Ghigna Maria-Rosa, Mercier Olaf, Mussot Sacha, Fabre Dominique, Fadel Elie, Dorfmuller Peter, de Montpreville Vincent Thomas
Department of Pathology, Marie Lannelongue Hospital, Le Plessis-Robinson, France.
Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital, Le Plessis-Robinson, France.
Ann Diagn Pathol. 2015 Oct;19(5):320-5. doi: 10.1016/j.anndiagpath.2015.07.001. Epub 2015 Jul 8.
Thoracic endometriosis is defined as the ectopic presence of endometrial glands and stroma in lung or pleura and constitutes an uncommon cause of spontaneous pneumothorax in nonsmoker women in childbearing age. From 2000 to 2014, 18 (7.3%) women of 246 had a histologically proven endometriosis-related pneumothorax. The examination of thoracic samples was performed on formalin-fixed, paraffin-embedded hematoxylin and eosin-stained slides. Immunohistochemistry was carried out on all samples. The pathologic findings included endometriosis foci appearing as a triad of endometrial glands, stroma, and hemosiderin-laden macrophages in 8 patients. In the remaining 10 patients, minute nests of endometrial stroma were recognized at histologic examination and immunohistochemistry. One patient displayed diaphragmatic endometriosis and pulmonary lymphangioleiomyomatosis. Thoracic endometriosis is an uncommon cause of recurrent pneumothorax necessitating histologic confirmation. The histologic diagnosis of endometriosis may be challenging on small pleural or lung biopsies because endometriosis mostly appears as minute nests of endometrial stromal cells. Here, we present our experience on thoracic endometriosis: considering frequent interpretation difficulties of biopsy samples, we propose a multidisciplinary diagnostic algorithm.
胸腔子宫内膜异位症定义为子宫内膜腺体和间质在肺或胸膜的异位存在，是育龄期非吸烟女性自发性气胸的罕见原因。2000年至2014年，246名女性中有18名（7.3%）经组织学证实患有与子宫内膜异位症相关的气胸。对胸腔样本的检查是在福尔马林固定、石蜡包埋的苏木精和伊红染色切片上进行的。对所有样本进行了免疫组织化学检查。病理结果包括8例患者出现子宫内膜异位病灶，表现为子宫内膜腺体、间质和含铁血黄素巨噬细胞三联征。在其余10例患者中，组织学检查和免疫组织化学发现了微小的子宫内膜间质巢。1例患者表现为膈肌子宫内膜异位症和肺淋巴管平滑肌瘤病。胸腔子宫内膜异位症是复发性气胸的罕见原因，需要组织学证实。子宫内膜异位症的组织学诊断在小的胸膜或肺活检中可能具有挑战性，因为子宫内膜异位症大多表现为微小的子宫内膜间质细胞巢。在此，我们介绍我们在胸腔子宫内膜异位症方面的经验：考虑到活检样本的解释困难，我们提出了一种多学科诊断算法。
