II. Inflammatory Diseases
After completing this section will be able to:
- describe the various types of inflammatory conditions that involve the
- indicate etiologic agents and describe pathways of infection
- describe and identify clinical lesions
- describe and identify characteristic histologic features
- predict clinical behavior and possible complications
Inflammation of the fallopian tube is referred to as salpingitis.
It may be acute or chronic. When it extends to involve the ovary,
often with added involvement of adjacent tissues, the term pelvic inflammatory
disease (PID) is used.
- Acute Suppurative Salpingitis
This is a purulent inflammatory process that arises as
a result of passage of bacteria from the endometrial cavity. The organisms
gain access to the tube either through the epithelial surface or lymphatic
channels. The major site of inflammation and the type of organisms involved
depend on the route used. N. gonorrhoeae and C. trachomatis spread from the
endometrial cavity to the epithelial surface and produce inflammation with
more severe changes in the mucosa than other layers of the tube and passage
of pus through the tubal ostium into peritoneal cavity. Organisms such as
Staphylococci, Streptococci, E. coli, and other anaerobic bacteria gain access
to the tube through the lymphatics and cause inflammation that involves mainly
the other layers with relative sparing of the mucosa. Infection by these organisms
may follow spontaneous or induced abortion and normal or abnormal deliveries
or may be IUD-related. Although any pyogenic bacteria may cause acute suppurative
salpingitis, the infection is typically polymicrobial.
There is marked acute inflammatory infiltrate in the mucosa
accompanied by edema and congestion. The lumen is filled with pus. Fibrin
exudate may involve the serosa.
- Chronic Salpingitis and Pelvic Inflammatory Disease
This may follow prolonged acute suppurative salpingitis
or result from repeated bouts of acute salpingitis. During acute salpingitis,
fibrin exudation into the lumen results in the plicae adhering to each other.
Subsequent healing and organization lead to permanent adhesions between the
plicae producing follicular salpingitis. Plasma cells, lymphocytes
or both are present in the mucosa. The fimbriae may adhere to each other sealing
the tube, which becomes distended with pus and tissue debris to form a pyosalpinx.
When the inflammation subsides, the tube becomes distended with an acellular
transudate producing a hydrosalpinx. The fimbriae may adhere to the
ovary leading to direct involvement of the latter and a tubo-ovarian abscess
may result. Fibrinous exudates between the serosal surface of the tube and
surrounding peritoneal surfaces may organize to form fibrous adhesions.
Pyosalpinx. Pus has been drained. Note dilated tubal lumen and thickened,
Complications include infertility and ectopic pregnancy.
- Granulomatous Salpingitis
This is usually caused by Mycobacterium tuberculosis and
occasionally by schistosomiasis, other parasites or actinomyces. Tuberculous
salpingitis is usually secondary to pulmonary tuberculosis, the organisms
reaching the tube via the bloodstream. Both tubes are almost always involved.
During the early stages many granulomas are present. As
the disease progresses fibrosis develops and the number of granulomas decrease.
Caseous abscess may develop. Calcification is common. Scarring and distortion
of the tubes lead to infertility.