Histopathologic analysis of intestinal endometriosis after laparoscopic low anterior resection
Makoto Jinushi1, Atsushi Arakawa, Toshiharu Matsumoto
1Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan.
Study Objective:
To determine how intestinal endometriosis spreads, and, thus, to improve outcomes of curative surgery.
Design:
Descriptive study (Canadian Task Force classification II-2).
Setting:
University hospital.
Patients:
Ten patients who underwent laparoscopic low anterior resection of intestinal endometriosis at our hospital between January 1999 and August 2007.
Intervention:
Laparoscopic low anterior resection of intestinal endometriosis.
Measurements And Main Results:
Mapping of endometriotic foci, degree of vertical infiltration to the intestinal layers, and longitudinal spread of endometriotic foci to the intestinal plane were defined using hematoxylin-eosin, estrogen receptor, progesterone receptor, and CD10 staining.
Results:
Endometriotic foci tended to spread concentrically around a primary lesion that comprised most of a resected specimen. The deepest layer containing endometriotic foci at the primary lesion was the submucosal layer in 7 specimens (70%), and the internal circular muscle layer in 3 (30%). Satellite lesions comprising thickened areas that were independent of the primary lesion were detected in 5 specimens (50%). Multiple endometriotic foci were confirmed in all satellite lesions.
Conclusions:
Endometriotic foci might not only infiltrate the primary lesion in intestinal endometriosis but also disseminate to other areas. Thus, the primary lesion of intestinal endometriosis with a large margin must be excised via low anterior resection.
