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Presented by Ashley Cimino-Mathews, MD and prepared by Armen Khararjian, MD.
This case talks about:
A 33 year-old female with an abdominal wall mass.
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Question 1 of 1
1. Question
Week 620: Case 2
A 33 year-old female with an abdominal wall mass.
Correct
Answer: Endometriosis
Histology: The abdominal wall mass consists of irregularly shaped glandular spaces lined by columnar cells which are occasionally ciliated and do not show cytologic atypia. The glandular spaces appear to be filled with secretions. The glands have associated endometrial-type stroma, consisting of small, blue wavy cells as well as extravasated red blood cells, hemosiderin deposition and hemosiderin-laden macrophages. The background tissue shows evidence of scarring, suggesting previous surgery in this site
Discussion: This abdominal wall mass is endometriosis, characterized by the endometrial glands with associated endometrial stroma and evidence of “menstruation” (i.e., blood, hemosiderin deposition and hemosiderin laden macrophages). Endometriosis can occur as implants in the peritoneal cavity (including along the bowel wall) and on the ovaries, within the ovaries as cysts, or as solid masses adjacent to the rectum and vagina. Endometriosis can even form mass like projections into the lumen of the bowel. When endometriosis involves the bowel wall and serosa, it can mimic invasive carcinoma and can present a diagnostic pitfall in staging an actual invasive adenocarcinoma such as colorectal carcinoma. The key to avoiding misdiagnosis is to identify the bland epithelium and the endometrial-type stroma. The exact origin of endometriosis is unclear, but some theories include “retrograde flow” of menstruated epithelium, metaplasia of mesothelial cells into endometrial-like cells, and transit of endometrial cells via the blood system.
References:
1. Bulun SE. Endometriosis. N Engl J Med 2009; 360:268-2792. Clement PB. The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Adv Anat Pathol. 2007 Jul;14(4):241-60.
Incorrect
Answer: Endometriosis
Histology: The abdominal wall mass consists of irregularly shaped glandular spaces lined by columnar cells which are occasionally ciliated and do not show cytologic atypia. The glandular spaces appear to be filled with secretions. The glands have associated endometrial-type stroma, consisting of small, blue wavy cells as well as extravasated red blood cells, hemosiderin deposition and hemosiderin-laden macrophages. The background tissue shows evidence of scarring, suggesting previous surgery in this site
Discussion: This abdominal wall mass is endometriosis, characterized by the endometrial glands with associated endometrial stroma and evidence of “menstruation” (i.e., blood, hemosiderin deposition and hemosiderin laden macrophages). Endometriosis can occur as implants in the peritoneal cavity (including along the bowel wall) and on the ovaries, within the ovaries as cysts, or as solid masses adjacent to the rectum and vagina. Endometriosis can even form mass like projections into the lumen of the bowel. When endometriosis involves the bowel wall and serosa, it can mimic invasive carcinoma and can present a diagnostic pitfall in staging an actual invasive adenocarcinoma such as colorectal carcinoma. The key to avoiding misdiagnosis is to identify the bland epithelium and the endometrial-type stroma. The exact origin of endometriosis is unclear, but some theories include “retrograde flow” of menstruated epithelium, metaplasia of mesothelial cells into endometrial-like cells, and transit of endometrial cells via the blood system.
References:
1. Bulun SE. Endometriosis. N Engl J Med 2009; 360:268-2792. Clement PB. The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Adv Anat Pathol. 2007 Jul;14(4):241-60.
