Fimbrial End Research Articles

Effects of salpingectomy on ovarian response in controlled ovarian hyperstimulation for in vitro fertilization: a reappraisal

To evaluate the effects of salpingectomy on ovarian response in controlled ovarian hyperstimulation (COH), 36 women who underwent controlled ovarian stimulation cycles for IVF before and after salpingectomy were studied. The overall number of dominant follicles and the number of oocytes aspirated before and after salpingectomy were comparable (7.2 ± 3.8 vs. 7.3 ± 3.7 and 10.2 ± 6.6 vs. 10.3 ± 7.4, respectively) as well as maximal E(2) levels, daily doses of gonadotropins, and the number of dominant follicles before and after surgery on the operated side, demonstrating that salpingectomy does not influence ovarian response in COH.

Adenofibroma and ectopic pregnancy of left fallopian tube: A rare coexistence

A rare coexistence of an adenofibroma and ectopic pregnancy in the left fallopian tube is reported. Adenofibroma is a rare benign neoplasm of the fallopian tube, and the fallopian tube is the most common site of ectopic pregnancies. However, coexistence of such rare tumor and ectopic pregnancy is extremely rare. Review of literature has not revealed another case of such coexistence in English literature. In the present case, the adenofibroma was found at the fimbrial end. Placental tissue, consisting of chorionic villi and trophoblastic cells was present in the ampulla of fallopian tube.

Advanced Fimbrial Ectopic Pregnancy Resulting in Live Birth

Background: Advanced fimbrial pregnancy resulting in live birth is a very rare entity and only 1 such case was reported in the literature. Case: A 30-year-old multigravida with no risk factors for ectopic pregnancy underwent a medical termination of pregnancy (MTP) and laparoscopic sterilization at 5 weeks and 5 days of pregnancy at a nursing home. She had minimal bleeding for 2 days following the procedure and suffered later with recurrent vomiting and fever and was hospitalized elsewhere for the same condition about 3 months later. She was diagnosed as having enteric fever and was accordingly treated. As she felt fetal movement, she approached a gynecologist who performed an ultrasound and diagnosed her as having intrauterine pregnancy of 32 weeks gestation with a breech presentation with oligohydramnios. When she came to our Institution, she was mildly pale with superficial fetal parts being felt in a 32-week-sized abdomen. Ultrasonography (USG) confirmed secondary abdominal pregnancy of a live fetus in breech presentation at 33 weeks without any anomalies. During conservative management, she had sudden pain in the abdomen with tachycardia, and the pregnancy was terminated by emergency laparotomy. The fetus was alive in the transverse position in the peritoneal cavity and weighed 2.8 kg and had minimal right-sided cranial asymmetry. The placenta was implanted on the left fimbrial end of the fallopian tube and derived its blood supply from the infundibulopelvic ligament. Conclusions: This case illustrates that if one is not careful in tracing the fallopian tube in its entire length at the time of sterilization, an ectopic pregnancy can be missed, which may be fatal. It is also essential to perform a transvaginal USG prior to MTP in cases of early pregnancy to avoid this happening. Onset of pain abdomen and tachycardia denote a rupture of the amniotic sac in cases of abdominal pregnancy on conservative treatment, and one should act upon it and do a laparotomy to save the fetus and mother from hemorrhage, as separation of the placenta can take place after a rupture of the amniotic sac, in some cases. (J GYNECOL SURG 26:57)

Automated sonographic tubal patency evaluation with three‐dimensional coded contrast imaging (CCI) during hysterosalpingo‐contrast sonography (HyCoSy)

Evaluation of tubal status is one of the initial steps in the diagnostic work-up of infertile women. Hysterosalpingo- contrast sonography (HyCoSy), currently performed as part of the infertility work-up to assess tubal patency by transvaginal ultrasound (TVS) 1 , is based on the introduction of fluid into the uterine cavity and Fallopian tubes. To evaluate the Fallopian tubes, a sonographic enhancing positive-contrast medium may be used. Air, albumin with micro air bubbles, and galactose with micro air bubbles have been studied. These positive- contrast agents outline the course of the Fallopian tubes, producingahyperechoicappearance.Themostsimpleand inexpensive positive-contrast medium is saline solution mixed with air. When this solution is shaken, it generates as uspension of air bubbles that is easily identif ied sonographically when injected into the uterine cavity and Fallopian tubes 2-4 with spillage around the ovaries. However, while two-dimensional (2D) TVS HyCoSy with saline solution mixed with air appears to be an accurate and inexpensive screening tool to assess tubal patency, it is highly observer-dependent and is accurate only in the hands of experienced investigators 2-5 . In addition,

