The lipofuscin-iron association in pigmentosis tubae

Intratubal Pseudopapillary Histiocytic Hyperplasia: A New Histologic Variant in the Spectrum of Histiocytic Lesions Involving the Fallopian Tube

Although histiocytic lesions of the fallopian tube are relatively rare compared to their epithelial counterparts, there exists a spectrum of histiocytic lesions involving the fallopian tube that are described under different terminologies dependent on the involved compartment of the fallopian tube. A common histologic denominator of all the hitherto reported tubal histiocytic lesions is the presence of sheets and clusters of histiocytes without any supportive connective tissue. The current study describes three cases of a heretofore-undescribed papillary histiocytic lesion in the lumen of the fallopian tube. All 3 lesions were characterized by avascular, hyaline collagenous papillary cores surrounded by a monotonous population of epithelioid cells, morphologically resembling mesothelial cell hyperplasia, but displaying a histiocytic immunophenotype with diffuse immunopositivity for CD68. Since the papillary cores did not harbor any vasculature, the term intratubal pseudopapillary histiocytic hyperplasia was proposed for this histiocytic proliferation which expands the spectrum of histiocytic lesions of the fallopian tube. Although probably of no clinical significance, practicing pathologists should be aware of this peculiar histiocytic lesion of the fallopian tube to avoid misdiagnosis and unnecessary immunohistochemical testing.

Histopathologic Features of Postablation Tubal Sterilization Syndrome

Postablation tubal sterilization syndrome (PATSS) is an uncommon complication of endometrial ablation in patients with antecedent tubal ligation characterized by cyclic pelvic pain. Recurrent tubal distention resulting from retrograde menstruation into occluded proximal fallopian tube segments by residual/regenerated cornual endometrial tissue is postulated to be the cause. Reports of PATSS have largely focused on the clinicoradiologic and operative findings. Detailed descriptions of the gross pathologic findings of PATSS are sparse and rarer still are examples in which the histologic manifestations are discussed. Three patients with a history of tubal ligation and subsequent endometrial ablation who underwent hysterectomy and bilateral salpingo-oophorectomy for pelvic pain were identified. A clinical suspicion of PATSS was conveyed to the pathologist at the time of initial pathologic examination in only 2 of the 3 cases. Pathologic findings in all 3 cases were similar and included hematosalpinx of the proximal fallopian tubes, intraluminal hemosiderotic material, mural hemosiderosis, and pseudoxanthomatous salpingitis featuring plical and mural lipofuscin-laden macrophages, along with inactive to attenuated endometrium with variable submucosal myometrial hyalinization/scarring compatible with postablative changes. The pathologic features, in conjunction with the appropriate clinicoradiologic findings, were interpreted as consistent with PATSS. PATSS complicates an estimated 5% to 10% of endometrial ablations, but is likely underreported due to a lack of awareness. Pathologists should consider PATSS in hysterectomy specimens that show postablative endometrial changes accompanied by hematosalpinx and pseudoxanthomatous salpingitis of the proximal segments of ligated fallopian tubes. To our knowledge, this is the first study to depict the histopathologic features of PATSS.

Melanosis tubae: histogenesis and appropriate terminology

We report 2 cases of abnormal localized deposition of lipofuscin-laden macrophages in the lamina propria of the fallopian tube. In both cases there was evidence of ovarian and tubal endometriosis. The authors propose the term "melanosis tubae" (MT) as the most appropriate terminology in the diagnosis of the disease, whose pathogenesis is similar to that occurring in gastrointestinal tract pigmented conditions. The lesion is not of an inflammatory nature so that the term "pseudoxanthomatous salpingitis" is inaccurate and should not be used. Other definitions such as "pseudoxanthomatous salpingiosis," "pigmentosis salpingiosis," "pigmentosis tubae" may be used, but these are descriptive terms that are not suitable for denoting histogenesis. None of the previously reported MT cases showed coexisting tubal endometriosis. Our cases are the first examples of MT associated with tubal endometriosis.

Xanthogranulomatous salpingitis associated with fallopian tube mucosal endometriosis: a clue to the pathogenesis

Xanthogranulomatous salpingitis is an unusual inflammatory lesion of the fallopian tube, characterized by accumulation of foamy macrophages in the wall of the fallopian tube along with other chronic inflammatory cells. Only a few cases of xanthogranulomatous salpingitis have been reported in the English medical literature, some under different nomenclature. An association, most commonly with pelvic inflammatory disease and endometriosis, has been suggested. A 41-year-old woman with prior history of breast carcinoma underwent bilateral salpingoophorectomy because of hematosalpinx. The histology revealed xanthogranulomatous salpingitis in the setting of extensive fallopian tube mucosal endometriosis, endometritis, and presence of an intrauterine contraceptive device. Multiple etiologies have been linked to the xanthogranulomatous process at this location in previously reported cases. A whole spectrum of changes may exist in this lesion and probably represent a specialized form of tissue reaction secondary to multiple etiologies. Although it has been associated with pelvic endometriosis, it has never been demonstrated through progressive changes, beginning with mucosal endometriosis to the full-blown xanthogranulomatous inflammation. To the best of our knowledge, this is the first reported case that demonstrates different stages in the pathogenesis of this lesion and provides an insight into the histogenesis of this entity.

Pseudoxanthomatous and xanthogranulomatous salpingitis of the fallopian tube: a report of four cases and a literature review

The clinical and pathological features of four cases of pseudoxanthomatous salpingitis (PXS) and xanthogranulomatous salpingitis (XGS) are described. The women with PXS underwent salpingectomy for primary sterility (Case 1) and endometriosis (Case 2). The two women with XGS presented with pelvic inflammatory disease (PID) and an adnexal mass and were initially treated with antibiotics. Shortly thereafter, a left salpingo-oophorectomy (Case 3) and total abdominal hysterectomy with bilateral salpingo-oophorectomy (Case 4) were performed. In Cases 1 and 2, histological examination revealed expansion of the tubal plicae with numerous pigmented histiocytes (PXS). In Cases 3 and 4, the tubal mucosa was infiltrated by foamy histiocytes admixed with other inflammatory cells (XGS). A review of the literature revealed that most patients with PXS have a clinical history of long-standing endometriosis, whereas XGS is an unusual manifestation of chronic PID. Although PXS can be confused on histological examination with XGS, the two processes should be distinguished because of their different clinical associations and pathogenesis.