Endosalpingiosis and chronic pelvic pain

Abstract

Objective: To show that endosalpingiosis (ES) is a frequently underdiagnosed or misdiagnosed entity in women thought to have endometriosis (EM) on initial pathologic review and that ES alone may be an independent cause of pelvic pain.

Study design: A retro-spective review of pathology records from gynecologic cases from June 1992 to November 1994 revealed 37 cases of EM and 5 cases of ES. These cases were reviewed by a single pathologist (J.M.), who assigned a final diagnosis. Preoperative diagnosis or symptoms that led to surgery were compared to the initial and final pathologic diagnoses.

Results: Of the 37 cases with the initial diagnosis of EM, 64.9% had EM only (group I), 18.9% had both EM and ES (group II), and 16.2% had ES alone (group III). Of the five patients with an initial diagnosis of ES, 80% had ES (group IV), while 20% had both ES and EM (group V). In patients who had ES as their final diagnosis (group III and IV), 70% had chronic pelvic pain or presumed endometriosis as a preoperative diagnosis. This was similar to the 53.1% of patients with a final diagnosis of EM who had the same preoperative diagnosis.

Conclusion: We conclude that ES is more common than once thought. Furthermore, when an initial diagnosis of EM is made, further review may reveal that many of these cases are a combination of both EM and ES, while still others may be ES alone. ES, which has been long been thought to be clinically insignificant, could be a source of pelvic pain.