Clinical-histological correlations in endometriosis

Objective: Endometriosis is associated with infertility and neoplasia and its diagnosis is usually delayed due to non-specific symptomatology. Despite the research efforts, there is an incomplete understanding of its etiopathogeny. The aim of this study was to evaluate the clinical and histological findings in endometriosis and endometriosis-related ovarian neoplasia in order to identify the possible correlations and to highlight some features which may provide an early diagnosis and appropriate therapeutic management. Material and Methods: We performed a retrospective study on a group of 91 patients with endometriosis, along with a second group of 21 patients with endometriosis-related ovarian neoplasia. The complete clinical findings, clinical diagnosis, therapy, and histopathological characteristics have been analyzed. Results: The mean age of patients from endometriosis group has been 37.56 years, the main symptoms have been dysmenorrhea (65.93%) and/or chronic pelvic pain (62.63%), and the diagnoses have been that of ovarian endometriotic cysts (79%), cutaneous abdominal wall endometriosis (13.18%), and multifocal endometriosis (7.69%). In endometriosis-related ovarian neoplasia, the mean age of patients has been 60.26 years, the diagnoses have been that of endometrioid (42.85%) and clear cell carcinoma (38.09%), and mixed epithelial tumors (19.04%), while atypical endometriosis has been associated in 19.04%. Conclusions: Our results support the retrograde menstruation as the main mechanism of endometriosis, followed by direct mechanical implantation, and co-existence of several pathogenic mechanisms, on a background of genetic, endocrine, metabolic, and immunologic anomalies. Endometriosis association with malignancies, with the probability of an atypical transition phase is supported by our histopathological findings.