Difference between revisions of "Endometriosis"

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Endometriosis (view source)

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Endometriosis_of_the_ovary.jpg
| Width      =
| Caption    = Endometriosis of the ovary. [[H&E stain]].
| Micro      = at least 2 of 3: (1) endometrial glands, (2) endometrial stroma, (3) hemosiderin-laden macrophages
| Subtypes  =
| LMDDx      = [[adenocarcinoma]], [[endosalpingiosis]]
| Stains    =
| IHC        = CK7 +ve, ER +ve, [[CD10]] +ve (stroma), CK20 -ve, CDX2 -ve
| EM        =
| Molecular  =
| IF        =
| Gross      = chocolate cyst
| Grossing  =
| Site      = [[ovary]], uterine ligaments, cul-de-sac, [[peritoneum]], [[cervix]], [[vagina]], [[fallopian tubes]], surgical [[scar]]s, [[gastrointestinal tract]]
| Assdx      = infertility, [[endometrioid adenocarcinoma of the ovary]], [[clear cell adenocarcinoma of the ovary]], [[seromucinous borderline tumour]]
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  = +/-pelvic pain, +/-deep dyspareunia
| Prevalence = common
| Bloodwork  = [[CA-125]] mildly elevated
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
}}
'''Endometriosis''' causes significant morbidity and is associated with increased risk of [[Endometriosis#Tumours associated with endometriosis|certain malignancies]].
'''Endometriosis''' causes significant morbidity and is associated with increased risk of [[Endometriosis#Tumours associated with endometriosis|certain malignancies]].


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===Clinical===
===Clinical===
*A significant cause of infertility.
*Associated with infertility.
*A cause of pelvic pain.
*Pelvic pain.
*Deep dyspareunia.
*Affects approximately 10% of women of child bearing age.
*Affects approximately 10% of women of child bearing age.
*Associated with moderate elevation of (serum) CA-125.
*Associated with moderate elevation of (serum) CA-125.
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Rare stuff:
Rare stuff:
*There case reports of endometriosis in men on estrogen therapy for prostate cancer.<ref name=pmid22104297>{{Cite journal  | last1 = Fukunaga | first1 = M. | title = Paratesticular endometriosis in a man with a prolonged hormonal therapy for prostatic carcinoma. | journal = Pathol Res Pract | volume = 208 | issue = 1 | pages = 59-61 | month = Jan | year = 2012 | doi = 10.1016/j.prp.2011.10.007 | PMID = 22104297 }}</ref><ref name=pmid2418693>{{Cite journal  | last1 = Beckman | first1 = EN. | last2 = Pintado | first2 = SO. | last3 = Leonard | first3 = GL. | last4 = Sternberg | first4 = WH. | title = Endometriosis of the prostate. | journal = Am J Surg Pathol | volume = 9 | issue = 5 | pages = 374-9 | month = May | year = 1985 | doi =  | PMID = 2418693 }}</ref>
*There are case reports of endometriosis in men on estrogen therapy for [[prostate cancer]].<ref name=pmid22104297>{{Cite journal  | last1 = Fukunaga | first1 = M. | title = Paratesticular endometriosis in a man with a prolonged hormonal therapy for prostatic carcinoma. | journal = Pathol Res Pract | volume = 208 | issue = 1 | pages = 59-61 | month = Jan | year = 2012 | doi = 10.1016/j.prp.2011.10.007 | PMID = 22104297 }}</ref><ref name=pmid2418693>{{Cite journal  | last1 = Beckman | first1 = EN. | last2 = Pintado | first2 = SO. | last3 = Leonard | first3 = GL. | last4 = Sternberg | first4 = WH. | title = Endometriosis of the prostate. | journal = Am J Surg Pathol | volume = 9 | issue = 5 | pages = 374-9 | month = May | year = 1985 | doi =  | PMID = 2418693 }}</ref>


