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Canete-Portillo S, Coleman AD, Mubeen A. Mullerianosis of the Ureter: An Uncommon Intersection of Gynecological and Genitourinary Pathology. Int J Surg Pathol 2024:10668969241272019. [PMID: 39275852 DOI: 10.1177/10668969241272019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2024]
Abstract
Mullerianosis is a term used to describe a pathologic entity comprised of at least 2 types of Mullerian-type epithelia (tubal, endocervical, or endometrial) at non-gynecologic sites. This is an uncommon occurrence in the urinary tract. To the best of our knowledge, only 3 instances of Mullerianosis involving the ureter have been reported. We present a fourth report and describe the clinical, radiological, and histopathologic findings. Awareness of this rare process is crucial to avoid misdiagnosis.
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Affiliation(s)
- Sofia Canete-Portillo
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Aysha Mubeen
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
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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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Habiba M, Brosens I, Benagiano G. Müllerianosis, Endocervicosis, and Endosalpingiosis of the Urinary Tract: A Literature Review. Reprod Sci 2018; 25:1607-1618. [PMID: 29739266 DOI: 10.1177/1933719118773441] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We reviewed reported cases of endocervicosis, endosalpingiosis, and müllerianosis of the bladder or ureters in women in order to highlight these conditions as distinct from endometriosis or adenomyosis. METHODS Medline and Scopus searches of all cases published till the October 1, 2017. All retrieved references were searched manually to identify relevant articles. RESULTS Twenty-six articles reported endocervicosis. These included 37 cases described by the authors as endocervicosis of the bladder. We identified 7 case reports of bladder endosalpingiosis. There were 26 publications including 27 cases of müllerianosis of the bladder and 3 cases affecting the lower ureter. Literature descriptions are limited but available accounts do not point to features that uniquely distinguished these conditions. Affected women tended to be older, and in many cases, there was a possible relation to past surgery and particularly to hysterectomy and caesarean sections. Many cases were reported in postmenopausal women. Local excision was sufficient in most cases. CONCLUSION The etiology of these conditions remains speculative, but case reports raise a possible link to pelvic surgery. There is a need for more detailed accounts of these lesions, which should be considered in the differential diagnosis of pre- and postmenopausal women with pelvic pain, dyspareunia, lower abdominal pain or discomfort, dysuria, frequency, or hematuria.
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Affiliation(s)
- Marwan Habiba
- 1 Department of Health Sciences, University of Leicester, Women and Perinatal Services, University Hospitals of Leicester, Leicester, United Kingdom
| | - Ivo Brosens
- 2 Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Giuseppe Benagiano
- 3 Department of Gynecology, Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
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Iida Y, Tabata J, Yorozu T, Kitai S, Ueda K, Saito M, Yanaihara N, Yamada K, Okamoto A. Polypoid endometriosis of the ovary and müllerianosis of pelvic lymph nodes mimicking an ovarian carcinoma with lymph node metastasis. Int Cancer Conf J 2017; 6:145-148. [PMID: 31149490 DOI: 10.1007/s13691-017-0295-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/04/2017] [Indexed: 11/26/2022] Open
Abstract
Polypoid endometriosis is a distinctive variant of endometriosis with histological features simulating those of endometrial polyps. Müllerianosis is characterized by the presence of lesions at any site containing admixtures of endosalpingiosis, endometriosis, and endocervicosis. Here, we report a rare case of polypoid endometriosis of the ovary with müllerianosis of the pelvic lymph nodes in a 44-year-old woman without a past history of pelvic surgery. Magnetic resonance imaging revealed an ovarian tumor containing papillary nodules up to 3.0 cm in diameter and left pelvic lymph node enlargement. Nodules in ovarian tumor showed heterogeneous high intensity on T2-weighted image and high intensity on diffusion-weighted image and were mildly enhanced by gadolinium contrast material. Enlarged lymph node was markedly enhanced by gadolinium. We considered polypoid endometriosis in the differential diagnosis according to the results of the magnetic resonance imaging, and polypoid endometriosis was included in intraoperative consultation, however, ovarian carcinoma with lymph node metastasis could not be denied. According to histological examination, the final diagnosis was determined as polypoid endometriosis with glandular hyperplasia of the left ovary and müllerianosis in the obturator lymph nodes. To the best of our knowledge, this is the first report of polypoid endometriosis and müllerianosis of the pelvic lymph node.
