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Case Report: A Laparoscopic Treated Case of Deep Infiltrating Endometriosis with Vaginal Invasion Diagnosed by Vaginal Cytology

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DOI: 10.4236/ojpathology.2015.53012    3,429 Downloads   3,784 Views   Citations

ABSTRACT

A recently observed case of deep infiltrating endometriosis with its vaginal invasion diagnosed by vaginal cytology is reported. A 28-year-old Japanese woman complained of a severe dysmenorrhea. Left ovarian endometriotic cyst and deep infiltrating endometriosis were suspected. Two red-spots were also present in the posterior fornix of vagina. Vaginal cytology with cytokeratin (CK) 7-immunocytochemistry suggested the presence of infiltrating endometriosis. She underwent left ovarian cystectomy and resection of thickened uterosacral ligaments with vaginal endometriotic spots, under a laparoscope, based on the diagnosis of endometriotic cyst. Histopathology revealed DIE with vaginal invasion. Immunostaining for CK7 was positive for endometriotic cyst, while CK20 was negative. The stromal cells in endometriosis were immunohistochemically positive for CD10. The vaginal fornix was well-healed one month later the surgery. Postoperatively, she got pregnant with her natural intercourse and delivered a healthy 2138 g girl at 36 weeks of gestation.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Niwa, K. , Yano, R. , Hatanaka, Y. , Mori, S. , Yamaguchi, Y. , Mori, M. , Ueda, Y. and Tanaka, T. (2015) Case Report: A Laparoscopic Treated Case of Deep Infiltrating Endometriosis with Vaginal Invasion Diagnosed by Vaginal Cytology. Open Journal of Pathology, 5, 84-89. doi: 10.4236/ojpathology.2015.53012.

References

[1] Giudice, L.C. and Kao, L.C. (2004) Endometriosis. The Lancet, 364, 1789-1799.
http://dx.doi.org/10.1016/S0140-6736(04)17403-5
[2] Koninckx, P.R., Meuleman, C., Demeyere, S., Lesaffre, E. and Cornillie, F.J. (1991) Suggestive Evidence That Pelvic Endometriosis Is a Progressive Disease, Whereas Deeply Infiltrating Endome-triosis Is Associated with Pelvic Pain. Fertility and Sterility, 55, 759-765.
[3] Anaf, V., Simon, P., El Nakadi, I., Fayt, I., Buxant, F., Simonart, T., Peny, M.O. and Noel, JC. (2000) Relationship between Endometriotic Foci and Nerves in Rectovaginal Endometriotic Nodules. Human Reproduction, 15, 1744-1750. http://dx.doi.org/10.1093/humrep/15.8.1744
[4] Protopapas, A., Giannoulis, G., Chatzipapas, I., Athanasiou, S., Grigoriadis, T., Haidopoulos, D., Loutradis, D. and Antsaklis, A. (2014) Posterior Deep Infiltrating Endometriotic Nodules: Operative Considerations According to Lesion Size, Location, and Geometry, during One’s Learning Curve. ISRN Obstetrics and Gynecology, 20, 1-8. http://dx.doi.org/10.1155/2014/853902
[5] Witz, C.A. (1999) Current Concepts in the Pathogenesis of Endometriosis. Clinical Obstetrics and Gynecology, 42, 566-585. http://dx.doi.org/10.1097/00003081-199909000-00013
[6] Mederios, F.C., Cavalcante, D.I.M., Mederios, M.A.S. and Eleutério Jr., J. (2010) Fine-Needle Aspiration Cytology of Scar Endometriosis: Study of Seven Cases and Literature Review. Diagnostic Cytopathology, 39, 18-21. http://dx.doi.org/10.1002/dc.21319
[7] Oliveira-Filho, M., Rao, V.S., Eleutério Jr., J. and Medeiros, F.C. (2013) Fine Needle Aspiration Cytology: A Tool to Diagnose Cervical and Vaginal Endometriosis in Low-Income Places. Acta Cytologica, 57, 203-206. http://dx.doi.org/10.1159/000345898
[8] Al-Khawaja, M., Tan, P.H., MacLennan, G.T., Lopez-Beltran, A., Montironi, R. and Cheng, L. (2008) Ureteral Endometriosis: Clinicopathological and Immunohistochemical Study of 7 Cases. Human Pathology, 39, 954-959. http://dx.doi.org/10.1016/j.humpath.2007.11.011
[9] Dharan, M. (2009) The Adjunctive Value of CD10 Immunostaining on Cell Block Preparations in Pelvic Endometriosis. Acta Cytologica, 53, 625-629. http://dx.doi.org/10.1159/000325402
[10] Clement, P.B., Young, R.H. and Scully, R.E. (1990) Stromal Endometriosis of the Uterine Cervix. A Variant of Endometriosis that May Simulate a Sarcoma. The American Journal of Surgical Pathology, 14, 449-455. http://dx.doi.org/10.1097/00000478-199005000-00004
[11] Biscotti, C.V. and Ray, N. (2010) Papanicolaou Tests Associated with Cervical Mucosal Endometriosis: An Analysis of Cellular Features and Comparison to Endocervical Adenocarcinoma in Situ. Diagnostic Cytopathology, 38, 551-554.
[12] Wang, G., Tokushige, N., Markham, R. and Fraser, I.S. (2009) Rich Innervation of Deep Infiltrating Endometriosis. Human Reproduction, 24, 827-834. http://dx.doi.org/10.1093/humrep/den464
[13] Chapron, C., Fauconnier, A., Dubuisson, J.B., Barakat, H., Vieira, M. and Bréart, G. (2003) Deep Infiltrating Endometriosis: Relation between Severity of Dysmenorrhoea and Extent of Disease. Human Reproduction, 24, 760-766. http://dx.doi.org/10.1093/humrep/deg152
[14] Chapron, C., Barakat, H., Fritel, X., Dubuisson, J.B., Bréart, G. and Fauconnier, A. (2005) Presurgical Diagnosis of Posterior Deep Infiltrating Endometriosis Based on a Standardized Questionnaire. Human Reproduction, 20, 507-513. http://dx.doi.org/10.1093/humrep/deh627
[15] Ferrero, S., Abbamonte, L.H., Giordano, M., Ragni, N. and Remorgida, V. (2007) Deep Dyspareunia and Sex Life after Laparoscopic Excision of Endometriosis. Human Reproduction, 22, 1142-1148.
http://dx.doi.org/10.1093/humrep/del465
[16] Vercellini, P., Pietropaolo, G., De Giorgi, O., Pasin, R., Chiodini, A. and Crosignani, P.G. (2005) Treatment of Symptomatic Rectovaginal Endometriosis with an Estrogen-Progestogen Combination versus Low-Dose Norethindrone Acetate. Fertility and Sterility, 84, 1375-1387.
http://dx.doi.org/10.1016/j.fertnstert.2005.03.083
[17] Donnez, J. and Squifflet, J. (2010) Complications, Pregnancy and Recurrence in a Prospective Series of 500 Patients Operated on by the Shaving Technique for Deep Rectovaginal Endometriotic Nodules. Human Reproduction, 25, 1949-1958. http://dx.doi.org/10.1093/humrep/deq135

  
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