

  • Discrete papillary growth - low power.
  • Formal criteria - need 3 or more:
    1. Atypical chromatin pattern.
    2. Nuclear enlargement.
    3. Nuclear pleomorphism.
    4. Nuclear moulding.
    5. Loss of nuclear polarity or epithelial stratification.

Image:

IHC

Features:[11]

  • p53 +ve.
  • Ki-67 +ve.
  • p16 +ve.[13]

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. ↑ 3.0 3.1 3.2 3.3 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.
  4. ↑ Stedman's Medical Dictionary. 27th Ed. Lippincott Williams & Wilkins.
  5. ↑ URL: http://www.medcyclopaedia.com/library/topics/volume_iv_2/s/salpingitis_isthmica_nodosa.aspx. Accessed on: 28 July 2010.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ URL: http://radiology.rsna.org/content/154/3/597.abstract. Accessed on: 28 July 2010.
  9. ↑ 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.
  10. ↑ Christensen C (1990). "Adenomatoid tumors of the uterus". Eur. J. Gynaecol. Oncol. 11 (2): 85–9. PMID 2199199.
  11. ↑ 11.0 11.1 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.
  12. ↑ Lee, Y.; Miron, A.; Drapkin, R.; Nucci, MR.; Medeiros, F.; Saleemuddin, A.; Garber, J.; Birch, C. et al. (Jan 2007). "A candidate precursor to serous carcinoma that originates in the distal fallopian tube.". J Pathol 211 (1): 26-35. doi:10.1002/path.2091. PMID 17117391.
  13. ↑ 13.0 13.1 13.2 Sehdev, AS.; Kurman, RJ.; Kuhn, E.; Shih, IeM. (Jun 2010). "Serous tubal intraepithelial carcinoma upregulates markers associated with high-grade serous carcinomas including Rsf-1 (HBXAP), cyclin E and fatty acid synthase.". Mod Pathol 23 (6): 844-55. doi:10.1038/modpathol.2010.60. PMID 20228782.
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