Tumor-Like Lesions and Endometriosis, Pathology of the Peritoneum

In: Encyclopedia of Pathology · 2023 · pp. 1–10 · doi:10.1007/978-3-319-28845-1_5679-1 · W4322722656
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Endosalpingiosis, defined as ectopic fallopian tube epithelium, occurs in 13% of women, often with ovarian serous tumors, and is microscopically characterized by simple glands with peg and ciliated cells.

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This pathology-focused paper reviews tumor-like peritoneal lesions, describing endosalpingiosis as ectopic fallopian tube epithelium that can present on the peritoneum, pelvic soft tissue, and lymph nodes, and notes it occurs in about 13% of cases, often as an incidental surgical finding. It reports that endosalpingiosis consists microscopically of simple glands lined by single-layer serous-type epithelium with peg and ciliated cells, occasionally with intraglandular stromal projections forming simple papillae; it is generally benign. The paper caveats that gross detection is usually not possible because lesions are typically not appreciable macroscopically, and it highlights clinical associations with ovarian serous borderline tumors and low-grade serous carcinoma. Relevance to endometriosis: the paper’s discussion is within a pathology context that contrasts tumor-like lesions with endometriosis-related pathology, and it explicitly cites endometriosis literature and diagnostic pitfalls involving peritoneal lesions where endometriosis is part of the differential—particularly in relation to endometriosis-associated mutations and selected endometriosis morphologic patterns, though the specific lesion profiled here is endosalpingiosis rather than endometriosis itself.

