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Immunohistochemical Expression Status of p53, CD44v9, and Ki-67 in a Series of Fallopian Tube Lesions of High-grade Serous Carcinoma
Sugimoto, Sumire M.D.; Uchiyama, Tomoko M.D., Ph.D.; Kawahara, Naoki M.D.; Ohbayashi, Chiho M.D., Ph.D.; Kobayashi, Hiroshi M.D., Ph.D.
doi : 10.1097/PGP.0000000000000738
September 2021 - Volume 40 - Issue 5 - p 419-426
Pelvic high-grade serous carcinoma (HGSC) has been postulated to arise via a stepwise accumulation of (epi)genetic alterations from normal epithelium to secretory cell outgrowth (SCOUT), p53 signature, and serous tubal intraepithelial carcinoma (STIC) to invasive HGSC. The aim of this study is to investigate alterations in p53 and CD44v9 expression and the status of Ki-67 labeling index in a series of fallopian tube lesions of HGSC patients. A total of 45 specimens were analyzed in 16 patients with HGSC, and their lesions were categorized as follows: morphologically normal fallopian tube epithelium (FTE, n=6 samples), SCOUT (n=5), p53 signature (n=4), dormant STIC (n=8), active STIC (n=6), and HGSC (n=16). Morphologic features and immunohistochemical expression patterns of the p53 protein, CD44v9 protein, and Ki-67 antigen were blindly evaluated by 2 pathologists. Increased nuclear p53 protein accumulation was observed in p53 signature, dormant STIC, active STIC and HGSC compared with normal FTE and SCOUT (P<0.001). Immunohistochemistry scores of CD44v9 protein expression were significantly higher in normal FTE, SCOUT, and p53 signature than in dormant STIC, active STIC, and HGSC (P<0.001). Both active STIC and HGSC had significantly higher Ki-67 labeling indices than normal FTE, SCOUT, p53 signature and dormant STIC (P<0.001). CD44v9 loss contributes to the stepwise progression of p53 signature to dormant STIC. In conclusion, p53 mutation followed by CD44v9 loss may be involved in the evolution of STIC, which may confer positive clonal selection with a growth and survival advantage.
Hyperreactio Luteinalis (Multiple Luteinized Follicle Cysts): A Report of 10 Cases
Watkins, Jaclyn C. M.D., M.S.; Lebok, Patrick M.D.; Young, Robert H. M.D.
doi : 10.1097/PGP.0000000000000746
September 2021 - Volume 40 - Issue 5 - p 427-434
Hyperreactio luteinalis is a rare entity arising in pregnancy and in the setting of gestational trophoblastic diseases (ie choriocarcinoma, molar pregnancy) that presents with, typically, bilateral ovarian enlargement due to numerous follicle cysts. While the phenomenon is benign and spontaneously regresses following delivery or treatment, a specimen may be seen in pathology when oophorectomy or cystectomy is performed to exclude malignancy or to manage acute complications such as torsion. Such resections may exhibit overlapping microscopic features with cystic granulosa cell tumors. We thus reviewed 10 cases of hyperreactio luteinalis in the setting of pregnancy, the largest pathologic cohort to date, to highlight notable features of this disorder. Patients ranged from 22 to 30?yr old. Most patients (n=6) presented at time of cesarean section with incidentally discovered ovarian masses. Three patients presented in the postpartum period, and 1 underwent surgery at 28?wk gestation due to the finding of a unilateral ovarian mass. The ovaries ranged from 8.5 to 29?cm and were multicystic and bilateral in 8 of the cases. Histologic examination demonstrated multiple, variably sized cystic follicles lined by a granulosa cell layer of varying thickness and theca cells with marked eosinophilic cytoplasm. Stromal edema was often prominent, with theca cells occasionally noted in nests, cords, and as single cells in foci of edema. Mitoses were generally seen more often in the granulosa cell layer (mean=2.6 per high power fields) compared with the theca cell layer (mean=1 per 10 high power fields). This series documents the key features of hyperreactio luteinalis that differentiate it from the other benign mass forming lesions encountered in pregnancy, most notably large solitary follicle cyst of pregnancy and puerperium, as well as cystic granulosa cell tumors, especially the juvenile variant, which may also present during pregnancy. Of particular use in differentiating them from juvenile granulosa cell tumor is the absence of pale or vacuolated cytoplasm and solid growth of granulosa cells in cases of hyperreactio luteinalis.
