J Pathol Transl Med.  2015 Mar;49(2):148-155. 10.4132/jptm.2014.10.15.

Fallopian Metaplastic Papillary Tumour: An Atypical Transdifferentiation of the Tubal Epithelium?

• Salazar MF
• Moscoso IE
• Vazquez LT
• Lopez Garcia NL
• Escalante Abril PA

• KMID: 2381370
• DOI: http://doi.org/10.4132/jptm.2014.10.15

Abstract

A metaplastic papillary tumor of the Fallopian tube is an extremely uncommon condition, with odd and confusing features that make it difficult to categorize as benign or borderline. Here, we summarize all the published cases to date and document the case of a 41-year-old woman diagnosed with this alteration after her last childbirth and ensuing tubal ligation. One of the tubes was bulky and filled with a caramel-like substance encircling a blurry spot. Light microscopy detailed a slender stalk covered by eosinophilic, columnar plump cells, showing atypical nuclei and focal budding. Mitotic figures were absent. The immunohistochemistry panel was positive for pan-cytokeratin, epithelial membrane antigen, cyclin D1, and hormone receptors. Additionally, a proliferation index of less than 5% was rated using Ki-67. The true nature of this tumor (reactive vs neoplastic) is uncertain. Nonetheless, its association with pregnancy suggests an adaptive change, likely similar to the atypical transdifferentiation proposed for Arias-Stella reaction.

Keyword

Metaplastic papillary tumour; Fallopian tubes; Arias-Stella reaction; Cell transdifferentiation

MeSH Terms

Adult
Cell Transdifferentiation
Cyclin D1
Eosinophils
Epithelium*
Fallopian Tubes
Female
Humans
Immunohistochemistry
Microscopy
Mucin-1
Parturition
Pregnancy
Sterilization, Tubal
Cyclin D1
Mucin-1

Figure

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  Fig. 1. Gross features/oxyphil metaplastic components. (A) Tubal ligation specimen. (B) Transverse cut surface. A crystallized syrup-like substance with a striking resemblance to a regional candy known as «acitrón» fills the lumen; there is also a left marginal blur with a snowflakelike appearance. The left column displays whole-mount sections stained with hematoxylin and eosin, periodic acid–Schiff, Alcian blue, and mucicarmine. (C) Panoramic photomicrograph showing a peninsular papillary framework in a lake of extracellular mucin. The stalk has a loose stroma and contains a small number of inflammatory cells (lymphocytes and neutrophils). (D) High magnification photomicrograph of the oncocytic epithelium. There is mild stratification and cell budding.

• 

  Fig. 2. Mucinous metaplastic components. (A) Some amphophilic mucin-filled cysts are noticeable beneath the epithelium (blue arrows). (B) Periodic acid−Schiff. (C) Alcian blue. (D) Mayer's mucicarmine.

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  Fig. 3. Immunohistochemistry panel. (A) Cytokeratin AE1/AE3 (+++/+++) in 100% of cells. (B) Epithelial membrane antigen (+++/+++) in 100% of cells. (C) Estrogen receptor (++/+++) in ~70% of cells. (D) Progesterone receptor (+++/+++) in ~95% of cells. (E) Androgen receptor (+/+++) in ~10% of cells. (F) Ki-67 (+++/+++) in ~3% of cells. (G) Cyclin-D1 (+++/+++) in ~90% of cells.

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