Introduction: Prolapse of the fallopian tube into the vaginal vault is a rare complication that may occur after hysterectomy (incidence cited around 0.1%). The clinical presentation includes abdominal pain, dyspareunia, post coital bleeding, and/or vaginal discharge. However, some rare cases can be asymptomatic and diagnosed at routine checkup. Pap smears alone can sometimes be challenging and diagnosing fallopian tube prolapse by the means of vaginal cytology is an even rarer occurrence. Methods: We present the case a 47-year old woman who underwent vaginal hysterectomy with abdominoperineal repair due to prolapse; the clinician made note of an uncommon pelvic laxity. During a routine postsurgical Pap smear check-up, atypical glandular cells were reported. The result and comment from the signing out pathologist triggered a vaginal colposcopy and a pelvic ultrasound, followed later by bilateral salpingo-oophorectomy. Results: The postsurgery Pap test showed the presence of atypical glandular cells with morphologic evidence of cilia. The comment mentioned prolapse of the fallopian tube into vagina. The followup colposcopy showed tissue at vaginal vault suspicious for fallopian tube prolapse. The biopsied tissue showed polypoid fragments of stroma and ciliated glandular epithelium, consistent with prolapsed fallopian tube. A transabdominal and transvaginal pelvic ultrasound was done that showed unremarkable ovaries; the fallopian tubes were not visualized. Laparotomy with bilateral salpingo-oophorectomy was performed. The specimen showed fallopian tubes with reactive type changes (marked chronic salpingitis and mesothelial hyperplasia) and no evidence of atypia or malignancy. Conclusions: The cytologic diagnosis of fallopian tube prolapse will be challenging without clinical history and definitive histological assessment. The differential diagnosis of atypical glandular cells in Pap smears, particularly atypical ciliated glandular cells, includes vaginal adenosis, endometriosis, primary or metastatic adenocarcinoma, vesicovaginal and uterovaginal fistulae and granulation tissue related to surgery. Fallopian tube prolapse should be considered in the differential diagnosis of the post-hysterectomy cases.

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