A Clinical and Pathologic Exploration of Suspected Peritoneal Endometriotic Lesions

Watkins JC, Jaclyn C. Watkins, Jaclyn C Watkins, DiVasta AD, Amy D. DiVasta, Vitonis AF, Allison F. Vitonis, Christopher P. Crum, Crum CP, Laufer MR, Marc R. Laufer, Kathryn L. Terry, Brooke E. Howitt, Missmer SA, Stacey A. Missmer
International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists · 2020 · vol. 40(6) , pp. 602–610 · doi:10.1097/pgp.0000000000000743 · PMID:33323857 · W3112140219
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This study reviewed biopsies of suspected peritoneal endometriosis, finding that less than half met diagnostic criteria, with non-diagnostic biopsies often showing features like hemosiderin-laden macrophages, and patients on hormonal therapy were less likely to receive a pathologic diagnosis.

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Abstract

Endometriosis is generally histopathologically defined as the presence of at least 2 of the following: endometrial stroma, Müllerian epithelium, and/or hemosiderin-laden macrophages (HLM). Despite clinically evident endometriotic lesions, biopsies are frequently nondiagnostic. In this study, we conducted a large-scale review of biopsies of lesions clinically thought to represent endometriosis and correlate the histologic findings with clinical appearance to expand sensitivity of the pathologic definition of endometriosis, particularly in patients on hormonal therapy. In all, 112 biopsies from 78 patients (mean age=25, range 18-39 yr) were reviewed for histopathologic features suggestive of or diagnostic for endometriosis including the presence of endometrial stroma, Müllerian epithelium, dystrophic calcifications, HLM, chronic inflammation, adhesions, and vascular proliferation. Endometriosis was confirmed by pathologic criteria in 37 of 78 patients (47%). Biopsies from patients on hormonal therapy (n=62, 80%) were significantly less likely to meet pathologic criteria for endometriosis (P=0.01). Nondiagnostic biopsies (70/112; 63%) frequently displayed HLM (20%), chronic inflammation (29%), dystrophic calcifications (26%), vascular proliferation (20%), or adhesions (20%) and were significantly more likely to have a vascular clinical appearance (P=0.01). Diagnostic biopsies (42/112; 38%) were more likely to have a blue/black clinical appearance (P=0.03), demonstrate HLM (P=0.004), and display pseudodecidualization (P=0.05). Patients with a high clinical suspicion of endometriosis have a range of histologic findings, with less than half meeting the current histopathologic criteria for diagnosing endometriosis. Given the heterogeneous histopathologic appearance, revision of the histologic criteria may be warranted with further exploration, particularly for lesions with predominantly vascular features.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Peritoneal Diseases Peritoneal Diseases Peritoneal Diseases Adult Adult Biopsy Biopsy Endometrium Endometrium Epithelium Epithelium Female Female Humans Humans

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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