Hydrotubation In The Management Of Female Infertility: Outcome In Low Resource Settings

To determine the outcome of therapeutic hydrotubation (tubal flushing) in patients with tubal infertility and unexplained infertility. Prospective non-randomised observational study. Alba hospital, a five bed multidisciplinary private hospital in Kaduna city, Nigeria. Infertile women with tubal and unexplained infertility. Two hundred and fifty seven patients that had therapeutic hydrotubation over 7.5 years were analysed. The age range was 21 to 44 years with mean of 34.5 years. Secondary infertility was found in 209 (81.3%) patients and primary infertility in 166 (64.6%) patients. Of the 257 patients, 134 (52.1%) had had induced abortion. Indications for hydrotubation were bilateral perifimbrial adhesion (incomplete tubal occlusion) 47.9%, bilateral fimbrial end occlusion 24.9%, bilateral cornual blockage 16% and unexplained infertility in 11.3% of cases. One hundred and nine conceptions were recorded in this study and the overall conception rate was 42.4%. Likewise, percentage ratio of conception in these 154 patients with evidence of post-hydrotubation tubal patency was 70.8%. Pregnancy outcome of the 109 conceptions are term pregnancy 84.4%, preterm pregnancy 9.2%, miscarriage 4.6% and ectopic pregnancy in 1.8% of the conceptions. Recorded complications were pelvic pain in 177 (68.9%) patients and vaginal bleeding in 63 (24.5%) patients. With good case selection, therapeutic hydrotubation may be beneficial in resource poor countries, especially in patients with incomplete tubal occlusion (bilateral perifimbrial adhesions) and as part of treatment for unexplained infertility.

High Rates of Occult Fallopian Tube Cancer Diagnosed at Prophylactic Bilateral Salpingo-Oophorectomy

To determine the rate of occult malignancy in patients undergoing prophylactic bilateral salpingo-oophorectomy in Northern Sydney. A retrospective case series of 45 consecutive patients who underwent prophylactic bilateral salpingo-oophorectomy between 2004 and March 2008. Five (11%) cases of occult neoplasia were found in 45 patients. This included 3 cases of micro-invasive serous carcinoma of the fallopian tube, 1 case of in situ carcinoma in the fallopian tube and 1 case of metastatic breast cancer in the ovary. All cases of primary neoplasia were in the fimbrial end of the fallopian tube. The importance of complete removal of the fallopian tubes and ovaries and the rigorous systematic pathological examination of these specimens are demonstrated in this case series. It supports emerging evidence that the fimbrial end of the fallopian tube is an important site of genesis of cancer in BRCA1/2 mutation carriers.

Secretory Leukocyte Protease Inhibitor: Immunohistochemical Evidence Supporting a Fallopian Tube Origin for Serous Papillary Carcinoma

Serous papillary carcinoma (SPC) represents the most common histological type of ovarian carcinoma, which is the fifth leading cause of cancer-related death in women in the United States. 1 The tissue of origin for SPC remains controversial. It is believed by many authors that the cancer arises from the surface epithelia of the ovary or the cells that line ovarian inclusion cysts. 2-3 In this theory, the ovarian surface epithelium (OSE), usually flattened with no distinct features, undergoes Mullerian metaplasia and through possible undefined molecular events, acquires serous papillary morphology during malignant transformation. A contrasting opinion is that SPC may arise from the fallopian tube (FT), this supposition based on the morphologic resemblance of SPC to the fimbriated end of the FT. A recent report 4 investigating the patterns of gene expression among different histotypes of epithelial ovarian cancer showed strong correlation of expression profile of serous papillary carcinoma with that of the fallopian tube. [N A J Med Sci. 2009;2(2):42-43.]

