Fallopian Tube: Diagnosis



Fallopian Tube: Diagnosis










An ectopic pregnancy can be a medical emergency and is identified by immature placental villi image and implantation site image within a fallopian tube. Fimbriae image underlie the implantation site.






In the absence of villi and embryonic tissue, the presence of implantation site trophoblasts image in the wall of a fallopian tube is sufficient for the diagnosis of an ectopic gestation.


SURGICAL/CLINICAL CONSIDERATIONS


Goal of Consultation



  • Determine if a mass-forming lesion of fallopian tube is benign or malignant


  • Diagnose suspected tubal pregnancies by identifying products of conception


Change in Patient Management



  • Additional biopsies may be taken for staging if carcinoma is present


  • If ectopic pregnancy is present, salpingectomy or salpingotomy is performed



    • Additional surgical exploration is not necessary to identify alternative sites


Clinical Setting



  • Majority of serous carcinomas are thought to arise in fimbriae of fallopian tubes



    • Women with BRCA1 or BRCA2 or P53 (Li-Fraumeni syndrome) germline mutations are at high risk


    • Tubal carcinoma is difficult to diagnose preoperatively



      • Inflammatory conditions are more common than malignancy


  • Women with elevated hCG levels but without documented intrauterine pregnancy may have ectopic pregnancy



    • Rupture and hemorrhage can be life threatening


    • Majority of cases are diagnosed by ultrasound and managed conservatively


    • In rare cases, clinical evaluation is inconclusive and intraoperative examination may be helpful


SPECIMEN EVALUATION


Gross



  • Describe size (length and diameter) and presence or absence of fimbriated end



    • Tubal carcinomas typically arise within fimbria



      • Close inspection for adhesions, discoloration, or masses is critical


  • Patency of lumen is determined with probe



    • Plastic ring may be present if there has been prior tubal ligation


  • Serosal surface is described



    • Normal: Smooth and glistening


    • Adhesions: Rough surface and attached tissue


    • Paratubal cysts


    • Purulent or fibrinous exudates


    • Rupture


  • For tubes removed as part of prophylactic salpingectomy



    • If grossly normal or if only cysts are present, fixation without sectioning is recommended



      • Likelihood of diagnosing carcinoma is very small


      • Detection of precursor lesions and small carcinomas may be compromised unless specimen is optimally fixed and processed


    • If a solid nodule > 0.5 cm is present and only a portion can be frozen, a frozen section may be appropriate


  • If a mass is present in tube



    • Make serial cross sections of tube; note any tubal contents



      • Purulent exudate


      • Hemorrhage


      • Placental or fetal tissue with membranes


      • Masses


      • Areas of firmness or discoloration


Frozen Section



  • If solid mass is present, a portion may be frozen to determine if carcinoma is present


  • In setting of suspected ectopic pregnancies, areas of hemorrhage and blood clot often contain products of conception if they are not readily evident


MOST COMMON DIAGNOSES


Serous Lesions



  • Serous tubal intraepithelial carcinoma (STIC)



    • May be seen in areas adjacent to invasive carcinoma



    • Identified at low power by irregular epithelial thickness with exfoliation of tumor cells



      • High nuclear to cytoplasmic ratio and loss of cilia


    • Nuclei show marked pleomorphism



      • Enlarged nuclei with prominent nucleoli


      • Frequent mitoses


      • Hyperchromasia


      • Apoptotic bodies common


    • May require supportive immunohistochemical studies for p53 and Ki-67 for diagnosis


  • Invasive serous carcinoma



    • 90% of fallopian tube carcinomas



      • 3-20% are bilateral


    • Similar histologic features as mentioned above with invasion into underlying stroma


    • Frequently associated with lymphovascular invasion, which may be identified on frozen sections


Ectopic Pregnancy



  • Most common implantation site for ectopic pregnancy is fallopian tube


  • 87-99% of tubal pregnancies can be diagnosed by transvaginal ultrasound



    • Only rare women have a positive pregnancy test and inconclusive ultrasound examinations


  • Surgical treatment can be by salpingotomy or salpingectomy



    • Intraoperative evaluation may be useful for cases with unclear clinical and imaging characteristics


    • Presence of fetal villi, gestational sac, implantation site, or embryonic parts is diagnostic


Infarction



  • Edematous, hemorrhagic tube grossly


  • Widespread hemorrhagic necrosis commonly present microscopically


Transitional Cell Lesions



  • Transitional cell metaplasia



    • Also termed Walthard nests


    • Common benign finding; not proven to be a precursor lesion


  • Transitional cell carcinoma



    • 10% of primary fallopian tube carcinomas


    • Histologic appearance is similar to urinary tract transitional carcinomas



      • Solid and papillary sheet-like growth


      • High-grade nuclei


      • Frequent mitoses


Inflammatory Conditions

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Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Fallopian Tube: Diagnosis

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