Fallopian tubes: Difference between revisions

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{{Top

<noinclude>{{Top

|author1=[[User:Mikael Häggström|Mikael Häggström]]

|author2=

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*For sterilization

*[[Fallopian tube in ectopic pregnancy]]

{{Comprehensiveness}}</noinclude>

==Gross processing==

[[File:Gross pathology of paratubal cysts.jpg|thumb|'''[[Paratubal cysts]]''' can be ignored if incidentally found.]]

{{Moderate-begin}}Look in the history for any intra-fallopian coils (Essure devices).{{Moderate-end}}<ref group=note>For a case with intra-fallopian coils in the medical records, an inability to find them on gross processing must be noted in order to raise the possibility of coil expulsion.</ref>

;For sterilization:

*'''Measure''' length and average diameter of each tube

*Serially '''section''' at 3-4 mm intervals,<ref name=rcpa>{{cite web|url=https://www.rcpa.edu.au/Manuals/Macroscopic-Cut-Up-Manual/Gynaecology-and-perinatal/Ovary-and-fallopian-tube-benign-setting|title=Ovary and fallopian tube -benign setting|website=Royal College of Pathologists of Australasia|author=Kerryn Ireland-Jenkin and Marsali Newman|accessdate=2020-10-16}}</ref> or 2-3 mm if suspected malignant (including BRCA mutation).<ref name="CrumMckeon2012">{{cite journal|last1=Crum|first1=Christopher P.|last2=Mckeon|first2=Frank D.|last3=Xian|first3=Wa|title=The Oviduct and Ovarian Cancer|journal=Clinical Obstetrics and Gynecology|volume=55|issue=1|year=2012|pages=24–35|issn=0009-9201|doi=10.1097/GRF.0b013e31824b1725}}</ref> Submit

*'''Submit''' 1 {{Moderate-begin}}or 3{{Moderate-end}} circumferential transverse sections. If the specimen is only a segment of the tube of less than <5mm{{Comprehensive-begin}}, ink the surgical cut surfaces and{{Comprehensive-end}} submit all tissue.<ref name=rcpa/>

Example gross report:

{|class=wikitable

| {{Moderate-begin}}A. Labeled - __. The specimen is received in formalin and consists of{{Moderate-end}} two fimbriated segments of fallopian tube measuring __ cm in length and __ cm in average diameter. On sectioning, each displays a patent lumen. No gross abnormalities are identified. The tubes are unoriented. The specimen is serially cross-sectioned and representative sections are submitted for microscopic examination in two cassettes.

|}

==Microscopic examination==

[[File:Histopathology of edematous fallopian tubes.jpg|thumb|220px|Fallopian tubes may be substantially edematous and congested, which can generally be attributed to surgery, in which case it does not need mention in the report.]]

*Ensure there is at least one full cross-section from each tube, and take further samples otherwise.

*Check for patency of the lumen.

===Neoplasias===

Look for:

*'''Adenomatoid tumor''', the most common tumor of the fallopian tubes:<ref name=adenomatoid>{{cite web|url=http://www.pathologyoutlines.com/topic/fallopiantubesadenomatoid.html|title=Fallopian tubes & broad ligament - Fallopian tube tumors - Adenomatoid tumor|author=Nicole Riddle, Jamie Shutter|website=Pathology Outlines}} Topic Completed: 1 September 2013. Minor changes: 13 December 2019</ref>

File:Histopathology of an adenomatoid tumor of the fallopian tube, low magnification.jpg|An '''adenomatoid tumor''' of the fallopian tube, low magnification, displaying infiltrative-like borders.

File:Histopathology of an adenomatoid tumor of the fallopian tube, intermediate magnification.jpg|High magnification of the same case, showing the typical<ref name=adenomatoid/> features of tubular spaces of varying size composed of flattened cells resembling endothelium.

</gallery>

*'''Atypia/crowding''' of the serous epithelium.

