Pleura & peritoneum
Peritoneum
Endosalpingiosis (peritoneum)
Last author update: 1 October 2017
Last staff update: 12 November 2024
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PubMed Search: Endosalpingiosis
Table of Contents
Definition / general | Essential features | Case reports | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Positive stains | Negative stains | Differential diagnosis | Board review style question #1 | Board review style answer #1Cite this page: Hodgson A, Parra-Herran C. Endosalpingiosis (peritoneum). PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/pleuraendosalpingiosis.html. Accessed December 24th, 2024.
Definition / general
- Glands lined by epithelium with morphology and immunophenotype resembling fallopian tube epithelium, identified outside of the fallopian tube proper (Obstet Gynecol 1980;55:57S)
- Ciliated and unciliated columnar cells, intercalated cells and peg cells are identified
- Typically affects pelvic and abdominal peritoneum, usually as an incidental microscopic finding
- Also known to involve ovary, uterus, cervix, bowel, omentum and skin
- Rarely occurs in inguinal, mediastinal or axillary lymph nodes
- Rarely forms a cystic mass, entitled florid cystic endosalpingiosis (Hum Pathol 2002;33:944, Am J Surg Pathol 1999;23:166)
Essential features
- Multiple theories of origin including direct implantation of normal fallopian tube epithelium, involution of ovarian surface epithelium and metaplastic changes in multipotential peritoneal cells
- Typically an incidental finding, except in cystic lesions which may be grossly seen
- Seen in association with ovarian serous tumors (usually of borderline type), in conjunction with implants or alone
- Theorized to be the precursor lesion in borderline and low grade serous neoplasms found on the peritoneum or in lymph nodes (Am J Surg Pathol 2010;34:1442)
- May be seen in isolation but more commonly seen in conjunction with other nonneoplastic lesions of the Müllerian system, such as endometriosis and endocervicosis
Case reports
- Adolescent girl with endosalpingiosis of the appendix (Gynecol Obstet Fertil 2016;44:669)
- 40 year old and 54 year old women with endosalpingiosis of the urinary bladder (Aktuelle Urol 2017 Jun 20 [Epub ahead of print], Int J Surg Pathol 2010;18:381)
- 70 year old woman with endosalpingiosis of axillary lymph nodes (Case Rep Pathol 2016;2016:2856358)
- Endosalpingiosis of lumbar nerve root (Clin Neuropathol 2017;36:108)
Gross description
- Usually not grossly discernible
- Cystic appearance when seen
Gross images
Images hosted on other servers:
Cystic endosalpingiosis
Microscopic (histologic) description
- Glands and tubules lined by low columnar or cuboidal cells, typically with cilia
- Psammoma bodies (J Reprod Med 2000;45:526) and papillae may be present
Microscopic (histologic) images
Images hosted on other servers:
Glandular epithelial structures
Gland with ciliated epithelium and psammoma body
Comparison with metastatic breast carcinoma in axillary lymph node
PAX8+
WT1+
Cytology description
- Ciliated epithelium similar to fallopian tube, surrounded by fibrous stroma
- May have psammoma bodies (J Reprod Med 1991;36:675, J Reprod Med 2000;45:526)
- May have crowding and hyperchromasia
Negative stains
- Calretinin, CK20, p53 (wild type), D2-40
Differential diagnosis
- Adenocarcinoma: has atypia, mitoses, necrosis, desmoplasia
- Benign lesions known to occur in lymph nodes include salivary gland inclusions, thyroid follicles, capsular nevi: use morphology and immunohistochemistry to aid in the distinction
- Endometriosis: no endometrial stroma or hemorrhage is seen with endosalpingiosis
- Extraovarian serous cystadenoma
- Implant: from serous borderline tumor
- Distinction between these two abnormalities is not always sharp
- Multicystic mesothelioma: for cystic endosalpingiosis
- Peritoneal inclusion cyst
Board review style question #1
What is the expected immunohistochemical staining profile for endosalpingiosis?
- WT1+, PAX8+, calretinin+, BCL2-
- WT1+, PAX8-, calretinin+, BCL2+
- WT1+, PAX8+, calretinin-, BCL2+
- WT1-, PAX8+, calretinin-, BCL2+
- WT1-, PAX8-, calretinin-, BCL2-
Board review style answer #1
C. WT1+, PAX8+, calretinin-, BCL2+. As endosalpingiosis is composed of tubal type epithelium and thought to be derived from the Müllerian system, it is not surprising that this lesion is positive for PAX8 and WT1. Calretinin would be expected to stain lesions of mesothelial origin and ovarian theca origin. Studies have shown that BCL2, in addition to new contemporary markers such as FOXJ1 and phospho-SMAD2, are contemporary and promising markers for tubal epithelium and endosalpingiosis (Gynecol Oncol 2014;132:316).
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