Process of oocyte release and capture in the human

The THL was performed under local anaesthesia. The patient was conscious and could follow the entire procedure. The ovulation stigma was identified on the caudal pole of the left ovary. The fimbriae were in close contact embracing the caudal pole of the ovary. Due to vasocongestion, the fimbrial vessels were engorged and the fimbrial ends erected. In a pulsatile way, they were sweeping the surface of the ovulation ostium. At closer inspection, a mucinous structure was seen protruding from the ovulation ostium and stretched between the fimbrial ends and the ostium. The pulsatile movements of the fimbriae, synchronous with the patient’s heartbeat, slowly pulled the cumulus–oocyte complex free from the ostium of the ruptured follicle. During the observation, follicular fluid could be seen leaking from the ostium. The total duration of the observation lasted for 15 min.

Three-Dimensional (3D) Coded Contrast Imaging: A New Ultrasound Approach to Evaluate Tubal Patency

Study Objective: Transvaginal hystero-salpingo-contrast-sonography (TVS HyCoSy) with air-saline mix solution appears to be an accurate and inexpensive screening tool to assess tubal patency. However, HyCoSy with saline-air mix solution has some limitations. Since the surrounding bowel and the fimbrial ends have similar echogenicity, is not easy to visualize spillage of the saline-air mix at the distal portion of the tubes. The aim of this study is to assess the validity of a new dedicated contrast-enhanced ultrasound technology in the evaluation of tubal patency and in the visualization of tubal course.

LAPAROSCOPIC DETECTION AND MANAGEMENT OF SUBTLE FIMBRIAL ABNORMALITIES AMONG INFERTILE WOMEN

Objective : To detect subtle fimbrial abnormalities by laparoscopy in infertile women and consequently to manage such cases.Material and Methods : Two hundred and eighty five patients with infertility underwent laparoscopy as a part of infertility evaluation at Mansoura University Hospital. During laparoscopy. fimbrial grasping by non-traumatic forceps and a probe were undertaken to evaluate the fimbrial end of the tube to detect any abnormalities. Serological testing for Chlamydia trachomatis was done in cases of fimbrial abnormalities and then following up pregnancy rate for at least one year.Results : Among 285 patients; 41(14.3%) patients had been found to have subtle fimbrial abnormalities in the form of fimbrial phimosis and agglutination. The technique was performed without significant complications. Chlamydia serology was observed in 26.8% of cases with subtle fimbrial abnormalities. The overall pregnancy rate was (36.5%). Conclusions : Laparoscopy still has its place for diagnosis and management of tubal factor infertility. Surgical correction of subtle fimbrial lesions may improve the fertility potential and increase pregnancy rate in infertile women.

A case of hydrosalpinx associated with the menstrual cycle

To describe a case report of hydrosalpinx that changed dramatically in size during the menstrual cycle. Case report. University teaching hospital reproductive endocrinology and infertility practice. A 32-year-old woman with a history of medical and surgical treatments of endometriosis who sought infertility treatment. Transvaginal ultrasonography performed sequentially during menstrual cycles. Size of hydrosalpinx-like image. The size of the hydrosalpinx-like image in the left adnexal region varied; it peaked during the ovulatory period and then remarkably diminished in a cyclic manner. Laparoscopy revealed a dense adhesion between the left tubal fimbriated end and the posterior uterine wall, which led to terminal obstruction of the tube. Change in the volume of the hydrosalpinx in this case was speculated to reflect the normal tubal fluid production regulated by ovarian hormones.

The distal fallopian tube: a new model for pelvic serous carcinogenesis

Research over the past 50 years has yielded little concrete information on the source of pelvic serous cancer in women, creating a knowledge gap that has adversely influenced our ability to identify, remove or prevent the earliest stages of the most lethal form of ovarian cancer. The distal fallopian tube is emerging as an established source of many early serous carcinomas in women with BRCA mutations (BRCA+). Protocols examining the fimbrial (SEE-FIM) end have revealed a noninvasive but potentially lethal form of tubal carcinoma, designated tubal intraepithelial carcinoma. Tubal intraepithelial carcinoma is present in many women with presumed ovarian or peritoneal serous cancer. A candidate precursor to tubal intraepithelial carcinoma, entitled the 'p53 signature', suggests that molecular events associated with serous cancer (p53 mutations) may be detected in benign mucosa. A fully characterized precursor lesion is a first and necessary step to pelvic serous cancer prevention. The emerging data offer compelling evidence for a model of 'fimbrial-ovarian' serous neoplasia, and call attention to the distal fallopian tube as an important source for this disease, the study of which could clarify pathways to cancer in both organs and generate novel strategies for cancer prevention.

