Galore International Journal of Health Sciences and Research

Vol. 8; Issue: 3; July-Sept. 2023

Website: www.gijhsr.com
Original Research Article P-ISSN: 2456-9321

Pattern and Frequency of Fallopian Tube Lesions in

Resected Hysterectomy Specimens
Dr. Monika Pangotra1, Dr. Himanshu Rana2, Dr. Rashmi Aithmia3
1,2,3
Department of Pathology, Government Medical College, Jammu University, Jammu, India.

Corresponding Author: Dr. Rashmi Aithmia

DOI: https://doi.org/10.52403/gijhsr.20230307

ABSTRACT apex of the broad ligament and spans the

distance between the uterine cornua and the
Introduction: The fallopian tube or salpinx has ovary. It is divided into four segments,
been named after scientist Gabrielis Fallopus, intramural, isthmus, ampulla and
who was the first to describe the fallopian tube
infundibulum. The inner aspect of the tube
precisely. Fallopian tubes are though very
common surgical specimens but are rarely
is lined by mucosa arranged in the shape of
studied. Inflammatory diseases of fallopian longitudinal folds (plicae), which merge
tubes and infertility due to various tubal factors with the fimbriae. Microscopically, the
are one most common disease observed in epithelium comprises three distinct cell
females. types: secretory, ciliated and intercalated
Aims and Objectives: To evaluate the spectrum (peg) (1). It is a conduit for oocyte transport
of fallopian tube lesions in surgically resected and provides a suitable environment for
hysterectomy specimens grossly and on fertilisation, transport and nourishment of
histopathology. To study the frequency of fertilised ovum (2). The most common
various histopathological lesions of fallopian disorders affecting the fallopian tube are
tubes. inflammations followed frequently by
Material and Methods: The prospective study
ectopic (tubal) pregnancy and
was conducted over one year, and 316 Right
fallopian tubes and 314 left fallopian tube endometriosis. The most common primary
specimens’ histopathology were analysed. lesions of the fallopian tube (excluding
Results: In this study, it was observed that endometriosis) are minute, 0.1 to 2cm
96.52% of right fallopian tubes and 95.86% of translucent cysts filled with clear serous
left fallopian tubes were normal on histology. fluid called para tubal cysts (3). Benign and
The most common histopathological lesions malignant tumours of the fallopian tube
observed were salpingitis and Para tubal cysts. account for 0.1-1.8% of gynaecological
Conclusion: Various histopathological lesions cancers (4) Salpingitis is the most common
can be observed in fallopian tubes. Although infective pathology in women of the
Malignancies of fallopian tubes are rare, they reproductive age group, and it occurs due to
must be subjected to histopathological
ascending infection from the vagina. It
examination to evaluate various pathological
lesions. affects approximately 11% of females.
Keywords: fallopian tube, salpinx, resected Salpingitis can lead to infertility and
hysterectomy increase the chances of ectopic pregnancies
(5,6). Histopathological analysis of fallopian
INTRODUCTION tube specimens is mandatory for diagnostic
The fallopian tube or salpinx is a hollow purposes and to assess the pattern of lesions.
muscular tubular structure measuring 11- This study analysed the pattern and
12cm in length that runs throughout the frequency of lesions of fallopian tubes
grossly as well on histopathology.

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Volume 8; Issue: 3; July-September 2023
Dr. Monika Pangotra et.al. Pattern and frequency of fallopian tube lesions in resected hysterectomy specimens

MATERIALS & METHODS portion of the fallopian tube was cut in cross
The study was prospective in nature. The sections at 2-3 mm intervals. Several
study material comprised hysterectomy sections from both fallopian tubes were
specimens received in the Department of made. The tissue was adequately processed
Pathology, Government Medical College, from them depending upon the lesion. The
Jammu, for one year, i.e., from 1st gross serial sections were fixed in 10%
November 2017 to 31st October 2018. All neutral buffered formalin, dehydrated with
the specimens of salpingectomy either done ascending grades of alcohol, cleared in
for TAH with bilateral salpingo- xylene and embedded in paraffin. 5-
oophorectomy, unilateral salpingectomy or micrometre thick paraffin sections were cut
salpingo-oophorectomy were included in the on a rotary microtome, dewaxed and stained
study. The clinical information of the routinely with Haematoxylin and Eosin
patients who underwent hysterectomy stain or other special stains whenever
during this period was obtained from the necessary (7).
histopathological requisition forms, and any
deficient relevant information was procured RESULT
from the clinical case sheets and the The right fallopian tube was removed in 316
concerned clinician. The relevant cases. Most cases, i.e., 305 (97.6%), were
investigations were obtained from the histopathologically within normal limits. 7
clinical case sheets and recorded. The (2.24%) cases of para tubal cysts were
specimens received by the Department of identified on histopathology. 4 (1.28%)
Pathology were properly labelled, numbered cases were diagnosed as salpingitis on
and then subjected to gross and detailed histopathology.
histopathological examination. Three The left fallopian tube was removed along
hundred sixteen fallopian tube specimens with a hysterectomy in 314 hysterectomy
were evaluated grossly and specimens. Most cases, i.e., 301 (96.32%),
histopathologically. The fallopian tubes showed normal histology. Para tubal cysts
were sampled using the SEE FIM protocol were identified in 6 (1.92%) cases,
to ensure optimal histological evaluation. As salpingitis in 4 (1.28%) cases, endometriosis
per the protocol, the distal 2 cm (the in 1 (0.32%) case and benign simple cyst in
fimbrial end) of the fallopian tube was 1 (0.32%) case. In 1(0.32%) case, Walthard
amputated from the rest of the tube and cell nests were observed on histopathology.
sectioned longitudinally. The remaining
Table 1: Frequency Distribution of The Lesions of the Fallopian Tubes
Right Fallopian tube Left Fallopian tube
S. No. Gross examination
No. of cases Percentage (%) No. of cases Percentage (%)
1. Dilated 0 0.00 1 0.32
2 Thickened 3 0.96 1 0.32
3 Para tubal Cyst 7 2.24 7 2.24
4. Unremarkable 306 97.92 305 97.6
Total 316 100 314 100

