[1156] 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

Morphologic Features of Endometriosis in Nondiagnostic and Negative Peritoneal Biopsies
 NONDIAGNOSTIC BIOPSIES (N=44) NEGATIVE CONTROLS (N=84)  
 N%N%TWO-SIDED P VALUE
HEMOSIDERIN715.91910.710.4108
HEMOSIDERIN-LADEN MACROPHAGES24.5533.571.0000
FOAMY MACROPHAGES1022.7344.760.0050
CHRONIC INFLAMMATION1840.914250.000.3561
FIBROSIS1329.552327.380.8375
ELASTOSIS36.8211.190.1170
MYXOID CHANGE36.8233.570.4130
SMOOTH MUSCLE METAPLASIA1022.731315.480.3384
MESOTHELIAL HYPERPLASIA24.5555.951.0000
CALCIFICATION12.2700.000.3438
CLUSTERED SMALL VESSELS2250.002530.950.0334



Conclusions: Identification of select morphologic features on routine H&E stains can increase the diagnostic yield of peritoneal biopsies for suspected endometriosis.
Category: Gynecologic & Obstetrics

Wednesday, March 6, 2013 9:30 AM

Poster Session V # 183, Wednesday Morning

 

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