Lymph nodes - not lymphoma
Inclusions, pigment, ectopic cells or tissue
Endometriosis

Author: Jaya Balakrishna, M.D. (see Authors page)
Editor: Abdelsalam Sharabi, M.D.

Revised: 6 July 2018, last major update March 2014

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Endometriosis [title] lymph nodes

Cite this page: Balakrishna, J. Endometriosis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lymphnodesendometriosis.html. Accessed August 17th, 2018.
Definition / general
  • Endometriosis: the presence of endometrial glands and stroma in extrauterine sites
  • Lymph node involvement by endometriosis is uncommon and consists of isolated endometriotic-like cells located in the peripheral sinus of lymph node and frank metastatic endometriotic lesions
Terminology
  • Lymphatic endometriosis
  • Metastases from endometriosis
Epidemiology
  • Endometriosis is a common disease affecting up to 15% of women of reproductive age
  • In women with ovarian or peritoneal endometriosis, endometriotic lesions are found in 11% and isolated endometriotic-like cells in 80% of pelvic sentinel lymph nodes
  • Spread of endometriosis is common in women with rectosigmoid, rectovaginal, and bowel endometriosis
Sites
  • Regional lymph nodes including mesorectal, pericolic and pelvic lymph nodes
Pathophysiology
  • May result from vascular drainage; in rectosigmoid endometriosis, by lymphovascular invasion by glands or stroma
  • Lymph node involvement represents a metaplastic process from the conceptual secondary Müllerian system
  • A process similar to malignant transformation allows some endometriotic cells from the primary endometriotic lesion (EL) to detach and to colonize regional pelvic sentinel lymph nodes (PSLN)
Clinical features
  • Pelvic pain, infertility, dysmenorrhea
  • May cause infertility
  • Malignant transformation can occur rarely
Diagnosis
  • Lapraoscopy
  • Biopsy
Case reports
Treatment
  • Similar to primary endometriosis
  • Lymph node dissection may be helpful
Clinical images

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Chocolate cyst

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Soft mass-like lesion in cecum

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Small bowel obstruction

Gross description
  • Enlarged lymph nodes
  • May or may not show hemorrhagic cut surfaces
Gross images

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Poorly demarcated
dense, gray-white
fibrous lesion

Microscopic (histologic) description
  • Glandular cystic spaces lined by Müllerian serous epithelium and endometrioid stroma
  • Recent and old hemorrhage and fibrosis may be seen
  • May undergo decidual reaction
  • Variable hemorrhage
  • Rarely has smooth muscle component
Microscopic (histologic) images

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Various images

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Endometriosis of unknown lymph node

Molecular / cytogenetics description
Differential diagnosis
  • Metastasis from endometrial adenocarcinoma
  • Other Müllerian abnormalities unaccompanied by stroma including:
    • Benign Müllerian cysts: Müllerian glands lined by nonciliated epithelium
    • Endosalpingiosis: Müllerian glands lined by ciliated tubal epithelium