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Vascular Pseudoinvasion After Endometrial Ablation.

Georgia Karpathiou, Thomas Corsini, Sami Dagher

    International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists
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    Vascular pseudoinvasion, a diagnostic challenge in uterine pathology, can mimic malignancy. This report details its occurrence after endometrial ablation, a previously unreported setting.

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    Area of Science:

    • Uterine pathology
    • Surgical pathology
    • Gynecologic oncology

    Background:

    • Vascular pseudoinvasion, the displacement of endometrial tissue into myometrial vessels, is a recognized diagnostic challenge.
    • It is often associated with uterine manipulators used in minimally invasive hysterectomies.
    • Distinguishing pseudoinvasion from true vascular invasion is critical for accurate cancer staging.

    Purpose of the Study:

    • To report vascular pseudoinvasion in the setting of post-endometrial ablation hysterectomy, an unreported scenario.
    • To review existing literature on artifactual or nonmalignant myometrial vessel involvement by endometrial tissue.

    Main Methods:

    • Case report of a hysterectomy specimen following endometrial ablation.
    • Literature review of studies investigating vascular pseudoinvasion and artifactual myometrial vessel involvement.

    Main Results:

    • Vascular pseudoinvasion was identified in a hysterectomy specimen after endometrial ablation.
    • The review confirmed that uterine manipulators are a common cause, but other factors may contribute.
    • Artifactual involvement can occur with both normal and neoplastic endometrial tissue.

    Conclusions:

    • Vascular pseudoinvasion can occur in post-endometrial ablation hysterectomy specimens.
    • Awareness of this phenomenon in this specific context is important for accurate pathological interpretation.
    • Pathologists must consider iatrogenic causes and differentiate pseudoinvasion from true malignancy.