Clement Philip B
Department of Pathology, Vancouver General Hospital, Vancouver, BC, Canada.
Adv Anat Pathol. 2007 Jul;14(4):241-60. doi: 10.1097/PAP.0b013e3180ca7d7b.
Although the histologic diagnosis of endometriosis is usually straightforward, many diagnostic problems can arise as a result of alterations or absence of its glandular or stromal components. The diagnostic difficulty in such cases can be compounded by tissue that is limited to a small biopsy specimen. The appearance of the glandular component can be altered by hormonal and metaplastic changes, as well as cytologic atypia and hyperplasia. Although the last 2 findings are often referred to collectively as "atypical endometriosis," they should be separately recognized as their premalignant potential likely differs. In some cases, the endometriotic glands are sparse or even absent (stromal endometriosis). The stromal component can be obscured or effaced by infiltrates of foamy and pigmented histiocytes, fibrosis, elastosis, smooth muscle metaplasia, myxoid change, and decidual change. Occasional findings in endometriosis that may raise concern for a neoplasm include necrotic pseudoxanthomatous nodules, polypoid growth (polypoid endometriosis), bulky disease, and venous, lymphatic, or perineural invasion. Inflammatory and reactive changes within, adjacent to, or at a distance from foci of endometriosis can complicate the histologic findings and include infection within endometriotic cysts, pseudoxanthomatous salpingitis, florid mesothelial hyperplasia, peritoneal inclusion cysts, and Liesegang rings. The histologic diagnosis of endometriosis can also be challenging when it involves an unusual or unexpected site. Five such site-specific problematic areas considered are endometriosis on or near the ovarian surface, superficial cervical endometriosis, vaginal endometriosis, tubal endometriosis, and intestinal endometriosis, including the important distinction of an endometrioid carcinoma arising from colonic endometriosis from a primary colonic adenocarcinoma. Finally, endometriotic foci can occasionally be intimately admixed with another process, such as peritoneal leiomyomatosis or gliomatosis, resulting in a potentially confusing histologic appearance.
虽然子宫内膜异位症的组织学诊断通常很直接，但由于其腺体或间质成分的改变或缺失，可能会出现许多诊断问题。此类病例的诊断困难可能因取材局限于小活检标本而加剧。腺体成分的外观可因激素和化生改变以及细胞异型性和增生而改变。尽管最后这两个发现通常统称为“非典型子宫内膜异位症”，但应分别予以认识，因为它们的恶变潜能可能不同。在某些情况下，子宫内膜异位腺体稀少甚至缺失（间质型子宫内膜异位症）。间质成分可被泡沫状和色素沉着的组织细胞浸润、纤维化、弹性组织变性、平滑肌化生、黏液样变和蜕膜样变所掩盖或消失。子宫内膜异位症中偶尔出现的可能引起肿瘤疑虑的表现包括坏死性假黄瘤样结节、息肉样生长（息肉样子宫内膜异位症）、肿块性病变以及静脉、淋巴管或神经周围侵犯。子宫内膜异位症病灶内、邻近或远处出现的炎症和反应性改变会使组织学表现复杂化，包括子宫内膜异位囊肿内的感染、假黄瘤样输卵管炎、旺盛的间皮增生、腹膜包涵囊肿和蕾西格环。当子宫内膜异位症累及不寻常或意外的部位时，其组织学诊断也可能具有挑战性。这里考虑的五个此类部位特异性问题区域是卵巢表面或其附近的子宫内膜异位症、浅表性宫颈子宫内膜异位症、阴道子宫内膜异位症、输卵管子宫内膜异位症和肠道子宫内膜异位症，包括结肠子宫内膜异位症引发的子宫内膜样癌与原发性结肠腺癌的重要鉴别。最后，子宫内膜异位病灶偶尔可与另一种病变紧密混合，如腹膜平滑肌瘤病或胶质瘤病，导致组织学表现可能令人困惑。
