Boyle D P, McCluggage W G
Department of Pathology, Royal Group of Hospitals Trust, Belfast, Northern Ireland, UK.
J Clin Pathol. 2009 Jun;62(6):530-3. doi: 10.1136/jcp.2008.064261. Epub 2009 Jan 20.
It is generally considered that an unequivocal histological diagnosis of endometriosis requires the presence of endometrioid-type glands and endometrioid-type stroma. However, small nodules or plaques of endometrioid-type stroma without glands have been noticed by the authors in repeated peritoneal biopsies performed for suspected endometriosis. These are often, but not always, accompanied by typical endometriosis with glands. This form of endometriosis has been previously referred to as stromal or micronodular stromal endometriosis. However, there has been little reference to this condition in the literature.
In this study, there was a review of a large series (n = 274) of peritoneal biopsies with a diagnosis of endometriosis with a view to ascertaining the frequency of stromal endometriosis.
Stromal endometriosis, characterised histologically by small microscopic nodules or plaques of endometrioid-type stroma, sometimes with a whorled pattern and prominent vascularity and erythrocyte extravasation, was identified in 44.9% of the biopsies. In 6.6% of the biopsies, stromal endometriosis occurred without typical endometriosis. The foci of stromal endometriosis usually had a superficial location just beneath the mesothelial surface or protruding above this. Associated histological features present in some cases included reactive mesothelial proliferation, inflammation, giant cell or granuloma formation, haemosiderin pigment deposition, microcalcification and decidualisation and myxoid change.
Stromal endometriosis, usually in the form of superficial nodules or plaques, is a relatively common form of endometriosis which typically occurs in association with typical endometriosis but occasionally on its own. Pathologists should be aware of the existence of this form of endometriosis, the morphological features of which may be subtle. The typical location, intimately associated with surface mesothelium, may suggest that stromal endometriosis derives from mesothelial or submesothelial cells via a metaplastic process.
一般认为，子宫内膜异位症明确的组织学诊断需要存在子宫内膜样腺体和子宫内膜样间质。然而，作者在对疑似子宫内膜异位症进行的反复腹膜活检中注意到，存在无腺体的子宫内膜样间质小结节或斑块。这些情况常伴有典型的有腺体的子宫内膜异位症，但并非总是如此。这种形式的子宫内膜异位症以前被称为间质型或微小结节型间质子宫内膜异位症。然而，文献中很少提及这种情况。
在本研究中，回顾了一大系列（n = 274）诊断为子宫内膜异位症的腹膜活检病例，以确定间质子宫内膜异位症的发生率。
在44.9%的活检病例中发现了间质子宫内膜异位症，其组织学特征为微小的子宫内膜样间质小结节或斑块，有时呈漩涡状，血管丰富，有红细胞外渗。在6.6%的活检病例中，间质子宫内膜异位症单独出现，无典型的子宫内膜异位症。间质子宫内膜异位症病灶通常位于浅表，就在间皮表面下方或突出于其上方。部分病例中存在的相关组织学特征包括反应性间皮增生、炎症、巨细胞或肉芽肿形成、含铁血黄素色素沉着、微钙化以及蜕膜化和黏液样改变。
间质子宫内膜异位症通常表现为浅表结节或斑块，是一种相对常见的子宫内膜异位症形式，通常与典型的子宫内膜异位症相关，但偶尔也单独出现。病理学家应意识到这种形式的子宫内膜异位症的存在，其形态特征可能较为细微。与表面间皮密切相关的典型位置可能提示间质子宫内膜异位症是通过化生过程从间皮或间皮下细胞衍生而来。
