Ovary
Other nonneoplastic
Endosalpingiosis
Topic Completed: 1 December 2017
Minor changes: 16 October 2020
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PubMed Search: Ovarian endosalpingiosis
Table of Contents
Definition / general | Essential features | Terminology | Epidemiology | Sites | Pathophysiology | Clinical features | Diagnosis | Prognostic factors | Case reports | Clinical images | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Differential diagnosis | Additional references | Board review style question #1 | Board review style answer #1Cite this page: Busca A, Parra-Herran C. Endosalpingiosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarynontumorendosalpingiosis.html. Accessed April 13th, 2021.
Definition / general
- Presence of ectopic glands in the ovary lined by fallopian tube type ciliated epithelium
Essential features
- Incidental finding in resection specimens
- Diagnosed by microscopic examination
- Defined as ectopic glands lined by fallopian tube type ciliated epithelium outside the fallopian tube
Terminology
- Most Müllerian type epithelial inclusion cysts are within the spectrum of endosalpingiosis
- When mass forming, lesion is called florid cystic endosalpingiosis
Epidemiology
- In 1/3 of cases, endosalpingiosis is associated with endometriosis (Gynecol Oncol 2016;142:255)
- Endosalpingiosis was diagnosed in 7.6% of 1107 women undergoing laparoscopy in one study (J Am Assoc Gynecol Laparosc 2000;7:215)
Sites
- Ovaries, fallopian tube serosa, uterine serosa, bladder, lymph nodes
Pathophysiology
- Most cases are believed to be caused by distal fallopian tube implants in the ovarian cortex during ovulation
- Term "papillary tubal hyperplasia" (PTH) has been proposed to describe small rounded clusters of tubal epithelial cells and small papillae, with or without associated psammoma bodies, that are present within the tubal lumen; PTH has been linked to endosalpingiosis (Am J Surg Pathol 2011;35:1605)
- Some cases are believed to represent developmentally misplaced Müllerian tissue (Reprod Sci 2013;20:1030)
Clinical features
- Mostly asymptomatic and incidentally found in resection specimens
- May be associated with chronic pelvic pain (Fertil Steril 1995;64:482)
- Florid cystic endosalpingiosis: rare mass forming or mass related symptoms (BMJ Case Rep 2014 Jan 30;2014)
Diagnosis
- By histopathological examination, with confirmation of morphology and exclusion of endometriosis
Prognostic factors
- Considered a benign finding
- Relationship with development of epithelial malignancies is not clear but patients with endosalpingiosis have been found to be more likely to have concurrent endometriosis as well as uterine and ovarian cancer (Gynecol Oncol 2016;142:255)
Case reports
- 31 year old woman with florid cystic endosalpingiosis, masquerading as a malignancy (BMJ Case Rep 2014 Jan 30;2014)
Clinical images
Images hosted on other servers:
Laparoscopy of enlarged ovary
Gross description
- Simple cysts on ovarian surface
- Florid cystic endosalpingiosis can form a multicystic tumor-like mass (BMJ Case Rep 2014 Jan 30;2014)
Gross images
Images hosted on other servers:
Multiple lesions
Microscopic (histologic) description
- Glands lined by ciliated tubal type epithelium
- Three types of cells:
- Ciliated columnar cells
- Nonciliated columnar secretory mucous cells
- So called intercalary or peg cells
- May have psammoma bodies
- Absence of endometrial stroma
- Glands can be cystically dilated; they are usually found in the superficial ovarian cortex, either scattered or in loose clusters
Microscopic (histologic) images
Contributed by Aurelia Busca, M.D., Ph.D.
Endosalpingiosis
AFIP images
Glands lined by ciliated epithelium lie in fibrous stroma
Ciliated, secretory and intercalated cells line cystic space
Images hosted on other servers:
Calretinin: polypoidal
endosalpingiosis
Positive stains
- PAX2, PAX8 (Am J Surg Pathol 2011;35:1837)
- WT1, ER, PR (Case Rep Pathol 2016;2016:2856358, Am J Surg Pathol 2014;38:1612)
- Endosalpingiosis has a similar biomarker profile to normal fallopian tube and serous neoplasms (phospho-Smad2, BCL2 and FOXJ1), which is distinct from ovarian surface epithelium (Gynecol Oncol 2014;132:316)
Negative stains
Differential diagnosis
- Cystic ovarian neoplasms when mass forming
- Other types or epithelial cyst (mucinous, peritoneal inclusion type, transitional type) have distinct epithelia
- Serous cystadenoma is lined by tubal type epithelium; distinction relies (arbitrarily) on size > 1 cm for cystadenomas
- Endometriosis: has endometrial stroma and hemorrhage
Additional references
Board review style question #1
What feature below is most important to distinguish endosalpingiosis from endometriosis?
- Location
- Presence of endometrial stroma
- Presence of tubal epithelium
- Reactivity for PAX8
Board review style answer #1
B. Endometrial stroma is seen in endometriosis but not endosalpingiosis. Endometriosis can have tubal differentiation. It tends to have a similar anatomic distribution as endosalpingiosis and to express markers of Müllerian derivation such as PAX8.
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Reference: Endosalpingiosis
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