Fallopian tube prolapse misdiagnosed as vault granulation tissue: a report of three cases

Prolapse of the fallopian tube into the vagina is an uncommon complication caused by either vaginal or abdominal hysterectomy. Recently, however, we encountered three cases with prolapse of the fallopian tube after abdominal hysterectomy. The patients presented with vaginal bleeding. A red hemorrhagic granular mass, misdiagnosed as vaginal granulation tissue both macroscopically and microscopically, was noted at the apex of vagina. Pathologically, one case was initially diagnosed as vaginal vault granulation tissue, but there were two recurrences after excision. Microscopically, the mass had a papillary or villous outer surface with a complex pattern of tubular and glandular structures, as well as acute and chronic inflammatory infiltrates in the fibrovascular stroma. A typical ciliated tubal type of epithelium was identified, and on immunohistochemical staining for cytokeratin, attenuated epithelial cells were detected. It is necessary to receive a pathologic confirmation by performing vaginal biopsy when fallopian tube prolapse is clinically suspected, thus preventing misdiagnosis.