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Bladder endometriosis: deep infiltrating endometriosis or adenomyosis?
L Fedele1, E Piazzola, R Raffaelli
1University of Verona, Italy.
Objective:
To describe the anatomopathologic characteristics of endometriosis infiltrating the bladder detrusor.
Design:
Descriptive anatomopathologic study.
Setting:
Tertiary care center for endometriosis.
Patient(S):
Four patients, aged 22-38 years, who underwent laparotomy for bladder endometriosis.
Intervention(S):
Surgical excision and pathologic analysis of bladder endometriotic nodules in four patients.
Main Outcome Measure(S):
Gross and microscopic characteristics of endometriotic nodules.
Result(S):
A nodule of adenomyosis on the anterior wall of the uterus, in continuity with the detrusor lesion, was excised in three patients. In the other patient, bladder endometriosis was continuous with a nodule that infiltrated the left parametrium and extended as far as the posterior leaf of the ipsilateral broad ligament. Microscopically, all of the lesions had a similar histologic pattern: foci of endometriosis scattered in the bladder wall. The main feature was the paucity of endometrial-type stroma, particularly in the bladder submucosa, where glands were almost always dilated and cystlike and were lined by flattened cells.
Conclusion(S):
Analysis of our patients, although it does not pinpoint the pathogenesis of the disease, seems to exclude the hypothesized intraperitoneal origin of endometriotic lesions of the bladder detrusor.