The occurrence and histopathological recognition of atypical endometriosis in patients with ovarian endometriosis - a retrospective cohort study

Sterre Leenen, Loes Kooreman, Johan Bulten, Johannes Bulten, Edith M G van Esch, Peggy J de Vos van Steenwijk, Theodoor E Nieboer, Ruud L M Bekkers, Anne M van Altena
Human pathology · 2025 · vol. 163 , pp. 105875 · doi:10.1016/j.humpath.2025.105875 · PMID:40706757 · W4412584785
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-12 ⓘ

This study re-evaluated 266 ovarian endometriosis cases and found atypical endometriosis in 7.1% after consensus, highlighting interobserver variability and proposing stricter criteria for identification.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This retrospective cohort study assessed interobserver variability and histopathological recognition of atypical endometriosis (AE) among 266 ovarian endometrioma cases collected between 1985 and 2017 from Radboud University Medical Centre, using PALGA database case identification and re-evaluation of pathology reports by two independent pathologists with literature-adapted diagnostic criteria. AE was reported in 31 cases (11.7%), but the revising pathologists identified AE in 48 cases (18%), which decreased to 19 cases (7.1%) after consensus discussion. The authors attribute variability to AE’s heterogeneous presentation and uncertain significance of inflammation-driven atypia, and they state limitations in that AE’s clinical role is undefined. This paper is centrally about endometriosis — it focuses on how atypical endometriosis is recognized in ovarian endometriosis and how consistently AE can be identified.

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Abstract

OBJECTIVE: - Atypical endometriosis (AE) is considered a potential precursor of endometriosis-associated ovarian carcinoma (EAOC). Despite this, AE identification currently lacks established clinical implications and is not routinely incorporated in histopathological examinations of endometriosis. This study aimed to determine the interobserver variability in AE diagnosis and to classify the features that may attribute to consistent AE identification and diagnosis. METHODS: - Cases of ovarian endometriosis, collected between 1985 and 2017 at the Radboud University Medical Centre Nijmegen, were identified using the PALGA database. Pathology reports were reviewed for descriptions of atypical features and mentions of AE. Using a predefined set of criteria adapted from the literature, two independent pathologists re-evaluated the 266 most recent ovarian endometriomas for AE. After revision, the pathologist revised cases with AE to reach consensus when discrepancies occurred. RESULTS: - Among 266 cases of ovarian endometriosis, AE was reported in 31 (11.7 %) cases. The revising pathologists identified AE in 48 cases (18 %), a number that was reduced to 19 cases (7.1 %) after a consensus meeting between the pathologist. After consensus was reached, the diagnostic criteria, adapted from the literature, were adjusted. DISCUSSION/FUTURE DIRECTIONS: - High interobserver variability likely reflects AE's heterogeneous presentation, the uncertain role of inflammation-driven atypia and AE's undefined clinical significance. However, given AE's association with malignant transformation, consistent identification may be essential. Stricter criteria were developed for AE in order to encourage uniform identification. Furthermore, we encourage adequate documentation of AE in order to increase the insight in endometriosis behavior by linking endometriosis subtypes to clinical progression.
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Abstract OBJECTIVE: - Atypical endometriosis (AE) is considered a potential precursor of endometriosis-associated ovarian carcinoma (EAOC). Despite this, AE identification currently lacks established clinical implications and is not routinely incorporated in histopathological examinations of endometriosis. This study aimed to determine the interobserver variability in AE diagnosis and to classify the features that may attribute to consistent AE identification and diagnosis. METHODS: - Cases of ovarian endometriosis, collected between 1985 and 2017 at the Radboud University Medical Centre Nijmegen, were identified using the PALGA database. Pathology reports were reviewed for descriptions of atypical features and mentions of AE. Using a predefined set of criteria adapted from the literature, two independent pathologists re-evaluated the 266 most recent ovarian endometriomas for AE. After revision, the pathologist revised cases with AE to reach consensus when discrepancies occurred. RESULTS: - Among 266 cases of ovarian endometriosis, AE was reported in 31 (11.7%) cases. The revising pathologists identified AE in 48 cases (18%), a number that was reduced to 19 cases (7.1%) after a consensus meeting between the pathologist. After consensus was reached, the diagnostic criteria, adapted from the literature, were adjusted. DISCUSSION/FUTURE DIRECTIONS: - High interobserver variability likely reflects AE's heterogeneous presentation, the uncertain role of inflammation-driven atypia and AE's undefined clinical significance. However, given AE's association with malignant transformation, consistent identification may be essential. Stricter criteria were developed for AE in order to encourage uniform identification. Furthermore, we encourage adequate documentation of AE in order to increase the insight in endometriosis behavior by linking endometriosis subtypes to clinical progression. | Original language | English | |---|---| | Article number | 105875 | | Number of pages | 8 | | Journal | Human Pathology | | Volume | 163 | | DOIs | | | Publication status | Published - 22 Jul 2025 | Fingerprint Dive into the research topics of 'The occurrence and histopathological recognition of atypical endometriosis in patients with ovarian endometriosis - a retrospective cohort study'. Together they form a unique fingerprint.Cite this - APA - Author - BIBTEX - Harvard - Standard - RIS - Vancouver

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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