==Gross==
==Gross==
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*Endometriosis can appear almost any where.
*Endometriosis can appear almost any where.
**A well-reported uncommon location is the abdominal wall post-caesarian section.<ref name=pmid22381104>{{Cite journal  | last1 = Ozel | first1 = L. | last2 = Sagiroglu | first2 = J. | last3 = Unal | first3 = A. | last4 = Unal | first4 = E. | last5 = Gunes | first5 = P. | last6 = Baskent | first6 = E. | last7 = Aka | first7 = N. | last8 = Titiz | first8 = MI. | last9 = Tufekci | first9 = EC. | title = Abdominal wall endometriosis in the cesarean section surgical scar: a potential diagnostic pitfall. | journal = J Obstet Gynaecol Res | volume = 38 | issue = 3 | pages = 526-30 | month = Mar | year = 2012 | doi = 10.1111/j.1447-0756.2011.01739.x | PMID = 22381104 }}</ref>
**A well-reported uncommon location is the abdominal wall post-caesarian section.<ref name=pmid22381104>{{Cite journal  | last1 = Ozel | first1 = L. | last2 = Sagiroglu | first2 = J. | last3 = Unal | first3 = A. | last4 = Unal | first4 = E. | last5 = Gunes | first5 = P. | last6 = Baskent | first6 = E. | last7 = Aka | first7 = N. | last8 = Titiz | first8 = MI. | last9 = Tufekci | first9 = EC. | title = Abdominal wall endometriosis in the cesarean section surgical scar: a potential diagnostic pitfall. | journal = J Obstet Gynaecol Res | volume = 38 | issue = 3 | pages = 526-30 | month = Mar | year = 2012 | doi = 10.1111/j.1447-0756.2011.01739.x | PMID = 22381104 }}</ref>
===Images===
<gallery>
Image: Endometriosis,_abdominal_wall.jpg |Endometriosis in C-section scar at cut-up. (Ed Uthman/WC)
</gallery>


==Microscopic==  
==Microscopic==  
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DDx:
DDx:
*[[Adenocarcinoma]].
*[[Adenocarcinoma]] - especially colorectal adenocarcinoma.
*[[Endosalpingiosis]] - does not have stromal component.
*[[Endosalpingiosis]] - does not have stromal component.
**In the GI tract, it classically expands the muscularis propria.


===Images===
===Images===
*[http://commons.wikimedia.org/wiki/File:Endometriosis_of_the_ovary.jpg Endometriosis - ovary (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Endometrioma1.jpg Endometriosis - low mag. (WC)].
Image:Endometriosis_of_the_ovary.jpg | Endometriosis - ovary. (WC/Nephron)
*[http://commons.wikimedia.org/wiki/File:Endometrioma3.jpg Endometriosis - high mag. (WC)].
Image:Endometrioma1.jpg | Endometriosis - low mag. (WC/Nephron)
Image:Endometrioma3.jpg | Endometriosis - high mag. (WC/Nephron)
</gallery>


Mimicking cancer:
Mimicking cancer:
*[http://commons.wikimedia.org/wiki/File:Intestine_with_endometriosis_-_low_mag.jpg Endometriosis in the small intestine - low mag. (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Endometriosis_lymph_node_-_2_-_intermed_mag.jpg Endometriosis in a lymph node - intermed. mag. (WC)].
Image:Intestine_with_endometriosis_-_low_mag.jpg | Endometriosis in the small intestine - low mag. (WC/Nephron)
Image:Endometriosis_lymph_node_-_2_-_intermed_mag.jpg | Endometriosis in a lymph node - intermed. mag. (WC/Nephron)
</gallery>
www:
*[http://path.upmc.edu/cases/case375.html Endometriosis - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case375.html Endometriosis - several images (upmc.edu)].


