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Ghaith S, Lewis GK, Craver EC, Li Z, Wasson MN, Burnett TL, Carrubba AR. The association of endosalpingiosis with chronic pelvic pain. Minerva Obstet Gynecol 2024; 76:151-158. [PMID: 36847525 DOI: 10.23736/s2724-606x.23.05241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Endosalpingiosis is a pathologic diagnosis of ectopic epithelium resembling the fallopian tubes. It has been described with clinical characteristics that are similar to endometriosis. The primary objective is to determine if endosalpingiosis (ES) has a similar association with chronic pelvic pain when compared to endometriosis (EM). METHODS This is a retrospective case-control analysis of patients with a histologic diagnosis of endosalpingiosis or endometriosis at three affiliated academic hospitals between 2000 and 2020. All ES patients were included, and 1:1 matching was attempted to obtain a comparable EM cohort. Demographic and clinical data were obtained, and statistical analysis was performed. RESULTS A total of 967 patients (515 ES and 452 EM) were included. ES patients were significantly older than EM patients (median age 52 vs. 48 years, P<0.001), but other demographic variables were similar. Fewer ES patients had baseline chronic pelvic pain than EM patients (25.3% vs. 47%, P<0.001), and patients with ES were less likely to undergo surgery for the primary indication of pelvic pain (16.1% vs. 35.4%, P<0.001). Pelvic pain as the surgical indication remained lower in the ES group in multivariable analysis (OR=0.49, P<0.001). There were similar rates of persistent postoperative pain between ES and EM groups (10.1% vs. 13.5%, P=0.109). CONCLUSIONS Although endosalpingiosis can be associated with chronic pelvic pain, the incidence of pain is significantly lower than in patients who have endometriosis. These findings suggest that ES is a unique condition that differs from EM. Further research including long-term follow-up and patient-reported outcomes is imperative.
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Affiliation(s)
- Summer Ghaith
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Gregory K Lewis
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Zhuo Li
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Megan N Wasson
- Department of Medical and Surgical Gynecology, Mayo Clinic, Scottsdale, AZ, USA
| | - Tatnai L Burnett
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA -
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Zhan H, Zhang H, Sun J, Wang W, Zhu J, Huang X. Refractory florid cystic endosalpingiosis: A case report with 5 years follow up and literature review. Int J Gynaecol Obstet 2023; 163:44-50. [PMID: 37014527 DOI: 10.1002/ijgo.14764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023]
Abstract
Endosalpingiosis is characterized by the presence of ectopic, benign glands with a fallopian tube-like ciliated epithelium. Florid cystic endosalpingiosis (FCE) is a rare type of endosalpingiosis and presents with tumor-like lesions. In general, FCE has no specific clinical features. In this case, extensive pelvic multiple Müllerian cysts were first observed and removed during the patient's second cesarean section. Lesions relapsed after a year. Therefore, the patient underwent total hysterectomy and bilateral salpingectomy; pathology revealed that the patient had FCE. According to imaging studies during the follow up, recurrent and progressive multiple pelvic and extra-pelvic cysts were observed. The patient had no obvious symptoms, and the results of her laboratory tests were within normal limits. Ultrasound-guided aspiration and lauromacrogol sclerotherapy were performed, and in the past year, the cysts have stabilized without progression. This is the first reported case of recurrent FCE after total hysterectomy and bilateral salpingectomy with a 5-year follow up. A literature review and novel ideas for diagnosing and managing FCE based on this case are also presented.
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Affiliation(s)
- Hong Zhan
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Obstetrics and Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongyun Zhang
- Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jin Sun
- Department of Radiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenwen Wang
- Department of Pathology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiang Zhu
- Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiufeng Huang
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Obstetrics and Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Intraoperative Appearance of Endosalpingiosis: A Single-Center Experience of Laparoscopic Findings and Systematic Review of Literature. J Clin Med 2022; 11:jcm11237006. [PMID: 36498581 PMCID: PMC9738105 DOI: 10.3390/jcm11237006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Endosalpingiosis is assumed to be the second most common benign peritoneal pathology after endometriosis in women. Although recent studies indicate a significant association with gynecologic malignancies, many underlying principles remain unclear. This work aimed to systematically describe the intraoperative appearance of endosalpingiosis. Methods: Data and intraoperative videos of patients with histologically verified endosalpingiosis were retrospectively reviewed. The main outcome measures were macroscopic phenotype and anatomical distribution. Additionally, a systematic review searching PubMed (Medline) and Embase was conducted. Results: In the study population (n = 77, mean age 40.2 years (SD 16.4)), the mean size of lesions was 3.6 mm and the main visual pattern was vesicular (62%). The most frequent localization was the sacrouterine ligaments (24.7%). In the systematic review population (n = 1174 (210 included studies overall), mean age 45.7 years (SD 14.4)), there were 99 patients in 90 different studies with adequate data to assess the appearance of the lesions. The mean size of the lesions was 48.5 mm, mainly with a cystic visual pattern (49.5%). The majority of the lesions affected the ovaries (23.2%), fallopian tubes (20.4%), or lymph nodes (18.5%). Comparing this study to the literature population, the main differences concerned the size (p < 0.001) and main visual patterns (p < 0.001) of lesions. Conclusions: The usual intraoperative findings of endosalpingiosis appeared less impressive than described in the literature. In our study population, lesions of a few millimeters in size with a vesicular appearance were mostly seen, most frequently in the sacrouterine ligament area. Intraoperative recognition by the gynecologic surgeon and histologic diagnosis should play an important role in further understanding this entity, scientifically and clinically.
