Endometriosis

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

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.

Diagnosis

Need 2 of 3 criteria to diagnose.

Criteria:

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 cholocate cyst is: light brown acellular material; this can be considered as a substitute for (3) - hemosiderin-laden macrophages.
• Epithelial component may have tubal metaplasia.
• Endometriosis may mimic cancer... to the initiated eye.

Images

• Endometriosis - ovary (WC).
• Endometriosis - low mag. (WC).
• Endometriosis - high mag. (WC).
• Endometriosis in small intestine - low mag. (WC).

Associations

Endometriosis is associated with:

• Endometrioid adenocarcinoma of the ovary
• Clear cell carcinoma of the ovary.
• Increased endocrine tumours, non-Hodgkin's lymphoma, brain tumours and decreased cervical cancer.
• Endocervical-like mucinous borderline tumor.

Immunohistochemical stains

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

See also

• Gynecologic pathology - overview.
• Immunohistochemical staining.