endosalpingiosis

Endosalpingiosis is a rare condition characterized by the presence of ectopic, cystic glands outside the fallopian tube that are lined with fallopian tube-type ciliated epithelium [10]. These glands can occur in various pelvic organs, including ovaries, fallopian tube serosa, uterine serosa, myometrium, or pelvic peritoneum.

The condition is often associated with chronic pelvic pain and may be mistaken for endometriosis due to its similar histological appearance [3]. However, endosalpingiosis differs from endometriosis in that it lacks endometrial stroma and is characterized by the presence of ciliated epithelium without endometrial-type stroma [7][9].

Microscopically, endosalpingiosis is diagnosed by the presence of glands lined by low columnar or cuboidal cells, typically with cilia, and may also feature psammoma bodies [4][8]. The condition was first described by Sampson in 1930 as misplaced tubal epithelium in tubal stumps following salpingectomy [6].

Endosalpingiosis is generally considered a non-neoplastic process derived from the secondary Müllerian system, which consists of structures covering the peritoneal mesothelium and adjacent mesenchyme in the small pelvis and lower part of the female abdominal cavity [13]. The condition is relatively unknown and may be missed due to its coexistence with endometriosis or other pelvic pathologies.

Overall, endosalpingiosis is a rare and benign entity characterized by ectopic cystic glands lined with fallopian tube-type ciliated epithelium that express similar biomarkers.

Diagnostic Methods for Endosalpingiosis

Endosalpingiosis can be challenging to diagnose, and a combination of diagnostic methods may be necessary to confirm the presence of this condition.

• Histopathological Examination: A biopsy of the affected tissue is essential for diagnosing endosalpingiosis. The pathologist examines the tissue under a microscope to look for characteristic features such as glands or cystic structures lined with tubal-type epithelium, and cilia on the surface of the cells [12].
• Imaging Tests: Imaging tests like ultrasound or MRI scans may be used to visualize the lesions, but they are not definitive diagnostic tools. These tests can help identify the location and size of the lesion, but a biopsy is still necessary for a definitive diagnosis [7, 11].
• Physical Examination and Medical History Evaluation: A physical examination and medical history evaluation can provide valuable information about the patient's symptoms and medical history. However, these methods are not sufficient on their own to diagnose endosalpingiosis.
• Laboratory Studies: Laboratory studies such as CBC count, sedimentation rate, serum drug screen, urine test, sexually transmitted disease testing, and hormone assays may be performed to rule out other conditions [9].

Key Points

• A biopsy is essential for diagnosing endosalpingiosis.
• Imaging tests like ultrasound or MRI scans can help identify the location and size of the lesion but are not definitive diagnostic tools.
• Histopathological examination of biopsied tissue is necessary to confirm the presence of fallopian tube-like cells.

References

[7] by J Park · Cited by 11 — Under the impression of pelvic mass, laboratory tests and radiological images of contrast enhanced chest computer tomography are taken. [9] Mar 17, 2023 — Laboratory Studies · CBC count and sedimentation rate · Serum drug screen · Urine test · Sexually transmitted disease testing · Hormone assays. [11] by J Park · 2014 · Cited by 11 — Under the impression of pelvic mass, laboratory tests and radiological images of contrast enhanced chest computer tomography are taken. [12] What does endosalpingiosis look like under the microscope? Under the microscope, endosalpingiosis appears as glands or cystic structures lined with tubal-type epithelium. The epithelial cells lining these structures resemble the cells found in the fallopian tubes. One characteristic feature is the presence of cilia on the surface of the cells.

Medical Management Options for Endosalpingiosis

Endosalpingiosis, a condition characterized by the presence of ectopic salpingial tissue in the pelvic organs, may be managed with various medical treatments. While there is no cure for this condition, certain medications and therapies can help alleviate symptoms and manage associated issues.

• Hormone Therapy: Hormonal treatments, such as gonadotrophin-releasing hormone (GnRH) analogues, have been used to manage endosalpingiosis with variable success [3][4]. These medications can help regulate hormonal imbalances that may contribute to the condition.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs, such as ibuprofen or naproxen, can be prescribed to alleviate pelvic pain and discomfort associated with endosalpingiosis [5].
• Antibiotics: In some cases, antibiotics like cefoxitin and doxycycline may be used to treat bacterial infections that can exacerbate symptoms of endosalpingiosis [7].

Important Considerations

It is essential to note that treatment for endosalpingiosis typically focuses on managing associated issues, such as cysts on the ovaries, chocolate cysts (endometrioma), fertility problems, pelvic pain, adhesions, and dyspareunia (painful sex) [10]. Treatment decisions should be made in consultation with a healthcare provider, who can assess individual circumstances and provide personalized guidance.

Current Research and Understanding

Research on endosalpingiosis is ongoing, and the pathogenesis of this condition remains largely uncertain. Current theories suggest that it may result from shedding of epithelia from the tubes into the pelvic peritoneum, coelomic metaplasia of pelvic peritoneal epithelium, or growth of vestigial embryonic Müllerian tissue [13].

References

[3] N Ong · 2004 · Cited by 42 [4] AH Scheel · 2013 · Cited by 16 [5] Dec 3, 2013 [7] Feb 16, 2023 [10] Because endosalpingiosis, generally, isn’t considered a pathologic condition, treatment isn’t necessarily required. [13] The pathogenesis of endosalpingiosis remains largely uncertain.

Differential Diagnosis of Endosalpingiosis

Endosalpingiosis, a rare condition characterized by the presence of ectopic glands lined by fallopian tube type ciliated epithelium in the ovary, can be challenging to diagnose. The differential diagnosis for endosalpingiosis includes several conditions that may present with similar symptoms and histological features.

Conditions to Consider:

• Endometriosis: A common condition characterized by the presence of endometrial tissue outside the uterus. Endosalpingiosis is often found concurrently with endometriosis, but they can be distinguished through histopathological examination.
• Pelvic Serous Neoplasms: These include lesions of low malignant potential, low-grade pelvic serous carcinoma, and other types of epithelial cysts. The histologic relationship between endosalpingiosis and these neoplasms is notable.
• Adenocarcinoma: A type of cancer that can be distinguished from endosalpingiosis through the presence of atypia, mitoses, and other characteristic features.
• Peritoneal Mesothelioma: A rare condition characterized by the growth of malignant cells in the peritoneum. It is another differential diagnosis to consider when evaluating patients with endosalpingiosis.
• Extrauterine Endometrial Stromal Sarcoma and Adenosarcoma: These conditions can be distinguished from endosalpingiosis through the presence of gland-poor areas and other characteristic features.

Key Diagnostic Features:

• Histopathological Examination: The diagnosis of endosalpingiosis is made through histopathological examination, which involves the examination of tissue samples under a microscope.
• Immunohistochemical Analysis: This analysis can be used to distinguish endosalpingiosis from other conditions by identifying specific markers such as PAX8 and WT1.
• Gross Appearance: The gross appearance of endosalpingiosis may mimic primary peritoneal tumors or papillary carcinoma of the ovary, but histopathological examination is necessary for accurate diagnosis.

References:

• [3] For diagnosis of endosalpingiosis, pathology on excision (e.g. biopsy), is needed.
• [11] The diagnosis of endosalpingiosis will be made during conventional pathologic observations if a pathologist is aware of the lesion.
• [14] Unlike endometriosis, endosalpingiosis should have WT-1 immunoreactivity.

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