Seidman Jeffrey D, Stone Rebecca, Moragianni Vasiliki A, Krishnan Jayashree, Vang Russell
Pathology Consultant, Gaithersburg.
Division of Gynecologic Oncology, Department of Gynecology and Obstetrics.
Am J Surg Pathol. 2025 Oct 1;49(10):1042-1059. doi: 10.1097/PAS.0000000000002414. Epub 2025 May 8.
A portion of the fimbriated end of the fallopian tube known as the fimbria ovarica extends along the lateral edge of the mesosalpinx to the ovary to which it is attached at its lateral pole. Seventy-four examples of fimbrial plicae that were attached to the ovary or broad ligament and lacked features of adhesions were studied. The fimbrio-ovarian attachments were characterized by one or more of the following: continuity between the tubal epithelium and either the ovarian surface epithelium, peritoneum, or both, in 51 cases; direct continuity of the ovarian stroma into the stroma of the fimbria ovarica in 42 cases; and direct insertion of plicae into the ovarian surface or ovarian stroma in 18 cases. In 21 cases, there was a direct attachment of plicae to the broad ligament close to the ovary. The mean size of the fimbria ovarica was 6.6 mm. The plicae were lined by normal tubal-type epithelium. The plical morphology was typically abnormal displaying one or more of the following features: short and blunted in 24 (32%), thickened in 18 (24%), elongated in 14 (19%), fusion in 13 (18%), edema in 13 (18%), and fibrosis in 11 (15%). Also noted were a mesothelial component in 69 cases (93%), the tubal-peritoneal junction in 53 cases (72%), transitional cell metaplasia/Walthard cell nests in 11 cases (15%), and foci resembling incipient fimbrial adenofibroma in 7 cases (9%). An understanding of the microanatomy and histology of the fimbria ovarica has important implications, particularly as: (a) portions may be left behind after prophylactic salpingectomy, providing a nidus for future development of high grade serous carcinoma (HGSC); (b) it constitutes an anatomic connection that may facilitate the spread of HGSC to the ovary, and (c) epithelial junctions are hotspots for carcinogenesis, and stem cells arising in such regions may be a source of HGSCs. In addition, understanding the fimbria ovarica has implications for the pathogenesis of ovarian surface epithelial inclusions, endosalpingiosis, and certain types of infertility. Its potential role as a site of origin of extrauterine HGSC, which typically arises in the fimbriae as serous tubal intraepithelial carcinoma, remains to be investigated.
输卵管有纤毛端的一部分，即卵巢伞，沿着输卵管系膜的外侧缘延伸至卵巢，并在其外侧极附着于卵巢。研究了74个附着于卵巢或阔韧带且无粘连特征的伞襞样本。卵巢伞附着具有以下一种或多种特征：51例中输卵管上皮与卵巢表面上皮、腹膜或两者之间存在连续性；42例中卵巢基质直接延续至卵巢伞的基质；18例中襞直接插入卵巢表面或卵巢基质。21例中，襞直接附着于靠近卵巢的阔韧带。卵巢伞的平均大小为6.6毫米。襞由正常的输卵管型上皮衬里。襞的形态通常异常，表现出以下一种或多种特征：短而钝的有24例（32%），增厚的有18例（24%），细长的有14例（19%），融合的有13例（18%），水肿的有13例（18%），纤维化的有11例（15%）。还观察到69例（93%）有间皮成分，53例（72%）有输卵管 - 腹膜交界处，11例（15%）有移行细胞化生/瓦尔塔德细胞巢，7例（9%）有类似早期伞状腺纤维瘤的病灶。了解卵巢伞的微观解剖学和组织学具有重要意义，特别是因为：（a）预防性输卵管切除术后可能会残留部分组织，为未来高级别浆液性癌（HGSC）的发生提供病灶；（b）它构成了解剖学连接，可能促进HGSC扩散至卵巢；（c）上皮交界处是致癌的热点，在此区域产生的干细胞可能是HGSC的来源。此外，了解卵巢伞对卵巢表面上皮包涵体、输卵管内膜异位症和某些类型不孕症的发病机制也有影响。其作为子宫外HGSC起源部位（通常起源于伞部，表现为浆液性输卵管上皮内癌） 的潜在作用仍有待研究
