Immunohistochemical evaluation of endometriotic lesions and disseminated endometriosis-like cells in incidental lymph nodes of patients with endometriosis

Mechsner, Sylvia; Weichbrodt, Miriam; Riedlinger, Wolfram F. J.; Kaufmann, Andreas M.; Schneider, Achim; Köhler, C.

doi:10.1016/j.fertnstert.2009.03.097

Cited by 40 publications

(45 citation statements)

References 28 publications

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“…Gastro-intestinal endometriosis is frequently reported in colorectum (70%), as had also been in two cases form our files, including the presented patient, and ileum (1-7%) [12,13]. Rectosigmoid and lymph node endometriosis is reported in 26.3% to 50% of cases [14,15], being confirmed in several studies [6,[13][14][15][16][17][18][19][20].…”

Section: Arch Clin Cases 2016; 3(3):105-114supporting

confidence: 82%

“…Rectosigmoid and lymph node endometriosis is reported in 26.3% to 50% of cases [14,15], being confirmed in several studies [6,[13][14][15][16][17][18][19][20]. Considering the literature data, the possibility of ectopic implants to be independently produced by retrograde menstruation to three different sites, or the participation of a metaplastic process involved in colonic location, associated with the possibility of dissemination, by lymphatics, from ovary and, furthermore, from colon to lymph nodes, are probable mechanisms.…”

Section: Arch Clin Cases 2016; 3(3):105-114mentioning

confidence: 74%

“…Some authors support the low incidence of lymph node involvement in ovarian and/or peritoneal disease [25]. The identification of endometrial elements in lymph nodes may be highly correlated to the coexistence of possible foci of endometriosis encompassing the evident lesions, as a strong predictor of local or distance recurrence [13]. Another hypothesis is that endometriosis histogenesis may be different according to the location and lesion type [26].…”

Section: Arch Clin Cases 2016; 3(3):105-114mentioning

confidence: 99%

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Multifocal endometriosis

Lozneanu¹,

Ciobanu-Apostol²,

Bălan³

et al. 2016

Arch Clin Cases

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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.

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Section: Arch Clin Cases 2016; 3(3):105-114supporting

confidence: 82%

Section: Arch Clin Cases 2016; 3(3):105-114mentioning

confidence: 74%

Section: Arch Clin Cases 2016; 3(3):105-114mentioning

confidence: 99%

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Multifocal endometriosis

Lozneanu¹,

Ciobanu-Apostol²,

Bălan³

et al. 2016

Arch Clin Cases

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“…The study showed typical immunophenotype in all cases (endometriotic lesions stained positively with ER, PR, CD10 and cytokeratin, endometriotic-like cells stained positively with ER and PR) (ref. 36 ). Currently, little is known about the mechanism of recurrence of endometriosis and its management is not efficacious.…”

Section: Discussionmentioning

confidence: 99%

“…Lymphatic spread of endometriosis to lymph nodes has been documented as a frequent event (25-42%) in bowel, rectosigmoid and rectovaginal endometriosis [17][18][19] . Lymph node involvement by endometriosis consists of isolated endometriotic-like cells (IELC) located in the subcapsular sinus of lymph nodes, representing an early stage of involvement, and frank metastatic endometriotic lesions 18 . An unusual case of pelvic lymph node endometriosis with an aberrant immunophenotype mimicking metastasis of adenocarcinoma is described as follows:…”

Section: Introductionmentioning

confidence: 99%

Endometriosis with an aberrant immunophenotype: Challenging differential diagnosis of glandular lesions in the pelvic lymph nodes

Vlckova¹,

Lenz

Chvatal³

et al. 2017

BIOMED PAP

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f Case report. We describe an unusual case of pelvic lymph node endometriosis with an aberrant immunophenotype mimicking metastasis of adenocarcinoma. A 37-year-old patient with a history of invasive cervical adenocarcinoma stage pT1a2 is presented. Due to insufficient loop electrosurgical excision procedure (LEEP) conization, total laparoscopic hysterectomy with pelvic lymphadenectomy was indicated. Intraoperatively, the diagnosis of deep infiltrating endometriosis of parametrial ligament and vesicouterine pouch, endometrioma of the left ovary and Allen Master's syndrome was suspected; the patient had no history or clinical symptoms of endometriosis. A PubMed search of similar cases was followed by a comparison to this case and discussion of the differential diagnosis of glandular lesions in the pelvic lymph nodes is reported. Results. Histological investigation showed no residual neoplasia; the diagnosis of endometriosis was confirmed. An interesting microscopic finding was represented by a solitary glandular lesion in one pelvic lymph node. Using immunohistochemistry, it was demonstrated that there was a complete loss of oestrogen and progesterone receptor expression (unlike parametrial ligament endometriosis). The diagnosis of endometriosis was based on the presence of endometrial stroma; malignancy was excluded by bland cytomorphologic features and results of immunohistochemical examination.Conclusions. This type of aberrant of the endometriotic gland immunophenotype has never been presented in the scientific literature before. This finding plays a significant role from the pathology standpoint and, perhaps more importantly, from the clinical standpoint. An asymptomatic patient with a correct diagnosis of lymph node endometriosis did not undergo excessive treatment for false positive diagnosis of metastatic cervical adenocarcinoma.

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