[[File:Histopathology of serous tubal intraepithelial lesion (STIL).jpg|thumb|Serous tubal intraepithelial lesion (STIL).<ref>{{cite journal

| last1 = Mizuno

| first1 = M

| last2 = Togami

| first2 = S

| last3 = Shirota

| first3 = K

| last4 = et al.

| title = Three Cases of Serous Tubal Intraepithelial Lesions (STILs)

| journal = Cureus

| year = 2024

| volume = 16

| issue = 6

| pages = e62895

| doi = 10.7759/cureus.62895

| pmc = 11261535

| doi-access = free

}}</ref> H&E staining shows mildly atypical tubal epithelium with largely preserved polarity. Immunohistochemistry demonstrates aberrant block-type p53 expression but a low Ki-67 proliferation index, insufficient for classification as serous tubal intraepithelial carcinoma (STIC).]]

===Reporting===

Example of a normal report in '''sterilization''':

{|class=wikitable

| {{Moderate-begin}}Right and left fallopian tubes, {{Comprehensive-begin}}laparoscopic{{Comprehensive-end}} bilateral salpingectomy:{{Moderate-end}}<br>Complete cross-sections of histologically unremarkable fallopian tubes.

|}

When included in a '''[[uterus]]''' specimen, normal tubes and ovaries may simply be mentioned as:

{|class=wikitable

| Bilateral fallopian tubes and ovaries, unremarkable.

|}

~~Example~~ of a ~~normal~~ report ~~in sterilization~~:

[[File:Histopathology of an ectopic pregnancy in a fallopian tube.jpg|thumb|Histopathology of an ectopic pregnancy in a fallopian tube, with chorionic villi and implantation site changes {{further|Products of conception}}.]]

When done for '''ectopic pregnancy''', report any rupture, either from the gross report or from microscopy, for example:

{|class=wikitable

| ~~{{Moderate-begin}}Left and right~~ fallopian ~~tubes~~, ~~laparoscopic bilateral salpingectomy:{{Moderate-end}}<br>Complete cross-sections of histologically unremarkable fallopian tubes~~.

| Benign ruptured fallopian tube with ectopic products of conception, including degenerated immature chorionic villi and implantation site with fresh hemorrhage.