The Value of DICER1 Mutation Analysis in “Subtle” Diagnostically Challenging Embryonal Rhabdomyosarcomas of the Uterine Cervix
Yoon, Ju-Yoon M.D.; Apellaniz-Ruiz, Maria Ph.D.; Chong, Anne-Laure B.Sc.; Slim, Zena M.D.; Salfinger, Stuart G. M.D.; Clarke, Blaise A. M.D.; Stewart, Colin J.R. F.R.C.Path.; Foulkes, William D. M.B.B.S., Ph.D.; McCluggage, W. Glenn F.R.C.Path.
doi : 10.1097/PGP.0000000000000718
September 2021 - Volume 40 - Issue 5 - p 435-440
Embryonal rhabdomyosarcoma of the uterine cervix is a rare neoplasm which is almost invariably associated with pathogenic somatic or germline DICER1 mutations; patients with germline mutations have DICER1 syndrome. We report 2 subtle cervical embryonal rhabdomyosarcoma, one occurring in a 21-yr-old woman with a known history of DICER1 syndrome and the other in a 19-yr-old woman with no history of DICER1 syndrome or DICER1-associated neoplasms. Both neoplasms focally involved otherwise benign endocervical polyps and were characterized histologically by subtle areas of increased stromal cellularity, nuclear atypia and mitotic activity; there was focal nuclear staining of these areas with the skeletal muscle markers myogenin and myoD1. In both cases, demonstration of a somatic DICER1 RNase IIIb mutation in the tumor was instrumental in establishing the diagnosis. We believe these neoplasms represent the earliest discernible phase of cervical embryonal rhabdomyosarcoma. Pathologists should have a high index of suspicion when atypical stromal elements are present in endocervical polyps and immunohistochemistry together with DICER1 sequencing will assist in diagnosis.
Mitotically Active Cellular Fibroma of the Ovary Recurring After the Longest Interval of Time (16?yr): A Challenging Case With Systematic Literature Review
Olivadese, Rocco M.D.; Ramponi, Antonio M.D.; Boldorini, Renzo M.D.; Dalla Dea, Giulia M.D.; Palicelli, Andrea M.D.
doi : 10.1097/PGP.0000000000000731
September 2021 - Volume 40 - Issue 5 - p 441-447
Cellular fibromas represent ~10% of ovarian fibromas. Mitotically active cellular fibromas show mild nuclear atypia but ?4 mitoses/10 high-power fields: the clinical course is usually uneventful but literature review is lacking. A 34-yr-old woman underwent left oophorectomy for a 9-cm ovarian mitotically active cellular fibroma at another hospital. The tumor was cellular (spindle cells in fascicular and storiform patterns) revealing mild atypia and 4 nonatypical mitoses/10 high-power fields without necrotic areas. After 16?yr, the tumor recurred as a 5-cm peritoneal nodule on the anterior sigmoid wall near the sigmoid-rectal junction. Frozen section revealed a spindle cell tumor invading the intestinal tunica muscularis propria: a gastrointestinal stromal tumor was favored as previous history was unavailable at that time. Intestinal resection was performed: no residual tumor was found. The patient was followed-up for 8?yr without further recurrences. The peritoneal nodule showed 2 mitoses/10 high-power fields and pericellular reticulin staining. The tumor was variably positive for vimentin/bcl-2/melan-A/CD56/ER/PR/?-inhibin/CD10/calretinin, focally positive for desmin, negative for pan-cytokeratin/actin/EMA/CD34/HMB45/CD117/CD99/S100/synaptophysin. The Ki67-index was ~9%. To our systematic literature review, 7 additional recurrent cases were reported. We describe a mitotically active cellular fibroma recurring after the longest interval of time. Extensive sampling of difficult cases should exclude malignant areas. Moderate nuclear atypia, tumor rupture, adhesions to pelvic/abdominal organs, infarction with extraovarian involvement, and incomplete excision may lead to relapse but there are conflicting data: prolonged follow-up can be suggested in these cases.
Osseous Metaplasia in Low-grade Ovarian Serous Carcinoma With a BRAF Mutation: A Case Report
Catteau, Xavier M.D., Ph.D.; Preat, Fanny M.D.; D’haene, Nicky M.D., Ph.D.; Noël, Jean-Christophe M.D., Ph.D.
doi : 10.1097/PGP.0000000000000732
September 2021 - Volume 40 - Issue 5 - p 448-451
A 44-yr-old woman presented with lower, painless abdominal discomfort and a vacuolated mass measuring 12?cm on the right-hand side of the pelvis. She subsequently underwent a bilateral salpingo-oophorectomy. An osseous lesion was identified in the left ovary, which was hard in consistency and was associated with a multicystic complex lesion. Microscopic examination of the left ovary showed clusters of serous cells with moderate atypia, surrounded by a desmoplastic stroma with large areas of bone matrix. To the best of our knowledge, this is the first reported case of low-grade serous carcinoma with osseous metaplasia and a BRAF mutation.
