Definition/General
Introduction:
Salpingitis is the inflammatory condition of the fallopian tubes, commonly part of pelvic inflammatory disease (PID)
It constitutes 60-80% of PID cases
It primarily affects women of reproductive age
It can lead to serious complications including infertility and ectopic pregnancy.
Origin:
Results from ascending infection from the lower genital tract
Commonly caused by sexually transmitted organisms
Can be caused by post-procedural infections
May result from hematogenous spread in rare cases
The infection typically starts in the cervix and ascends through the uterus to reach the fallopian tubes.
Classification:
Classified as acute salpingitis (duration <30 days)
Chronic salpingitis (duration >30 days)
Subclinical salpingitis (minimal symptoms)
Can be unilateral or bilateral
Severity ranges from mild tubal inflammation to tubo-ovarian abscess.
Epidemiology:
Peak incidence in 20-30 years age group
Affects approximately 1-2% of sexually active women annually
Higher prevalence in developing countries including India
Risk factors include multiple sexual partners
Early sexual activity
History of STDs
Use of intrauterine devices
Previous episodes of PID increase recurrence risk.
Clinical Features
Presentation:
Lower abdominal pain (bilateral in 75% cases)
Pelvic pain with movement
Fever and chills (60-70% cases)
Abnormal vaginal discharge (purulent, foul-smelling)
Dyspareunia (painful intercourse)
Menstrual irregularities
Cervical motion tenderness on examination.
Symptoms:
Bilateral lower abdominal pain (most common)
Fever >38°C (60% cases)
Purulent vaginal discharge (50-60% cases)
Dysuria and urinary frequency
Nausea and vomiting (30% cases)
Post-coital bleeding
Intermenstrual bleeding
Chronic pelvic pain in chronic cases.
Risk Factors:
Multiple sexual partners
Age <25 years
History of sexually transmitted infections
Previous episodes of PID
Intrauterine device use
Douching practices
Bacterial vaginosis
Recent instrumentation (D&C, hysteroscopy)
Immunocompromised status.
Screening:
Clinical examination with bimanual pelvic examination
Laboratory tests for STD screening
Nucleic acid amplification tests (NAAT) for gonorrhea and chlamydia
Transvaginal ultrasonography
Laparoscopy (gold standard for diagnosis)
MRI in complex cases.
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Gross Description
Appearance:
Dilated, erythematous fallopian tubes with edematous walls
Tubes may be filled with purulent exudate
Adhesions between tube and ovary (tubo-ovarian complex)
External surface shows hyperemia and fibrinous exudate
Fimbrial ends may be sealed or patent depending on stage.
Characteristics:
Tube wall shows thickening and induration
Luminal contents vary from serous to purulent
Fibrinous adhesions to surrounding structures
Ovarian involvement may create tubo-ovarian mass
Surface may show fibrinopurulent exudate.
Size Location:
Tubes typically enlarged 2-3 times normal diameter
Length may be normal or shortened due to inflammation
Bilateral involvement in 70-80% cases
Ampullary region most commonly affected
Isthmic involvement in severe cases.
Multifocality:
Bilateral disease is the rule rather than exception
May involve adjacent structures (ovaries, uterus)
Can extend to form tubo-ovarian abscess
Chronic cases show hydrosalpinx formation
Associated endometritis in 90% cases.
Microscopic Description
Histological Features:
Acute inflammatory infiltrate predominantly neutrophils in acute phase
Mucosal edema and hyperemia
Epithelial desquamation and ulceration
Luminal exudate containing neutrophils and cellular debris
Muscular wall infiltration by inflammatory cells.
Cellular Characteristics:
Tubal epithelium shows reactive changes with enlarged nuclei
Loss of cilia in affected areas
Increased mitotic activity in epithelial cells
Inflammatory infiltrate composed of neutrophils, lymphocytes, and plasma cells
Endothelial swelling and vascular congestion.
Architectural Patterns:
Plicae fusion and architectural distortion
Pseudostratification of tubal epithelium
Formation of inflammatory polyps
Muscular hyperplasia and fibrosis in chronic cases
Glandular pattern disruption
Stromal fibrosis and chronic inflammation in longstanding cases.
Grading Criteria:
Acute phase: Predominant neutrophilic infiltrate
Subacute phase: Mixed inflammatory infiltrate
Chronic phase: Lymphocytes and plasma cells predominate
Severity graded as mild, moderate, or severe based on extent of inflammation and tissue destruction.