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Endosalpingiosis Definition Ectopic fallopian tube epithelium. Clinical Features - Incidence 13%. Frequently occurs in association with ovarian serous borderline tumors and low-grade serous carcinoma. - Age Wide age range, but more commonly found in women of reproductive age. - Sex Female. - Site Peritoneum, pelvic soft tissue, and lymph nodes. - Treatment Usually an incidental finding at surgery for other indications. - Outcome This is a benign lesion. Macroscopy Not typically grossly appreciable. When presenting as florid cystic endosalpingiosis, it rarely forms a mass lesion. Microscopy Simple glands lined by a single layer of serous-type epithelium containing peg cells and ciliated cells. Intraglandular stromal projections forming simple papillae may be present (Fig. 1). References and Further Reading Anglesio, M. S., Papadopoulos, N., Ayhan, A., Nazeran, T. M., Noe, M., Horlings, H. M., Lum, A., et al. (2017). Cancer-associated mutations in endometriosis without cancer. The New England Journal of Medicine, 376, 1835–1848. Anrique, D., Anton, A., Kruger, K., Niedobitek-Kreuter, G., & Ebert, A. D. (2013). Splenosis: An uncommon differential diagnosis in gynecology. Journal of Minimally Invasive Gynecology, 20, 708–709. Ayhan, A., Mao, T. L., Seckin, T., Wu, C. H., Guan, B., Ogawa, H., Futagami, M., et al. (2012). Loss of ARID1A expression is an early molecular event in tumor progression from ovarian endometriotic cyst to clear cell and endometrioid carcinoma. The International Journal of Gynecological Cancer, 22, 1310–1315. Baker, P. M., Clement, P. B., & Young, R. H. (2005). Malignant peritoneal mesothelioma in women: A study of 75 cases with emphasis on their morphologic spectrum and differential diagnosis. American Journal of Clinical Pathology, 123, 724–737. Boyle, D. P., & McCluggage, W. G. (2009). Peritoneal stromal endometriosis: A detailed morphological analysis of a large series of cases of a common and under-recognised form of endometriosis. Journal of Clinical Pathology, 62, 530–533. Carvalho, L., Podgaec, S., Bellodi-Privato, M., Falcone, T., & Abrao, M. S. (2011). Role of eutopic endometrium in pelvic endometriosis. Journal of Minimally Invasive Gynecology, 18, 419–427. Chapel, D. B., Husain, A. N., Krausz, T., & McGregor, S. M. (2017). PAX8 expression in a subset of malignant peritoneal mesotheliomas and benign mesothelium has diagnostic implications in the differential diagnosis of ovarian serous carcinoma. The American Journal of Surgical Pathology, 41, 1675–1682. Charatsi, D., Koukoura, O., Ntavela, I. G., Chintziou, F., Gkorila, G., Tsagkoulis, M., Mikos, T., et al. (2018). Gastrointestinal and urinary tract endometriosis: A review on the commonest locations of extrapelvic endometriosis. Advances in Medical Education and Practice, 2018, 3461209. Chikkamuniyappa, S., Herrick, J., & Jagirdar, J. S. (2004). Nodular histiocytic/mesothelial hyperplasia: A potential pitfall. Annals of Diagnostic Pathology, 8, 115–120. Chui, M. H., & Shih, I. M. (2020). Oncogenic BRAF and KRAS mutations in endosalpingiosis. The Journal of Pathology, 250, 148–158. Churg, A., Sheffield, B. S., & Galateau-Salle, F. (2016). New markers for separating benign from malignant mesothelial proliferations: Are we there yet? Archives of Pathology & Laboratory Medicine, 140, 318–321. Clement, P. B. (2007). The pathology of endometriosis: A survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Advances in Anatomic Pathology, 14, 241–260. Clement, P. B., & Young, R. H. (1993). Florid mesothelial hyperplasia associated with ovarian tumors: A potential source of error in tumor diagnosis and staging. International Journal of Gynecological Pathology, 12, 51–58. Clement, P. B., & Young, R. H. (1999). Florid cystic endosalpingiosis with tumor-like manifestations: A report of four cases including the first reported cases of transmural endosalpingiosis of the uterus. 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Fukunaga, M., & Ushigome, S. (1998). Epithelial metaplastic changes in ovarian endometriosis. Modern Pathology, 11, 784–788. Fukunaga, M., Nomura, K., Ishikawa, E., & Ushigome, S. (1997). Ovarian atypical endometriosis: Its close association with malignant epithelial tumours. Histopathology, 30, 249–255. Gerber, D., Frey, M. K., & Caputo, T. A. (2015). Pelvic splenosis misdiagnosed as a uterine sarcoma. Gynecologic Oncology Reports, 12, 1–2. Harrison, B. T., & Mittal, K. (2015). Morphologic features suggestive of endometriosis in nondiagnostic peritoneal biopsies. International Journal of Gynecological Pathology, 34, 507–516. Khan, K. N., Fujishita, A., Kitajima, M., Hiraki, K., Nakashima, M., & Masuzaki, H. (2014). Occult microscopic endometriosis: Undetectable by laparoscopy in normal peritoneum. Human Reproduction, 29, 462–472. Lameiras, R., Matos, A. P., Luz, C., Palas, J., & Ramalho, M. (2017). Pelvic splenosis-a very unusual location. BJR Case Reports, 3, 20160026. Lemos, A. 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Gross deciduosis peritonei obstructing labor: A case report and review of the literature. International Journal of Gynecological Pathology, 21, 273–275. Markou, G. A., Goubin-Versini, I., Carbunaru, O. M., Karatzios, C., Muray, J. M., & Fysekidis, M. (2016). Macroscopic deciduosis in pregnancy is finally a common entity. European Journal of Obstetrics & Gynecology and Reproductive Biology, 197, 54–58. Matias-Guiu, X., & Stewart, C. J. R. (2018). Endometriosis-associated ovarian neoplasia. Pathology, 50, 190–204. McCluggage, W. G. (2020). Endometriosis-related pathology: A discussion of selected uncommon benign, premalignant and malignant lesions. Histopathology, 76, 76–92. Michal, M., Kazakov, D. V., Dundr, P., Peckova, K., Agaimy, A., Kutzner, H., Havlicek, F., et al. (2016). Histiocytosis with raisinoid nuclei: A unifying concept for lesions reported under different names as nodular mesothelial/histiocytic hyperplasia, mesothelial/monocytic incidental cardiac excrescences, intralymphatic histiocytosis, and others: A report of 50 cases. The American Journal of Surgical Pathology, 40, 1507–1516. Naik, M. A., & Pai, S. A. (2020). Leydig cells in the fallopian tube and Walthard cell nests in the ovary: Heterotopia or Eutopia? International Journal of Gynecological Pathology, 39, e11–e12. Oparka, R., McCluggage, W. G., & Herrington, C. S. (2011). Peritoneal mesothelial hyperplasia associated with gynaecological disease: A potential diagnostic pitfall that is commonly associated with endometriosis. Journal of Clinical Pathology, 64, 313–318. Parker, R. L., Dadmanesh, F., Young, R. H., & Clement, P. B. (2004). Polypoid endometriosis: A clinicopathologic analysis of 24 cases and a review of the literature. The American Journal of Surgical Pathology, 28, 285–297. 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Splenosis: A rare etiology for bowel obstruction-a case report and review of the literature. Case Reports in Surgery, 2015, 890602. Zinsser, K. R., & Wheeler, J. E. (1982). Endosalpingiosis in the omentum: A study of autopsy and surgical material. The American Journal of Surgical Pathology, 6, 109–117. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2023 Springer Nature Switzerland AG About this entry Cite this entry Djordjevic, B. (2023). Tumor-Like Lesions and Endometriosis, Pathology of the Peritoneum. In: van Krieken, J. (eds) Encyclopedia of Pathology. Encyclopedia of Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-28845-1_5679-1 Download citation DOI: https://doi.org/10.1007/978-3-319-28845-1_5679-1 Received: Accepted: Published: Publisher Name: Springer, Cham Print ISBN: 978-3-319-28845-1 Online ISBN: 978-3-319-28845-1 eBook Packages: Living Reference MedicineReference Module Medicine

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