{"paper_id":"7ca9b2a6-16b9-4dc4-8c57-d0ba0628ff3a","body_text":"32\nIntroduction\nIn gynecology endosalpingiosis is a benign condition in \nwhich fallopian tube-like epithelium is found outside of \nthe fallopian tube. Endosalpingiosis is associated with the \nformation of psammoma bodies, which may lead to the \nmisdiagnosis of malignancy such as serous carcinoma.\n1\nThe significance of endosalpingiosis is not settled; medical \nexperts differ on whether it causes pelvic pain, or is an inci-\ndental (asymptomatic) finding discovered in the course of \ninvestigating pelvic pain, menstrual irregularities or infertility.\nEndosalpingiosis is diagnosed by a pathologist on excision \nand biopsy. Endosalpingiosis is occasionally found in lymph \nnodes, and may be misinterpreted as an adenocarcinoma \nmetastasis.\nIn one study, they found that 34.5% of endosalpingiosis \ncases had concurrent endometriosis; 40% of the \nendosalpingiosis group were postmenopausal. Endometriosis \nwas significantly associated with infertility and chronic \npelvic pain. In contrast, there was no significant link \nbetween endosalpingiosis and infertility nor chronic pelvic \npain. Gynecologic malignancy occurred significantly more in \npremenopausal women with endosalpingiosis than in those \nwithout. Endosalpingiosis appears to affect postmenopausal \nwomen at a rate much higher than previously reported.\n2\nCase Report\nA 75-year-old woman, gravida 2, postmenopausal \nReceived: November 19, 2013  Revised: December 4, 2013  Accepted: January 12, 2014\nAddress for Correspondence:  Tae-Hee Kim, Department of Obstetrics and Gynecology, College of Medicine, Soonchunhyang \nUniversity Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon 420-767, Korea\nTel: +82-32-621-5380, Fax: +82-2-6008-6874, E-mail: heeobgy@schmc.ac.kr\nCase Report\npISSN: 2288-6478, eISSN: 2288-6761\nhttp://dx.doi.org/10.6118/jmm.2014.20.1.32\nJournal of Menopausal Medicine 2014;20:32-34\nCopyright © 2014 by The Korean Society of Meno pause\nThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License  (http://creativecommons.org/licenses/by-nc/3.0/).\nEndosalpingiosis in Postmenopausal Elderly Women\nJunsik Park, M.D., Tae-Hee Kim, M.D., Ph.D., Hae-Hyeog Lee, M.D., Ph.D., \nSoo-Ho Chung, M.D., Ph.D., Dong-Su Jeon, M.D.\nDepartment of Obstetrics and Gynecology, College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea\nIn gynecology, endosalpingiosis is a benign condition in which the fallopian tube-like epithelium is found outside the fallopian \ntube. The thirty-four point five percent of endosalpingiosis cases have concurrent endometriosis and 40% of the endosalpingiosis \ngroup are in postmenopausal states. In contrast with endometriosis, there are no significant links between infertility, chronic  \npelvic pain and endosalpingiosis. The symptoms of endosalpingiosis are not yet settled. Endosalpingiosis is almost always an \nincidental finding; it is commonly found through microscopic examinations, and is then confirmed by pathologists for excision and \nbiopsy. Therefore, the clinical differential diagnosis of an intramural mass is more important for clinicians when discussing further \nsurgery with the patients. We report case of woman who has endosalpingiosis and is presented with vaginal bleeding. We first \nsuspect the disease during physical examination. Under the impression of pelvic mass, laboratory tests and radiological images \nof contrast enhanced chest computer tomography are taken. Images show multisepted cystic masses in left adnexa. To rule out \nthe pelvic mass, we executed exploratory laparotomy. Pathologic results show endosalpingiosis near the ovary section. But the \nendosalpingiosis, is not generally considered a pathology, and thus, no treatment is necessary.