[The changing morphological pattern of endometriosis. 2. Multiple recurrences of external endometrioses several years after hysterectomy and bilateral salpingo-oophorectomy]

K O Schmid, Schmid KO
Archiv fur Gynakologie · 1972 · doi:10.1007/BF00667727 · PMID:4678919
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This paper describes three cases of recurrent endometriosis in the vaginal stump years after hysterectomy and oophorectomy, with varying histological types and potential causes including hormonal substitution and endogenous estrogen production.

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This paper describes a case in which endometriosis lesions were excised from the vaginal stump and surrounding tissue at 4, 6, and 16 years after a hysterectomy with bilateral salpingo-oophorectomy, performed for severe adnexal tuberculosis. Across time, the first two lesions showed hyperproliferative corpus-type endometriosis, while the intrauterine and final lesions were classified as a mixed corpus–cervical/mucosa type with marked regressive (retrogressive) changes; the author also discusses differential diagnosis versus adenosis vaginae and provides a histological classification into basalis, functionalis, and mixed types plus corpus-cervical endometriosis. The paper attributes the early hyperproliferation to hormonal substitution and the later relative preservation despite a 5-year hormone-free interval to endogenous adrenal estrogen production, with the major limitation being its reliance on a single case observation. This paper is centrally about endometriosis — it documents longitudinal changes in endometriosis morphology after hysterectomy and bilateral salpingo-oophorectomy and relates differential diagnosis to adenosis and adenomyosis in the surgical context.

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Summary Excision of endometriosis of the vaginal stump and its vicinity, 4, 6, 16 years after operation respectively finally suspicious of colonic-cancer in a now 60 year old women who has undergone hysterectomy and bilateral salpingo-oophorectomy, because of severe adnextuberculosis. The first two endometriosis were of the hyperproliferated corpus-type, while intrauterine and in the final endometriosis a mixed corpus-cervical-type with distinct retrogressive changes were found. Differential diagnosis of corpus-cervix endometriosis from adenosis vaginae. Histological classification of endometriosis into basalis-, functionalis-and basalis-functionalis mixed type and corpus-cervicalendometriosis. The marked hyperproliferation of the two first vaginalstump-endometriosis is the result of hormonal substitution, the final endometriosis probably being caused by endogenous suprarenal estrogen production. Zusammenfassung Ausschneidung von Endometrioseherden des Vaginalstumpfes und seiner Umgebung, zuletzt wegen Verdachtes auf Dickdarmcarcinom bei einer jetzt 60jährigen Frau 4, 6 und 16 Jahre nach Totalexstirpation des Uterus samt beiden Adnexen wegen hochgradiger Adnextuberkulose (histologisch auch Adenomyosis interna). Die beiden ersten Endometrioseherde hyperproliferierte Korpusendometriosen, während intrauterin und im letzten Endometrioseherd ein Korpus-Cervixmucosa-Mischtyp vorlag, herdförmig mit ausgeprägten Rückbildungserscheinungen. Differentialdiagnostische Abgrenzung der Korpus-Cervixendometriose gegen die Adenosis vaginae. Histologische Endometrioseeinteilung in Basalis-, Funktionalis-, Basalis-Funktionalismischtyp und Corpus-Cervixendometriose. Die Hyperproliferation der beiden ersten Vaginalstumpfendometriosen ist auf hormonelle Substitution, der relativ gute Erhaltungszustand der letzten Endometriosen (5 Jahre hormonfreies Intervall) wahrscheinlich auf endogene Oestrogenproduktion der Nebennieren zurückzuführen. Similar content being viewed by others Literatur Bennet, E. T.: Endometriosis in the older age group. Amer. J. Obstet. Gynec.65, 100–108 (1953). Navratil, E., Reiffenstuhl, G.: Geriatrische Gynäkologie. In: Doberauer, Hittmair, Nissen, Schulz, Handbuch der praktischen Geriatrie, Bd. III. Stuttgart: Ferdinand Enke 1968. Propst, A.: Die Angioblastomatose des Uterus (sog. Stromaendometriose). Virchows Arch. path. Path.336, 555–572 (1964). Richter, K.: Erkrankungen der Vagina. In: Schwalm-Döderlein, Klinik der Frauenheilkunde und Geburtshilfe. München-Berlin-Wien: Urban Schwarzenberg 1972. Schmid, K. O.: Über ungewöhnliche Epithelveränderungen und Rückbildungsvorgänge der Corpusmukosa infolge abnormer Hormonzufuhr. Arch. Gynäk.205, 466–482 (1968). Schmid, K. O.: Zum wechselnden morphologischen Erscheinungsbild der Endometriose. 1. Mitteilung: Ungewöhnliche Rückbildungsvorgänge in einer retrocervicalen Endometriose durch Ovulationshemmer. Im Druck. Schmidt-Matthiessen, H.: Das normale menschliche Endometrium. Stuttgart: Georg Thieme 1963. Siegler, S. L., Bisaccio, J. R.: Zit. nach Bennet. Witt, H. J.: Strukturelemente und funktionelle Gesamtheit des Endometriums. Lichtoptische Morphologie I. In: Schmidt-Matthiessen. Das normale menschliche Endometrium, S. 60. Stuttgart: Georg Thieme 1963. Author information Authors and Affiliations Additional information Herrn Prof. Dr. E. Navratil, Vorstand der Universitäts-Frauenklinik Graz, zum 70. Geburtstag gewidmet. Rights and permissions About this article Cite this article Schmid, K.O. Zum wechselnden morphologischen Erscheinungsbild der Endometriose. Arch. Gynak. 212, 413–422 (1972). https://doi.org/10.1007/BF00667727 Received: Issue date: DOI: https://doi.org/10.1007/BF00667727

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endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Female Humans Hysterectomy Middle Aged Neoplasm Recurrence, Local Time Factors Uterine Neoplasms Uterine Neoplasms Vaginal Neoplasms Vaginal Neoplasms

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