Prolapsed fallopian tube: Cytological findings in a ThinPrep liquid based cytology vaginal vault sample

Abstract

Fallopian tube prolapse through the vaginal vault after hysterectomy is a rare complication. The clinical diagnosis is difficult and the patient may undergo unnecessary treatment. A cytological diagnosis of tubal prolapse is rare. There are very few descriptions of the cytological appearances of prolapsed fallopian tube and to our knowledge, they have not been described in liquid based cytology preparations. The presence of classic columnar cells with cilia and sheets of cells with small granular uniform nuclei in an orderly arrangement are the diagnostic appearances of cells originating from the fallopian tube. We describe a case in which the cells had undergone squamous metaplasia with nuclear enlargement and increased nuclear to cytoplasmic ratios corresponding to reactive atypia but with fine and evenly distributed chromatin and smooth nuclear contours, which indicated their benign nature. In addition, in this case intracytoplasmic polymorphs and associated extracellular infiltrates of inflammatory cells are noted. The description of this case may help others to consider a cytological diagnosis of prolapsed fallopian tube, thus preventing repeated cauterisations of vault granulation tissue on one hand, and possibly excessive surgical treatment of a mistaken malignant lesion on the other.

Cytomorphologic clues for the diagnosis of fallopian tube prolapse in liquid‐based vault samples with review of the literature

“…8,11 Few authors have highlighted the presence of large, crowded hyperchromatic nuclei, while some have highlighted the presence of three-dimensional groups of columnar cells as well as squamous metaplastic cells with mild nuclear atypia and leucophagocytosis. 7,10 The presence of colum- Though the prolapse occurs on its own, spontaneous resolution is…”

“…A comprehensive review of the literature revealed five previous reports highlighting the cytomorphologic features of FTP in vault smears. [7][8][9][10][11] The clinical, cytological as well as histopathologic details of all the reported cases have been presented in Table 1.…”

“…The cytologic features of the FTP in vault smears have been rarely described in the literature. [7][8][9][10][11] The diagnostic difficulty is compounded by the low frequency of this condition and misdiagnosis of this condition of vault smears. In the present study, we describe the distinctive cytomorphologic features of exfoliated cells from four cases, with histopathologically proven FTP, in Papanicolaou-stained SurePath™ liquid-based cervical cytology preparations.…”

Robotic Assisted Repair of Bilateral Fallopian Tube Prolapse after Vaginal Hysterectomy

“…Imaging diagnostic studies may pose a diagnostic pitfall, even with the use of advanced modalities such as pelvic MRI and biopsy of the prolapsed tissue. Vaginal cuff cytology can demonstrate squamous or glandular cells, often with superimposed granulation changes or reactive atypia secondary to chronic inflammation [17][18][19]. Histopathology remains the only means of definitive diagnosis.…”