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Journal of Postgraduate Medicine
Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India
ISSN: 0022-3859 EISSN: 0972-2823
Vol. 48, Num. 3, 2002, pp. 241-242

Journal of Postgraduate Medicine, Vol. 48, Issue 3, 2002 pp. 241-242

Letter to the Editor

Prolapsed Fallopian Tube with Squamous Metaplasia

Jashnani KD, Naik LP

Department of Pathology, TN Medical College and BYL Nair Ch Hospital, Mumbai, India. E-mail: kusumjash@hotmail.com

Code Number: jp02083

Sir,

45 year-old-female complained of leucorrhoea and lower abdominal pain since two months. Abdominal hysterectomy done one and half years back for unknown reasons. Perspeculum examination showed a tan-coloured polyp on the vaginal vault, measuring 1.5x1.0 cm and tender to touch. Clinical impression was granulation tissue, and the polyp was excised. Light microscopy showed polypoidal projections lined by low cuboidal epithelium; lamina propria showed chronic inflammatory cells with an abundance of plasma cells. Deeper down were seen thick walled blood vessels and few smooth muscle bundles. One papilla showed squamous metaplasia of the lining epithelium. There was no evidence of mucosal hyperplasia or atypia. The papillae resembled tubal plicae and the presence of few smooth muscle bundles clinched the diagnosis of prolapsed tube.

Tubal prolapse in vagina can occur following vaginal and abdominal hysterectomy, and rarely following interposition and colpotomy. Predisposing factors include febrile episode, haematoma formation, profuse postoperative vaginal drainage or presence of drains through the cul-de-sac. The patient may present two months to six years after surgery with profuse vaginal discharge, either watery or bloody, and occasional dyspareunia. Apart from vagina, urinary bladder and uterus are the other two rare sites of prolapsed tube.1,2

The diagnosis of a prolapsed tube has usually not been made prior to biopsy (except in occasional cases where fimbrial end had prolapsed) since the clinical appearance is that of granulation tissue. Symmonds et al3 have pointed out that the fallopian tube tissue is firmer than the usual granulation tissue and is also more tender. The easy passage of a probe in to the lumen of the tube or in to the abdominal cavity will aid in establishing the diagnosis. The presence of tubal epithelial cells in a vaginal smear after hysterectomy is also a point in favor of tubal prolapse.4

Differential diagnosis on microscopy includes cysts of mesonephric or paramesonephric duct, vaginal adenosis, endometriosis, primary and metastatic adenocarcinom.5 The presence of typical tube epithelium and smooth muscle fibers deep down are helpful aids to diagnosis.

Squamous metaplasia has occurred here due to chronic irritation and severe inflammation. The significance of squamous metaplasia being that, if extensive, it can conceal the normal tubal epithelium making the diagnosis difficult. It may also undergo malignant transformation.

Excision constitutes both the definitive diagnostic procedure and therapy for prolapsed tube.

Jashnani KD, Naik LP

Department of Pathology, TN Medical College and BYL Nair Ch Hospital, Mumbai, India. E-mail: kusumjash@hotmail.com

References

  1. Anastasiades KD, Majmudar B. Prolapse of fallopian tube into urinary bladder, mimicking bladder carcinoma. Arch Pathol Lab Med 1983;107:613-4.
  2. Steigad SJ, Margin CT. Fallpian tube presenting as uterine polyp. Aust NZJ Obstet Gynarcol 1978;18:281-3.
  3. Symmonds RE, Counceller VS, Pratt JH. Prolapse of a fallopian tube as a complication of hysterectomy. Am J Obstet Gynecol 1957;74:214-7.
  4. Hellen EA, Coghill SB, Clark JV. Prolapsed Fallopian tube after abdominal hysterectomy, a report of the cytological findings. Cytopathology 1993;4:181-5.
  5. Wheelock JB, Schneider V, Goplerud DR. Prolapsed fallopian tube masquerading as adenocarcinoma of vagina in a postmenopausal woman. Gynacol Oncol 1985;21:369-75.

This article is also available in full-text from http://www.jpgmonline.com/

© Copyright 2002 - Journal of Postgraduate Medicine

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