Muscular and Vascular Fallopian Tube Morphology in Ectopic Tubal Pregnancy

Seema Baxi; Mitesh Koyani; Md Hashmi Sabugar; Dhwani Pandya

doi:10.21276/apalm.3292

Seema Baxi Department of Pathology, Pathology, Govt Medical college, Bhavnagar
Mitesh Koyani Department of Pathology, Pathology, Govt Medical college, Bhavnagar
Md Hashmi Sabugar Department of Pathology, Pathology, Govt Medical college, Bhavnagar
Dhwani Pandya Department of Pathology, Pathology, Govt Medical college, Bhavnagar

DOI: https://doi.org/10.21276/apalm.3292

Keywords: atherosis, chronic salpingitis, ectopic tubal pregnancy, grotesque vessels, salpingitis isthmica nodosa, tubal muscle splaying, vascular muscle splaying

Abstract

Background Although literature is full of articles on histopathological changes in fallopian tube in ectopic pregnancy and the predisposing conditions associated with ectopic pregnancy, none have mentioned or reported abnormal muscle and vascular architecture of the tube. The study was undertaken to find the percentage of different sites of ectopic pregnancies coming to the institute for treatment and to calculate the proportion of various morphological risk factors which could have led to the ectopic pregnancy and to discern the various histopathological changes in cases of ectopic tubal pregnancies. Methods A retrospective study was conducted on all the cases of ectopic pregnancies in the year of 2021 and 2022. For comparison of morphological changes equal number of tubes received for tubal ligation were assessed as they served age matching purpose. Hematoxylin & eosin-stained slides were retrieved and re-examined for the histological patterns. Results 92% of the ectopic pregnancies were tubal pregnancies. Amongst predisposing factors of tubal pregnancies detected morphologically, chronic salpingitis was seen in 71.5% of cases while Salpingitis Isthmica Nodosa (SIN) was seen in 26.1% of cases. Conclusion Abnormal morphological findings like tubal muscle splaying, arterial wall thickening leading to grotesque shapes, clear changes in different layers of tunica of blood vessel with or without concentric muscle splaying were seen in tubal ectopic pregnancies in significant numbers of cases.

References

Barnhart KT. Ectopic pregnancy. N Engl J Med 2009; 361: 379-87.

Bai S, Sujatha R. A study of incidence, clinical presentation and risk factors associated with ectopic pregnancy. J Evidence Based Med Health Care:2015;2(19):2700-8.

Rose IA, Oluwole A, Olalekan OA, Adebajo S. Risk factors for ectopic pregnancy in Lagos, Niger. Acta Obstet Gynecol Scand.2005;84:184-8.

Vessey MP, Yeates D, Flavel R. Risk of ectopic pregnancy and duration of use of an intrauterine device. Lancet.1979; 2(8141):501-2.

Westrom L . Effect of acute pelvic inflammatory disease on fertility. Venereology. 1995; 8(4):219-22.

Rasheed F, Vijayaraghvan L. A study on histopathological changes in ectopic tubal pregnancy. Int J Adv Med.2022:9(7);818-824.

Kutluay L, Vicdan K, Turan C, Batioglu S, Oguz S, Gokmen O. Tubal histopathology in ectopic pregnancies. Eur J Obstetr Gynecol Reproduct Biol. 1994;57(2):91-94.

Dahiya N, Singh S, Kalra R, Sen R, Kumar R. Histopathological changes associated with ectopic tubal pregnancy. Int J Pharmac Sci Res. 2011;2(4): 929-933.

Sharma S, Shah MM, Shah IM & Shah MR. A clinic-histopathological study of ectopic pregnancy in a tertiary care hospital with special focus on histomorphology of fallopian tubes in tubal ectopic pregnancy. International Journal of Health Sciences. 2022: 6(S3), 10838-10848.

Huang CC, Lin SY, Lin WC, Chung CH, Lin FH, Tsao CH, Lo CM, Chien WC. Association of pelvic inflammatory disease(PID) with ectopic pregnancy and preterm labor in Taiwan: A nation wide population based retrospective cohort study. PLos ONE.2019:14(8).

Dubuisson JB, Aubriot FX, Cardone V, Vacher-Lavenu MC. Tubal causes of ectopic pregnancy. Fertil Steril 1986; 46: 970-972.

Green LK, Kott ML. Histopathologic findings in ectopic tubal pregnancy. Int J Obstet Gynecol Pathol 1989; 8: 255-256.

Persaud Y. Etiology of tubal ectopic pregnancy. Obstet Gynecol 1970; 36: 257-263.

Hoenderboom BM, Van Benthem BHB, Van Bergen Jeam, Dukers M,Gotz HM, Hoebe CJ. Relation between chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a dutch cohort. Sex transm Infect 2019:95(4): 300-306.

Deborah L, Donegan E, James J, Sweet R, Brooks G. In vitro modelling of acute salpingitis caused by Neisseria gonorrhoeae. Americal Journal of Obste Gynecol.1980:138(7):996-1002.

Chawla N, Kudesia S, Azad S, Singhal M, Rai S. Salpingitis isthmica nodosa. Ind J Pathol Microbiol. 2009;52: 434-435.

Shimray R, Pal PR, Laishram S, Pukhrambam G. Study of resected specimen of ectopic pregnancy : A 5 year experience in a regional institute of medical sciences hospital. J Med Soc.2020;34:149-153.

Jenkins C, Williams S, Schmidt G. Salpingitis isthmica nodosa : a review of literature, discussion of clinical significance and consideration of patient management. Fertility and sterility.1993;60(4):599-607.

Kurman J, Ellenson L, Ronnette B. Blaustin’s pathology of female genital tract. Sixth edition New york: Springer.2011.p-539-541.

Mills S. Sterberg’s diagnostic surgical pathology. Sixth Edition. Walters Kluwer health : Philadelphia. 2015. p-3904-3906.

Tateishi A, Ohira S, Yamamoto Y, Kanno H. Histopathological findings of pregnancy induced hypertension : Histopathology of early onset type reflects two stage disorder theory. Virchows Arch.2018;472:635-642.

Kaur M, Goyal N, Kaur S. Histopathological changes in early human ectopic pregnancy and anatomical considerations for its rupture. Ann. Int. Med. Den. Res. 2018; 4(2): PT01-PT04.