Reply

Sir, We thank Dr. Sjors Coppus for his interest in our article. The sensitivity and specificity of 3D-HyCoSy stated in the article referred to those for detection of tubal patency in our study, as stated in the abstract and results sections of the manuscript. Although the sensitivity and specificity for tubal occlusion are used in most studies, some studies did express their results in terms of tubal patency 1, 2 including the largest study evaluating the diagnostic accuracy of HyCoSy as compared to laparoscopy by Hamilton et al. 1. In fact, the same problem exists when studies comparing the diagnostic accuracy of various modalities of evaluating tubal patency. In the future, it will be ideal to standardize the data presentation method. In our study, we were unable to determine the tubal patency in 8 out of 42 (19%) tubes. In two patients (9.5% of patients), the procedure was abandoned because of excessive pain. They represented true procedure failure. The percentage was compatible with that reported (7.4%) in the literature 1. We failed to trace the remaining 4 tubes in 2 patients to the fimbrial end and hence could not draw a conclusion as to whether the tubes were patent. This represented 10.5% of all tubes that were subjected to 3D-HyCoSy assessment and was again compatible with that reported (7.4%) in the study by Hamilton et al. 1. Two early studies evaluating tubal patency with 3D-HyCoSy reported even higher failure rates (14.9% and 24%) in visualizing the entire tube 2, 3. The interpretation and calculation of the test accuracy of the inconclusive results from 3D-HyCoSy did present a problem. There is no ideal way to solve this problem, which happens in real clinical situations. We have chosen to assume those which were inconclusive as discordant with laparoscopy so as not to over-exaggerate the diagnostic accuracy of this new modality of tubal assessment at the expense of underestimating its performance. Nevertheless, we believe that one should be more stringent in the evaluation of a new diagnostic method. Underestimating is always better than overestimating its usefulness as a new diagnostic tool. Expressing the sensitivity and specificity of the HyCoSy test based on the number of Fallopian tubes studied has been used previously 1, 2, 4. Using the number of Fallopian tubes rather than patients studied as the base for calculation better reflects the usefulness of this new diagnostic tool in the study of tubal status. Even when clinical practice is concerned, unilateral tubal blockage still bears significance in deciding the treatment that should be advised. Patients should be treated with superovulation and intrauterine insemination only when both tubes are patent. Those with tubal disease including unilateral tubal blockage should be offered in vitro fertilization early. There is little controversy in the operator dependency of conventional 2D-HyCoSy as pointed out by Dr. Sjors Coppus. 3D-HyCoSy has the advantage that the images can be captured at the time of scanning and be evaluated later, so that the requirement on the technique of the operator is minimal. Although we did not evaluate the intrapersonal variability in diagnosis of tubal patency, the reproducibility can be indirectly reflected by the relatively lower percentage of tubes that could not be evaluated in our study as compared to that previously reported 2, 3. All images were analyzed by a single investigator and hence any interpersonal variation was eliminated. We admit that this study was a preliminary one and further evaluation on the diagnostic accuracy, patient acceptability, and cost-effectiveness has to be performed before it can be recommended as a standard diagnostic tool in the initial assessment of patients with subfertility.