Table 2: Spectrum of Histopathological Diagnosis of the Fallopian Tube Lesions

Right Fallopian tube Left Fallopian tube
S. No. Histopathological diagnosis
No. of cases Percentage (%) No. of cases Percentage (%)
1. Walthard cell nests 0 0.00 1 0.32
2. Benign simple cyst 0 0.00 1 0.32
3. Endometriosis 0 0.00 1 0.32
4. Salpingitis 4 1.28 4 1.28
4. Para tubal cyst 7 2.24 6 1.92
6. Normal histology 305 97.6 301 96.32
Total 316 100 314 100

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Volume 8; Issue: 3; July-September 2023
Dr. Monika Pangotra et.al. Pattern and frequency of fallopian tube lesions in resected hysterectomy specimens

Right fallopian tube: Most cases, i.e., 305

(96.52%), were histopathologically within
normal limits. 7 (2.22%) cases of para tubal
cysts were identified on histopathology. 4
(1.26%) cases were diagnosed as salpingitis
on histopathology. Left fallopian tube: The
majority of the cases, i.e., 301 (95.86%),
showed normal histology. Para tubal cysts
were identified in 6 (1.91%) cases,
salpingitis in 4 (1.27%) cases, endometriosis
Figure 1. Paratubal cyst showing flattened epithelial lining
(H&E) 100X in 1 (0.32%) case and benign simple cyst in
1 (0.32%) case. In 1(0.32%) case, Walthard
cell nests were observed on histopathology.

DETAILED HISTOMORPHOLOGY OF
FALLOPIAN TUBES SALPINGITIS:
8 cases were identified. 4 (1.26%) cases
were identified in the right-sided fallopian
tube. 4 (1.27%) cases were identified in the
left-sided fallopian tube. Grossly, the tube
was thickened on the right side in 3 cases
and unremarkable in the other case. The
left-sided fallopian tube was dilated in one
case. On microscopic examination, 6 cases
Figure 2. Endometriosis of Fallopian tube (H &E)400X were observed as chronic salpingitis and
two as tubercular salpingitis.
Chronic salpingitis: 6 cases were identified.
Grossly, the wall of the fallopian tube was
thickened in 3 cases and unremarkable in
others. Microscopically, chronic
inflammatory cell infiltrate comprising
predominantly of lymphocytes and plasma
cells was seen infiltrating the wall.
Tubercular salpingitis: 2 (0.64%) cases
were identified. The patent clinically
Figure 3. Tubercular Salpingitis (H&E) 400X presented pain abdomen. Grossly the tube
was dilated in one case and thickened in one
case. Microscopically, epithelioid cell
granulomas and Langhans-type giant cells
admixed with lymphomononuclear cell
infiltrate were seen.
Endometriosis of the tube: One (0.32%)
case was observed in the left-sided fallopian
tube. It was found incidentally, grossly, that
the tube was thickened. Microscopic
examination showed few endometrial glands
surrounded by scant stroma.
FIGURE 4. Walthard Cell Nests in Serosal Layer of Fallopian
tube(H&E)100X.

