BENIGN DISEASES OF UTERUS, FALLOPIAN TUBES AND OVARIES Rukset Attar, MD, PhD Department of Obstetrics and Gynecology

BENIGN DISEAESES OF THE FALLOPIAN TUBES Infections (Salpingitis, tuboovarian abcess, Pyosalpinx and hydrosalpinx, Salpingitis Isthmica Nodosa Endosalpingiosis Ectopic Pregnancy Isolated Tubal Torsion Paratubal Cyst Benign tubal tumors

Salpingitis is the most common serious infection in women of reproductive age Neisseria gonorrhoeae and Chlamydia trachomatis Gardnerella vaginalis, Escherichia coli, Haemophilus influenzae, group B beta-hemolytic streptococci, nonhemolytic streptococci, Prevotella bivia, Bacteroides species, Peptostreptococcus species, Mycoplasma hominis, and Ureaplasma urealyticum

Salpingitis Outpatient regimens can be considered in mild to moderate PID. The regimens include the following: Ceftriaxone 250 mg IM once, plus doxycycline 100 mg PO bid for 14 d, with or without metronidazole 500 mg PO bid for 14 d Cefoxitin 2g IM single dose plus probenecid 1 g IM single dose plus doxycycline 100 mg PO bid for 14 d, with or without metronidazole 500 mg PO bid for 14 d Other parental 3rd generation cephalosporin plus doxycycline 100 mg PO bid for 14 d, with or without metronidazole 500 mg PO bid for 14 d

Salpingitis Isthmica Nodosa The etiology of SIN is unknown, but it is thought to be an inflammatory condition of the fallopian tubes most likely acquired during the reproductive years as a consequence of an infection. localized nodular thickening or swelling of the On hysterosalpingogram, the fallopian tubes appear normal in size and position; however, numerous small round luminal outpouchings of contrast material are seen in the isthmic portion. These represent the diverticula protruding from the lumen into the myosalpinx. The clinical significance of SIN relies on its strong association with infertility and ectopic pregnancy

Salpingitis Isthmica Nodosa Surgical correction of SIN by tubocornual anastomosis (TCA) or by transcervical recanalization (TCR) of the tubes has been suggested

Endosalpingiosis Refers to the presence of tubal epithelium outside the fallopian tubes, most commonly involving the peritoneal surface of the uterus, fallopian tubes, ovaries, or cul-de-sac. It is most often an incidental finding, affecting about 8% of women. The pathogenesis of endosalpingiosis is similar to that of endometriosis

Endosalpingiosis Most patients in whom diagnosis is made are asymptomatic, and the finding is purely incidental. However, in others, the diagnosis is made during laparoscopic workup of infertility or pelvic pain. Treatment- local resection

Ectopic Pregnancy is the leading cause of pregnancy-related death during the first trimester The major cause of ectopic pregnancy is acute salpingitis, accounting for 50% of cases

Isolated Tubal Torsion is an uncommon cause of acute lower abdominal pain incidence of isolated tubal torsion is about 1 in 1.5 million. It occurs at all ages, although most frequently during reproductive age, in normal as well as diseased tubes, in pregnancy, and even after tubal sterilization.

Isolated Tubal Torsion The etiology of isolated tubal torsion has been subdivided into intrinsic and extrinsic factors. Intrinsic factors include hydrosalpinx, tubal tumor, congenital abnormalities, and prior surgery (including tubal ligation). The extrinsic factors include ovarian and paratubal masses, trauma, adhesions, pelvic congestion, pregnancy, and sudden body movements. These factors contribute to the torsion by providing a point of reference around which the tube can twist

Paratubal Cyst They commonly occur in women aged 30-40 years and are usually discovered incidentally during surgery for other gynecologic reasons. Together with paraovarian cysts, they constitute 10% of all adnexal masses. They are often multiple and small but can vary in size from 0.5 cm to more than 20 cm and can be mistaken for an ovarian mass. When the cysts are in proximity to the ovary, they are called paraovarian cysts. Hydatid cysts of Morgagni are paratubal cysts that are pedunculated and in close contact with the fimbriated end of the fallopian tube.

Paratubal Cyst During pregnancy, paratubal cysts can grow rapidly causing torsion. Management is simple excision. Rarely, malignant changes occur within the cyst, most of which are serous borderline tumors of endometrioid type with low malignant potential. However, few cases of serous papillary cystadenocarcinoma with capsular invasion, as well as transitional cell carcinoma, have been documented

Benign Tubal Tumors Leiomyomas Lipomas Adenomatoid tumors: Adenomatoid tumors of the fallopian tube are common and often associated with leiomyomas and adenomyosis of the uterus. They appear as small subserosal nodules 1-2 cm in size, gray-white in color, and circumscribed. They are formed of a combination of 2 tumor types, adenoid and angiomatoid, can be solid or cystic, and are of mesothelial origin