Histological Evaluation of a New Concept Eliminating the Need for Suture or Glue During Fallopian Tube Anastomosis in the Sheep Model

Fragestellung: Histologische Evaluation einer neuen Technik zur Tubenanastomose im Tiermodell. Methode: Eileiter von 12 Schafen wurden bilateral durchtrennt. Ausgehend vom Fimbrientrichter wurde ein Polyvinylkatheter in die Tube eingefügt. Die freien Enden wurden zusammengefügt und der Katheter mithilfe von Titanklemmen ohne Verwendung von Faden oder Klebematerial fixiert. Die Operationsdauer, die Tubendurchgängigkeit, die Bildung von Fibrosen, Granulomen, Entzündungen und Lumenänderungen wurden 30 Tage nach Eingriff evaluiert. Ergebnisse: In 21 (87,5 %) der resezierten Tuben konnte durchgängiges Epithel gefunden werden. Akute entzündliche Veränderungen und Fistelbildung wurden in 2 (8,3 %) beziehungsweise in 1 (4,2 %) der Fälle beobachtet. Es gab keine Fibrosen oder Granulome. Schlussfolgerung: Die Verwendung eines inerten Katheters für die tubare Anastomose im Tiermodell führt in situ zu einer hohen Rate an Reepithelisierung. Die vorgestellte Technik verspricht eine mögliche Anwendung in der Tubenrekonstruktion.

Borderline endometrioid tumor arising in a paratubal cyst: a case report

Background Paratubal cysts, generally known as hydatid cysts of Morgagni, are small round cysts attached by a pedicle to the fimbriated end of the tube. The following represents the first reported case of an endometrioid tumor of low malignant potential arising in a paratubal cyst. Case report A 45-year-old nulliparous female was referred with a complex right adnexal mass on pelvic sonogram. She underwent laparoscopic bilateral ovarian cystectomy and partial right salpingectomy (for a 3-cm torsed paratubal cyst). All frozen-section diagnoses were benign; however, final pathology revealed a borderline tumor of low malignant potential of endometrioid type in the right paratubal cyst. The patient underwent extensive counseling regarding management options and decided to have a laparoscopic right salpingo-oophorectomy. Final pathologic analysis revealed no evidence of persistent borderline tumor. Conclusion Paratubal cysts are very difficult to diagnose with sonography; therefore, their management should be approached as any other adnexal mass. Laparoscopic surgery is an option in the management of adnexal masses; however, rupture or puncture of masses should be avoided when possible to prevent potential tumor dissemination in the event of a malignancy.

Primary fallopian tubal transitional cell carcinoma with exfoliation of malignant cells in cervical Pap smear

Primary fallopian tubal carcinoma is a rare (0.2- 0.5%) gynecological malignancy. A primary transitional cell carcinoma (TCC) of the fallopian tube accounts for about 10% of primary fallopian tubal carcinomas. Exfoliation of cells of primary fallopian tubal TCC in cervical Pap smear has not been described previously. The present case is of a 52 years old female, who presented with episodic spotting per vaginum. Cervical Pap smear revealed clusters of malignant cells. Total abdominal hysterectomy with bilateral salpingo ophrectomy was performed. A tumor was found in the right fallopian tube occluding its fimbrial end. On microscopy, the tumor was confirmed to be a TCC. Therefore, if cervical Pap smear is positive for malignant cells and the cervical biopsy is negative, the patient should be investigated for a gynecological malignancy higher up in the gynecological tract. Though rare, a possibility of primary fallopian tubal malignancy should be considered in these cases.

Hystero-salpingo-contrast-sonography with 3-d-ultrasound -- a pilot study

Hystero-salpingo-contrast sonography (HyCoSy) is a sensitive method of assessing tubal patency but cannot completely substitute diagnostic laparoscopy with blue dye and hysteroscopy. Three-dimensional sonography has new imaging facilities which could lead to a reduction of invasive diagnostic procedures. The aim of this pilot study was to analyse the feasibility of HyCoSy by 3D- and 3D-Doppler-sonography. In a prospective setting conventional (2D) HyCoSy was performed in 21 patients with an ultrasound device designed for 3D-ultrasound. After the completion of the 2D procedure, 3D-ultrasound was carried out. In five patients an additional 3D-Doppler-HyCoSy was performed. The generated 3D-volumina were then examined. Laparoscopy with blue dye was performed immediately after the ultrasound examination. A total of 42 Fallopian tubes was assessed. On 2D-ultrasound, visibility of the tubes was excellent in 28 and limited in seven tubes. Of the seven tubes not visible on 2D-ultrasound, four were not patent on laparoscopy. On 3D-ultrasound, visibility of the tubes was excellent in 15 and limited in twelve tubes. 15 tubes were not visible on 3D-ultrasound. 3D-Doppler-HyCoSy revealed excellent assessment in eight of ten tubes, even in one of those with limited visibility on 2D- and 3D-HyCoSy. In 19 patients the assessment of the uterine cavity was excellent by 2D- and 3D-HyCoSy, whereas it was limited in two patients. It is possible to visualise the full length of the tubes in a very detailed way from the uterine cavity to the fimbrial end in some patients, but the diagnostic power of HyCoSy is not improved by adding 3D-imaging. The accuracy of 3D-ultrasound seemed to be improved by 3D-Doppler-ultrasound.

