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Presented by Dr. Ashley Cimino-Mathews and prepared by Dr. Yembur Ahmad
This case talks about a 30-year-old female with an abdominal mass.
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1. Question
Clinical history: A 30 year-old female with an abdominal mass
Choose the correct diagnosis:
Correct
Diagnosis: D. Endometriosis
Histology: The resection specimen shows areas of scarring with scattered infiltrative-appearing glands. The glands are composed of cuboidal cells with occasional admixed small cells with clear cytoplasm. There is no cytologic atypia or mitotic activity. The glands are surrounded by a stroma of small, round to oval blue cells with minimal cytoplasm. In areas, the stroma cells are associated with extravasated red blood cells and hemosiderin-laden macrophages.
Discussion: Endometriosis is the presence of ectopic endometrial tissue, including the glands and stroma. There are three characteristic features: benign endometrial glands, associated endometrial stroma, and the presence of hemorrhage or hemosiderin-laden macrophages. At least two of these three features are required to definitively classify a lesion as endometriosis. Endometriosis can involve essentially any site in the pelvic and abdominal cavity, but can occasionally be seen in supradiaphragmatic locations such as lymph nodes. The most common site of endometriosis is the ovary, which can form a dominant cystic nodule termed an endometrioma. Endometriosis can give rise to endometrioid carcinoma or clear cell carcinoma, and the risk of malignancy is highest in the ovary. The glands of endometriosis can irregularly “infiltrate” through benign tissues, and the most important point is to not mistake endometriosis for invasive carcinoma.
Reference:
Matias-Guiu X, Stewart CJR. Endometriosis-associated ovarian neoplasia. Pathology. 2018 Feb;50(2):190-204. doi: 10.1016/j.pathol.2017.
Incorrect
Diagnosis: D. Endometriosis
Histology: The resection specimen shows areas of scarring with scattered infiltrative-appearing glands. The glands are composed of cuboidal cells with occasional admixed small cells with clear cytoplasm. There is no cytologic atypia or mitotic activity. The glands are surrounded by a stroma of small, round to oval blue cells with minimal cytoplasm. In areas, the stroma cells are associated with extravasated red blood cells and hemosiderin-laden macrophages.
Discussion: Endometriosis is the presence of ectopic endometrial tissue, including the glands and stroma. There are three characteristic features: benign endometrial glands, associated endometrial stroma, and the presence of hemorrhage or hemosiderin-laden macrophages. At least two of these three features are required to definitively classify a lesion as endometriosis. Endometriosis can involve essentially any site in the pelvic and abdominal cavity, but can occasionally be seen in supradiaphragmatic locations such as lymph nodes. The most common site of endometriosis is the ovary, which can form a dominant cystic nodule termed an endometrioma. Endometriosis can give rise to endometrioid carcinoma or clear cell carcinoma, and the risk of malignancy is highest in the ovary. The glands of endometriosis can irregularly “infiltrate” through benign tissues, and the most important point is to not mistake endometriosis for invasive carcinoma.
Reference:
Matias-Guiu X, Stewart CJR. Endometriosis-associated ovarian neoplasia. Pathology. 2018 Feb;50(2):190-204. doi: 10.1016/j.pathol.2017.
