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 21 May 2018

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News

Clinical and pathologic evaluation of intestinal tract endometriosis

Endometriosis can involve the intestinal tract extensively, causing numerous clinical symptoms, and can result in a large variety of mucosal alterations, according to a team from Canada and the USA.

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The researchers evaluated 44 cases of intestinal endometriosis in which endometriosis was the primary pathologic diagnosis. They evaluated subjects for a variety of gross and histologic changes and reported their findings in April's American Journal of Surgical Pathology.

Patients ranged in age from 28 to 56 years (mean age, 44 years). Presenting complaints included abdominal pain (n = 15), an abdominal mass (n = 12), obstruction (n = 8), rectal bleeding (n = 2), infertility (n = 3), diarrhea (n = 2), and increasing urinary frequency (n = 1).

The individuals' clinical differential diagnoses included diverticulitis, appendicitis, Crohn's disease, tubo-ovarian abscess, irritable bowel syndrome, carcinoma, and lymphoma.

Endometriosis can mimic other intestinal diseases.
American Journal of Surgical Pathology

42 patients underwent resection of the diseased intestine and 2 patients underwent endoscopic biopsies.

Pathologic evaluation revealed there were predominantly mural masses in 13 patients, which were multiple in two patients. In addition, 11 cases had luminal stenosis or strictures, 6 had mucosal polyps, 4 had submucosal masses that ulcerated the mucosa, 3 had serosal adhesions, 1 had deep fissures in the mucosa, and 1 was associated with appendiceal intussusception.

The team found involvement of the submucosa in 29 cases (66%), and, of these, 19 had features of chronic injury, including architectural distortion. Three cases had features of mucosal prolapse, ischemic changes were seen in 4, and segmental acute colitis and ulceration were seen in 4 and 6 cases, respectively.

In 14 patients, endometriosis formed irregular congeries of glands involving the intestinal surface epithelium, mimicking adenomatous changes.

Follow-up of 20 patients (range, 1-30 years; mean, 7.8 years) revealed that only 2 patients had recurrent symptoms.

None of the patients developed inflammatory bowel disease.

Rhonda K. Yantiss, of the Massachusetts General Hospital, Boston, USA, said on behalf of the group, "Endometriosis can involve the intestinal tract extensively, causing a variety of clinical symptoms, and can result in a spectrum of mucosal alterations."

"As the endometriotic foci may be inaccessible to endoscopic biopsy, or may not be sampled because of their focality, clinicians and pathologists should be aware of the potential of this condition to mimic other intestinal diseases," she concluded.

Am J Surg Path 2001; 25: 445-54
30 April 2001

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