Multifocal endometriosis

Ludmila Lozneanu, Delia Gabriela Ciobanu-Apostol, Raluca Anca Balan, Ioana Păvăleanu, Simona Eliza Giuşcă, Irina-Draga Căruntu, Cornelia Amalinei

Abstract


Endometriosis represents a complex entity, characterized by tissue located in ectopic sites, outside uterus, with the highest incidence in ovaries and peritoneum. We report a rare case, with multiple endometriotic foci, in a 34 year old woman. The patient presented with intestinal subocclusion syndrome, associated with pelvic and abdominal pain. The imagistic exploration identified two peritoneal and one left ovarian masses and the clinical exam detected a 48/22 mm Douglas pouch mass. The surgical treatment, by exploratory laparotomy, resulted in segmental resection of the rectosigmoid junction and left adnexectomy. The intraoperative frozen section consultation, followed by paraffin-embedded, routine and immunohistochemical staining, led to a rare diagnosis of multiple foci of endometriosis, involving left adnexa, colorectum, and pericolic lymph nodes, without any atypia or malignancy. The postoperative evolution had been favorable. According to the identification of multiple endometriotic foci in our case, the hypothesis of different etiopathogenic mechanisms involvement may be supported by our findings.

Keywords


endometriosis, multiple foci, immunohistochemistry, colon

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References


Nothnick W, Alali Z. Recent advances in the understanding of endometriosis: the role of inflammatory mediators in disease pathogenesis and treatment. F1000 Res 2016; 5:F1000 Faculty Rev 186.

Machairiotis N, Stylianaki A, Dryllis G, et al. Extrapelvic endometriosis: a rare entity or an under diagnosed condition? Diagn Pathol 2013; 8:194.

De Ceglie A, Bilardi C, Blanchi S, et al. Acute small bowel obstruction caused by endometriosis: a case report and review of the literature. World J Gastroenterol 2008; 14:3430-3434.

Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet 2010; 27:441-447.

Ruffo G, Scopelliti F, Scioscia M, Ceccaroni M, Mainardi P, Minelli L. Laparoscopic colorectal resection for deep infiltrating endometriosis: analysis of 436 cases. Surg Endosc 2010; 24:63-67.

Insilla CA, Granai M, Gallippi G, et al. Deep endometriosis with pericolic lymph node involvement: a case report and literature review. World J Gastroenterol 2014; 20:6675-6679.

Fluegen G, Jankowiak F, Zacarias Foehrding L, Kroepil F, Knoefel WT, Topp SA. Intrahepatic endometriosis as differential diagnosis: case report and literature review. World J Gastroenterol 2013; 19:4818-4822.

Jablonski C, Alifano M, Regnard JF, Gompel A. Pneumoperitoneum associated with catamenial pneumothorax in women with thoracic endometriosis. Fertil Steril 2009; 91(3):930.

Cheng CH, Kuo HC, Su B. Endometriosis in a kidney with focal xanthogranulomatous pyelonephritis and a perinephric abscess. BMC Res Notes 2015; 8:591.

Zamurovic M. Rare extrapelvic endometriosis on iliac vein wall-diagnosis and treatment. Clin Exp Obstet Gynecol 2014; 41:349-450.

Albutt K, Glass C, Odom S, Gupta A. Endometriosis within a left-sided inguinal hernia sac. J Surg Case Rep 2014; 2014(5).

Mechsner S, Weichbrodt M, Riedlinger WF, et al. Estrogen and progestogen receptor positive endometriotic lesions and disseminated cells in pelvic sentinel lymph nodes of patients with deep infiltrating rectovaginal endometriosis: a pilot study. Hum Reprod 2008; 23:2202–2209.

Mechsner S, Weichbrodt M, Riedlinger WF, Kaufmann AM, Schneider A, Köhler C. Immunohistochemical evaluation of endometriotic lesions and disseminated endometriosis-like cells in incidental lymph nodes of patients with endometriosis. Fertil Steril 2010; 94:457-463.