==Immunohistochemical stains==
==Immunohistochemical stains==
*CD10 [[stains]] the stromal cells<ref name=Ref_DCHH236>{{Ref DCHH|236}}</ref> - used to look for endometriosis.
Features:<ref>{{cite journal |authors=Jiang W, Roma AA, Lai K, Carver P, Xiao SY, Liu X |title=Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases |journal=Mod Pathol |volume=26 |issue=9 |pages=1270–8 |date=September 2013 |pmid=23579618 |doi=10.1038/modpathol.2013.51 |url=}}</ref>
*ER +ve
**Stains the epithelium.
*[[CK7]] +ve
**Stains the epithelium.
*[[CK20]] -ve
**Used to exclude [[colorectal adenocarcinoma]].
*CDX2 -ve.
**Used to exclude [[colorectal adenocarcinoma]].
*[[CD10]] +ve
**Marks the stromal cells.<ref name=Ref_DCHH236>{{Ref DCHH|236}}</ref>
 
==Sign out==
===Biopsy===
<pre>
OVARIAN FOSSA, RIGHT, BIOPSY:
- ENDOMETRIOSIS.
- FIBROADIPOSE TISSUE PARTIALLY COVERED BY MESOTHELIUM.
</pre>
 
<pre>
CYST WALL, OVARY LEFT, CYSTECTOMY:
- ENDOMETRIOSIS.
</pre>
 
<pre>
CUL-DE-SAC, BIOPSY:
- ENDOMETRIOSIS.
 
COMMENT:
A CD10 immunostain marks the endometrial-type stroma and confirms the presence of
endometriosis.
</pre>
 
===Ovary and tube===
<pre>
OVARY AND FALLOPIAN TUBE, LEFT, SALPINO-OOPHORECTOMY:
- OVARY WITH ENDOMETRIOSIS.
- FALLOPIAN TUBE WITHIN NORMAL LIMITS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
===TAH-USO===
<pre>
UTERUS, UTERINE TUBES, LEFT OVARY, TOTAL HYSTERECTOMY, BILATERAL SALPINGECTOMY
AND LEFT OOPHRECTOMY:
- LEIOMYOMATA WITH HYALINE CHANGE.
- NONPROLIFERATIVE ENDOMETRIAL GLANDS WITH STROMAL DECIDUALIZATION, AND GLANDULAR
  DILATION.
- LEFT OVARY WITH ENDOMETRIOSIS, SEE COMMENT.
- LEFT UTERINE TUBE WITH ENDOMETRIOSIS, SEE COMMENT.
- RIGHT UTERINE TUBE WITHIN NORMAL LIMITS.
- UTERINE CERVIX WITHIN NORMAL LIMITS.
- NEGATIVE FOR MALIGNANCY.
 
COMMENT:
The presence of endometrial stroma was demonstrated with CD10 immunostaining, thus
confirming the presence of endometriosis.
</pre>
 
===TAH-BSO===
<pre>
UTERINE CERVIX, UTERUS, UTERINE TUBES AND OVARIES, TOTAL HYSTERECTOMY AND BILATERAL SALPINGOOPHERECTOMY:
- UTERINE CERVIX WITHIN NORMAL LIMITS.
- PROLIFERATIVE PHASE ENDOMETRIUM.
- UTERUS WITH FIBROUS SEROSAL ADHESIONS.
- LEFT UTERINE TUBE WITH ENDOMETRIOSIS.
- RIGHT UTERINE TUBE WITHIN NORMAL LIMITS.
- RIGHT AND LEFT OVARIES WITH ENDOMETRIOSIS.
</pre>
 
===Soft tissue abdominal wall mass===
<pre>
MASS, RIGHT LOWER ABDOMEN, EXCISION:
- ENDOMETRIOMA.
- SCAR.
 
COMMENT:
Immunostains confirm the presence of endometriosis (glandular component ER positive,
endometrial-like stroma CD10 positive).
</pre>
 
===Micro===
The sections show soft tissue with endometrial-type glands surrounded by endometrial-type
stroma. Siderophages are present. No nuclear atypia is identified. Mitotic activity is not
apparent.


==See also==
==See also==
Michael
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