INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue X October 2025
www.rsisinternational.org
Page 1327
Endosalpingiosis Presenting as Infraumbilical Mass- A Rare Case Report
with Review of Literature
Dr. Nanda J Patil, Dr. Drashti Maradiya, Dr. Sai Kaushal Manchikalapudi
*
Department of Pathology, Kishna Institute of Medical Sciences(KIMS), KVV Karad, Maharashtra,
India.
*Corresponding Author
DOI:
https://dx.doi.org/10.51584/IJRIAS.2025.10100000116
Received: 27 October 2025; Accepted: 01 November 2025; Published: 12 November 2025
ABSTRACT
Background: Endosalpingiosis is an understudied gynaecological entity with limited research on it. Clinical
significance of endosalpingiosis is not fully understood. Because of unfamiliar presentation, it can lead to
misdiagnosis.
Case Report:We present a case of endosalpingiosis in a 54 years old female patient presenting as infraumbilical
mass with history of tubal ligation 30 years ago. Gross examination reveals a grey white to grey brown lesion of
size 5 x 3.5 x 3cm, microscopy showing cystically dilated spaces lined by low columnar to cuboidal and
attenuated epithelium with focal areas showing dystrophic calcification.
Discussion: Endosalpingiosis is a rare benign diagnosis which presents at postmenopausal or older age with
clinical presentation as abdominal pain, dysmenorrhea, pelvic discomfort, dysuria or hematuria.
Conclusion: Endosalpingiosis is a rare and uncommon clinical entity. The definitive diagnosis is possible only
with histopathological examination. It is important to rule out other comorbidities existing with endosalpingiosis.
Key words: Endosalpingiosis, Tubectomy scar, Histopathological examination
INTRODUCTION
Endosalpingiosis is the presence of ciliated tubal lining epithelium in an ectopic location other than normal origin
of fallopian tube [1]. Endosalpingiosis may be found as incidental diagnosis during surgery or it can present as
pelvic pain or chronic pelvic inflammation. The entity was first described by Sampson in 1930[2]. We present a
case of endosalpingiosis to highlight its rare occurrence and uncommon clinical presentation which can lead to
misdiagnosis.
Case Report:
A 54 year old female presented with infraumbilical mass with lower abdominal pain since 3 months. She gave
history of tubal ligation 30 years ago. There were no other comorbidities. Routine laboratory parameters
including complete blood count and urine examination were within normal limits. Hypoechoic, irregular shaped
mass lesion with minimal spongiform cystic change noted in the infra-umbilical region beneath the incisional
scar site.
Figure 1The mass was surgically excised considering as a neoplasm and sent for histopathological examination.
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue X October 2025
www.rsisinternational.org
Page 1328
Figure 1: Hypoechoic, irregular shaped mass lesion with minimal spongiform cystic change noted in the infra-
umbilical region beneath the incisional scar site.
Gross examination revealed a single, irregular, grey white to grey brown, soft to firm mass of size 5 x 3.5 x 3cm.
Cut section was grey white with small punctate translucent spaces(Figure 2).
Figure 2: Gross examination: grey white translucent lesion with punctate spaces.
Microscopic examination revealed cystically dilated spaces lined by low columnar to cuboidal as well as
attenuated epithelium, focally showing multilayering of cells and rounded regular nuclei. Lumina of these cystic
spaces revealed secretions and focal areas showing psammoma bodies. Intervening fibrous tissue showed chronic
nonspecific inflammation. Endometrial
Stroma was not seen on microscopy(Figure3a and 3b) Considering the past history and microscopic features,
diagnosis was offered as endosalpingiosis. After excision of the lesion, 6-month postoperative follow-up is
uneventful.