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Lewis GK, Ghaith S, Craver EC, Li Z, Wasson MN, Burnett TL, Carrubba AR. The association of endosalpingiosis with gynecologic malignancy. Gynecol Oncol 2022; 167:81-88. [PMID: 35909004 DOI: 10.1016/j.ygyno.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Endosalpingiosis is a poorly understood condition of ectopic epithelium resembling the fallopian tubes. It has been described as an incidental pathology finding, a disease similar to endometriosis, and in association with malignancy. The objective of this study is to determine if endosalpingiosis (ES) has an increased association with gynecologic malignancy when compared to endometriosis (EM). METHODS This is a retrospective case-control analysis of patients with a histologic diagnosis of endosalpingiosis or endometriosis at three affiliated academic hospitals between 2000 and 2020. All ES patients were included, and 1:1 matching was attempted to obtain a comparable cohort of EM patients. Demographic and clinical data were obtained, and statistical analysis was performed. RESULTS A total of 967 patients (515 ES and 452 EM) were included. ES patients were significantly older than EM patients (median age 52 vs 48 years, p < 0.001). The ES group had significantly more cancer diagnoses at surgery than the EM group (40.1% vs 18.1%, p < 0.001); this difference persisted in a sub-analysis excluding patients with known or suspected malignancy (20.9% vs 5.6%, p < 0.001). ES patients had lower overall survival (10-year freedom from death: 77.0% vs 90.5%, p < 0.001). After adjusting for confounders, multivariable analysis showed that ES patients had increased cancer diagnosed at surgery (OR = 2.48, p < 0.001) and greater risk of death (OR = 1.69, p = 0.017). CONCLUSIONS Endosalpingiosis was found concurrently with malignancy in 40% of cases, and this effect was preserved in multi-variable and sub-group analyses. Further research consisting of longer follow-up and exploration of molecular relationships between ES and cancer are forthcoming.
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Affiliation(s)
- Gregory K Lewis
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, United States of America
| | - Summer Ghaith
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, United States of America
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States of America
| | - Zhuo Li
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States of America
| | - Megan N Wasson
- Department of Medical and Surgical Gynecology, Mayo Clinic, Scottsdale, AZ, United States of America
| | - Tatnai L Burnett
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, United States of America
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, United States of America.
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Bonin M, Juncos AC, Ganzer LM, Cardona FP, Abrego M. UTERINE FLORID CYSTIC ENDOSALPINGIOSIS WITH CONSERVATIVE SURGERY. J Minim Invasive Gynecol 2021; 29:331-333. [PMID: 34801713 DOI: 10.1016/j.jmig.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Mónica Bonin
- Minimally Invasive Gynecology Section (Drs Bonin and Abrego)
| | - Ana Carolina Juncos
- Residency Program (Dr Juncos) of the Department of Gynecology and Obstetrics, Hospital Privado Universitario de Córdoba, Argentina.
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Fujii S, Inoue C, Mukuda N, Murakami A, Yamaji D, Yunaga H, Nosaka K. Magnetic resonance imaging findings of endosalpingiosis: a case report. Acta Radiol Open 2021; 10:20584601211022504. [PMID: 34178378 PMCID: PMC8202271 DOI: 10.1177/20584601211022504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/15/2021] [Indexed: 11/15/2022] Open
Abstract
Endosalpingiosis is characterized by the presence of glands lined by benign tubal-type epithelium outside the fallopian tube. It is usually an incidental finding and rarely occurs as a tumor-like mass lesion. Here, we describe the magnetic resonance imaging findings of endosalpingiosis that presented as a paraovarian multicystic lesion. It exhibited iso to low intensity on T1-weighted images and inhomogeneous high intensity on T2-weighted images. The septa presented relatively iso to slight high intensity on T2-weighted images and strong contrast enhancement on dynamic contrast-enhanced imaging. Endosalpingiosis should be considered as a differential diagnosis in cases of paraovarian multicystic lesions along the uterine serosa.
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Affiliation(s)
- Shinya Fujii
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
- Shinya Fujii, Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, Tottori 683-8504, Japan.
| | - Chie Inoue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Naoko Mukuda
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Atsushi Murakami
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Daisuke Yamaji
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroto Yunaga
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kanae Nosaka
- Department of Pathology, Faculty of Medicine, Tottori University, Yonago, Japan
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Fernandez H, Dupeux M, Paris M, Sauvan M. Florid Cystic Endosalpingiosis and Adenomyosis of the Uterus Mimicking Malignancy. J Minim Invasive Gynecol 2020; 28:741-742. [PMID: 32835864 DOI: 10.1016/j.jmig.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Hervé Fernandez
- Departments of Gynecology and Obstetrics (Drs. Fernandez, Paris, and Sauvan); Assistance Publique-Paris Hospitals, GHU-Sud, Bicêtre Hospital, Faculty of Medicine, University Paris-Sud Saclay (Dr. Fernandez), Le Kremlin; Bicêtre, University Paris-Sud Saclay, University of Versailles Saint-Quentin-en-Yvelines, Inserm, Center of Research in Epidemiology and Population Health, Villejuif (Dr. Fernandez), France..
| | | | - Marine Paris
- Departments of Gynecology and Obstetrics (Drs. Fernandez, Paris, and Sauvan)
| | - Marine Sauvan
- Departments of Gynecology and Obstetrics (Drs. Fernandez, Paris, and Sauvan)
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