Insulinoma-associated Protein 1 Expression and Its Diagnostic Significance in Female Genital Tract Neuroendocrine Carcinomas
Ting, Ching-Heng M.D., M.S.; Wang, Tao-Yeuan M.D.; Wu, Pao-Shu M.D., Ph.D.
doi : 10.1097/PGP.0000000000000722
September 2021 - Volume 40 - Issue 5 - p 452-459
Neuroendocrine carcinomas (NECs) are rare, but aggressive malignant tumors of the female genital tract, especially in the uterine the cervix. Beside histologic morphology, positivity of neuroendocrine markers with immunohistochemistry plays an important role in diagnosis of NECs. Insulinoma-associated protein 1 (INSM1) is a novel marker reported to be widely expressed in a variety of neuroendocrine tumors. A previous study also suggested INSM1 has superior performance to conventional neuroendocrine markers in cervical NECs. In our present study, comparison between immunomarkers was performed in female genital tract NECs. Forty-nine patients with gynecologic NECs (4 vagina, 39 cervix, 5 endometrium, 1 ovary) were included from 1993 to 2019 at our center. Immunohistochemistry was performed with INSM1, CD56, synaptophysin (SYN), chromogranin-A (CgA), and thyroid transcription factor 1 (TTF1). The results show INSM1 has superior sensitivity and intensity compared with CD56, SYN, CgA, and TTF1 in cervical small cell NECs, but not in large cell NECs. In contrast to cervical NECs, INSM1 immunohistochemistry shows only focal and weak staining in endometrial NECs. Our result suggested INSM1 is a sensitive marker which can be used as first-line test in histologic suspicious cervical cases, especially small cell NECs. However, negative INSM1 stain does not exclude the possibility of NECs. In endometrial NECs, conventional panel with CD56, SYN, CgA has better diagnostic performance than INSM1 alone.
A Case of Synchronous Malignant and Benign Granular Cell Tumor of the Vulva
Baranova, Katherina M.D.; Goebel, Emily A. M.D., F.R.C.P.C.; McGee, Jacob M.D., M.Sc, F.R.C.P.C.; Walsh, Joanna C. M.B.B.Ch, M.R.C.P.(UK), F.R.C.P.C.
doi : 10.1097/PGP.0000000000000712
September 2021 - Volume 40 - Issue 5 - p 460-464
Granular cell tumors (GCT) are rare soft tissue neoplasms, which seldom occur in the vulva. They are more commonly benign, but malignant GCT do occur. We report a case of a 50-yr-old postmenopausal woman who presented with a vulvar lesion that was diagnosed as GCT on biopsy. Imaging and clinical examination revealed an enlarged, likely positive lymph node. Pathology of the subsequently resected total deep vulvectomy specimen showed 2 histologically distinct GCTs. The larger lesion met criteria for malignancy and histologically corresponded to metastatic deposits seen in the pelvic lymph nodes. The separate smaller lesion was histologically benign. This case illustrates a malignant GCT with a synchronous, likely benign GCT both occurring in the vulva. Our case demonstrates the application of histologic criteria in the diagnosis of malignant and benign GCT with discussion on the diagnosis and treatment of this rare tumor.
Perineal Clear Cell Hidradenoma: A GATA3-positive Neoplasm With Potential for Misdiagnosis
Hudacko, Rachel M.D.; Anderson, Patrick M.D.; Guerrieri, Claudio M.D.
doi : 10.1097/PGP.0000000000000713
September 2021 - Volume 40 - Issue 5 - p 465-469
We report a case of clear cell hidradenoma of the perineum that was initially misinterpreted as a papillary urothelial carcinoma, either metastatic or of Bartholin gland origin, on initial excisional biopsy. The misinterpretation may have been due to the pseudopapillary architecture and GATA3-positivity of the biopsy tissue. Clear cell hidradenomas often show a range of histologic growth patterns and cellular differentiation and are one of many tumors that react immunohistochemically with GATA3. Although rare, these tumors can occur in the genital region and can mimic malignant tumors such as metastatic renal cell carcinoma and carcinomas of the genitourinary tract. This report details the morphologic and immunohistochemical pitfalls that make accurate diagnosis of clear cell hidradenoma in this unusual location challenging.