Abrao MS, Podgaec S, Dias JA Jr, et al. Deeply infiltrating endometriosis affecting the rectum and lymph nodes. Fertil Steril 2006; 86:543-547.

Noel JC, Chapron C, Fayt I, Anaf V. Lymph node involvement and lymphovascular invasion in deep infiltrating rectosigmoid endometriosis. Fertil Steril 2008; 89:1069-1072.

Jerby BL, Kessler H, Falcone T, Milsom JW. Laparoscopic management of colorectal endometriosis. Surg Endosc 1999; 13:1125-1128.

Poyatos LR, Perez PA, Bravo BF, et al. Rectosigmoid endometriosis with lymph node involvement. Gastroenterol Hepatol 2003; 26:23-25.

Thomakos N, Rodolakis A, Vlachos G, Papaspirou I, Markaki S, Antsaklis A. A rare case of rectovaginal endometriosis with lymph node involvement. Gynecol Obstet Invest 2006; 62:45-47.

Barrier BF, Dick EJ Jr, Butler SD, Hubbard GB. Endometriosis involving the ileocaecal junction with regional lymph node involvement in the baboon-striking pathological finding identical between the human and the baboon: a case report. Hum Reprod 2007; 22:272-274.

Rossini R, Monsellato D, Bertolaccini L, et al. Lymph node involvement in deep infiltrating intestinal endometriosis: does it really mean anything? J Minim Invasive Gynecol 2016; 23:787-792.

Sampson JA. Metastatic or embolic endometriosis, due to the menstrual dissemination of endometrial tissue into the venous circulation. Am J Pathol 1927; 3(2):93-110.

Meyer R. Über den Stand der Frage der Andenomyositis und Adenomyome im allgemeinen und insbesondere über Adenomyositis seroepithelialis und Adenomyometritis sacromatosa. Zentralbl Gynakol 1919; 36:754.

Simpson JL, Bischoff FZ, Kamat A, Buster JE, Carson SA. Genetics of endometriosis. Obstet Gynecol Clin North Am 2003; 30:21-40.

Bulun SE. Endometriosis. N Engl J Med 2009; 3:268-279.

Tempfer CB, Wenzl R, Horvat R, et al. Lymphatic spread of endometriosis to pelvic sentinel lymph nodes: a prospective clinical study. Fertil Steril 2011; 96:692-696.

Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 1997; 68:585-596.

Gargett CE, Schwab KE, Deane JA. Endometrial stem/progenitor cells: the first 10 years. Hum Reprod Update 2016; 22:137-163.

Jerman LF, Hey-Cunningham AJ. The role of the lymphatic system in endometriosis: a comprehensive review of the literature. Biol Reprod 2015; 92(3):64.

Berbic M, Hey-Cunningham A, Ng C, et al. The role of Foxp3þ regulatory T-cells in endometriosis: a potential controlling mechanism for a complex, chronic immunological condition. Hum Reprod 2010; 25:900–907.

Schmidt D, Ulrich U. Endometriosis-related ovarian tumors. Pathologe 2014; 35:348-354.

Troyer MR. Differential diagnosis of endometriosis in a young adult woman with nonspecific low back pain. Phys Ther 2007; 87:801-810.

De Wilde RL, Hesseling M, Hirschelmann G, Tchartchian G, Verhoeven HC. Differential Diagnosis in Endometriosis: Endosalpingiosis; the Unknown Entity. An Overview of 1,100 Video-Documented Laparoscopies. JMIG 2012; 19:S93-S94.




DOI: http://dx.doi.org/10.22551/2016.12.0303.10078

Copyright (c) 2016 Ludmila Lozneanu, Delia Gabriela Ciobanu-Apostol, Raluca Anca Balan, Ioana Păvăleanu, Simona Eliza Giuşcă, Irina-Draga Căruntu, Cornelia Amalinei

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