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I have two differential diagnoses: First, it is not uncommon to see prolapsed fimbrea of the left fallopian tube adhesed to the vaginal cuff after a simple hysterectomy. For that possiblity, you need to carefully search if there are some smooth muscle bundles around or adjacent to the glandular structures, as smooth muscle layer is the normal structure of the fallopian tube. However, if it is just the fimbrea end. smooth muscle bundle is not necessary to make diagnosis. In this case, all the glands are ciliated glandular cells and should rule out this possiblity.  Secondly, it is possible an endometriosis with tubal metaplasia. In either case, it should be a benign process, not overdiagnosed as malignancy, such as endometrial adenocarcinoa. This patient is relatively young for the endometrial malignancy.

 阴道腺病．宫颈内膜腺为主，可有少量输卵管或子宫内膜型上皮．炎性刺激致鳞状化生．

翻译杨老师的话 

“有两个鉴别诊断要考虑：第一，在单纯子宫切除子宫后，输卵管伞端脱垂并粘连在阴道残端的情况并不少见，针对这种可能性，你应仔细寻找腺体周围是否有平滑肌束，因为平滑肌层是输卵管的正常结构。然而如果仅是输卵管的伞端，就并不一定有平滑肌束。在这一例所有的腺体都是纤毛上皮，应排除这种可能性。第二，可能是子宫内膜异位症伴输卵管上皮化生。无论那种情况，都应是良性病变，不要过诊断为恶性病变如子宫内膜腺癌。”

谢谢杨老师