Cytomorphologic clues for the diagnosis of fallopian tube prolapse in liquid-based vault samples with review of the literature.

INTRODUCTION: Fallopian tube prolapse (FTP) is a rare complication of hysterectomy. The cytological features of the prolapsed fallopian tube in vault smears have been occasionally described in the literature.

MATERIALS AND METHODS: This was a retrospective study conducted to identify and describe the characteristic cytologic features of histopathologically confirmed cases of FTP in SurePath™ liquid-based preparations. Additionally, the literature documenting cytologic features of the prolapsed fallopian tube in vault smears was also reviewed.

RESULTS: A total of four corresponding vault cytology samples of FTP cases, reported on histopathology, were available. On cytologic examination, these cases demonstrated strips and papillaroid clusters of columnar-shaped cells with mild nuclear enlargement, round to elongated nuclei, fine chromatin, inconspicuous nucleoli, and a moderate amount of wispy cytoplasm. Admixed inflammatory cells were also noted. Some of these cells demonstrated the presence of cilia and terminal bar toward the apical surface, indicative of tubal epithelium. The presence of three-dimensional papillaroid clusters lined by columnar cells as well as strips of similar cells with cilia and terminal bars at the apical surface and fine nuclear chromatin were the most consistent cytologic features in these cases.

CONCLUSION: We conclude that a high index of clinical suspicion in post-hysterectomy cases with knowledge of the characteristic cytologic features can help in suggesting a diagnosis of tubal prolapse in vault samples.