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Affiliation(s)
- Yasushi Iida
- 1Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 105-8461 Japan
| | - Junya Tabata
- 1Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 105-8461 Japan
| | - Takashi Yorozu
- 2Department of Pathology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 105-8461 Japan
| | - Satomi Kitai
- 3Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi Mianto-ku, Tokyo, 105-8461 Japan
| | - Kazu Ueda
- 1Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 105-8461 Japan
| | - Motoaki Saito
- 1Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 105-8461 Japan
| | - Nozomu Yanaihara
- 1Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 105-8461 Japan
| | - Kyosuke Yamada
- 1Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 105-8461 Japan
| | - Aikou Okamoto
- 1Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 105-8461 Japan
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Altal Y, Nagarajan S, Phillips G, Cresswell J. Müllarianosis of the bladder presenting with hydronephrosis. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415814534232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Florid Cystic Endosalpingiosis (Müllerianosis) in Pregnancy. Case Rep Obstet Gynecol 2016; 2016:8621570. [PMID: 27668111 PMCID: PMC5030444 DOI: 10.1155/2016/8621570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 11/17/2022] Open
Abstract
Cystic endosalpingiosis refers to the existence of heterotopic cystic müllerian tissue resembling structures of the fallopian tubes. We report a case of florid cystic endosalpingiosis discovered in a pregnant woman during a scheduled cesarean section and review the current knowledge of this disease. A 30-year-old woman with a twin pregnancy attended the hospital day unit at term. The first twin was in a breech presentation and a cesarean section was scheduled. During the procedure the uterine fundus and part of the body were seen completely seeded with multitude of cyst-like structures resembling hydatids of Morgagni. The immunohistochemistry analysis showed a positive expression for PAX8 (Box-8), CK7, and estrogen and progesterone receptors. The lesions did not disappear after pregnancy. Cystic endosalpingiosis should be always borne in mind, even in pregnancy, when it comes to making the differential diagnosis of a pelvic or systemic multicystic mass.
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Im S, Jung JH, Choi HJ, Kang CS. Intramural florid cystic endosalpingiosis of the uterus: a case report and review of the literature. Taiwan J Obstet Gynecol 2015; 54:75-7. [PMID: 25675925 DOI: 10.1016/j.tjog.2014.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE We report a case of intramural florid cystic endosalpingiosis in the lower uterine segment of the uterus. CASE REPORT A 43-year-old female presented with vaginal bleeding. Abdominal computed tomography suggested a leiomyoma with cystic degeneration. A total hysterectomy revealed a 4.0 cm × 3.8 cm cystic mass in the lower uterine segment. The cystic space microscopically was lined with a single layer or stratified layer of ciliated columnar cells that resembled tubal epithelium without cytologic atypia. The glandular spaces were surrounded by normal myometrium with no evidence of periglandular endometrial stroma, which was consistent with the diagnosis of florid cystic endosalpingiosis. CONCLUSION Florid cystic endosalpingiosis involving the uterus is a rare and clinically unexpected finding; however, it should be considered in the differential diagnosis of a uterine mass.
