Original Research Paper
Histopathological Changes in Fallopian Tubes in Ectopic Tubal Pregnancy: An Observational Study
Background: The incidence of ectopic tubal pregnancy varies from 1 in 300 to 1 in 150 pregnancies. Tubal pregnancy may terminate by tubal abortion or tubal rupture, contributing significantly to maternal morbidity and mortality. Keeping in view the high rate of tubal pregnancy and highly variable incidence of pathological changes in the tube, this work was planned to study the morphological alterations in fallopian tube histology in ectopic tubal gestation and to identify the pathological conditions most frequently associated with it. Methods: The 6 year study (5years- retrospective and one year prospective) included 220 histologically proven cases of ectopic tubal pregnancy diagnosed in the Department of Pathology, Government Medical College, Jammu.For the prospective study, formalin-fixed gross specimens were routinely processed and stained with H&E. Retrospective analysis was done by retrieving the slides of the diagnosed cases of tubal ectopic pregnancy from archives of Histopathology Section of the Department of Pathology, Government Medical College, Jammu. The sections from fallopian tubes with tubal pregnancy were examined microscopically for the evaluation of associated morphological features like haemorrhage, edema, acute/chronic/granulomatous/inflammation, perforation/rupture, extent of wall invasion by chorionic villi, necrosis, fibrosis, luminal contents, decidualised stroma, salpingitis isthmica nodosa, walthard cell nests, inclusion cysts, neoplasia and any congenital anomaly.Results: Out of 220 cases studied, majority of ectopic tubal pregnancies were on right side and presented at less than 8 weeks of gestation. Approximately three-fourth of the cases were encountered in females aged 18-32 years. The most frequent and consistent observation was the presence of an inflammatory infiltrate in the tubal wall seen in 203 out of 220 cases. Based on the morphological alterations observed on microscopy, the pathological conditions associated with the ectopic tubal gestation were classified as chronic salpingitis (53.18%), acute on chronic salpingitis (15.45%), acute salpingitis (12.73%), follicular salpingitis (5%), granulomatous salpingitis (0.45%), salpingitis isthmica nodosa (10%), walthard cell nests (6.82%) and inclusion cysts (0.90%). Conclusion: The study highlights that inflammation of tubes i.e. salpingitis is the most common pathological condition associated with tubal ectopic pregnancy followed by the salpingitis isthmica nodosa.
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