Cystic endosalpingiosis presenting as chronic back pain, a case report

Extravertebral low back pain: a scoping review

BACKGROUND

Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered.

METHODS

A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included.

RESULTS

The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes.

DISCUSSION

Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient.

CONCLUSION

The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.

Uterine Serous Cystadenoma or Endosalpingiosis?: A Case Report with a Review of Literature

Endosalpingiosis is a nonneoplastic lesion defined by the presence of tubal epithelium at ectopic sites such as the peritoneum, bladder, appendix, and even uterus. They may be asymptomatic and detected incidentally on ultrasonography. However, cystic endosalpingiosis is also known to be a mimicker of ovarian neoplasms. It is crucial for both the clinician and the pathologist to be aware of this benign lesion so that overdiagnosis and overtreatment can be avoided. We report a case of endosalpingiosis of the uterine serosa in a 45-year-old woman which was misdiagnosed as an adnexal cyst on radiological investigations.

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.

Paratubal endosalpingiosis: a case report

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Endosalpingiosis is a rare, benign, challenging and hard-to-diagnose condition.

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Specific comorbidities may co-exist in patients with endosalpingiosis.

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Endosalpingiosis can present with abdominal pain and be easily misdiagnosed.

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Endosalpingiosis can occur at any age but is considerd a disease of older age.

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Endosalpingiosis is an incidental finding in gynecological procedures.

Introduction

Endosalpingiosis is a rare condition and its pathogenesis and clinical significance are not fully understood. The unfamiliar presentation of this disease can misguide health care professionals. The reports available on this matter describe it as a disease of older age. In the majority of the cases it is an incidental finding in those with other concurrent gynecologic conditions.

Presentation of Case

Here we report the case of a 14-year-old female who presented with abdominal pain and no specific past medical history. Imaging and physical examination were highly suggestive of appendicitis. With the initial diagnosis of acute abdomen, she underwent surgery. During the surgery gastrointestinal tract organs were found to be normal and in gynecological examination, the ovaries were normal, however the fallopian tube revealed a twisted paratubal cyst which was removed and sent to the laboratory for further investigation. On the basis of the cellular pathology, tubal like epithelium in the cyst was found and patient diagnosed with endosalpingiosis.

Discussion

We suggest that in our case, the lesion possibly originated from the metaplasia of coelomic membrane into tubal cells. There are studies suggesting that co-occuring diseases should be considered when the diagnosis of endosalpingiosis is established and further studies are needed in regard to this matter.

Conclusion

Endosalpingiosis, although being a rare condition, should be included in our differential diagnosis since co-existing comorbidities are a possibility in patients with endosalpingiosis and can be of great importance.

Endosalpingiosis in conjunction with ovarian serous cystadenoma mimicking metastatic ovarian malignancy

Patient: Female, 26

Final Diagnosis: Endosalpingiosis

Symptoms: Chronic pelvic pain

Medication: —

Clinical Procedure: Diagnostic laproscopy (conservative management)

Specialty: Obstetrics and Gynecology