Figure 3A:Microscopy- cystically dilated spaces lined by low columnar epithelium(100x H&E)Figure 3B:
Microscopy- Cystic spaces with secretions and psammoma bodies(400x H &E)
Figure 3A
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue X October 2025
www.rsisinternational.org
Page 1329
Figure 3B
DISCUSSION
Endosalpingiosis is a benign, uncommon, and challenging diagnosis. It can exist with other comorbidities,
commonest age of presentation is postmenopausal and older age women[3]. In one of the studies, it was found,
in 7.6% of 110 women undergoing laparoscopic procedure [4] Clinical presentation of endosalpingiosis is
abdominal pain, fever, dysuria, dysmenorrhea, back pain and hematuria. Occasionally, it can manifest as tumor
as seen in our case [5]. The pathogenesis of endosalpingiosis is obscure. However, 3 main theories include
shedding of tubal epithelium into pelvic peritoneal, coelomic metaplasia of pelvic peritoneum epithelium and
growth of embryonic mullerian tissue which is misplaced during embryogenesis [6]. Other possible mechanism
is transplantation of tubal mucosa to peritoneal surfaces during tubal surgery or lymphatic vascular implantation
of tubal epithelium [2]. In our case, the mechanism may be transplantation of tubal mucosa during tubal ligation.
Endosalpingiosis can coexist with endometriosis.
Endosalpingiosis involves uterus, ovary, fallopian tubes and within the skin [2], but can be found anywhere in
the abdomen and pelvis [3,7]. However, the lesion is not easily recognized by gynecologist and hence can be
misdiagnosed with neoplastic lesion, as seen in our case.
Laparoscopy remains the main diagnostic tool to visualize this lesion. However, it is often misdiagnosed as
endometriosis by the gynecologist and the definitive diagnosis is made only by histopathological examination
of excised lesion, which on examination shows numerous punctate fluid filled translucent lesions as observed in
our case. Histopathological examination of endosalpingiosis shows presence of glands lined by tubal epithelium
or containing three types of cells that is ciliated columnar cells, non-ciliated columnar mucus cells and intercalary
or peg cells in a ectopic site. Also, it has been associated with psammoma bodies. This observation was also
noted in our case. Endometrial stroma and hemorrhagic areas are absent which rules out possibility of
endometriosis[2].
Endosalpingiosis can be differentiated from serous tumors using IHC. The epithelial cells in endosalpingiosis
are typically positive for PAX8, WT1, and CK7, and negative for calretinin and D2-40, supporting a Müllerian
(tubal) origin. Unlike serous borderline or malignant tumors, p53 shows a wild-type (non-mutant) staining
pattern, and Ki-67 proliferation index is low. In contrast, serous tumors often exhibit aberrant p53 expression
(mutant-type), high Ki-67 index, and may show architectural complexity and stromal invasion.
In our case, the patient underwent complete excision of the lesion, and a 6-month postoperative follow-up was
uneventful. Surgical exicision is treatment of choice in cases with endosaphingiosis, as hormonal therapeutics
are not useful. In few cases malignant change has been observed [2].
CONCLUSION
Endosalpingiosis is a rare diagnosis which can be clinically mistaken as endometriosis, pelvic inflammatory
disease or neoplasm. Laproscopic examination may help to make a diagnosis however histopathological
examination of surgical biopsies helps to give definitive diagnosis.
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue X October 2025
www.rsisinternational.org
Page 1330
REFERENCES
1. Heinig J, Gottschalk I, Cirkel U, Diallo R. Endosalpingiosis – anunderestimated cause of chronic
pelvic pain or an accidental finding? A retrospective study of 16 cases. Eur J Obstet Gynecol
Reprod Biol. 2002;103:75–8.
2. Ong, N.C.S., Maher, P.J., Pyman, J.M. et al. Endosalpingiosis, an unrecognized condition: report
and literature review. Gynecol Surg 1, 11–14 (2004). https://doi.org/10.1007/s10397-003-0001-0
3. L. Prentice, A. Stewart, S. Mohiuddin, N.P. Johnson What is endosalpingiosis? Fertil. Steril.,
2012;98 (4), pp. 942-947
4. M.H. Hesseling, R.L. De Wilde Endosalpingiosis in laparoscopy J. Am. Assoc. Gynecol.
Laparosc., 2000;7 (2), pp. 215-219
5. Liang JJ, Malpica A, Broaddus RR. Florid cysticendosalpingiosis presenting as an obstructive
colon massmimicking malignancy: case report and literature review. JGastrointest Cancer.
2007;38:83–6.
6. Batt RE, Yeh J. Müllerianosis: four developmental (embryonic) mullerian diseases. Reprod Sci
2013; 20(9): 1030–1037
7. R.K. Khangura, V.R. Katukuri, S.M. Lieblein, Z. Sharif, T. Anwar, Z. ZhangUnderstanding
Endosalpingiosis [89]Obstet. Gynecol., 125 (2015), p. 35S
