Histopathologic changes in fallopian tubes following tubal ligation

Although tubal sterilization is a common procedure, reports of post-ligation histopathologic changes in fallopian tubes are sporadic and outdated. We aim to report our findings of the histopathologic changes in fallopian tubes in a series of women who had tubal ligation. We identified 14 women [age range: 36-53 years, average age: 43 years, ligation interval time range: 10 months- 20 years, average ligation interval: 10 years] who met the inclusion criteria for post-ligation tubal changes. The proximal segments of the ligated tubes showed salient histopathologic changes. Hydrosalpinx was present in eight tubes from seven patients (six unilateral, one bilateral; diameter range: 9-15 mm, average: 11.0 mm), while eleven tubes from ten patients demonstrated hematosalpinx (ten unilateral, one bilateral; diameter range: 8-14 mm, average: 11.0 mm). Six tubes from three patients showed concurrent unilateral hydrosalpinx with contralateral hematosalpinx. Additionally, five tubes from four patients revealed flat and nodular polypoid endometrialization of the endosalpinx (tubal endometriosis), four were associated with hematosalpinx and one with hydrosalpinx. Two tubes from two patients manifested pseudoxanthomatous salpingitis, one was associated with pelvic endometriosis and the other one with hematosalpinx. Eight unilateral tubes from eight patients did not demonstrate any histopathologic changes. The ten patients who demonstrated tubal histopathologic changes had uterine leiomyomas, adenomyosis and endometrial polyps, whereas one patient had pelvic endometriosis. The remaining three patients showed similar tubal changes without any associated lesions. Five tubes from four patients revealed miscellaneous endosalpingeal and peritubal histopathologic findings. They included mucosal pseudopolyps with foamy macrophage aggregates and microcalcifications within the lamina propria. Additionally, peritubal stromal foreign-body giant cell reaction, suture granulomas, pseudoxanthomatous nodules, and detached fimbriae with foreign-body giant cells within their lamina propria were identified. The distal segments of the ligated tubes, when present, were unremarkable. Certain endosalpingeal histopathologic features can provide clues to ligation-related changes of fallopian tubes in gynecologic resection specimens. Additionally, certain peritubal findings may indicate previous tubal sterilization procedures when clinical history is lacking. However, because these features overlap with non-ligation tubal lesions, clinically confirming a history of ligation is essential to reach the correct diagnosis.