|}

@@ Line 1: / Line 1: @@
-{{Top
+<noinclude>{{Top
 |author1=[[User:Mikael Häggström|Mikael Häggström]]
 |author2=
@@ Line 6: / Line 6: @@
 *For sterilization
 *[[Fallopian tube in ectopic pregnancy]]
+{{Comprehensiveness}}</noinclude>
+==Gross processing==
+[[File:Gross pathology of paratubal cysts.jpg|thumb|'''[[Paratubal cysts]]''' can be ignored if incidentally found.]]
+{{Moderate-begin}}Look in the history for any intra-fallopian coils (Essure devices).{{Moderate-end}}<ref group=note>For a case with intra-fallopian coils in the medical records, an inability to find them on gross processing must be noted in order to raise the possibility of coil expulsion.</ref>
+;For sterilization:
+*'''Measure''' length and average diameter of each tube
+*Serially '''section''' at 3-4 mm intervals,<ref name=rcpa>{{cite web|url=https://www.rcpa.edu.au/Manuals/Macroscopic-Cut-Up-Manual/Gynaecology-and-perinatal/Ovary-and-fallopian-tube-benign-setting|title=Ovary and fallopian tube -benign setting|website=Royal College of Pathologists of Australasia|author=Kerryn Ireland-Jenkin and Marsali Newman|accessdate=2020-10-16}}</ref> or 2-3 mm if suspected malignant (including BRCA mutation).<ref name="CrumMckeon2012">{{cite journal|last1=Crum|first1=Christopher P.|last2=Mckeon|first2=Frank D.|last3=Xian|first3=Wa|title=The Oviduct and Ovarian Cancer|journal=Clinical Obstetrics and Gynecology|volume=55|issue=1|year=2012|pages=24–35|issn=0009-9201|doi=10.1097/GRF.0b013e31824b1725}}</ref> Submit
+*'''Submit''' 1 {{Moderate-begin}}or 3{{Moderate-end}} circumferential transverse sections. If the specimen is only a segment of the tube of less than <5mm{{Comprehensive-begin}}, ink the surgical cut surfaces and{{Comprehensive-end}} submit all tissue.<ref name=rcpa/>
+Example gross report:
+{|class=wikitable
+| {{Moderate-begin}}A. Labeled - __. The specimen is received in formalin and consists of{{Moderate-end}} two fimbriated segments of fallopian tube measuring __ cm in length and __ cm in average diameter. On sectioning, each displays a patent lumen. No gross abnormalities are identified. The tubes are unoriented. The specimen is serially cross-sectioned and representative sections are submitted for microscopic examination in two cassettes.
+|}
 ==Microscopic examination==
-{{Comprehensiveness|noheader=yes}}
+[[File:Histopathology of edematous fallopian tubes.jpg|thumb|220px|Fallopian tubes may be substantially edematous and congested, which can generally be attributed to surgery, in which case it does not need mention in the report.]]
+*Ensure there is at least one full cross-section from each tube, and take further samples otherwise.
+*Check for patency of the lumen.
+===Neoplasias===
+Look for:
+*'''Adenomatoid tumor''', the most common tumor of the fallopian tubes:<ref name=adenomatoid>{{cite web|url=http://www.pathologyoutlines.com/topic/fallopiantubesadenomatoid.html|title=Fallopian tubes & broad ligament - Fallopian tube tumors - Adenomatoid tumor|author=Nicole Riddle, Jamie Shutter|website=Pathology Outlines}} Topic Completed: 1 September 2013. Minor changes: 13 December 2019</ref>
+<gallery mode=packed heights=230>
+File:Histopathology of an adenomatoid tumor of the fallopian tube, low magnification.jpg|An '''adenomatoid tumor''' of the fallopian tube, low magnification, displaying infiltrative-like borders.
+File:Histopathology of an adenomatoid tumor of the fallopian tube, intermediate magnification.jpg|High magnification of the same case, showing the typical<ref name=adenomatoid/> features of tubular spaces of varying size composed of flattened cells resembling endothelium.
+</gallery>
+*'''Atypia/crowding''' of the serous epithelium.
+[[File:Histopathology of serous tubal intraepithelial lesion (STIL).jpg|thumb|Serous tubal intraepithelial lesion (STIL).<ref>{{cite journal
+ | last1 = Mizuno
+ | first1 = M
+ | last2 = Togami
+ | first2 = S
+ | last3 = Shirota
+ | first3 = K
+ | last4 = et al.
+ | title = Three Cases of Serous Tubal Intraepithelial Lesions (STILs)
+ | journal = Cureus
+ | year = 2024
+ | volume = 16
+ | issue = 6
+ | pages = e62895
+ | doi = 10.7759/cureus.62895
+ | pmc = 11261535
+ | doi-access = free
+}}</ref> H&E staining shows mildly atypical tubal epithelium with largely preserved polarity. Immunohistochemistry demonstrates aberrant block-type p53 expression but a low Ki-67 proliferation index, insufficient for classification as serous tubal intraepithelial carcinoma (STIC).]]
+===Reporting===
+Example of a normal report in '''sterilization''':
+{|class=wikitable
+| {{Moderate-begin}}Right and left fallopian tubes, {{Comprehensive-begin}}laparoscopic{{Comprehensive-end}} bilateral salpingectomy:{{Moderate-end}}<br>Complete cross-sections of histologically unremarkable fallopian tubes.
+|}
+When included in a '''[[uterus]]''' specimen, normal tubes and ovaries may simply be mentioned as:
+{|class=wikitable
+| Bilateral fallopian tubes and ovaries, unremarkable.
+|}
-Example of a normal report in sterilization:
+[[File:Histopathology of an ectopic pregnancy in a fallopian tube.jpg|thumb|Histopathology of an ectopic pregnancy in a fallopian tube, with chorionic villi and implantation site changes {{further|Products of conception}}.]]
+When done for '''ectopic pregnancy''', report any rupture, either from the gross report or from microscopy, for example:
 {|class=wikitable
-| {{Moderate-begin}}Left and right fallopian tubes, laparoscopic bilateral salpingectomy:{{Moderate-end}}<br>Complete cross-sections of histologically unremarkable fallopian tubes.
+| Benign ruptured fallopian tube with ectopic products of conception, including degenerated immature chorionic villi and implantation site with fresh hemorrhage.
 |}
+{{further|Products of conception}}
 {{Bottom}}

Fallopian tubes: Difference between revisions

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