Florid cystic endosalpingiosis inside a uterine subserous leiomyoma

Intraoperative Appearance of Endosalpingiosis: A Single-Center Experience of Laparoscopic Findings and Systematic Review of Literature

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.

Uterine endosalpingiosis: Case report and review of the literature

OBJECTIVE

Endosalpingiosis rarely occurs in the uterus. We report a case and review literature to explore its current clinical diagnosis and treatment.

CASE REPORT

A 31-year-old woman was admitted to the hospital for suspected uterine leiomyoma with cystic degeneration based on ultrasound and magnetic resonance imaging and surgical treatment. Laparoscopy revealed a large cystic mass protruding from the posterior uterine wall. The mass was resected, and a histologic examination showed that the cyst wall was lined with benign fallopian tube-type ciliated epithelium surrounded by normal myometrium, consistent with the diagnosis of endosalpingiosis of the uterus (also known as a Müllerian cyst). Currently, there are 18 cases (including ours) in the literature. Of these, two had a uterine malignancy, one endometrioid endometrial carcinoma, and another cervical adenocarcinoma. The age at diagnosis varied from 31 to 73, with a mean of 47 ± 8. The typical clinical manifestations were a palpable low abdominal mass, abnormal menstrual bleeding, and pelvic pain. Overall, 75% (12 of 16) of patients underwent a total hysterectomy, while 62.5% (10 in 16) had a concomitant bilateral salpingo-oophorectomy for nonmalignancy. No recurrence was reported.

CONCLUSION

We describe the youngest patient with tumor-like uterine endosalpingiosis. The preoperative diagnosis is challenging because of its rarity. Most patients had a hysterectomy with castration, which may have resulted in overtreatment. Awareness of this lesion is necessary for the differential diagnosis of uterine and adnexal tumors. Review of relevant literature has shown a relationship between endosalpingiosis progression and cancer development, indicating an uncertain and complicated pathology.

Intramural florid cystic endosalpingiosis of the uterus: a case report and review of the literature

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.