Pathology Thread

II. Inflammatory Diseases

Objectives:

After completing this section will be able to:

• describe the various types of inflammatory conditions that involve the fallopian tube
• 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.

1. 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.

Histology

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.

2. 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, edematous wall.

Complications include infertility and ectopic pregnancy.

3. 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.

Histology

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.