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 42

Volume 8; Issue: 3; July-September 2023
Dr. Monika Pangotra et.al. Pattern and frequency of fallopian tube lesions in resected hysterectomy specimens

Simple cyst: A simple cyst was identified extension from adjacent organs or lymphatic
incidentally in the left fallopian tube. spread from intestinal tuberculosis (14).
Grossly, a small cyst measuring 0.4-0.8cm Tuberculosis, along with other
was seen. Microscopically, the cyst was inflammatory diseases of the tube, is an
lined by a layer of low cuboidal to flat cells. important cause of infertility (15).
Para tubal cysts: 13 cases of para tubal Endometriosis frequently involves the
cysts were identified. 7 (2.22%) were fallopian tube. An endometriosis diagnosis
identified in the right fallopian tube, and 6 requires endometrial glands and or
(1.91%) were identified in the left fallopian endometrial stroma within the fallopian tube
tube. They ranged in size from 0.5 to 1.2cm wall. In this study, the frequency of
and contained clear fluid. Microscopically endometriosis on histopathology was 0.32%
cysts were lined by low cuboidal to ciliated and was low compared to the incidence of
columnar epithelium. Of these, three were 1.08% observed by Kujur et al. in their
histologically identified as mesothelial cysts study (16,17). In the present study, para
and one as paramesonephric cyst. tubal cysts were reported to be the
commonly encountered lesions in the
DISCUSSION fallopian tube, i.e., 4.13 %, similar to
Fallopian tubes are complex structures observations made by Jha et al. (2006).
representing more than conduits from the Sucheta KL et al. (2016) encountered
ovary to the endometrial cavity. They are salpingitis as the most common lesion in the
the seats of various interactions culminating fallopian tube, the second most common
in a normally implanted pregnancy (8). lesion in the present study. (18,19). Similar
They are affected by a wide spectrum of observations were reported by Raza AKM
diseases, but there are only occasional (2017) and Rather G et al. (2013); the
studies documenting histological changes in majority of cases revealed no pathological
the fallopian tube removed for all reasons. lesion in the fallopian tube in their study,
In most cases in the present study, fallopian which is comparable to the present study
tubes were within normal histological limits (20,21). Other lesions encountered in the
(95.8%), whereas, in other studies, normal fallopian tubes were 1 case of simple cyst, 1
histopathology was observed in 66-72%of case of endometriosis, 1 case of Walthard
cases (9-12). The only remarkable lesions cell nests and 1 case of paramesonephric
observed were 4 cases of salpingitis and 7 cyst, the least common lesions. Walthard
cases of para-tubal cysts in the right cell nests are foci of benign epithelial
fallopian tube and 4 cases of salpingitis, and collection containing elliptical nuclei with
5 cases of para-tubal cysts in the left prominent nuclear grooves. Due to
fallopian tube. Salpingitis is one of the most transitional cell metaplasia, anatomical
common infections of women in proximity, similar immunohistochemistry
reproductive age group. Commonly due to profile and cilia presence, the tubal origin of
ascending infection and can vary from the Brenner tumor is strongly suspected.
asymptomatic to life-threatening illnesses Many studies have observed the association
(11). In this study, the incidence of acute on of Brenner tumor with Walthard cell nests
chronic salpingitis was lower compared to in about 40% of cases. In this study, no such
other studies (13) Incidence of tubercular association was observed. (22,23). Benign
salpingitis in this study was 0.64%. Lakshmi and malignant tumors can occur in the
et al. observed an almost equal incidence of fallopian tube but are uncommon.
tuberculous salpingitis (0.59%).
Tuberculosis of the fallopian tube develops CONCLUSION
commonly by hematogenous spread of the In this study, the fallopian tube was
organism, usually from a primary unremarkable in most cases. Para tubal cysts
pulmonary infection and rarely by direct were the most common lesions of the

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 43

Volume 8; Issue: 3; July-September 2023
Dr. Monika Pangotra et.al. Pattern and frequency of fallopian tube lesions in resected hysterectomy specimens

fallopian tubes grossly and on techniques, 5th Edn.: Churchill Livingstone,

histopathology, followed by salpingitis and 2002; pp. 125-38
endometriosis. Our study provides a fair 8. Arora KVS, Sreenivasulu K, Janaki M,
insight into the histopathological spectrum Harish V, Raja V. Study of
of lesions in fallopian tube specimens in our Histomorphological lesions of the Fallopian
tubes. J Evol Med Dent Sci 2015; 4(40):
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stressed that it should be made a routine scientific research 2016;5(1):180-1.
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Sengupta M, Ghosh D. Spectrum of
Declaration by Authors histopathological lesions in the fallopian
Ethical Approval: Approved tubes. Journal of Pathology of Nepal 2013;
Acknowledgement: None 3:356-60.
Source of Funding: None 12. Lakshmi K, Baleswari G, Mallikarjun C,
Conflict of Interest: The authors declare no Arasi TD, Rao BL. Histopathological study
conflict of interest. of the spectrum of lesions in the fallopian
tubes. Journal of evolution of medical and
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Cancer 2013;49(18):3839-49. 4. DOI: https://doi.org/10.52403/gijhsr.20230307

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