HYDROSALPINX SIMPLEX AS SEEN BY THE SCANNING ELECTRON MICROSCOPE*

Transcription

1 FERTILITY AND STERILITY Copyright," 1977 The American Fertility Society Vol. 28, No.9, September 1977 Printed in U.s.A. HYDROSALPINX SIMPLEX AS SEEN BY THE SCANNING ELECTRON MICROSCOPE* EVA PATEK, M.D.t LENNART NILSSON, M.D. Department of Obstetrics and Gynecology, Huddinge University Hospital, S Huddinge, Sweden Five cases of hydrosalpinx simplex were studied by light microscopy and scanning electron microscopy (SEM). Comparison was made with normal fallopian tube epithelia. By light microscopy numerous ciliated cells as well as nonciliated cells were found in both hydrosalpinx and normal tubal material. In hydrosalpinx material the epithelium was found to be compressed to one-sixth its usual height. The SEM survey of large areas of hydrosalpinx did not reveal any deciliation. In fact, the mucosa of the hydrosalpinx did not differ conspiciously from that of a healthy fallopian tube. However, some nonciliated cells with collapsed areas were revealed by SEM. The significance of the compressed areas is unknown. Previous investigations of the morphologic structure of the human fallopian tubel -6 have shown that scanning electron microscopy (SEM) offers ample opportunities to study the minute details of the epithelial mucosa. Changes in the epithelial surface were studied under normal and experimental conditions, in particular focusing on the effect of some steroid hormones on the epitheliallining. It was believed that the SEM technique might be a useful tool in exploration of the tubal epithelium under some pathologic conditions. Therefore, in the present study attempts were made to study the specific morphologic alterations which may occur in the epithelial surface in relation to hydrosalpinx and to compare these findings with those of the normal fallopian tube. The study was carried out during the period 1972 to 1974 at the Department of Women's Diseases, Karolinska Hospital, and the Swedish Medical Research Council, Reproductive Endocrinology Research Unit, Stockholm, Sweden. Received November 16,1976; revised May 31,1977; accepted June 2,1977. *Supported by Swedish Medical Research Council Grant B X ; Karolinska Institutet; the World Health Organization, Geneva, Switzerland; The Ford Foundation, New York, N. Y.; and JEOL Inc., Tokyo, Japan. tto whom reprint requests should be addressed. 962 MATERIALS AND METHODS Five patients with clinically or roentgenologically verified hydrosalpinx were included in the study. They were between 25 and 44 years old and had various complaints such as pain, irregular menstrual bleeding, and fibroids. None was using oral contraceptives or undergoing any hormonal therapy. The patients were subjected to laparotomy. During surgery the hydrosalpinx was removed and immediately processed for scanning electron microscopy according to the method described previously.2-s.7 Specimens were obtained simultaneously for light microscopic examination to determine the presence of any specific inflammatory reaction. A biopsy specimen was also obtained from the anterior fundus of the endometrial cavity and was dated according to the criteria of Noyes et al. 8 RESULTS In all five patients the excised fallopian tube was enlarged, translucent, and filled with a clear exudate. The walls of the hydrosalpinges were thin; the fimbriae were inverted; and the abdominal ostia were completelyseaied off, rounded and bulbous, and adherent to surrounding structures.

2 Vol. 28, No.9 SEM OF HYDROSALPINX SIMPLEX 963 FIG. 1. Thin, flattened epithelium of a hydrosalpinx seen by interference microscopy. Numerous ciliated cells are found, and a few nonciliated ones. Midproliferative phase (x 500). Figure 1 shows the light microscopic picture of one abnormal fallopian tube obtained during the proliferative phase of the menstrual cycle. A few nonciliated cells as well as a large number of cells with ciliary filaments are easily recognized. No inflammatory cells are seen. Figure 2, which shows the light microscopic picture of a normal fallopian tube obtained during the same phase of the menstrual cycle, reveals a similar distribution of nonciliated and ciliated cells. However, when compared with the epithelium of the hydrosalpinx, severe compression of the cells is seen in the abnormal tube. When a comparison is made of the height of the lining cell, those of the healthy tube are six times higher than those of the hydrosalpinx. The SEM picture of the epithelium in one of the five cases of hydrosalpinx is shown in Figures 3 to 7. All of the biopsy specimens for SEM were obtained from the ampullary-isthmic region and in all five cases showed a similar appearance. Ciliated and nonciliated cells were intermingled, as seen in a healthy tube. Moreover, the distribution of ciliated cells seemed to be quite uninfluenced by the disease process of the oviduct. When surveying large areas by SEM we found some secretory cells which were compressed or even collapsed (Figs. 6 and 7). We have not found this phenomenon in healthy fallopian tube epithelia. The surfaces of these collapsed areas were found to contain microvilli as ordinary nonciliated cells.

3 964 PATEK AND Nll.SSON September 1977 FIG. 2. Similar picture of the epithelium of a healthy fallopian tube. Even in this picture mainly ciliated cells are recognized. A few nonciliated cells and peg cells are seen. Notice that the height of the lining cells is six times that of the cells of the hydrosalpinx. Midproliferative phase (x 500).

