Acute salpingitis may be secondary to a variety of organisms, including gonorrhea, chlamydia, and occasionally actinomyces (Fig. 8.1), the latter usually in association with IUD usage. Grossly, if the fimbria become adherent, the tube becomes dilated with purulent material, forming a pyosalpinx. Histologically, purulent material, composed of neutrophils and necrotic debris, is seen within the mucosa and the tubal lumen (Fig. 8.2).

Patterns of chronic salpingitis depend on how the Fallopian tube heals after an episode of acute salpingitis. The fimbria may remain open or may be sealed shut by adhesions. If the tube remains patent, there may be no changes at all, or there may be chronic salpingitis, characterized by a chronic inflammatory infiltrate composed of lymphocytes, plasma cells, and/or histiocytes. The folds of the tube may agglutinate, and although no inflammation is seen, there are numerous blind pouches created, termed follicular salpingitis (Fig. 8.3). This is thought to increase the risk of tubal ectopic pregnancies, as the fertilized ovum can get trapped in one of these areas. If the fimbria are sealed, and pyosalpinx resolves, what is left is flattened epithelium in a tube filled with nonpurulent fluid, a hydrosalpinx (Fig. 8.4).

Although rare in developed countries, tuberculous salpingitis is a common cause of infertility in endemic areas, where it may spread to the genital tract through hematogenous or lymphatic spread, or rarely through sexual contact [2]. It has also been reported in association with immunosuppression [3]. Clinically, the tube has been described as sometimes having a beaded appearance [2]. Histopathologically, the hallmark of tuberculosis is granulomatous inflammation (Fig. 8.5), usually with central necrosis called caseation, due to the gross cheesy appearance. However, even in the absence of central necrosis, stains for fungi and acid fast bacilli should be performed on cases of granulomatous salpingitis. Clinicians need to be aware that the stain for acid fast bacilli is very insensitive for confirmation of tuberculosis, due to the rarity of identifiable microorganisms, differing from some other strains of mycobacterium. If suspected clinically, other modalities, such as culture and PCR, should be considered.