ENDOMETRIOSIS and Endosalpingiosis

ENDOMETRIOSIS (Robbins pp 1057)

• Endometriosis is defined as the presence of endometrial tissue outside the uterus.
  
• Adenomyosis is defined as presence of endometrial glands in the myometrium.
  
• The ovaries (36%) are most frequent areas of ectopic tissue.
  
• The endometriotic tissue is still under influence from hormones.
• Pathogenesis:
  
• 1) Regurg theory: Retrograde menstruation into fallopian tubes + ovaries may also take some endometrial tissue,
  
• 2) Metaplastic theory: Endometrium arises from coelomic epithelium, and can arise in odd places,
  
• 3) Vascular/Lymphatic dissemination theory: endometrial tissue dessiminates through blood/lymph.
  
• Clinical features: painful menstruation, painful coitus, pelvic pain.
• Morphology:
  
• Macroscopically: haemorrhagic spots, scarring (from bleeding), ovaries have chocolate cysts (filled with brown blood debris).
  
• Microscopically: endometrial glands, stroma, hemosiderin pigment.

Why isn’t endometriosis cancer?

1) Under influence of hormone,

2) 2 cell proliferation (not monoclonal),

3) mortality rate none.

ENDOSALPINGIOSIS

• The fallopian tubes have a simple columnar epithelium and are ciliated.
  
• Sometimes, you get this tubal epithelium in sites other than the fallopian tubes.
  
• Common sites are: pelvic peritoneum, ovaries etc.
• Morphology: Macroscopically: not under influence of hormones, so no scarring. Microscopically: You see tubal epithelium with fibrous tissue surrounding it, no glands.

Category: Pathology Notes