Female Genital System Diseases: Inflammation of Fallopian Tube and Ovary

Inflammation of the Fallopian Tube

• Acute salpingitis is usually caused by bacterial infection, commonly due to sexual transmission (Neisseria gonorrheae, Chlamydia, Mycoplasma) and may cause infertility.
• Gross features of acute salpingitis include pyosalpinx (pus), hematosalpinx, enlarged, erythematous, and edematous tubes with fibrinous exudate.
• Microscopic features include marked neutrophilic infiltrate, congestion, edema, mucosal ulceration, and reactive epithelial changes.
• Good prognosis, can be healed, but may lead to tubo-ovarian abscess.

Chronic Salpingitis

• Results from repeated episodes of acute salpingitis.
• Destroys tubal epithelium, leading to fibrosis and infertility.
• May lead to ectopic pregnancy and can be superinfected with acute inflammation.
• Gross features include enlarged, distorted tubes adherent to ovaries, with hydrosalpinx or pyosalpinx that transforms to a tubo-ovarian cyst.

Tuberculous Salpingitis

• Usually bilateral, with hematogenous spread from primary locus elsewhere in the body (mostly lung).
• Associated with young infertile patients with endometrial involvement.
• Chronic interstitial salpingitis features fibrosis or mononuclear cell infiltration of all layers of the wall.
• Foreign body salpingitis features giant cell formation.

Complications of Salpingitis

• Tubal damage and infertility.
• Ectopic pregnancy is a major complication, approximately 7-10 times more common in women who have had 1 episode of salpingitis.
• Other complications include chronic pelvic pain, dyspareunia, and adhesions.

Ovaries

• Almond-shaped bodies, 3cm long, covered by germinal epithelium (simple squamous).
• Beneath the germinal epithelium lies the tunica albuginea, a dense connective tissue.
• The cortex lies underneath the tunica albuginea, where ovarian follicles are situated.
• Medulla contains a rich vascular bed in loose connective tissue.

Inflammation of the Ovary (Ovaritis/Oophoritis)

• Oophoritis is an uncommonly used term for pelvic inflammatory disease (PID).
• Ascending infection of the ovaries from surroundings or by hematogenous spread.
• Tubes are always infected, leading to ovariosalpingitis (inflammation of both ovary and fallopian tube).
• Usually acute, suppurative reaction, with tubo-ovarian abscess formation, which can rupture and lead to peritonitis.
• Healing is accompanied by fibrosis, which can lead to sterility.

Complications of Ovaritis

• Ruptured tubo-ovarian abscess (TOA) is a surgical emergency with a high mortality rate.
• Infertility occurs in 12-15% of women after a single episode of PID.
• The chances of ectopic pregnancy are increased with PID.
• Chronic pelvic pain is a possible long-term consequence of PID.