Extraskeletal Myxoid Chondrosarcoma of the Vulva Confirmed by EWSR1 FISH: A Case Report and Review of the Literature
Salah, Haneen T. M.D.; Stivers, Nicole S. M.D.; Jarboe, Elke A. M.D.; Dodson, Mark K. M.D.; Ward, Michael B. M.D.
doi : 10.1097/PGP.0000000000000723
September 2021 - Volume 40 - Issue 5 - p 470-476
Extraskeletal myxoid chondrosarcoma of the vulva is a very rare tumor, with less than 10 cases reported in the literature. We report a case of a 45-yr-old woman with extraskeletal myxoid chondrosarcoma of the vulva confirmed by EWSR1 fluorescence in situ hybridization. Given the unusual site and prominent myxoid morphology, a broad differential diagnosis and a variety of ancillary testing was required. This article aims to review extraskeletal myxoid chondrosarcoma of the vulva, the differential diagnosis of a myxoid spindle cell neoplasm of the vulva, and the diagnostic importance of immunohistochemistry and EWSR1 fluorescence in situ hybridization.
Cervical Pemphigus Vulgaris Presenting as Postmenopausal Bleeding
Smith, Stephen M. M.D.; Moscarelli, Richard M.D.; Panse, Gauri M.D.; Parkash, Vinita M.B.B.S., M.P.H.
doi : 10.1097/PGP.0000000000000724
September 2021 - Volume 40 - Issue 5 - p 477-481
Pemphigus vulgaris is a severe mucocutaneous blistering disease with rare genital involvement. When present, female genital involvement is typically vulvo-vaginal and associated with characteristic bullous lesions elsewhere, most commonly in the oral cavity. Postmenopausal bleeding as a symptom of pemphigus is not reported to date. We present 2 cases of pemphigus vulgaris with postmenopausal bleeding that led to significant work-up for the patients, including hysterectomy for 1 patient. The site of bleeding was established to be related to cervical involvement in 1 patient and assumed to be of cervical origin in the other. As improving treatment modalities result in long-term survival in patients with pemphigus, isolated genital relapse/recurrence of pemphigus vulgaris involving the cervix may result with symptoms not previously attributed to the disease including postmenopausal bleeding. Both gynecologists and pathologists need to be aware of this possibility to accurately label symptoms as disease related and avoid unnecessary interventions for patients.
Vulvar Pilomatrix Carcinoma: Morphologic and Molecular Features
Bueno, Diego M.D.; Caniego-Casas, Tamara M.Sc.; Sánchez-Martínez, María Concepción M.D., Ph.D.; Saavedra-Serrano, Cristina M.D., Ph.D.; Palacios, José M.D., Ph.D.; Pérez-Mies, Belén M.D., Ph.D.
doi : 10.1097/PGP.0000000000000726
September 2021 - Volume 40 - Issue 5 - p 482-486
Pilomatrix carcinoma (PC) is a rare malignant variant of pilomatrixoma, a skin adnexal tumor originating from hair matrix cells. It is most often located in the head, neck region, upper back and upper extremities. PC has a locally aggressive behavior but metastasis only occur in 10% of cases. Mutations in CTNNB1, the encoding gene of beta-catenin, have been found in both pilomatrixoma and PC, but other molecular alterations are unknown. The authors present a case of PC in the clitoris, the third known reported case located on the external genitalia. The tumor followed an unusual clinical course with the development of multiple metastases. Next-generation sequencing analysis of the tumor identified, in addition to a characteristic CTNNB1 mutation, pathogenic mutations in PTEN, PIK3CA, and ARID1A, which could explain the aggressive course of the disease. The diagnostic criteria of PC and the differential diagnoses of this unusual tumor in the genital area are discussed.
