Endosalpingiosis and chronic pelvic pain

To show that endosalpingiosis (ES) is a frequently underdiagnosed or misdiagnosed entity in women thought to have endometriosis (EM) on initial pathologic review and that ES alone may be an independent cause of pelvic pain.

A retro-spective review of pathology records from gynecologic cases from June 1992 to November 1994 revealed 37 cases of EM and 5 cases of ES. These cases were reviewed by a single pathologist (J.M.), who assigned a final diagnosis. Preoperative diagnosis or symptoms that led to surgery were compared to the initial and final pathologic diagnoses.

Of the 37 cases with the initial diagnosis of EM, 64.9% had EM only (group I), 18.9% had both EM and ES (group II), and 16.2% had ES alone (group III). Of the five patients with an initial diagnosis of ES, 80% had ES (group IV), while 20% had both ES and EM (group V). In patients who had ES as their final diagnosis (group III and IV), 70% had chronic pelvic pain or presumed endometriosis as a preoperative diagnosis. This was similar to the 53.1% of patients with a final diagnosis of EM who had the same preoperative diagnosis.

We conclude that ES is more common than once thought. Furthermore, when an initial diagnosis of EM is made, further review may reveal that many of these cases are a combination of both EM and ES, while still others may be ES alone. ES, which has been long been thought to be clinically insignificant, could be a source of pelvic pain.