Prolapse of the uterine tube after subtotal hysterectomy

Hysterectomy is one of the most frequently performed operations in gynaecology. Subtotal hysterectomy may lead to complete relief of symptoms while sexual and bladder function may be less affected, compared with total hysterectomy. Many comparative studies have been published, as well as a decision analysis. According to the latest reports, the earlier proposed benefits of subtotal hysterectomy have not been substantiated, and complications following both procedures seem to be more or less comparable. In this case report, we present a complication which, to our knowledge, never before occurred following subtotal hysterectomy but is known as a rare complication of both vaginal and abdominal hysterectomy. A 49 year old woman visited the outpatient department of our hospital with menorrhagia resulting in anaemia. She had a history of angina pectoris, severe abuse of alcohol and psychiatric problems. Transvaginal sonography showed uterine fibroids. She was initially treated with lynestrenol, which failed to relieve her symptoms. She then received goserelin, also without success. A subtotal hysterectomy was performed without complication. A reversed conal biopsy, as suggested in literature in order to prevent persistent menstruation, was not performed. The woman went home one week later. Two weeks after discharge she attended the outpatient department complaining of abdominal discomfort and vaginal discharge and bleeding. Transvaginal sonography showed an echodense mass measuring 6 5 8 cm, thought to be an abscess or an organising haematoma, situated at the top of the cervix. Amoxycillin was started, after which her fever decreased. The pelvic mass also decreased, and drainage was not performed. Two weeks later, her fever and abdominal discomfort had fully disappeared. On speculum examination, a polyp protruded from the external os of the cervix. On close inspection, this structure seemed to be the fimbrial part of a uterine tube. Pulling of the structure resulted in pain on the left side of the lower abdomen. Under regional anaesthesia, the uterine tube was resected transvaginally as proximally as possible, 5 cm from the fimbrial end (Fig. 1). The proximal part of the uterine tube retracted via the cervical canal into the abdomen. Finally, the external os was securely closed. The woman recovered from this operation without any problems and was discharged later that day. Pathological examination of the excised tissue confirmed that it was a uterine tube. One year later she has had no complaints.

Undescended fallopian tubes and ovaries: a rare incidental finding during an infertility investigation work up

