Peritoneal stromal endometriosis: a detailed morphological analysis of a large series of cases of a common and under-recognised form of endometriosis.
Level 4 - case-series / case-control
Retrospective case series of pathology specimens
PubMed 19155237 · doi:10.1136/jcp.2008.064261
What was done
The authors conducted a morphological review of 274 peritoneal biopsy specimens previously diagnosed with endometriosis to determine the frequency and histological characteristics of stromal endometriosis (endometrioid-type stroma lacking endometrioid glands).
What was found
Stromal endometriosis, defined as microscopic nodules or plaques of endometrioid-type stroma, was identified in 44.9% of the 274 biopsies. In 6.6% of the biopsies, stromal endometriosis occurred in the absence of typical glandular endometriosis. Lesions were typically superficial beneath or protruding above the mesothelial surface and showed associated features including reactive mesothelial proliferation, inflammation, giant cell/granuloma formation, hemosiderin deposition, microcalcification, decidualization, and myxoid change.
Why it matters
It demonstrates that endometrioid stroma frequently occurs without glandular elements in peritoneal biopsies, which may cause under-recognition if classic criteria requiring both glands and stroma are strictly enforced.
Limits
The study is an observational series of pre-selected endometriosis biopsies without non-endometriosis controls, clinical outcome data, patient symptom correlation, or assessment of inter-observer diagnostic agreement.
Cited by
- partial Stromal endometriosis lesions lack glandular structures and consist of connective tissue and nerve endings that cause severe bloating, inflammation, and deeper pain.