4 Vol. 28, No.9 SEM OF HYDROSALPINX SIMPLEX 965 FIG. 3. SEM picture of a hydrosalpinx obtained during the proliferative phase. Numerous ciliated cells are seen and also nonciliated cells (x 800).

5 966 PATEK AND NILSSON September 1977 FIG. 4. A specimen similar to that shown in Figure 3 but at higher magnification. Nonciiated cells are intermingled with the ciliated cells (x 2,500).

6 Vol. 28, No.9 SEM OF HYDROSALPINX SIMPLEX 967 FIG. 5. High magnification of ciliated and nonciliated cells of a hydrosalpinx. Both cell types are well developed. The nonciliated cells are covered by a large number of microvilli (x 8,000).

7 968 PATEK AND NILSSON September 1977 FIG. 6. Several ciliated and nonciliated cells on the surface of a hydrosalpinx. One nonciliated cell in the middle of the picture has a "hole" (x 5,400).

8 Vol. 28, No.9 SEM OF HYDROSALPINX SIMPLEX 969 FIG. 7. Higher magnification of the nonciliated cell shown in Figure 6. The surface of the cell is covered by a large number of well developed microvilli. These are also seen in the collapsed area. In the upper right corner are some cilia from a ciliated cell (x 10,000).

9 970 PATEK AND NILSSON September 1977 FIG. 8. Epithelium of a healthy fallopian tube obtained from the isthmus during the proliferative phase. The cilia are tall and slender and the microvilli are well distributed over the surface of the nonciliated cells (x 2,000).

10 Vol. 28, No.9 SEM OF HYDROSALPINX SIMPLEX 971 For comparison, a specimen of the healthy oviduct shown by light microscopy in Figure 2 is shown by SEM in Figure 8. The SEM survey of this normal tubal mucosa reveals no particular difference from abnormal tubal mucosa. DISCUSSION In all five cases of hydrosalpinx simplex the normal columnar epithelium was found to be compressed to a cuboidal or even mesothelial type as seen by light microscopic studies. This is a well known fact from earlier work in light microscopy.9.10 It is also well established that the cells of the hydrosalpinx retain their normal architecture, including the cilia The present study confirmed these earlier findings. Some of the folds of the tubes of the ampullary-isthmic region were still there, but the lining surface usually was found to be quite flattened. The SEM appearance of hydrosalpinx confirmed the results previously published Numerous ciliated cells were found. These cilia were well developed and did not differ from those seen in a normal subject. However, some of the nonciliated cells were found to be compressed or collapsed. The significance of these collapsed areas is unknown. However, they might represent empty secretory vacuoles. 11 The point should be made that,although the surface cilia do not appear to be adversely affected, the remainder of the tube-the subserosal portions-may in fact be rather severely damaged and often display areas of fibrosis which could be associated with impaired function after patency is restored surgically. Thus, the comforting thought that the ciliated cells themselves are not disturbed could lead to the erroneous conclusion that restitution of the normal tubal anatomy is possible in all cases. There are certain limitations in using SEM, since only the epithelial surfaces may be studied. The compression of the mucosa is better observed by light microscopy than by SEM. Transmission electron microscopy may yield additional information about the underlying structures. Acknowledgment. The expert technical assistance of Mrs. Mia Higelin is gratefully acknowledged. REFERENCES 1. Nilsson L, Patek E, Johannisson E, Lindberg J: Scanning electron microscopic studies of the human fallopian tube. JEOL News 10 (No 2):53, Patek E, Nilsson L, Johannisson E: Scanning electron microscopic study of the human fallopian tube. Report I. The proliferative and secretory stages. Fertil Steril 23: 459, Patek E, Nilsson L, Johannisson E: Scanning electron microscopic study of the human fallopian tube. Report II. Fetal life, reproductive life, and postmenopause. Fertil Steril 23:719, Patek E, Nilsson L, Johannisson E, Hellema M, Bout J: Scanning electron microscopic study of the human fallopian tube. Report III. The effect of midpregnancy and of various steroids. Fertil Steril 24:31, Patek E, Nilsson L, Hellema M: Scanning electron microscopic study of the human fallopian tube. Report IV. At term gestation and in the puerperium. The effect of a synthetic progestin on the postmenopausal tube. Fertil Steril 24:832, Patek E, Nilsson L: Some scanning electron microscopic observations on the ciliogenesis ofthe infundibulum of the human fetal and adult fallopian tube epithelium. Fertil Steril 24:819, Parapat SR, Landboe-Christiansen E: Scanning electron microscopic observations on the surface pattern of the fundic and pyloric mucose of the stomach in man. Micro Electronique 3:475, Noyes RW, Hertig AT, Rock J: Dating the endometrial biopsy. Fertil Sterill:3, Novak ER, Woodruff JD: Salpingitis. In Gynecologic and Obstetric Pathology, Sixth Edition. Philadelphia, WB Saunders Co, 1967, Chap 15, p Woodruff JD, Pauerstein CJ: Non-granulomatous salpingitis. In The Fallopian Tube: Structure, Function, Pathology and Management. Baltimore, The Williams & Wilkins Co, 1969, Chap 7, p Sandstedt B: Personal communication, 1972