Immunohistochemistry
Positive Markers:
CD45 (leukocyte common antigen) highlights inflammatory cells
CD3 and CD20 identify T and B lymphocytes respectively
CD68 marks macrophages
Myeloperoxidase highlights neutrophils
Cytokeratin marks residual epithelium.
Negative Markers:
Typically negative for malignancy markers (p53, Ki-67 high)
Hormonal receptors (ER, PR) may be decreased
Smooth muscle actin shows disrupted muscular architecture
E-cadherin may show focal loss in severely damaged epithelium.
Diagnostic Utility:
IHC mainly used to exclude malignancy in chronic cases
CD45 confirms inflammatory nature
Helps distinguish from endometriosis (CD10 positive)
Cytokeratin patterns help assess epithelial damage
Special stains may identify specific organisms.
Molecular Subtypes:
Not applicable for inflammatory conditions
Microbiological identification more relevant than molecular subtyping
PCR-based methods can identify Chlamydia trachomatis
Neisseria gonorrhoeae detection by nucleic acid amplification
Bacterial culture remains gold standard.
Molecular/Genetic
Genetic Mutations:
No specific genetic mutations associated with salpingitis
Host genetic factors may influence susceptibility
HLA associations reported in some populations
Polymorphisms in cytokine genes may affect inflammatory response
Complement deficiencies predispose to recurrent infections.
Molecular Markers:
Inflammatory cytokines (IL-1, TNF-α, IL-6) elevated
C-reactive protein and ESR elevated during acute phase
White blood cell count typically elevated
Procalcitonin may be elevated in severe cases
Pathogen-specific antigens or DNA detectable.
Prognostic Significance:
Early treatment prevents complications and preserves fertility
Chronic inflammation leads to tubal damage and infertility
Recurrent episodes significantly increase risk of complications
Severity of initial episode correlates with long-term sequelae
Bilateral involvement has worse prognosis for fertility.
Therapeutic Targets:
Antibiotic therapy targets causative organisms
Anti-inflammatory agents may reduce tissue damage
Pain management with NSAIDs or analgesics
Surgical intervention for complications (abscess drainage)
Partner treatment essential to prevent reinfection.
Differential Diagnosis
Similar Entities:
Appendicitis (right-sided pain, different location)
Endometriosis (cyclical pain, chocolate cysts)
Ovarian torsion (sudden onset, absent flow on Doppler)
Ectopic pregnancy (pregnancy test positive, adnexal mass)
Tubal carcinoma (rare, elderly patients).
Distinguishing Features:
Salpingitis: Bilateral involvement common
Salpingitis: STD history
Salpingitis: Fever and leukocytosis
Appendicitis: Right lower quadrant pain
Appendicitis: McBurney's point tenderness
Endometriosis: Cyclical symptoms
Endometriosis: Chocolate cysts
Ectopic pregnancy: Positive β-hCG
Ectopic pregnancy: Adnexal mass on ultrasound.
Diagnostic Challenges:
Distinguishing acute from chronic salpingitis (duration, symptoms)
Differentiating from endometriosis (cyclical nature, cysts)
Excluding malignancy in chronic cases (imaging, biopsy)
Identifying causative organism (culture, PCR)
Laparoscopy may be required for definitive diagnosis.
Rare Variants:
Tuberculous salpingitis (granulomatous inflammation, AFB positive)
Xanthogranulomatous salpingitis (foam cells, chronic inflammation)
Follicular salpingitis (lymphoid follicles prominent)
Pseudoxanthomatous salpingitis (lipid-laden macrophages)
Parasitic salpingitis (rare, specific organisms).
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[fallopian tube specimen], measuring [length] cm in length and [diameter] cm in diameter
Diagnosis
[acute/chronic/mixed] salpingitis
Inflammation Grade
Inflammation: [mild/moderate/severe] with [acute/chronic/mixed] inflammatory infiltrate
Histological Features
Shows [inflammatory pattern] with [epithelial changes] and [stromal changes]
Complications
Complications: [present/absent], details: [abscess/hydrosalpinx/adhesions]
Extent of Disease
Extent: [unilateral/bilateral], involvement: [mucosal/transmural]
Special Studies
Gram stain: [positive/negative/not performed]
AFB stain: [positive/negative/not performed]
Culture: [organism identified/negative/pending]
Recommendations
Recommendations: [antibiotic therapy/further testing/clinical correlation]
Final Diagnosis
Final diagnosis: [complete diagnosis with grade and extent]