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Review
. 2022 Mar;43(2):117-125.
doi: 10.1007/s00292-021-00978-x. Epub 2021 Oct 1.

[S2k guidelines for the diagnosis and treatment of endometriosis-Recommendations for pathology]

[Article in German]
Lars-Christian Horn  1 , Anne Kathrin Höhn  2 , Stefanie Burghaus  3 , Sebastian Daniel Schäfer  4 , Uwe Andreas Ulrich  5 , Dietmar Schmidt  6 ; Mitglieder der AWMF-Leitlinienkommission zur Erstellung der S2k-Leitlinie Endometriose
Affiliations
Review

[S2k guidelines for the diagnosis and treatment of endometriosis-Recommendations for pathology]

[Article in German]
Lars-Christian Horn et al. Pathologe. 2022 Mar.

Abstract
in English, German

The present article summarises the recommendations for the handling, histopathological workup, diagnostics and reporting in surgical pathology of biopsies and resection specimens in patients with the clinical diagnosis of endometriosis. In addition to practical aspects of pathology, the guidelines also take into account the clinical requirements for histopathology for the optimal diagnosis and therapy of the patients.Based on the definition of endometriosis of the corpus uteri (adenomyosis uteri) most commonly used in the pathological literature, this was defined in the guidelines as the detection of the endometriosis focus in the myometrium at a distance from the endomyometrial border of a medium-sized visual field (100× magnification), which in metric units corresponds to around 2.5 mm. In bowel resection specimens, the status of the resection margins had to be documented within the histopathological report.Also mentioned are the requirements for the reporting of carcinomas associated with endometriosis, including the immunohistochemical evaluation of steroid hormone receptors and mismatch repair proteins.

Die vorliegende Übersicht fasst die relevanten Aspekte der S2k-Leitlinie Endometriose zusammen. Die Empfehlungen umfassen die Aufarbeitung und Befunderhebung bei Biopsien und Resektaten, die bei der klinischen Diagnose einer Endometriose entnommen wurden. Die Leitlinie berücksichtigt neben praktischen Aspekten der Pathologie ebenso die klinischen Notwendigkeiten an die Histopathologie für eine optimale Diagnostik und Therapie der Patientinnen.Basierend auf der in der pathologischen Literatur gebräuchlichsten Definition der Endometriose des Corpus uteri (Adenomyosis uteri) wurde diese in der Leitlinie definiert als der Nachweis des Endometrioseherdes im Myometrium in einem Abstand zur endomyometranen Grenze von einem mittelgroßen Gesichtsfeld (100fache Vergrößerung), was metrisch rund 2,5 mm entspricht. Bei Darmresektaten soll zum Status der Resektionsränder Stellung genommen werden.Ebenso definiert werden Anforderungen im Kontext endometrioseassoziierter Karzinome (z. B. Hormonrezeptorbestimmungen, immunhistochemische Untersuchung auf Ausfall der DNA-Mismatch-Reparaturproteine).

Keywords: Carcinoma; Diagnostic histopathology; Endometriosis; Recommendations; Workup.

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