Definition/General
Introduction:
Fallopian tube tuberculosis is a chronic granulomatous infection of the fallopian tubes caused by Mycobacterium tuberculosis
It represents the most common site of female genital tuberculosis
It accounts for 90-95% of genital TB cases
It is particularly common in developing countries including India.
Origin:
Primary infection usually occurs in the pulmonary system
Secondary spread to fallopian tubes occurs via hematogenous route
Less commonly through lymphatic spread from pulmonary focus
Direct spread from adjacent organs is possible
Reactivation of dormant foci in immunocompromised states.
Classification:
Classified as primary or secondary genital tuberculosis
Primary genital TB involves only genital organs
Secondary follows pulmonary tuberculosis
Based on pathology: acute exudative
Chronic productive
Caseous or fibro-caseous
Calcified or healed stage.
Epidemiology:
Most common in reproductive age group (20-40 years)
Higher prevalence in developing countries
India shows significant burden
Associated with HIV infection
Malnutrition increases risk
Infertility is common presentation (30-70% cases)
Peak incidence in 3rd-4th decade of life.
Clinical Features
Presentation:
Chronic pelvic pain (most common)
Primary or secondary infertility (70% cases)
Menstrual irregularities
Constitutional symptoms (fever, weight loss)
Abdominal distension
Ascites in advanced cases
Dyspareunia.
Symptoms:
Infertility (primary complaint in 70%)
Lower abdominal pain (chronic, dull aching)
Menstrual disorders (oligomenorrhea, amenorrhea)
Constitutional symptoms (low-grade fever, night sweats)
Weight loss and anorexia
Dysmenorrhea
Postcoital bleeding.
Risk Factors:
History of pulmonary tuberculosis
HIV infection
Malnutrition
Immunosuppression
Poor socioeconomic status
Overcrowding
Contact with TB patients
Previous pelvic inflammatory disease
Diabetes mellitus.
Screening:
Menstrual blood culture and PCR
Endometrial biopsy for histopathology
Hysterosalpingography (HSG) shows characteristic changes
Laparoscopy for direct visualization
Tuberculin skin test
Interferon-gamma release assays
Chest X-ray for pulmonary TB.
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Gross Description
Appearance:
Fallopian tubes show marked thickening and distension
Hydrosalpinx or pyosalpinx formation
Tubes appear tortuous and beaded
Cut surface shows caseous necrosis
Adhesions to surrounding structures.
Characteristics:
Bilateral involvement in majority of cases (80-90%)
Tubes are thickened, dilated and may be blocked
Caseous material within lumen
Fimbrial ends often sealed
Peritubal adhesions are common
Calcification in chronic cases.
Size Location:
Usually bilateral involvement
Ampullary and isthmic portions commonly affected
Entire tube length may be involved
Size varies from normal to markedly distended
Fimbrial involvement leads to tubal blockage
Associated ovarian involvement in 20-30% cases.
Microscopic Description
Histological Features:
Epithelioid cell granulomas with Langhans giant cells
Caseous necrosis at center of granulomas
Chronic inflammatory infiltrate
Lymphocytes, plasma cells and histiocytes
Fibrosis in chronic cases.
Cellular Characteristics:
Epithelioid cells with elongated nuclei and abundant cytoplasm
Langhans giant cells with peripherally arranged nuclei
Lymphocytes and plasma cells
Caseous necrosis with loss of cellular detail
Neutrophils in acute phases.
Architectural Patterns:
Well-formed granulomas in wall of fallopian tube
Granulomas may involve mucosa, muscularis and serosa
Caseation varies from minimal to extensive
Fibrosis and calcification in healed lesions
Loss of normal tubal architecture.
Immunohistochemistry
Positive Markers:
CD68 positive in epithelioid cells and giant cells
CD163 positive in macrophages
Lysozyme positive in epithelioid cells
S-100 may be positive in Langhans cells
Alpha-1-antitrypsin positive.
Negative Markers:
Cytokeratin negative in granulomatous inflammation
EMA negative in inflammatory cells
CD3/CD20 help identify lymphocyte populations
CD34 highlights vascular changes.
Diagnostic Utility:
IHC helps characterize inflammatory cells
Helps distinguish from other granulomatous conditions
CD68 confirms epithelioid nature
Useful in cases with poorly formed granulomas
Helps identify associated malignancy.
Molecular/Genetic
Differential Diagnosis
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, [side], measuring [dimensions]
Clinical History
Clinical presentation: [symptoms], duration: [time period]
Macroscopic Examination
Fallopian tube shows [thickening/distension], cut surface reveals [caseous material/adhesions]
Microscopic Examination
Shows epithelioid cell granulomas with [Langhans giant cells/caseous necrosis] and chronic inflammatory infiltrate
Special Stains
Ziehl-Neelsen stain: [positive/negative] for acid-fast bacilli
Molecular Studies
PCR for M.tuberculosis: [positive/negative], Gene Xpert: [result]
Diagnosis
Chronic granulomatous inflammation consistent with tuberculosis of fallopian tube
Recommendations
Anti-tubercular therapy, clinical correlation, follow-up recommended