Hydrosalpinx in patients with hysterectomy without salpingo-oophorectomy referred for pelvic magnetic resonance imaging

Abstract

Women with ovarian-sparing hysterectomy before 2007 are more likely to have retained Fallopian tube remnants which can become fluid-filled, distended masses, potentially mistaken for a cystic adnexal neoplasm on imaging. Here we assess the prevalence and appearance of hydrosalpinx in women with ovariansparing hysterectomy prior to 2007 referred for pelvic MRI. Methods: A total of 3044 consecutive pelvic MRI exams performed over a two-year period (2003-2004) were selected from our radiology database and retrospectively reviewed. Examinations performed on male patients (N = 858), duplicate examinations on the same patient (N = 675) and examinations performed for MR guided biopsy (N = 1) were excluded from the study. From the remaining female pelvic MRI examinations (N = 1510), patients with hysterectomy without oophorectomy were identified. The frequency of hydrosalpinx in this population was then determined visually by two experienced radiologists and kappa analysis was then performed to assess for interobserver agreement. Results: Of the 3044 pelvic MRI examinations, 1510 were performed on females and 76 (5%) of these women had ovarian-sparing hysterectomy. Of these 76 women, 14 patients (18%) had hydrosalpinx (kappa = 0.8) of which 11 were unilateral and 3 bilateral. A total of 9 of the 14 cases positive for hydrosalpinx in patients with ovarian-sparing hysterectomy were referred to MRI for evaluation of cystic adnexal masses detected on other modalities. Conclusion: Hydrosalpinx should be considered in the differential diagnosis of cystic adnexal lesions in women with prior hysterectomy and retained ovaries.

Association between pelvic inflammatory disease and subsequent salpingectomy on the risk for ovarian cancer

“…Fallopian tubes left in situ after pelvic surgery constitute a source of potentially precancerous transformation (regardless of carcinogenic pathway) and a significant proportion of these women require additional surgery to remove retained tubes [17]. Concerns regarding the effect of opportunistic salpingectomy on subsequent ovarian function have not been substantiated by clinical data and the potential harm if any ought to be outweighed by the oncological benefits [18].…”

Spectrum of Lesions in the Fallopian Tubes – A Histopathogical Study

“…1) constituted about 15% of the total specimens and all were unilateral (Picture from the pathology archives). Based on another study by Sharyn, et.al showed 18% had hydrosalpinx and were unilateral and very few were bilateral [8]. Hematosalpinx was found in about 8% of the specimens.…”