SATB2 Expression in Uterine Sarcoma: A Multicenter Retrospective Study
Le Page, Cécile Ph.D.; Almadani, Noorah M.D.; Turashvili, Gulisa M.D., Ph.D., F.R.C.P.C.; Bataillon, Guillaume M.D.; Portelance, Lise B.A.; Provencher, Diane M.D.; Mes-Masson, Anne-Marie Ph.D.; Gilks, Blake M.D., F.R.C.P.C.; Hoang, Lien M.D.; Rahimi, Kurosh M.D., M.Sc., F.R.C.P.C.
doi : 10.1097/PGP.0000000000000730
September 2021 - Volume 40 - Issue 5 - p 487-494
Uterine sarcomas represent a clinical challenge because of their difficult diagnosis and the poor prognosis of certain subtypes. The aim of this study was to evaluate the expression of the special AT-rich sequence-binding protein 2 (SATB2) in endometrial stromal sarcoma (ESS) and other types of uterine sarcoma by immunohistochemistry. We studied the expression of SATB2 on 71 full tissue sections of endometrial stromal nodule, low-grade ESS, uterine leiomyomas and leiomyosarcoma, undifferentiated uterine sarcoma, adenosarcoma, and carcinosarcoma samples. Nuclear SATB2 expression was then evaluated in an extended sample set using a tissue microarray, including 78 additional uterine tumor samples. Overall, with a cut-off of ?10% of tumor cell staining as positive, the nuclear SATB2 score was negative in all endometrial stromal nodule samples (n=10) and positive in 83% of low-grade ESS samples (n=29/35), 40% of undifferentiated uterine sarcoma (n=4/10), 13% of leiomyosarcoma (n=2/16), 14% of adenosarcoma (n=3/22), and 8% carcinosarcoma (n=2/25) samples. Furthermore, in ESS patients, direct comparison of nuclear SATB2 scores with clinicopathologic parameters and other reported biomarkers such as progesterone receptor and estrogen receptor showed that nuclear SATB2 was associated with PR expression and a decreased risk of disease-specific death (odds ratio=0.06, 95% confidence interval=0.04–0.81, P=0.04). Our data suggest that SATB2 could be a marker with relative sensitivity (83%) for distinguishing between endometrial stromal nodule and ESS with potential prognostic value.
Diagnostic Accuracy in Assessment of Depth of Myometrial Invasion in Low-grade Endometrioid Carcinoma: A 2 Center Comparative Study by MRI and Intraoperative Assessment
Nagar, Rebecca; Peters, Toni M.D.; Nagar, Hans M.D.; McCluggage, W. Glenn F.R.C.Path.; Gupta, Mamta M.D.
doi : 10.1097/PGP.0000000000000703
September 2021 - Volume 40 - Issue 5 - p 495-500
The role of lymphadenectomy in endometrial carcinomas is controversial, especially in low-grade endometrioid carcinomas. In many institutions, lymphadenectomy in the latter neoplasms is undertaken only when there is deep myometrial invasion, defined as invasion involving 50% or more of the myometrium (FIGO stage IB). There has been considerable debate as to the best modality to detect deep myometrial invasion. In Europe, preoperative magnetic resonance imaging (MRI) is the most commonly used modality while in North America, intraoperative assessment (IOA) is undertaken in most, but not all, institutions. The aim of this study was to compare the diagnostic accuracy of these 2 modalities in identifying deep myometrial invasion in low-grade endometrioid carcinomas. Two patient cohorts were studied from Belfast, UK (n=253) and Boston, USA (n=276). With respect to detecting deep myometrial invasion, MRI had a sensitivity of 72.84%, positive predictive value of 75.64% and a positive likelihood ratio of 6.59 (95% confidence interval; 4.23–10.28). IOA had a sensitivity of 78.26%, positive predictive value of 80% and a positive likelihood ratio of 20.00 (95% confidence interval; 10.35–38.63). The superior positive likelihood ratio suggests that IOA is better than MRI in determining deep myometrial invasion and the nonoverlapping 95% confidence intervals suggest this is a significant finding. However, there are significant resource implications associated with IOA and preoperative MRI carries other advantages that are discussed herein.
Folate Receptor Alpha Is Preferentially Expressed in the Carcinoma Component of Endometrial Carcinosarcomas: A Potential Target for Adjuvant Therapy
Hanley, Krisztina Z. M.D.; Horowitz, Ira R. M.D.; Gordon, Alan M.D.; Meisel, Jane M.D.; Khanna, Namita M.D.
