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Difference between revisions of "Endometriosis"
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| LMDDx = [[adenocarcinoma]], [[endosalpingiosis]] | | LMDDx = [[adenocarcinoma]], [[endosalpingiosis]] | ||
| Stains = | | Stains = | ||
| IHC = CD10 +ve (stroma) | | IHC = CK7 +ve, ER +ve, [[CD10]] +ve (stroma), CK20 -ve, CDX2 -ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| Line 19: | Line 19: | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = | ||
| Symptoms = pelvic pain | | Symptoms = +/-pelvic pain, +/-deep dyspareunia | ||
| Prevalence = common | | Prevalence = common | ||
| Bloodwork = CA-125 mildly elevated | | Bloodwork = [[CA-125]] mildly elevated | ||
| Rads = | | Rads = | ||
| Endoscopy = | | Endoscopy = | ||
| Line 39: | Line 39: | ||
===Clinical=== | ===Clinical=== | ||
* | *Associated with infertility. | ||
* | *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. | ||
| Line 73: | Line 74: | ||
*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. | **In the GI tract, it classically expands the muscularis propria. | ||
| Line 108: | Line 114: | ||
==Immunohistochemical stains== | ==Immunohistochemical stains== | ||
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 | *ER +ve | ||
*CK7 +ve | **Stains the epithelium. | ||
*CK20 -ve - | *[[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== | ==Sign out== | ||
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CYST WALL, OVARY LEFT, CYSTECTOMY: | CYST WALL, OVARY LEFT, CYSTECTOMY: | ||
- ENDOMETRIOSIS. | - ENDOMETRIOSIS. | ||
</pre> | |||
<pre> | |||
CUL-DE-SAC, BIOPSY: | |||
- ENDOMETRIOSIS. | |||
COMMENT: | |||
A CD10 immunostain marks the endometrial-type stroma and confirms the presence of | |||
endometriosis. | |||
</pre> | </pre> | ||
| Line 162: | Line 184: | ||
- RIGHT AND LEFT OVARIES WITH ENDOMETRIOSIS. | - RIGHT AND LEFT OVARIES WITH ENDOMETRIOSIS. | ||
</pre> | </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== | ||