{"paper_id":"8c3d6287-7299-487e-a2c8-56e81896b3c9","body_text":"Gynecol Obstet, an open access journal\nISSN: 2577-2236\n1 V olume 7; Issue 3\nCase Report\nEndosalpingiosis in Pelvic Lymph Node with Atypical \nEndometrial Hyperplasia\nFatma AlSayegh*, Hassan Rajab\nDepartment of Gynecology, Beaumont Hospital, Dublin, Ireland\n*Corresponding author: Fatma AlSayegh, Department of Gynecology, Beaumont Hospital, Dublin, Ireland\nCitation: AlSayegh F, Rajab H (2023) Endosalpingiosis in Pelvic Lymph Node with Atypical Endometrial Hyperplasia. Gynecol \nObstet Open Acc 7: 175. DOI: https://doi.org/10.29011/2577-2236.100175\nReceived Date: 21 December 2023; Accepted Date: 27 December, 2023; Published Date: 29 December, 2023\nObstetrics & Gynecology: Open Access\nAlSayegh F and Rajab H. Gynecol Obstet Open Acc 7: 175.\nwww.doi.org/10.29011/2577-2236.100175\nwww.gavinpublishers.com\nAbstract\nEndosalpingiosis, defined by the presence of tubal-type epithelium in multiple anatomical places, has emerged as a \nbenign condition related with Mullerian disease, most notably endometriosis and endocervices. Remarkably, its association \nwith persistent pelvic discomfort and genital tract cancers has received more attention. We describe the case of a 44-year-\nold female with nodal Endosalpingiosis with underlying atypical endometrial hyperplasia. The case discussed here adds to \nunderstanding the existence of Endosalpingiosis inside pelvic lymph nodes, which goes beyond staging for gynecological \ncancers.\nKeywords: Endosalpingiosis; Pelvic Lymph Node; \nEndometrial Atypical Hyperplasia.\nIntroduction\nEndosalpingiosis is a benign condition characterized by the \npresence of tubal-type epithelium in female reproductive organs, \nbladder, variform appendix, colon, lymph nodes and skin \n[1]. Recent \nevidence have suggested that Endosalpingiosis is the end spectrum \nof Mullerian disorder (milrinones) and mostly seen in concordance \nwith endometriosis and endocervices \n[2]. Endosalpingiosis has been \nlinked with chronic pelvic pain and genital tract malignancies [3]. \nThe histological changes of Endosalpingiosis have been previously \nreported in pelvic lymph nodes of patients undergoing staging for \ngynecological malignancies, axillary lymph nodes of women with \nbreast cancer. The reported prevalence of Endosalpingiosis in \nliterature ranges from 7.6-12.5%. When Endosalpingiosis is found \nin a lymph node, it must be distinguished from adenocarcinoma \nlymph node metastases. Here we are presenting a case of 44-year-\nold women with nodal Endosalpingiosis with underlying atypical \nendometrial hyperplasia.\nCase Report\nA 44- year Para 2 female, with previous two normal vaginal \ndeliveries referred to our gynecology department with abnormal \nuterine bleeding described mainly by prolonged heavy menstrual \nbleeding and dysmenorrhea. Patient was initially investigated \nwith pelvic ultrasound which revealed thickened endometrium. \nShe was then booked for hysteroscopy, endometrial sampling \nand IUD insertion which was performed and showed a thickened \nendometrial lining with no endometrial polyps or submucosal \nfibroids. Unfortunately, histopathology came back showing \natypical endometrial hyperplasia. As her family is complete, \npatient has been counselled and booked for total laparoscopic \nhysterectomy, bilateral salpingectomy with lymph node sampling. \nPrior to the procedure, the patient had MRI pelvis performed as a \nbaseline due to the underlying pathology of atypical endometrial \nhyperplasia, which showed no underlying endometrial cancer or \nfurther abnormality. Procedure was done 8 weeks post the initial \ndiagnosis. During laparoscopy, it was noted that there is inactive \nendometriotic nodules with both ovaries’ adherent to the uterine \nside walls, adenomyotic uterus and enlarged pelvic lymph nodes. \nProcedure was carried out as planned and she had an uneventful \nrecovery and post-operative period.