Ectopic adrenal tissue in the mesosalpinx: a rare incidental finding in an adult woman

Ectopic adrenal tissue is most often identified incidentally on histopathological examination. It is reported mainly in male children and is usually located within the abdominopelvic cavity. Although adrenal cortical rests have been described in the female genital tract, involvement of the mesosalpinx (paratubal region) is exceptionally rare. We report a microscopic adrenal cortical rest in the left mesosalpinx of a 47-year-old woman who underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy for abnormal uterine bleeding and evaluation of bilateral complex ovarian cysts. The ectopic rest formed a well-circumscribed 3-mm nodule composed of bland polygonal cells with clear to eosinophilic cytoplasm, consistent with adrenal cortex. This case underscores the value of careful gross sampling and microscopic review in detecting uncommon developmental anomalies that are clinically silent.