endometriosis interna


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Related to endometriosis interna: adenomyosis uteri

endometriosis interna

endometriosis

A condition affecting up to 50% of women, which is defined as the presence of functioning endometrial glands and stroma outside of uterine cavity, occurring (in descending order of frequency) in: ovaries, broad ligaments, rectovaginal septum, umbilical scars, intestine, lungs, breast; laparoscopic resection or ablation of minimal lesions increased fecundity.

Clinical findings
Often accompanied by dysmenorrhoea, cyclical pain, low back pain, thigh pain, hypermenorrhoea, repeated miscarriages, infertility, bleeding per rectum or bladder. Regional swelling with vicarious ectopic bleeding parallels menses.

Evaluation
Laparoscopy.
 
Management
Surgery if anatomy is distorted; TAH-BSO is definitive therapy.

Prognosis
Endometriosis is associated with future development of cancer.

Malignancy in endometriosis
Malignancy can arise in the epithelium (e.g., clear-cell or endometrioid carcinomas), stroma (e.g., endometrial stromal sarcoma, MMMT, adenosarcoma), or in other lesions (e.g., borderline tumours, endometrioid adenofibroma). Cancer allegedly occurs in up to 10% of cases.

Endometriosis, criteria and comments
Glands
• Active (functional) or inactive.
• Metaplastic changes—ciliated, hobnail, mucinous or squamous.

Stroma
• Usually readily apparent.
• May be inconspicuous cuff.
• Spiral arterioles, haemosiderin, CD10.
• Decidualisation.
• Myxoid change.
• Smooth muscle metaplasia/elastosis.

Haemosiderin
• Pigmented histiocytes.
• Pseudoxanthomatous.
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