\n (J Menopausal Med 2014;20:32-34)\nKey Words: Endometriosis, Fallopian tube diseases, Menopause, Uterine hemorrhage\n\n33\nJunsik Park, et al. Endosalpingiosis\nhttp://dx.doi.org/10.61 18/jmm.2014.20.1.32\nwomen, presented with vaginal bleeding which occurred \na week ago. She had hyperlipidemia and took medical \ntherapy. Under the impression of pelvic mass, cancer \nantigen 125 (CA-125), CA 19-9, complete blood cell count, \nserum chemistry, contrast enhanced - abdomen - computer \ntomography were done. CA 19-9 is 9.8 U/mL, CA-125 is \n13.5 U/mL and glucose is 118 mg/dL. In contrast enhanced \nchest computer tomography, image showed multiseptated \ncystic mass in left adnexa which adhesion with left psoas \nmuscle, adjacent small and large bowel loops and there is \npossibility of underlying chronic inflammatory process with \nabscess (Fig. 1). To rule out mucinous cyst adenoma, we \nexecuted exploratory laparotomy. Pathologic result shows \nendosalpingiosis near ovary. Vaginal bleeding is caused by \nthe atrophic vaginitis considering that the patient’s age is 75 \nyears old.\nDiscussion\nEndosalpingiosis is a non-neoplastic process and is \ngenerally considered to be derived from the secondary \nMüllerian system, which consists of structures covering the \nperitoneal mesothelium, the adjacent mesenchyme in the \nsmall pelvis and the lower part of the female abdominal \ncavity.\n3 Proliferation of these structures can result in the \ncreation of three different types of lesions: endometriosis, \nwhich occurs most frequently, and the less common \nendosalpingiosis and endocervicosis.\n4\nThe symptom of endosalpingiosis is not settled; medical \nexperts differ on whether it causes pelvic pain,5 or is an \nincidental (asymptomatic) finding discovered in the course \nof investigating pelvic pain, menstrual irregularities or \ninfertility.\n6\nThe causes of the endosalpingiosis are unknown. In \nthis case the endosalpingiosis was found incidentally. \nHowever, it is almost always an incidental finding, either at \nthe time of operation or, more commonly, on microscopic \nexamination.\n7 It is most commonly encountered on the pelvic \nperitoneum covering the uterus, Fallopian tubes, ovaries \nand culde-sac. Less frequent sites include the pelvic parietal \nperitoneum, omentum, bladder and bowel serosa, paraaortic \narea and skin.\n8 Only a few examples of tumor-like cystic \nendosalpingiosis localized to the female pelvis have been \ndescribed, and most of these cases are reported to be \nderived from the serosal surface of the uterus and the ovary \n6-10 or from the paraovarianregion.\n8\nFor diagnosis of endosalpingiosis, pathology on excision \n(e.g. biopsy), is needed. It is characterized by cysts with \ntubal-type epithelium (e.g. ciliated epithelium) surrounded \nby a fibrous stroma. Unlike endometriosis, it is not \nassociated with hemorrhage. A tubal-type epithelial \nsurrounded by endometrial-type stroma is a variant of \nendometriosis, not endosalpingiosis. Endosalpingiosis \nis occasionally found in lymph nodes, and may be \nmisinterpreted as an adenocarcinoma metastasis.\n9 The \npathological differential diagnosis of endosalpingiosis \nis discussed in detail in previously reported cases.\n7,10~14 \nHowever, the clinical differential diagnosis of an intramural \nmass, whether it causes any symptoms or not, is more \nFig. 1.  From contrast enhanced \nabdominal computer tomography, \nthe image shows multiseptated \ncystic mass in left adnexa.