Tuberculous pyosalpinx associated with serous tubal intraepithelial lesion: a case report on evidence of early tubal neoplastic transformation

Serous tubal intraepithelial lesion (STIL) is an uncommon precursor lesion in the spectrum of tubal serous neoplasia, characterised by atypical epithelial proliferation, aberrant p53 expression and a low proliferative index. Chronic inflammatory conditions such as tuberculosis may contribute to carcinogenesis through persistent epithelial injury. This report describes the case of a 29-year-old woman with previously treated tubercular endometritis who presented with persistent pelvic pain and bilateral pyosalpinx. Diagnostic laparoscopy revealed grossly enlarged fallopian tubes with torsion and purulent intraluminal contents, necessitating bilateral salpingectomy. Histopathological examination demonstrated chronic granulomatous salpingitis with focal epithelial atypia. Immunohistochemistry showed diffuse abnormal p53 overexpression (80%) and a low Ki-67 proliferation index (<10%), consistent with STIL. Marked cytological atypia and high proliferative activity were absent, favouring STIL over serous tubal intraepithelial carcinoma. This case highlights a rare association between chronic tuberculous inflammation and early tubal neoplastic transformation. It emphasises the importance of meticulous histopathological and immunohistochemical evaluation of salpingectomy specimens.