Multifocal endometriosis

Abstract

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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“…The pathology is basically a chronic gynecological disorder with marked aseptic inflammatory reactions as a result of overproduction of the tissue hormone prostaglandins and with the involvement of cytokine macrophages, Tumor Necrosis Factor (TNF) and many other factors resulting in adhesion, fibrosis, scarring and anatomical distortions manifesting in painful conditions. It may be running within the family members subsequent to genetic predisposition [1][2][3].…”

“…The Villar's nodule is one of the rare and atypical types (Villar, 1886) and the list cannot be claimed to be exhaustive. Hence, the signs and symptoms could equally be diverse and very much dependent on the degree of involvement of the respective anatomical locations as it hardly spares any of the body organs [3].…”