Endometriosis

Uterus
Non tumor
Endometriosis

Author: Nat Pernick, M.D. (see Authors page)

Revised: 10 October 2018, last major update November 2011

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed search: endometriosis [title] uterus NOT tumor

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Table of Contents

Cite this page: Endometriosis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterusendometriosis.html. Accessed January 22nd, 2019.

Definition / general

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 Müllerian 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

Diagrams / tables

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Chocolate cyst

Treatment

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

Gross description

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

Microscopic (histologic) description

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)

Microscopic (histologic) images

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