Morphologic Features Suggestive of Endometriosis in Nondiagnostic Peritoneal Biopsies
Beth T Harrison, Khushbakhat Mittal. New York University Langone Medical Center, New York, NY
Background: Endometriosis is a common disorder that causes significant morbidity from dysmenorrhea, pelvic pain, and subfertility. Establishment of a definitive diagnosis has important therapeutic implications; however, only 50% of laparoscopic biopsies of suspicious areas provide a diagnosis of endometriosis. Histologic criteria for diagnosis require the presence of endometrial glands or endometrial-type stroma. We hypothesize that other frequently identified, but nondiagnostic, histologic features of endometriosis suggest its presence in patients with nondiagnostic peritoneal biopsies.
Design: We performed a retrospective clinicopathologic study of morphologic features that may be suggestive of endometriosis by comparing peritoneal biopsies diagnosed as negative for endometriosis (n = 44) from pathologically confirmed endometriosis cases (endometriosis was seen in other biopsies obtained at the same time) with negative peritoneal biopsies (n = 84) from early stage gynecologic cancer cases without spread to the pelvis. Statistical analysis employed Fisher's exact test.
Results: Foamy macrophages and clustered small vessels were the only morphologic features significantly increased in biopsies from endometriosis patients over negative controls (p = 0.005 and p = 0.0334, respectively). Presence of foamy macrophages had a positive predictive value of 71.4% and likelihood ratio of 4.773 for a diagnosis of endometriosis. Other features (hemosiderin, hemosiderin-laden macrophages, chronic inflammation, fibrosis, elastosis, myxoid change, and smooth muscle metaplasia) did not differ between the two groups
|NONDIAGNOSTIC BIOPSIES (N=44)||NEGATIVE CONTROLS (N=84)|
|N||%||N||%||TWO-SIDED P VALUE|
|SMOOTH MUSCLE METAPLASIA||10||22.73||13||15.48||0.3384|
|CLUSTERED SMALL VESSELS||22||50.00||25||30.95||0.0334|