Choudhary S 1, Agnihotri P 2, Sehgal S 3, Jindal A4, Yadav A5
1Dr. Shweta Choudhary, Resident, 2Dr. Priyanka Agnihotri, Resident, 3Dr. Sangita Sehgal, Associate Professor, 4Dr. Arpita Jindal, Associate Professor, 5Dr. Ajay Yadav, Professor and Head, All authors affiliated with Department of Pathology, S.M.S Medical College, Jaipur, Rajasthan, India
Address for Correspondence: Dr. Shweta Choudhary, Girls Hostel, S.M.S Medical College, Jaipur, Rajasthan. E-mail id: drshwetachoudhary@gmail.com
Abstract
Cystic endosalpingiosis is a non - neoplastic lesion characterised by multiple cysts lined with benign tubal type epithelium. Our case presented as cystic ovarian neoplasm clinically and radiologically. Patient underwent Total abdominal hysterectomy and bilateral salpingo-oophorectomy. Microscopically, the cyst consists of multiple cysts lined by benign tubal type epithelium. A diagnosis of subserosal cystic endosalphingiosis was made. Increasing awareness of this entity would be helpful in making correct diagnosis by pathologists.
Key words: Cysts, Endosalpingiosis, Uterus
Manuscript received: 14th June 2016, Reviewed: 26th June 2016
Author Corrected: 12th July 2016, Accepted for Publication: 27th July 2016
Introduction
Endosalpingiosis is almost always discovered as an incidental finding on microscopic examination without clinical symptoms and is characterized by benign glandular structures with tubal type epithelium [1]. It usually involves the peritoneum, subperitoneal tissues, and retroperitoneal lymph nodes in women [2,3]. Myometrial endosalpingiosis is rare. We report a rare case of subserosal cystic endosalpingiosis which simulated a cystic ovarian neoplasm clinically and radiologically.
Case Report
A 50-year-old woman presented with vaginal bleeding off and on since 5 yrs. The ultrasonography showed 7x4cm multiloculated cyst in the right adnexal region. Pap smear was negative for malignancy. The other laboratory investigations were normal. Total abdominal hysterectomy and bilateral salpingo - oophorectomy were performed. Intraoperatively, subserosal brownish multicystic polypoid mass was seen in the posterior fundus of uterus. The bilateral adnexae were unremarkable. The subsequent course of treatment was uneventful after the operation. Grossly, there was a subserosal cystic polypoid mass in the posterior surface of the fundus of uterus [Fig. 1] measuring 5x4cm. On the cut surface, mass was multiloculated, solid and cystic showing a smooth inner surface filled with yellowish brown material. Microscopically, the mass consisted of cysts of various size and shape [Fig. 2]. They were lined by a benign-appearing tubal type epithelium. The epithelial lining of the cysts was of the tubular type and was composed of ciliated columnar cells, non-ciliated columnar cells and intercalated peg cells [Fig. 3]. Rest of the uterus, cervix, both adnexae were unremarkable except for adenomyosis in myometrium.
Figure-1: Gross specimen of uterus with bilateral adnexa showing multicystic mass at posterior aspect of fundus
Figure-2: Figure showing multiple cysts of various sizes . (HE 100X)
Figure-3: Cysts are lined by ciliated tubal epithelium. (HE 400X)
Discussion
Endosalpingiosis refers to the presence of tubal epithelium outside the uterine tube proper and is generally considered as an incidental finding [1]. Many extragenital locations have been reported in the literature such as peritoneum, subperitoneal tissue, colon, appendix, umbilicus, and lymph nodes [2,3]. Histologically it needs to be differentiated from cystic tumor-like lesions involving the uterus, cystic adenomyosis or endometriosis with tubal metaplasia, adenomatoid tumor and peritoneal inclusion cyst. Lack of endometrial stroma in our case ruled out cystic adenomyosis or cystic endometriosis. In contrast to ciliated tubal type epithelium lining as seen in our case, the cystic spaces of Cystic adenomatoid tumor are lined with flattened and cuboidal, non tubal type cells admixed with smooth muscle. Peritoneal inclusion cysts (benign cystic mesotheliomas) are usually adherent to the pelvic organs and they may appear to be a cystic ovarian tumor on the clinical and radiological examinations. Microscopically, however, they are typically lined with a single layer of flat to cuboidal mesothelial cells [4]. The pathogenesis of cystic endosalpingiosis is unknown. The sub-serosal location of the cyst in this case may be explained by the so-called ‘secondary Mullerian system theory’ [5].
Conclusion
In conclusion, clinically and radiologically, endosalpingiosis in the uterine horns may simulate a cystic ovarian neoplasm. Awareness of the existence of this rare lesion will prevent an incorrect diagnosis by clinician and pathologist.
Funding: Nil, Conflict of interest: None initiated
Permission from IRB: Yes
References
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3. Papavramidis TS, Sapalidis K, Michalopoulos N, Karayannopoulou G, Cheva A, Papavramidis ST. Umbilical endosalpingiosis: a case report. J Med Case Rep. 2010 Aug 24;4:287. doi: 10.1186/1752-1947-4-287. [PubMed]
4. Clement PB. Disease of the peritoneum. In: Kurman RJ ed. Blaustein’s Pathology of the Female Genital Tract. 5th ed. New York:Springer 2002; 735-6.
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How to cite this article?
Choudhary S, Agnihotri P, Sehgal S, Jindal A, Yadav A. Cystic endosalpingiosis of the uterus-a rare entity in disguise. Int J Med Res Rev 2016;4(8):1315-1317.doi:10.17511/ijmrr.2016.i08.06.