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

Leighton Hospital, Mid Cheshire NHS Foundation Trust, Middlewich Road, Crewe, Cheshire, CW1 4QJ.
Diagnostic Cytopathology (Impact Factor: 1.12). 02/2013; 41(2). DOI: 10.1002/dc.21742
Source: PubMed


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. Diagn. Cytopathol. 2011; © 2011 Wiley-Liss, Inc.

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    ABSTRACT: We reported on a case of granulation tissue of large size in the vagina after Manchester operation. A 71-year-old patient was admitted with a tumor of 7 cm in diameter in the vagina. The patient had undergone Manchester operation a year before. Granulation of tissues in the vagina are an often complication after hysterectomy. Clinical symptoms are mucous or blood secretion and mild coital bleeding. In some cases it might also be asymptomatic. It was found that in more than 30% of women after hysterectomy there is granulation tissue in the vagina. It was observed that in more than 60% it is ≤5 mm in size and that it regresses more often than in cases where it is of >5 mm (72% and 33%, respectively). Granulation tissue of >10 mm is very rare. Double biopsies of the 7-centimeter tumor did not provide sufficient information on the tumor origin. There are different therapeutic options for granulation tissue depending on its size - from observation to laser and surgical treatment. In the presented case the only possible option was according to us cautious removal of the tumor from the anterior wall of the vagina to prevent bladder damage. Tumor excision was performed - immunohistochemical staining methods revealed granulation tissue.
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