Adrenal Cortical Rests in the Fallopian Tube: A Case Report and Review of the Literature

Abstract

Ectopic adrenal rest is a rare phenomenon usually discovered incidentally during microscopic evaluation. The most common site reported in the literature is the genitourinary system and pelvis. Ectopic adrenal rest is more common in male than in female children. The documented site for females is mainly along the broad ligament. However, only two cases of ectopic adrenal rest in the fallopian tube have been reported in the literature, showing that they are extremely rare. In this article, we outline a case of adrenal cortical rest that was discovered incidentally during a microscopic examination of the left fallopian tube after a total hysterectomy with a left salpingo-oophorectomy specimen from a 49-year-old female patient who was complaining of severe bleeding related to severe adenomyosis.

Keywords: adenomyosis; adrenal rest; ectopic tissue; fallopian tube; hysterectomy.

Figure 1. Pelvic MRI

Sagittal section of MRI pelvis showing enlarged uterus with multiple small cysts within the myometrium (white arrows). The endometrial cavity is highlighted by the blue arrow, which shows thickened endometrium.

Figure 2. Adrenal cortical rest of the fallopian tube (H&E and immunostaining)

This figure shows the histopathologic examination by hematoxylin and eosin (H&E) stains and immunohistochemistry studies. (A) Examination revealed a well-circumscribed nodule of adrenal cortical tissue located in the hilar region of the fallopian tube. (B) This panel shows the cytological features of this nodule with no infiltration into the adjacent tissue and no necrosis. The nucleus is central with fine chromatin and inconspicuous nucleoli. The cytoplasm is abundant and clear (H&E, 4x and 20x). (C) Inhibin immunostaining showing granular cytoplasmic positivity (40x). (D) Calretinin immunostaining showing nuclear and cytoplasmic reactivity (20x).