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 etc., 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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