Other nonneoplastic lesions


Editorial Board Member: Gulisa Turashvili, M.D., Ph.D.
Deputy Editor-in-Chief: Jennifer A. Bennett, M.D.
Aurelia Busca, M.D., Ph.D.
Carlos Parra-Herran, M.D.

Last author update: 28 January 2022
Last staff update: 28 January 2022

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PubMed Search: Endosalpingiosis [TIAB] ovary

Aurelia Busca, M.D., Ph.D.
Carlos Parra-Herran, M.D.
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Cite this page: Busca A, Parra-Herran C. Endosalpingiosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarynontumorendosalpingiosis.html. Accessed March 22nd, 2023.
Definition / general
  • Presence of ectopic glands lined by fallopian tube type ciliated epithelium
Essential features
  • Defined as ectopic glands lined by fallopian tube type ciliated epithelium outside the fallopian tube
  • Incidental finding in resection specimens
  • Diagnosed by microscopic examination
  • Dilated glands measure less than 1 cm in size (if more than 1 cm, serous cystadenoma)
  • Typically seen in women of reproductive age
  • In 33% of cases, endosalpingiosis is associated with endometriosis (Gynecol Oncol 2016;142:255)
  • Ovaries, omentum, fallopian tube serosa, uterine serosa, bladder, lymph nodes
  • Multiple hypotheses, including distal fallopian tube implants in the ovarian cortex during ovulation or metaplastic changes of the ovarian surface epithelium or peritoneal cells (Reprod Sci 2013;20:1030)
  • Papillary tubal hyperplasia (PTH) is a term that 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 and serous tumor (Am J Surg Pathol 2011;35:1605)
  • No specific etiology identified
Clinical features
  • By histopathological examination, with confirmation of morphology and exclusion of endometriosis
Radiology description
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
  • Surgery for the mass forming lesions
Gross description
Gross images

Images hosted on other servers:

Multiple lesions

Microscopic (histologic) description
  • Glands lined by ciliated tubal type epithelium
  • 3 types of cells:
    • Ciliated columnar cells
    • Nonciliated columnar secretory mucous cells
    • So called intercalated 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
  • Reference: Clement: Atlas of Gynecologic Surgical Pathology, 4th edition, 2019
Microscopic (histologic) images

Contributed by Aurelia Busca, M.D., Ph.D.
Cystically dilated glands Cystically dilated glands

Cystically dilated glands

Tubal differentiation Tubal differentiation Tubal differentiation

Cystically dilated glands with tubal differentiation

Stromal microcalcifications

Cystically dilated glands with stromal microcalcifications

Positive stains
Negative stains
Sample pathology report
  • Right and left ovaries, bilateral oophorectomies:
    • Benign ovaries with focal endosalpingiosis
    • Note: many pathologists do not report the finding of endosalpingiosis since it is common and benign
Differential diagnosis
Additional references
Board review style question #1

Which of the following is true about the finding illustrated in the photo of the ovary shown above?

  1. It represents an indication for resection
  2. Tubal differentiation distinguishes it from endometriosis
  3. Typically PAX8 negative
  4. Usually an incidental finding
Board review style answer #1
D. Usually an incidental finding. Endosalpingiosis is typically benign incidental finding in resection specimens, Müllerian derived (PAX8 positive). Absence of endometrial stroma distinguishes it from endometriosis, as tubal differentiation can be seen in both entities.

Comment Here

Reference: Endosalpingiosis
Board review style question #2
What feature below is most important to distinguish endosalpingiosis from endometriosis?

  1. Location
  2. Presence of endometrial stroma
  3. Presence of tubal epithelium
  4. Reactivity for PAX8
Board review style answer #2
B. Presence of endometrial stroma. 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.

Comment Here

Reference: Endosalpingiosis
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