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Affiliation(s)
- Soyoung Im
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Han Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Hyun Joo Choi
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Suk Kang
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Branca G, Barresi V. Müllerianosis of the Urinary Bladder: A Rare Tumorlike Lesion. Arch Pathol Lab Med 2014; 138:432-6. [DOI: 10.5858/arpa.2012-0681-rs] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Müllerianosis was first described as a rare entity consisting of an admixture of cervical, tubaric, or endometrial epithelium within the lamina propria and muscularis propria of the urinary bladder. This lesion occurs mainly in the dome or posterior wall of the urinary bladder in women of fertile age. Its clinical presentation is characterized by hematuria, pelvic pain, and dysuria, nonspecific symptoms that are related to the responsiveness of müllerian glands to hormonal stimuli. The major interest of müllerianosis resides in its similarity, from clinical, cytologic, and histologic viewpoints, to more threatening conditions, such as neoplasias. The clinical context and the identification of periglandular endometrial stroma at histologic examination with conventional hematoxylin-eosin stain, as well as the immunohistochemical demonstration of estrogen and progesterone receptors in the glands, are of diagnostic utility in the differential diagnosis. Müllerianosis may be responsive to gonadotropin-releasing hormone agonists. Surgical resection may be justified in the case of clinical symptoms refractory to hormone therapy.
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Affiliation(s)
- Giovanni Branca
- From the Department of Pathology, University of Messina, Messina, Italy
| | - Valeria Barresi
- From the Department of Pathology, University of Messina, Messina, Italy
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Abstract
The theory of müllerianosis predicts that embryonic müllerian tissue, misplaced during organogenesis, results in the formation of 4 benign müllerian diseases-developmental adenomyosis, endometriosis, endosalpingiosis, and endocervicosis-(developmental müllerian diseases) that will be identified in human female fetuses, infants, children, adolescents, and adults. Direct evidence is presented to support the existence of developmental adenomyosis, developmental endometriosis, and developmental endocervicosis in human female fetuses along with strong circumstantial evidence supporting the existence of all 4 developmental müllerian diseases in human female infants, children, adolescents, and adults. This evidence throws light upon the pathogenesis of rare müllerian lesions whose pathogenesis remains inexplicable by classical and modern theories. Furthermore, this research has scientific and clinical relevance: scientific relevance because it opens up a new field of comparative research-the 4 developmental müllerian diseases complement the 4 acquired müllerian diseases; clinical relevance because it identifies rare müllerian diseases curable by complete surgical excision.
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Affiliation(s)
- Ronald E Batt
- Department of Gynecology-Obstetrics, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA.
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Ndokera R, Brewster S, Dhar S. Mullerianosis: a rare cause of acute renal colic. BMJ Case Rep 2012; 2012:bcr-2012-006704. [PMID: 23097575 DOI: 10.1136/bcr-2012-006704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 50-year-old woman presented to the urology department with an acute history suggestive of left-sided renal colic. There were no other associated symptoms, but urine dipstick revealed non-visible haematuria. CT-KUB revealed a soft tissue mass at the left vesico-ureteric junction. Flexible cystoscopy demonstrated a mass intruding into the posterior bladder. A transurethral resection of the bladder 'tumour' was undertaken, and it was noted that the mass was not macroscopically consistent with transitional cell carcinoma. Histology demonstrated Müllerianosis, a rare lesion characterised by locally invasive growth of tissue originating from the Müllerian (paramesonephric) duct. The patient was seen by gynaecologist who initiated hormone treatment with an lutenising hormone--releasing hormone (LH-RH) analogue. Urological follow-up 3 months later highlighted ongoing pelvic pain but no further colicky loin pain. Repeat cystoscopy showed the mass had become smaller and the left ureter was laterally displaced. Further gynaecological input is planned if symptoms are ongoing.
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Perry KD, Cheng NL, Eberts P, Yang J. Ciliated cells in abdominal or pelvic fine needle aspirations: A case report and review of the literature. Diagn Cytopathol 2011; 41:71-6. [DOI: 10.1002/dc.21750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 05/06/2011] [Indexed: 01/11/2023]
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Affiliation(s)
- Michael Ryan Abern
- Department of Urology, Rush University Medical Center, Chicago, Illinois 60612, USA.
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