doi : 10.1097/PGP.0000000000000736
September 2021 - Volume 40 - Issue 5 - p 501-509
Carcinosarcomas (CSs) of the endometrium are biphasic malignancies, composed of high-grade carcinomatous and sarcomatous components. Surgical stage and pathologic characteristics are the most important prognostic findings, with a 5-yr survival of 15% to 30% in advance stage disease. Folate receptor alpha (FRA) overexpression has been observed in endometrial carcinomas and not yet studied in CSs. This study evaluates semiquantitative expression of FRA in both carcinomatous and sarcomatous components of CSs on whole tissue sections. Immunohistochemistry for FRA expression was performed and extent and intensity of staining were recorded for each case for both histologic components. A total of 46 cases were stained for FRA. The majority of these (40/46, 87%) showed FRA staining at variable intensity in the carcinomatous component, stronger in serous carcinomas and high-grade endometrioid, while only a small subset of tumors demonstrated weak staining in the sarcomatous component (2/46, 4.35%). CS is known to be associated with poor prognosis and adjuvant therapy is recommended even in low stage disease. Serous and high-grade endometrioid carcinomas are the most common carcinomatous components of CSs and are known to show consistently high FRA expression. Folate plays a role in tumor cell migration and loss of cellular adhesion, which are key steps in epithelial-mesenchymal transition, the process by which CS develops from carcinoma cells. Our study shows expression of FRA in the carcinomatous component of almost all CS cases (87%), further favoring FRA as a target for adjuvant treatment. While expression of FRA in the sarcomatous component was rarely observed, the carcinomatous component being associated with metastatic potential underscores the importance of anti-FRA therapy for systemic disease control.
Androgenetic/Biparental Mosaic/Chimeric Conceptions With a Molar Component: A Diagnostic and Clinical Challenge
Hodgson, Anjelica M.D.; Dube, Valerie M.D.; Strickland, Sarah M.D.; Kolomietz, Elena Ph.D.; Noor, Abdul Ph.D.; Akbari, Amir M.B.Ch.B.; Colgan, Terence M.D.; Turashvili, Gulisa M.D., Ph.D.
doi : 10.1097/PGP.0000000000000719
September 2021 - Volume 40 - Issue 5 - p 510-517
Hydatidiform moles (HM) are gestational trophoblastic diseases which arise due to an imbalance in genetic material and which are morphologically characterized by enlarged and irregular chorionic villi and trophoblastic hyperplasia, among other features. The morphologic differential diagnosis for HM encompasses a number of entities including androgenetic/biparental mosaic/chimeric (ABMC) conceptions, an interesting duo of lesions with a nonmolar form (placental mesenchymal dysplasia) and a molar form (typically with a complete HM component). ABMC conceptions contain a mixture of 2 cell populations (1 androgenetic and 1 biparental) and arise as a result of mosaicism (mitotic error in a zygote) or chimerism (fusion of 2 zygotes). Because of their unique molecular underpinnings, these rare lesions show a number of findings including the presence of multiple villous populations, discordant p57 immunostaining, and mixed genotypes. ABMC conceptions are important to accurately diagnose as the molar form in particular carries a risk for persistent gestational trophoblastic diseases and thus requires appropriate treatment and follow-up. In this report, we provide detailed characterizations of 2 such cases of ABMC conceptions with a molar component. Both patients (ages 34 and 31) were in the first trimester of pregnancy and had ultrasound findings concerning for HM. Increased comprehension of the pathogenesis and morphology of ABMC conceptions, combined with ancillary techniques including p57 immunohistochemistry, fluorescence in situ hybridization, and molar genotyping, has allowed us to accurately and efficiently identify these lesions. However, a number of pitfalls exist which may lead to misdiagnosis.
Vascular Involvement: An Uncommon Histologic Finding of Rectal Endometriosis
Mobarki, Mousa M.D.; Fenouil, Tanguy M.D.; Lavrut, Pierre-Marie M.D.; Rabeyrin, Maud M.D.; Karpathiou, Georgia M.D., Ph.D., B.Sc.; Hervieu, Valerie M.D.
doi : 10.1097/PGP.0000000000000734
September 2021 - Volume 40 - Issue 5 - p 518-521
Deep infiltrating endometriosis frequently affects the rectosigmoid region. It clinically presents as a chronic painful condition affecting women in their reproductive time. Here, we present a case of a 28-yr-old female patient who had a history of dysmenorrhea, dyspareunia, chronic abdominal and pelvic pain, and constipation secondary to rectal wall endometriosis. Microscopic examination of the resected rectal segment showed endometriosis with vascular and lymph node involvement. Vascular involvement is an uncommon histologic finding that may raise concern for potential malignancy. The aim of this report is to alert pathologists and physicians about this infrequent pitfall that can be mistaken for a neoplastic process and to discuss the underlying pathophysiology of vascular involvement by endometrial tissue in otherwise benign conditions.