\n\nJournal of Menopausal Medicine 2014;20:32-34\n34 http://dx.doi.org/10.61 18/jmm.2014.20.1.32\nimportant for clinicians when discussing further surgery \nwith the patient. Therefore the symptoms and the \nimaging findings of this rare entity are very important. As \nendosalpingiosis, generally, is not considered a pathology, \nno treatment is necessary.\nEndosalpingiosis appears to affect an older age group, with \n40% of endosalpingiosis cases occurring in postmenopausal \nwomen.\n2 Premenopausal women with endosalpingiosis \nwere more likely to have a gynecologic malignancy.2 \nEndosalpingiosis appears to affect postmenopausal women \nat a much higher rate than previously thought, and in \nconsequence the average age of women presenting with \nendosalpingiosis was higher than expected.\n2 In this case, \n75-year-old woman, gravida 2, postmenopausal women, \npresented with vaginal bleeding was reported. The patient \nshowed untypical symptom and clinical manifestation. Her \nchief complain was vaginal bleeding. The most common \nsymptom of endosalpingiosis is chronic pelvic pain. However, \nit must be kept in mind that vaginal bleeding can be caused \nby endosalpingiosis, especially in the postmenopausal elderly \nwomen. Possibility of endosalpingiosis must be considered in \nthe differential diagnostic spectrum of vaginal bleeding, thus \navoiding the problem of misdiagnosis of endosalpingiosis. \nReferences\n1. Fausett MB, Zahn CM, Kendall BS, Barth WH, Jr. The \nsignificance of psammoma bodies that are found incidentally \nduring endometrial biopsy. Am J Obstet Gynecol 2002; 186: \n180-3.\n2. Prentice L, Stewart A, Mohiuddin S, Johnson NP. What is \nendosalpingiosis? Fertil Steril 2012; 98: 942-7.\n3. Clement PB, Young RH. Florid cystic endosalpingiosis with \ntumor-like manifestations: a report of four cases including \nthe first reported cases of transmural endosalpingiosis of \nthe uterus. Am J Surg Pathol 1999; 23: 166-75.\n4. Kajo K, Zubor P, Macháleková K, Plank L, Visnovskỳ  J. \nTumor-like manifestation of endosalpingiosis in uterus: a \ncase report. Pathol Res Pract 2005; 201: 527-30.\n5. deHoop TA, Mira J, Thomas MA. Endosalpingiosis and \nchronic pelvic pain. J Reprod Med 1997; 42: 613-6.\n6. Heinig J, Gottschalk I, Cirkel U, Diallo R. Endosalpingiosis-\nan underestimated cause of chronic pelvic pain or an \naccidental finding? A retrospective study of 16 cases. Eur J \nObstet Gynecol Reprod Biol 2002; 103: 75-8.\n7. Clement PB. Diseases of the peritoneum. In: Kurman RJ, \neditor. Blaustein’s pathology of the female genital tract. \nNew York, NY: Springer New York; 1994. p 647-703.\n8. Lee SN, Cho MS, Kim SC, Han WS. Tumor-like multi-\nlocular cystic endosalpingiosis of the uterine serosa: possible \nclinical and radiologic misinterpreted. Acta Obstet Gynecol \nScand 2005; 84: 98-9.\n9. Corben AD, Nehhozina T, Garg K, Vallejo CE, Brogi E. \nEndosalpingiosis in axillary lymph nodes: a possible pitfall \nin the staging of patients with breast carcinoma. Am J \nSurg Pathol 2010; 34: 1211-6.\n10. Heatley MK, Russell P. Florid cystic endosalpingiosis of the \nuterus. J Clin Pathol 2001; 54: 399-400.\n11. Fukunaga M. Tumor-like cystic endosalpingiosis of the \nuterus with florid epithelial proliferation. A case report. \nAPMIS 2004; 112: 45-8.\n12. Youssef AH, Ganesan R, Rollason TP. Florid cystic \nendosalpingiosis of the uterus. Histopathology 2006; 49: \n546-8.\n13. Park J, Kim TH, Lee HH, Lee W, Chung SH. Ovarian rete \ncyst in a post-menopausal woman: a case report. J Korean \nSoc Menopause 2012; 18: 67-9.\n14. Kim TH, Lee HH, Chung SH, Kwak JJ, Park HS. \nEndometriosis detected in postmenopausal women not \nreceiving menopausal hormone therapy: two case reports. J \nKorean Soc Menopause 2010; 16: 176-80.","source_license":"CC0","license_restricted":false}