Congenital anomalies of tubes and ovaries are quite uncommon. Failure of descent of the ovary has been reported in the literature. Evans and Cade presented the first case while Walker made references to another three cases (1–3). Transabdominal migration of the testis compared with the ovary occurs at the 10–15 weeks of gestation in the human and inguinoscrotal migration occurs at 26–35 weeks of gestation (4). Hutson et al. previously proposed that the first phase of migration is controlled by mullerian inhibiting substance, although this remains controversial. The second phase is androgen dependent and is possibly mediated indirectly through the release from the genitofemoral nerve of the neuropeptide calcitonin gene-related peptide. This paper is the first reported case of such malpositioned organs as an incidental finding during the routine infertility investigation work-up A 19-year-old female, gravida 0, presented with a desire to bear children with a history of unprotected intercourse for 1.5 years in duration. Her menstrual periods were regular, 25 days interval with 7 days of normal amount of bleeding. On the speculum examination the cervix was normal in appearance. On bimanual examination, the uterus was retroverted and normal in size. Transvaginal ultrasonographic examination failed to demonstrate both ovaries. Cycle day 3 plasma FSH, LH, PRL and TSH levels were all in normal laboratory ranges. Her husband's semen parameters revealed normal values. Hysterosalpingography revealed a bicornuate uterine appearance with bilateral tubal extending all the way up to the level of the third lumbar vertebra. Tubal patency was confirmed by the visualization of the radioopaque fluid in paracolic area. There was no dye found in the pelvic localization. 1-3 Hysterosalpingographic appearance of the case. Note the uterine biocornuate shape. Left tube extending to the hypocondriac area and distribution of the radioopaque dye. Right Tube extending to the right hypocondriacarea and tubal passage of the dye. A diagnostic laparoscopy was performed. Left and right tubes were extending cranially to the hipocondriac areas crossing the iliac vessels and ureters anteriorly on both sides.Figures 4–6. Methylene blue passed from the fimbrial ends of both tubes. Panoramic view of the internal genitalia. Fig. 5. Right adnexial structure. Fig. 6. Right proper ligament of the ovary and the right tube crossing the iliac vessels. There are reports in the literature about undescended ovary and its relation with the adverse reproductive outcome. Seoud et al. reported a case of a ruptured ectopic pregnancy in an undescended fallopian tube. The tube and its ipsilateral ovary were located near the splenic flexura of the colon (5). Knudsen and Clausen reported an ectopic pregnancy in a non-communicating undescended fallopian tube. A rare embryological failure in development consisted of a right hemiuterus, remotely located non-communicated left fallopian tube and undescended left ovary; associated with the agenesis of the left kidney (6). They suggested that a non-communicating fallopian tube should be removed to prevent ectopic pregnancy; immediately when recognized. Granat et al. reported the first case of pregnancy in the proximal end of a fallopian tube situated in the left upper quadrant, attached to the peritoneum (7). However, in their patient, the ipsilateral ovary was found in the mid-abdomen and both structures were unattached to the pelvic organs by any structure. All three cases in the literature have occured in the undescended fallopian tubes. Authors have thought that ectopic pregnancies found in the undescended tubes could have occured via transperitoneal migration of the sperm through the normal contralateral tube. There are reports in the literature unrelated to adverse reproductive outcome. Machiels et al. presented a case of ectopic ovary in a 5-month-old-baby in the left labia majora (8). Kriplani et al. and Peedicayil et al. reported ectopic ovaries in the omentum (9, 10). The ectopic ovary in a stillborn female is the first report described by Lachman and Berman (11). Carosso and Rickenbacher presented an ectopic avary and fallopian tube without fimbriated end in a 17-year-old-female with a retroperitoneal cystic tumor (12). Peer et al. published a case of bilateral adnexal agenesis with an ectopic ovary (13). We present a rare case that is well documented and illustrated, but we are not able to explain why this patient is infertile. Apparently the major risk is ectopic pregnancy and the review of the literature on this complication could be more elaborated and the results tabulated. From this point of view our case is unique in the literature for being both tubes and ovaries undescended may be a causative factor for infertility. We would like to emphisize that under the light of this limited literature, in the case of undescended ovaries and tubes, there is a need of investigation whether this rare event may cause infertility.

Saline infusion sonohysterography in endometrial cancer: assessment of malignant cells dissemination risk

To assess the risk of malignant cells dissemination in patients with endometrial cancer undergoing saline infusion sonohysterography (SIS). Fourteen consecutive patients (mean age: 58.1 years, range: 41-74 years) diagnosed as having a clinical stage I endometrial carcinoma and scheduled for surgical staging were entered in this study. SIS was performed at the time of laparotomy just when the abdomen was opened and prior to the start of the surgical procedure. 10-20 mL of saline was infused. All fluid spilled from the fimbrial ends of the fallopian tubes was collected and analyzed for the presence or absence of malignant endometrial cells. Samplings were also taken from ascites, if found, or cytological washings, prior to and after SIS. SIS could be satisfactorily performed in all patients. There was no spillage from either tube in nine patients. Mean fluid volume obtained from the other five patients was 4.4 mL. Cytologic analysis revealed the presence of malignant cells in the spilled fluid in one case (7.1%, one out of fourteen). Our data show that a small but real risk of malignant cell dissemination exists in patients with endometrial carcinoma who undergo SIS.