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. 2022 Nov 3:12:e2021409.
doi: 10.4322/acr.2021.409. eCollection 2022.

The many faces of endometriosis

Marcelo Luis Pereira de Souza  1 , Talita Porto da Costa  2 , Nathanael Pinheiro de Freitas  2 , Maiara Ferreira de Souza  2 , Daniel Abensur Athanazio  1   2
Affiliations

The many faces of endometriosis

Marcelo Luis Pereira de Souza et al. Autops Case Rep. .

Abstract

Endometriosis is a common disease; however, unusual findings may cause diagnostic difficulties. We present herein three cases illustrating different morphological appearances of endometriosis: 1) endometriosis with atypical hyperplasia associated with bilateral ovarian carcinoma (mixed clear cell/endometrioid in the left ovary and endometrioid in the right ovary); 2) deep infiltrating endometriosis with intravascular spread, polypoid configuration in peritoneal surfaces, and involvement of a lymph node; and 3) decidualized endometriosis with prominent myxoid/mucinous change and multivacuolated (pseudoxanthoma) cells. Awareness of uncommon morphological manifestations of endometriosis is important to avoid improper consideration of malignancy.

Keywords: Endometriosis; Ovary; Pathology.

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Conflict of interest statement

Conflict of interest: None.

Figures

Figure 1
Figure 1. Case 1. Solid and cystic tumor in the left ovary. Cut surface. (A - Gross appearance during intraoperative frozen section consultation). Photomicrographs of the clear cell carcinoma component of the mixed carcinoma of the left ovary (B - HE, 100×; C - HE, 400×). The right ovary showed an endometrioid carcinoma. Adjacent tissues showed atypical endometriosis (D and E - HE, 100×; F: HE, 400×).
Figure 2
Figure 2. Case 2. Endometriosis within vessels and lymph nodes. Intravascular foci of both endometrial stroma and epithelium (A and B - HE, 40×). Weigert’s stain highlights the walls of large vessels (C and D - 40×; E and F - 100×). Intravascular endometriosis showing D2-40 labeling of both the inner surface of a lymphatic vessel and the external surface of the intravascular mass (G - D2-40 immunostain, 40×). An endometriosis focus within a lymph node from the sigmoid mesocolon (H - HE, 100×).
Figure 3
Figure 3. Case 2. Polypoid endometriosis in a specimen removed as an epiploic appendix (A - External appearance with HE). The microscopic image is reminiscent of an ordinary endometrial polyp (B - HE, 40×; C - HE, 40×; D - HE, 100×).
Figure 4
Figure 4. Case 3. Endometriosis in a cesarean section scar. Stromal decidualization and flat/atrophic epithelium (A - HE, 40×). Multifocal zones demonstrated a transition from typical areas to myxoid/mucinous changes (B - HE, 40×; C - HE, 100×). The latter areas showed numerous vacuolated cells (pseudoxanthoma cells) (D and E - HE, 400×). The Alcian Blue stain highlighted a striking accumulation of mucin (F - 40×; G - 100×; H - 400×).
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