ENDOMETRIOSIS

Dr. Shahab Riaz

Pathology Dept.

PMC.

• Non-neoplastic functional ectopic endometrial tissue.

• Pre-menopause, ovarian hormones influence.

• Ovaries, pouch of Douglas, uterine ligament, tubes, recto-vaginal septum

• Peritoneal cavity, about umbilicus• Lymph nodes, lungs, heart, bone, joints, skin, kidneys

• Chocolate Cyst or Endometrioma in Ovary.

• Infertility, dysmenorrhea, pelvic pain (cyclical), dyspareunia

(uterine serosa), dysuria (bladder serosa), dyschezia (rectal wall)

Gross Features

• Reddish blue or yellowish brown nodules• Microscopic – 1-2 cms• On or just under affected serosal surface• Coalesce sometimes to large size• Ovaries, large chocolate cysts• Fibrosis, adhesions, with later seepage and

organisation• Sealing of tubal fimbrae, oviduct or ovary

distortion

GROSS SPECIMENS

PATHOPHYSIOLOGY REGURGITATION THEORYAnimal experiments, females with outflow

abnormality have common

METAPLASTIC THEORYCoelomic epithelial transformation, common

origin of mullerian duct, peritoneum and ovarian cells, cellsdedifferentiateprimitive origintransform to endometrial cells

Ovarian hormones?? Uterine endometrium?? Inflammatory??

VASCULAR / LYMPHATIC SPREADEmbolizationdistant sitessites outside

P.Cavity supports this theory (rare)

GENETIC / IMMUNOLOGIC FACTORS or susceptibility of women

incidence in 1st degree relatives of patients + racial differences

in Oriental women and in Afro-Caribbean.

HISTOPATHOLOGY

• Histological Dx if 2 out of following 3 present within lesion.

• ENDOMETRIAL GLANDS• STROMA• HEMOSIDERIN PIGMENT

FALLOPIAN TUBE SECTION

COLONIC WALL (higher magnif.)

CLASSIFICATION (correlation b/w histological, morphological and functional activity)

Histological subtype

Components Hormonal response

Laparoscopic appearance

FREE

Surface epithelium, glands and stroma

Proliferative, secretory and menstrual changes

Haemorrhagic vesicle /bleb

ENCLOSED

Glands and stroma

Proliferative, variable secretory change, no menstruation

Papule and (later) nodule

HEALED

Glands only No response White nodule or flattened fibrotic scar