Endometriosis

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Endometriosis causes significant morbidity and is associated with increased risk of certain malignancies.

General

Clinical:

  • A cause of infertility.
  • A cause of pelvic pain.
  • Affects approximately 10% of women of child bearing age.
  • Associated with moderate elevation of (serum) CA-125.

Rare stuff:

  • There case reports of endometriosis in men on estrogen therapy for prostate cancer.[1][2]

Gross

Appearance:

  • Chocolate cyst = cyst containing light brown material.

Classic locations:

  • Ovary - most common location according to Jenkins et al.[3]
  • Utero-sacral ligament.[4]
  • Cul-de-sac.[4]
  • Broad ligament.

Note:

  • The hierarchy of the most common sites, i.e. what is most common and what is the second most common, depends on the paper one reads, e.g. compare Jenkins et al[3] with Stegmann et al.[4]
  • Endometriosis can appear almost any where.
    • A well-reported uncommon location is the abdominal wall post-caesarian section.[5]

Microscopic

Criteria - need at least 2 / 3 for the diagnosis:[6]

  1. Endometrial glands - endometrial glands are classically: circular, with nuclei that are hyperchromatic & cigar-shaped.
  2. Endometrial stroma - endometrial stroma is classically: cellular and hyperchromatic (may resemble a lymphocytic infiltration on low power).
  3. Hemosiderin-laden macrophages - light brown, may be granular.

Notes:

  • The epithelial component (1) may appear cuboidal in cysts or be sloughed-off, i.e. absent.
  • The microscopic correlation of chocolate cyst is: light brown acellular material; this can be considered as a substitute for (3) - hemosiderin-laden macrophages.
  • Epithelial component may have tubal metaplasia.[7]
  • Endometriosis may mimic cancer[8] - see images below.
  • If it is just endometrial type glands - the stroma is missing... it is probably endosalpingiosis.

DDx:

Images

Mimicking cancer:

Associations

Endometriosis is associated with gynecologic tumours:

  1. Endometrioid adenocarcinoma of the ovary.[9]
  2. Clear cell carcinoma of the ovary.[10]
  3. Endocervical-like mucinous borderline tumour (EMBT).[11]

Other tumours & decreased risk:[12]

Immunohistochemical stains

  • CD10 stains the stromal cells[13] - used to look for endometriosis.

See also

References

  1. ↑ Fukunaga, M. (Jan 2012). "Paratesticular endometriosis in a man with a prolonged hormonal therapy for prostatic carcinoma.". Pathol Res Pract 208 (1): 59-61. doi:10.1016/j.prp.2011.10.007. PMID 22104297.
  2. ↑ Beckman, EN.; Pintado, SO.; Leonard, GL.; Sternberg, WH. (May 1985). "Endometriosis of the prostate.". Am J Surg Pathol 9 (5): 374-9. PMID 2418693.
  3. ↑ 3.0 3.1 Jenkins, S.; Olive, DL.; Haney, AF. (Mar 1986). "Endometriosis: pathogenetic implications of the anatomic distribution.". Obstet Gynecol 67 (3): 335-8. PMID 3945444.
  4. ↑ 4.0 4.1 4.2 Stegmann, BJ.; Sinaii, N.; Liu, S.; Segars, J.; Merino, M.; Nieman, LK.; Stratton, P. (Jun 2008). "Using location, color, size, and depth to characterize and identify endometriosis lesions in a cohort of 133 women.". Fertil Steril 89 (6): 1632-6. doi:10.1016/j.fertnstert.2007.05.042. PMID 17662280.
  5. ↑ Ozel, L.; Sagiroglu, J.; Unal, A.; Unal, E.; Gunes, P.; Baskent, E.; Aka, N.; Titiz, MI. et al. (Mar 2012). "Abdominal wall endometriosis in the cesarean section surgical scar: a potential diagnostic pitfall.". J Obstet Gynaecol Res 38 (3): 526-30. doi:10.1111/j.1447-0756.2011.01739.x. PMID 22381104.
  6. ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 239. ISBN 978-0470519035.
  7. ↑ Clement PB (July 2007). "The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects". Adv Anat Pathol 14 (4): 241–60. doi:10.1097/PAP.0b013e3180ca7d7b. PMID 17592255.
  8. ↑ Corben, AD.; Nehhozina, T.; Garg, K.; Vallejo, CE.; Brogi, E. (Aug 2010). "Endosalpingiosis in axillary lymph nodes: a possible pitfall in the staging of patients with breast carcinoma.". Am J Surg Pathol 34 (8): 1211-6. doi:10.1097/PAS.0b013e3181e5e03e. PMID 20631604.
  9. ↑ Nagle CM, Olsen CM, Webb PM, Jordan SJ, Whiteman DC, Green AC (November 2008). "Endometrioid and clear cell ovarian cancers: a comparative analysis of risk factors". Eur. J. Cancer 44 (16): 2477-84. doi:10.1016/j.ejca.2008.07.009. PMID 18707869.
  10. ↑ Kawaguchi R, Tsuji Y, Haruta S, et al. (October 2008). "Clinicopathologic features of ovarian cancer in patients with ovarian endometrioma". J. Obstet. Gynaecol. Res. 34 (5): 872–7. doi:10.1111/j.1447-0756.2008.00849.x. PMID 18834345.
  11. ↑ Moriya T, Mikami Y, Sakamoto K, et al. (December 2003). "Endocervical-like mucinous borderline tumors of the ovary: clinicopathological features and electron microscopic findings". Med Electron Microsc 36 (4): 240–6. doi:10.1007/s00795-003-0221-4. PMID 16228656.
  12. ↑ URL: http://www.medicalnewstoday.com/articles/3890.php. Accessed on: 26 September 2011.
  13. ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 236. ISBN 978-0470519035.
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