\nHistopathology review showed no evidence of malignancy. \nThere was evidence of adenomyosis and leiomyoma in the uterus. \nLeft pelvic lymph nodes had focus of Endosalpingiosis. We \nbelieve that this is the first case in literature of pelvic lymph node \nEndosalpingiosis with no underlying gynecological malignancy.\n\nCitation: AlSayegh F, Rajab H (2023) Endosalpingiosis in Pelvic Lymph Node with Atypical Endometrial Hyperplasia. Gynecol Obstet Open Acc 7: 175. DOI: https://\ndoi.org/10.29011/2577-2236.100175\n2\nV olume 7; Issue 3\nGynecol Obstet, an open access journal\nISSN: 2577-2236\nDiscussion\nEndosalpingiosis, a peritoneal serous lesion, has been \nassociated with serous borderline tumors and low-grade serous \novarian neoplasms [4]. Hence, there is increasing evidence that \nthere might be a direct association between Endosalpingiosis and \novarian cancer \n[5]. Endosalpingiosis involving the pelvic and para-\naortic lymph nodes is not uncommon. Nodal Endosalpingiosis has \nbeen reported to be present in 5%of women undergoing pelvic or \npara-aortic lymph node removal during surgery for gynecological \ncancer. In 2012, Prince et al published a series of 110 cases \ndiagnosed with Endosalpingiosis, endometrial adenocarcinoma \nwas also present in 16% of cases, while serous borderline ovarian \ntumors were present in 7% of cases. Endosalpingiosis involving \npelvic nodes with atypical endometrial hyperplasia has not been \nreported.\nRise was the first to identify peritoneal Mullerian inclusions \nin 1897. Sampson used the term “Endosalpingiosis” in 1930 to \ncharacterize the local proliferative and invasive features of tubal \nmucosa following surgical interruption. He investigated the tubal \nstumps of 147 individuals who had previously had a salpingectomy \nor tubal sterilization and discovered that sprouts of fallopian tube \nepithelium frequently infiltrated and expanded beyond the stump \nwall. Novak questioned this description, noting that similar lesions \nwere also detected in individuals who had a history of pelvic \ninflammatory illness but had no history of tubal surgery. These \nlesions were radiologically and histologically similar to salpingitis \nisthmic nodosa.\nIt is a significant clinical entity since it has been linked to \nchronic pelvic discomfort, can cause substantial diagnostic issues \nwith peritoneal washings, has been linked to ovarian and cervical \nneoplasms, and can progress to malignancy \n[6]. Unfortunately, it \nis frequently misdiagnosed as endometriosis and ablated with \ndiathermy (Shah et al.). Laparoscopy with excision of lesions \nsuggestive of endometriosis will very certainly raise the frequency \nof Endosalpingiosis just by diagnosis. Excision of worrisome \nlesions rather than ablating lesions would not only help our \nunderstanding of Endosalpingiosis but may also be the most \nappropriate treatment for the illness.\nEndosalpingiosis is a very uncommon but growingly \nrecognized disorder defined by the presence of tubal-type \nepithelium in diverse extra-tubal locales. It is currently described \nas the presence of benign epithelium histologically comparable \nto tubal epithelium in an ectopic location \n[7]. The peritoneum is \nthe most common location of development, although it is also \nseen in the omentin, urinary bladder, and pelvic and para-aortic \nlymph nodes \n[8]. Endosalpingiosis is seen in 5.3% of pelvic lymph \nnodes dissected for the treatment of gynecological malignant \ntumors. Recent research reveals a link between it and Mullerian \ndiseases, as well as endometriosis and endocervices. According to \nthe research, its prevalence ranges from 7.6% to 12.5%. The case \ndiscussed here contributes to a better understanding of its presence \ninside pelvic lymph nodes, which has previously been documented \nin patients undergoing staging for gynecological cancers and other \ndisorders.