Umbilical endosalpingiosis: a case report

Cutaneous endosalpingiosis arising from C-section scar: A case report with review of literature

Endosalpingiosis is a pathologic phenomenon in which non-neoplastic fallopian tube epithelium implants in ectopic locations. It is an uncommon and poorly understood condition, with most cases occurring within the abdominopelvic cavity. Cutaneous presentations of endosalpingiosis are even more rare, with only six cases described in international literature to-date. This report describes an additional case of cutaneous endosalpingiosis. The lesion arose within the scar tissue of a Pfannenstiel incision from 4 years prior in a 24-year old, previously healthy African American female. Punch biopsy of the lesion revealed a cystic mass lined by PAX8⁺ ciliated columnar cells and a surrounding fibrotic stroma with focal CD10-positivity, consistent with a histopathologic diagnosis of endosalpingiosis. In addition, this report provides a comprehensive review of the other documented cases of cutaneous endosalpingiosis, as well as the proposed pathogenesis, histopathologic and clinical features, and potential treatment avenues for this unique clinical entity.

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.

Imaging of Abdominal Wall Masses, Masslike Lesions, and Diffuse Processes

Abdominal wall masses, masslike lesions, and diffuse processes are common and often incidental findings at cross-sectional imaging. Distinguishing among these types of masses on the basis of imaging features alone can be challenging. The authors present a diagnostic algorithm that may help in distinguishing different types of abdominal wall masses accurately. Hernias may mimic discrete masses at clinical examination, and imaging is often ordered for evaluation of a possible abdominal wall mass. Once a discrete mass is confirmed to be present, the next step is to determine if it is a fat-containing, cystic, or solid mass. The most common fat-containing masses are lipomas. Fluid or cystic masses include postoperative abscesses, seromas, and rectus sheath hematomas. Solid masses are the most common abdominal wall masses and include desmoid tumors, sarcomas, endometriomas, and metastases. Multiple masses and other diffuse abdominal wall processes are often manifestations of an underlying condition or insult. The most frequently found diffuse processes are multiple injection granulomas from administration of subcutaneous medication. This article offers an algorithmic approach to characterizing abdominal wall masses on the basis of their composition and reviews abdominal wall diffuse processes. Online supplemental material is available for this article. ^©RSNA, 2020.

Endosalpingiosis of the Gallbladder: A Unique Complication of Ruptured Ectopic Pregnancy

A 60-year-old woman with a history of a ruptured ectopic pregnancy and subsequent salpingo-oophorectomy presented with clinical signs. Pre-operative imaging and intra-operative observations were highly suggestive of acute on chronic cholecystitis. A laparoscopic cholecystectomy was performed. In addition to confirming calculous cholecystitis, final pathology revealed endosalpingiosis on the serosal surface of the gallbladder. Endosalpingiosis is a rare, benign presence of glands lined by tubal-like epithelium, and the few case reports describe it on the surface of the female reproductive organs or seeded on the pelvic peritoneum. We hypothesize that, in this unique case, the endosalpingiosis is due to patient’s ruptured ectopic pregnancy, which allowed tubal epithelial cells to spread to the gallbladder. The only documented cases of endosalpingiosis outside the pelvic and lower abdominal organs have been congenital choristomas. To our knowledge, this is the first documented case of acquired endosalpingiosis of the gallbladder.

Vaginal Endosalpingiosis Case Report: A Rare Entity Presenting as Intermenstrual Bleeding

Endosalpingiosis is a benign and rare entity whose pathophysiology remains unknown. It has been described in pelvic organs, the abdomen, or axillar lymph nodes. Its underrecognition has occasionally led to its misinterpretation for an adenocarcinoma. This case reports the treatment and follow-up of vaginal endosalpingiosis, presenting as a vaginal polyp in a premenopausal women with intermenstrual bleeding. To our knowledge this is the first reported case of vaginal endosalpingiosis and the second mucosal localization after bladder endosalpingiosis.

Florid Cystic Endosalpingiosis (Müllerianosis) in Pregnancy

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.

Florid cystic endosalpingiosis, masquerading as malignancy in a young patient: a brief review

Endosalpingiosis is a rare condition characterised by the presence of tubal epithelium outside the fallopian tube. Most of the previous case reports have described this condition in women in their fifth decade or older. We report a case of a woman presenting at 31 years with a history of heavy bleeding during menses and pain in the lower abdomen for the past 2 years. An ultrasound examination showed a left ovarian cyst of 4.3×3.2 cm with multiple septations. CA 125 was within normal range. Laparoscopy was performed with the plan of ovarian cystectomy, peroperatively; there were papillary projections all over the uterus and the peritoneal surface. The left ovary was enlarged with papillary projections on the surface. Multiple biopsies were taken from the surface of the uterus, ovary and the peritoneum as the picture was quite suspicious of malignancy. Histopathological examination gave the picture of endosalpingiosis. The patient underwent laparoscopic ovariotomy with fulguration of lesions 4 months later, in view of persistent pain and discomfort, and increase in the size of the cyst on ultrasound monitoring. Presently, she is free of symptoms.