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Uterus

Non tumor

Endometriosis

Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 13 November 2011, last major update November 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

General
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● Endometrial tissue outside the uterus; closely related to adenomyosis
● Women 20-30 years old, up to 10% of all women affected
● Consists of functional layers of endometrium that go through menstrual changes, although is more proliferative than normal endometrium
● Causes pain, infertility (1/3 of women are infertile)
● Causes: regurgitation (retrograde menstruation), metaplasia and angiolymphatic dissemination (to lungs, nodes); metaplastic change of secondary mullerian system represented by pelvic mesothelium
● Sites: ovaries > uterine ligaments > rectovaginal septum > pelvic peritoneum > scar
● Rarely in lymph nodes, usually with cuboidal epithelium, no stroma, limited to capsule and resembles tubal epithelium; call endosalpingiosis
● Rarely has extensive intestinal tract involvement, resembling other intestinal diseases (Am J Surg Pathol 2001;25:445)
● May undergo malignant transformation (Hum Pathol 2000;31:456)
● Malignant tumors: endometrioid > clear cell, endometrial stromal sarcoma and MMMT
● Organizing hemorrhage may cause adhesions, ovarian chocolate cysts

Diagram
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Chocolate cyst

Treatment
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● Hormones, surgery (including robotic assisted laparascopy, JSLS 2011;15:387)

Gross description
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● Blue cystic nodules surrounded by fibrosis
● Rarely, polypoid masses simulating a neoplasm (Am J Surg Pathol 2004;28:285)

Gross images
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Small foci resembling "powder burns"


"Chocolate" cyst

Micro description
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● Contains at least two of three features - endometrial glands, endometrial stroma and hemorrhage
● May be a dense fibrous mass
● May undergo mucinous metaplasia (also called endocervicosis or myxoid change)
● Associated with perineurial invasion
● May be associated with skeletal muscle regeneration (Am J Surg Pathol 2010;34:10)

Micro images
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Focus of endometriosis

       
Endometrial glands and stroma in wall of GI tract


Multifocal polypoid endometriosis presenting as huge pelvic masses


p63 expression

Cytology images
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Contributed by Dr. Carmen Luz:

Sheet of endometrial epithelium in FNA from abdominal wall


Sheet of endometrial epithelium adjacent to a group of endocervical epithelium and endometrial stroma from an endometrial direct cytology


Round endometrial epithelial group with slight atypia

Positive stains
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● CD10 (endometrial stromal cells, Arch Pathol Lab Med 2003;127:1003), p63 (nuclear staining in glandular component, Arch Pathol Lab Med 2007;131:1099)
● Also CK7, ER, PR, usually CA125 (Hum Pathol 2008;39:954)

Differential diagnosis
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● Well differentiated adenocarcinoma if endocervicosis present
● Pseudomyxoma peritonei if myxoid change (may also be caused by endometriosis, Am J Clin Pathol 2000;113:860)

Additional references
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● Wikipedia, eMedicine

End of Uterus > Non tumor > Endometriosis

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