Kosin Med J.  2024 Mar;39(1):66-70. 10.7180/kmj.23.120.

Heterotopic ovarian hilus cells of the salpinx: a case report and literature review

• Kim B

• KMID: 2556800
• DOI: http://doi.org/10.7180/kmj.23.120

Abstract

Ovarian hilus cells (OHCs), a counterpart of testicular Leydig cells, are usually found in the ovarian poles and produce androstenedione. Their origin remains a matter of debate, although OHCs are assumed to come from the adrenogenital primordium. OHCs are rarely observed around the poles of the ovary, including the mesoovarium, stroma (perisalpinx) of the salpinx, and the wall of paratubal cysts. Their clinical and pathological characteristics are not well-known because of their rarity. Herein, we present a case of ectopic OHCs in a 48-year-old woman. The patient underwent total hysterectomy and bilateral salpingectomy for vaginal bleeding due to multiple leiomyomas. We incidentally found OHCs in the stroma of the infundibulum of the salpinx, just beneath the tubal epithelium. Their size was less than 1 mm, and they were composed of large cells with central round nuclei and abundant clear or granular cytoplasm. OHCs share morphological and immunohistochemical profiles with ectopic adrenal glands, and the differential diagnosis is sometimes difficult. They do not exhibit microscopic encapsulation or the normal adrenal cortex zonation pattern. The patient was discharged and did not show any abnormal findings during 19 months of follow-up. Analyzing the characteristics of testicular Leydig cells will help understand how OHCs develop and why heterotopic OHCs occur in and around the salpinges.

Keyword

Case reports; Fallopian tubes; Growth and development; Heterotopic tissue; Ovary

Figure

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  Fig. 1. Gross findings. Anterior (A) and posterior side (B) of the fresh right fallopian tube following hysterectomy with bilateral salpingectomy showing several fimbrial cysts at the end of the right fallopian tube. The external surface of the bilateral salpinges was smooth. A couple of subserosal small leiomyomas were also noted.

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  Fig. 2. Microscopic and immunohistochemical findings. (A) Under low-power magnification, the infundibulum of the fallopian tube had a thinned myosalpinx and tertiary branch of plicae. Thick-walled vessels and bundles of nonmyelinated nerves were noted in the mesosalpinx (hematoxylin and eosin stain [H&E], ×12.5). (B) Some nests of epithelial cells are present just beneath the tubal epithelium and admixed with smooth muscle fascicles of the myosalpinx. These oval cells had abundant eosinophilic cytoplasm and were arranged in a trabecular pattern with sinusoidal blood vessels. They were just next to the blood vessels (H&E, ×100). (C) Oval or round cells had round nuclei, some of which had inconspicuous nucleoli. Cells on the left side showed vacuolated cytoplasm (H&E, ×400). (D) The cells were immunoreactive to antibodies produced against inhibin-alpha (inhibin-alpha immunohistochemistry, ×100). (E) CD56 was expressed in the periphery of the nest of hilus cells (CD56 immunohistochemistry, ×100). (F) Wolffian duct remnants, showing ducts lined by cuboidal cells and wrapped with smooth muscle, were identified in the mesosalpinx around ectopic hilus cells (H&E, ×200).

Reference

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