Lymph nodes & spleen, nonlymphoma
Ectopic tissue / inclusions

Topic Completed: 1 March 2014

Minor changes: 5 October 2020

Copyright: 2003-2021,, Inc.

PubMed Search: Endometriosis [title] lymph nodes

Jayalakshmi Balakrishna, M.D.
Page views in 2020: 1,018
Page views in 2021 to date: 364
Cite this page: Balakrishna J, Sharabi A. Endometriosis. website. Accessed June 12th, 2021.
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
  • Lymphatic endometriosis
  • Metastases from endometriosis
  • 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
  • Regional lymph nodes including mesorectal, pericolic and pelvic lymph nodes
  • 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
  • Lapraoscopy
  • Biopsy
Case reports
  • 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
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
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