Fibrinopurulent exudate can be seen in the tubal lumen.
Here is a different case of pyosalpinyx. Often, the tubal plicae may fuse and distort normal anatomy.
The tubal lamina propria is almost entirely replaced by a dense infiltrate of neutrophils.
Pelvic inflammatory disease (PID) is commonly caused by gonococcal and chlamydial organisms. Other than these STDs, PID can also occur after delivery or abortions (puerperal fever), which are usually polymicrobial infections and include staphylococi, streptococci, Clostrium and enteric organisms. Infection will ascend from the lower female genital tract into the cervix and upwards into the fallopian tube and ovaries.1
Sequelae of PID include acute suppurative salpingitis, salpingo-oophoritis, pyosalpinx, tubo-ovarian abscess and hydrosalpinx. In tubo-ovarian abscess, a vigorous acute and chronic inflammatory infiltrate is seen, with surrounding edema and hemorrhage. In both the gross and microscopic specimens, the tube and fimbriae may be plastered against the ovary (due to adhesions and exudate) and obscuring normal anatomic landmarks.2
Symptoms are those seen in pelvic inflammatory disease and include pelvic pain, cervical motion tenderness, fever, leukocytosis and vaginal discharge. If the abscess is large, a palpable mass may be present in the adnexa. The diagnosis is typically made by pelvic ultrasound.
Treatment is accomplished with broad spectrum IV antibiotics on an inpatient basis until the patient is remote from febrile episodes. Oftentimes patients will require percutaneous drainage with interventional radiology assistance. Another option is for surgical removal of the infected tissues though this is often very complicated due to pelvic reactive changes, and is often a last resort.
PID is a common cause of female infertility as well as chronic pelvic pain. Fulminant infections may lead to sepsis and death if untreated.
1 Kumar V, Abbas AK, Fausto N. Robbins and Cotran Pathologic Basis of Disease. 7th Ed. Philadelphia, PA: Elsevier; 2005: 1064.
2 Nucci MR, Oliva Esther. Gynecologic Pathology: Foundations in Diagnostic Pathology. Philadelphia, PA: Elsevier: 2009: 390-1.