Endometriosis: A Clinical Enigma

Emmanuel Igho Odokuma, H O Abedi, E A Onohwakpor


Endometriosis has been defined as the presence of endometrial tissue (gland and stroma) outside the inner lining of the endometrium. The lesion has been associated with debilitating and bizarre clinical features and in the absence of histopathologic assessment may result in severe consequences to the patient. Specifically, albeit rare, there is the possibility of malignant transformation. Therefore, this presentation on endometriosis as an unusual occurrence is of ardent import to health personnel, especially as regard to the requirements for in-depth intra/interdisciplinary consultation in general and the role of the pathologist, specifically in management of cases.

Materials and methods. This was the case of a 30-year-old self-employed nulliparous female who was referred from a secondary health facility due to abdominal swelling of eight-month duration. The swelling was progressive and associated with an unproductive cough, chest pain, weight loss and dysmenorrhoea. The patient was subjected to clinical examination, haematologic review, radiologic assessment and histopathologic investigations.

Results. The examination revealed dull percussion notes, reduced air entry into both right and left thoracic lung fields with bilateral crepitations in both lung fields. The abdomen was distended with massive ascitic fluid. The patient was stabilized and, consequently, an exploratory laparotomy demonstrated endometrial glands in the follicular phase with the associated stroma in the right ovaries. In sections of the omentum, there were endometrial glands and stroma, some of them were cystically dilated, filled with fluid and cellular debris in their lumen.

Contribution to knowledge. This study has established the existence of endometriosis in a woman in her reproductive years further substantiating the multiple distribution presentation, debilitating nature and the role of histopathologic input in management of this lesion.



endometriosis; omentum; ovary; ascitis; malignancy

Full Text:



Worley MJ, Welch WR, Berkowitz RS, Ng SW. Endometriosis-associated ovarian cancer: a review of pathogenesis. Int J Mol Sci. 2013;14(3):5367-5379. DOI: https://doi.org/10.3390/ijms14035367

Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789-1799. DOI: https://doi.org/10.1016/S0140-6736(04)17403-5

Olive DL, Schwartz LB. Endometriosis. N Engl J Med. 1993;328(24):1759-1769. DOI: https://doi.org/10.1056/NEJM199306173282407

Salati SA, Rather AA. Endometriosis: a rare cause of appendicitis. J Coll Physicians Surg Pak. 2011;(21)5:304-305.

Deger A, Yaylaf F, Bayhan Z. Endometriosis in the surgical scar tissue after caesarean section. Ann Clin Pathol. 2;(2):2022.

Uysal A, Mun S, Taner CE. Endometrioma in abdominal scars: case reports of four cases and review of the literature. Arch Gynecol Obstet. 2012;286:805. DOI: https://doi.org/10.1007/s00404-012-2320-8

Mistrangelo M, Gilbo N, Cassoni P, Micalef S, Faletti R, Miglietta C et al. Surgical scar endometriosis. Surg Today. 2014;44(4):767-772. DOI: https://doi.org/10.1007/s00595-012-0459-3

Pearce CL, Templeman C, Rossing MA, Lee A et al. Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies. Lancet Oncol. 2012;13(4):385-394. DOI: https://doi.org/10.1016/S1470-2045(11)70404-1

Gazvani R, Templeton A. New considerations for the pathogenesis of endometriosis. Int. J Gynaecol Obstet. 2002;76(2):117-126. DOI: https://doi.org/10.1016/S0020-7292(01)00577-X

Halme J, Hammond MG, Hulka JF, Raj SG, Talbert LM. Retrograde menstruation in healthy women and in patients with endometriosis. Obstet Gynecol. 1984;64(2):151-154. [PMid:6234483]

Sampson JA. Metastatic or embolic endometriosis, due to the menstrual dissemination of endometrial tissue into the venous circulation. Am J Pathol. 1927;3(2):93-110. [PMid:19969738 PMCid:PMC1931779]

Sainz de la Cuesta R, Eichhorn JH, Rice LW, Fuller AF Jr, Nikrui N, Goff BA. Histologic transformation of benign endometriosis to early epithelial ovarian cancer. Gynecol Oncol. 1996;60(2):238-244. DOI: https://doi.org/10.1006/gyno.1996.0032 [PMid:8631545]

Jiang QY, Wu RJ. Growth mechanisms of endometriotic cells in implanted places: a review. Gynecol Endocrinol. 2012;28(7):562-567. DOI: https://doi.org/10.3109/09513590.2011.650662

Vlahos NF, Economopoulos KP, Fotiou S. Endometriosis, in vitro fertilisation and the risk of gynaecological malignancies, including ovarian and breast cancer. Best Pract Res Clin Obstet Gynaecol. 2010;24:39-50. DOI: https://doi.org/10.1016/j.bpobgyn.2009.08.004

Vlahos NF, Kalampokas T, Fotiou S. Endometriosis and ovarian cancer: a review. Gynecol Endocrinol. 2010;26(3):213-219. DOI: https://doi.org/10.1080/09513590903184050

Kobayashi H, Sumimoto K, Moniwa N, Imai M, Takakura K, Kuromaki T, Morioka E, Arisawa K, Terao T. Risk of developing ovarian cancer among women with ovarian endometrioma: a cohort study in Shizuoka, Japan. Int J Gynecol Cancer. 2007;17(1):37-43. DOI: https://doi.org/10.1111/j.1525-1438.2006.00754.x

Brinton LA, Gridley G, Persson I, Baron J, Bergqvist A. Cancer risk after a hospital discharge diagnosis of endometriosis. Am J Obstet Gynecol. 1997;176(3):572-579. DOI: https://doi.org/10.1016/S0002-9378(97)70550-7

Melin A, Sparén P, Persson I, Bergqvist A. Endometriosis and the risk of cancer with special emphasis on ovarian cancer. Hum Reprod. 2006;21(5):1237-1242. DOI: https://doi.org/10.1093/humrep/dei462

Vercellini P, Parazzini F, Bolis G, Carinelli S, Dindelli M, Vendola N, Luchini L, Crosignani PG. Endometriosis and ovarian cancer. Am J Obstet Gynecol. 1993;169:181-182. DOI: https://doi.org/10.1016/0002-9378(93)90159-G

Ogawa S, Kaku T, Amada S, Kobayashi H, Hirakawa T, Ariyoshi K, Kamura T, Nakano H. Ovarian endometriosis associated with ovarian carcinoma: a clinicopathological and immunohistochemical study. Gynecol Oncol. 200;77(2):298-304. DOI: https://doi.org/10.1006/gyno.2000.5765

Kumar S, Munkarah A, Arabi H, Bandyopadhyay S, Semaan A, Hayek K, Garg G, Morris R, Ali-Fehmi R. Prognostic analysis of ovarian cancer associated with endometriosis. Am J Obstet Gynecol. 2011;204(63):61-67. DOI: https://doi.org/10.1016/j.ajog.2010.08.017

Dilermando P, Laerte J, Vivian F. Accuracy of laparoscopy for assessing patients with endometriosis. Sao Paulo Med J. 2008;126(6):305-308. DOI: https://doi.org/10.1590/S1516-31802008000600002

Khairy GA. Endometriosis of the appendix: a trap for the unwary. Saudi J Gastroenterol. 2005;11:45-47. DOI: https://doi.org/10.4103/1319-3767.33337 [PMid:19861847]

DOI: http://dx.doi.org/10.21802/10.21802/gmj.2018.1.3

Copyright (c) 2018 EI Odokuma, HO Abedi, EA Onohwakpor

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


Free counters!