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Deeply infiltrating endometriosis affecting the rectum and lymph nodes
Mauricio S Abrao1, Sergio Podgaec, Joao Antonio Dias
1Obstetrics and Gynecology Department, Hospital das Clínicas, São Paulo Medical School, São Paulo, Brazil. msabrao@attglobal.net
Bowel endometriosis can affect lymph nodes, particularly with thicker lesions or when over 80% of the intestinal circumference is involved. This suggests bowel endometriosis may not always be a benign condition.
Area of Science:
- Gastroenterology
- Gynecologic Pathology
- Surgical Oncology
Background:
- Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus.
- Bowel endometriosis, a specific form, can present with complex morphologic features.
- Understanding these features is crucial for accurate diagnosis and management.
Purpose of the Study:
- To investigate the detailed morphologic characteristics of bowel endometriosis.
- To assess the involvement of lymph nodes in cases of bowel endometriosis.
Main Methods:
- A prospective study involving 35 patients with bowel endometriosis.
- Histologic analysis of tissue samples obtained via laparoscopic rectosigmoidectomy.
- Evaluation of lesion size, number, affected intestinal layers, circumference involvement, and lymph node status.
Main Results:
- Lymph nodes were found in pericolic adipose tissue in 54% of cases.
- Endometriotic foci within lymph nodes were observed in 26.3% of cases.
- Lesion thickness >1.75 cm or >80% circumference involvement correlated with lymph node positivity.
Conclusions:
- The findings challenge the classification of bowel endometriosis as strictly benign.
- Morphologic assessment, including lymph node status, is vital for understanding disease behavior.
- Further research is needed to fully elucidate the implications of these findings.
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