\nThe presented case is notable for the conjunction of nodal \nEndosalpingiosis with underlying atypical endometrial hyperplasia \n[9]. Prior research has not thoroughly established this connection. \nThis revelation may prompt future research into the potential \ninteraction or shared pathophysiology between these disorders, \nimplying the need for thorough examination and therapeutic \noptions for individuals who arrive with comparable findings.\nClinically, the importance of detecting nodal Endosalpingiosis \nin the presence of atypical endometrial hyperplasia necessitates a \nmultidisciplinary approach to treating such patients. While there \nwas no indication of malignancy on histology, the putative link \nbetween Endosalpingiosis and gynecological tumors demands \nclose monitoring and follow-up for prospective malignancy \ndevelopment. Furthermore, this instance emphasizes the \nsignificance of rigorous preoperative evaluations and meticulous \nhistological exams ingynecological abnormalities patients. We \nreport a case of nodal Endosalpingiosis involving pelvic nodes \nwith underlying atypical endometrial hyperplasia \n[10].\nConclusion\nThis case emphasizes the importance of heightened \nmonitoring and extensive examination when facing unusual but \npotentially significant presentations such as nodal Endosalpingiosis \nin conjunction with atypical endometrial hyperplasia. The \nunique feature of this case resides in the coexistence of nodal \nEndosalpingiosis with atypical endometrial hyperplasia, a link \nthat has not been widely described in the current literature. \nThis case report adds to the growing body of knowledge about \nnodal Endosalpingiosis in conjunction with atypical endometrial \nhyperplasia, highlighting the importance of ongoing research, \ncomprehensive evaluation, and multidisciplinary collaboration in \nthe management of such complex clinical scenarios.\nDeclaration of Interest: None \nEthical Approval is not Required by Beaumont Ethical Committee \nfor Case Reports.\nReferences\n[1]. Niwa K, Sakamoto K, Goto M, Kojima Y, Takahashi M, et al. (2020) A \nCase of Endosalpingiosis in the Lymph Nodes of the Mesocolon. Surg \nCase Rep 6: 181.\n[2]. Yang M, Li Y, Chen M, Chen J, Kung FT (2019) Uterine Endosalpingiosis: \nCase Report and Review of the Literature. Taiwan J Obstet Gynecol \n58: 324-327.\n\nCitation: AlSayegh F, Rajab H (2023) Endosalpingiosis in Pelvic Lymph Node with Atypical Endometrial Hyperplasia. Gynecol Obstet Open Acc 7: 175. DOI: https://\ndoi.org/10.29011/2577-2236.100175\n3\nV olume 7; Issue 3\nGynecol Obstet, an open access journal\nISSN: 2577-2236\n[3]. Lewis GK, Ghaith S, Craver EC, Li Z, Wasson MN, et al. (2022) \nThe Association of Endosalpingiosis with Gynecologic Malignancy. \nGynecol Oncol 167: 81-88. \n[4]. Hermens M, Altena AM, Bulten J, Siebers AG, Bekkers RLM, et al. \n(2020) Increased Association of Ovarian Cancer in Women with \nHistological Proven Endosalpingiosis. Cancer Epidemiol 65: 101700. \n[5]. Subbiah M, Ch Toi P, Devarajan G, Stephen SM (2020) Cystic Uterine \nEndosalpingiosis in a Patient with Carcinoma Endometrium. J Midlife \nHealth 11: 178-180. \n[6]. Jocelyn S, Swan K (2020) Endosalpingiosis: Clinical Presentation and \nCoexisting Pathology [07H]. Obstetrics & Gynecology 135: 83S-83S.\n[7]. Balthazar P, Kearns C, Mauricio Zapparoli M (2021) Endosalpingiosis. \nRadiographic 41: E61-62. \n[8]. Mahdavi FS,Tavallaei M, Ketabforoush AHME, Bahadorinia M \nParatubal (2020) Endosalpingiosis: A Case Report. Int J Surg Case \nRep 77: 839-842. \n[9]. Talia KL, Fiorentina L, Scurry McCluggage WG (2020) A \nClinicopathologic Study and Descriptive Analysis of ‘Atypical \nEndosalpingiosis. Int J Gynecol Pathol 39: 254-260. \n[10]. Shah A, Zangmo R, Jain K (2020) Endosalpingiosis with Concurrent \nEndometriosis of Ovary Masquerading as Ovarian Malignancy. \nInternational Journal of Reproduction, Contraception, Obstetrics and \nGynecology 9: 2595-98.","source_license":"CC0","license_restricted":false}