An unusual clinical presentation and histological findings provide insight into the pathogenesis of endometriosis

The aetiology of endometriosis is poorly understood resulting in a number of different models of pathogenesis. None of these models completely explains all of the available evidence. As such, there remains significant uncertainty about the origins and development of the disease, and in particular the involvement of the lymphatic system in that process. A 37-year-old patient with known endometriosis presented with a rapidly growing endometrioma following previous surgical drainage. The cyst enlarged over 5 months to extend above the umbilicus, necessitating a mid-line laparotomy and right salpingo-oophorectomy for the relief of severe pain symptoms. At the time of surgery, significant retroperitoneal inflammation and fibrosis were noted and a 2.5 cm pelvic lymph node was excised. This contained a cystic structure that was concluded to be an endometriotic cyst within the lymph node. The clinical significance of this is unknown but it does highlight the role the lymphatic system may play in the pathogenesis of endometriosis. Similar content being viewed by others

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World J Gastroenterol 20:6675–6679. doi:10.3748/wjg.v20.i21.6675 Author information Authors and Affiliations Corresponding author Ethics declarations Disclosures None. Funding This work received no funding. Conflict of interest PD Simpson has received honoraria from Gedeon Richter. X Tyler has no conflicts of interest to declare. EP Morris has received speaker’s fees and honoraria from Gedeon Richter, Besins, Bayer, Novo Nordisk, Mylan, Cook Medical and Kebomed. Research involving human participants and/or animals All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study. Rights and permissions About this article Cite this article Simpson, P., Tyler, X. & Morris, E. An unusual clinical presentation and histological findings provide insight into the pathogenesis of endometriosis. Gynecol Surg 13, 479–484 (2016). https://doi.org/10.1007/s10397-016-0984-y Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s10397-016-0984-y