İntestinal Endometriozis Tanılı Olguların Klinikopatolojik Bulgularının Değerlendirilmesi

Öz

Ekstrapelvik endometriozis, endometrial glandüler ve/veya stromal komponentin ekstrauterin lokalizasyonlarda bulunması olarak tanımlanmakta olup en sık gastrointestinal sistemde görülmektedir. Biyopsi örneğinde endometrial gland ve stroma varlığında endometriozis yönünde tanı vermek zor olmasa da, endoskopik biyopsi materyalleri genellikle endometriozis tanısı için yeterli doku içermemektedir. Çalışmamızda intestinal endometriozis olgularımızda, intestinal epitelde ve endometriozis odağında gözlenen histomorfolojik bulgular belirlenmiş ve endometriozis odağının bulunduğu lokalizasyon ile ilişkisi araştırılmıştır. Endometriotik odağın lokalize olduğu intestinal tabaka ile intestinal epitelde görülen mikroskopik değişikliklerin birbiri ile ilişkili olduğu saptanmış olup, bu mikroskopik değişikliklerin inflamatuar bağırsak hastalığı, iskemik kolit, karsinoma gibi antitelerin taklitçisi olabileceği dikkat çekmiştir.

Anahtar Kelimeler

• Endometriozis
• İntestinal endometriozis
• Patoloji

Evaluation of Clinicopathological Findings of Cases Diagnosed With Intestinal Endometriosis

Öz

Extrapelvic endometriosis is defined as the presence of endometrial glandular and/or stromal components in extrauterine localizations and is most commonly seen in the gastrointestinal tract. Although it is not difficult to diagnose endometriosis in the presence of an endometrial gland and stroma, endoscopic biopsy materials generally do not contain sufficient tissue for the diagnosis of endometriosis. In our study, histomorphological findings observed in the intestinal epithelium and endometriosis focus were determined in our intestinal endometriosis cases. The relationship between these findings and the localization of the endometriosis focus was investigated. It has been determined that the intestinal layer where the endometriotic focus is localized and the microscopic changes seen in the intestinal epithelium are related to each other, and it has been noted that these microscopic changes may mimic entities such as inflammatory bowel disease, ischemic colitis, and carcinoma.

Anahtar Kelimeler

• Endometriosis
• Intestinal endometriosis
• Pathology

Kaynakça

1. 1. Singh N, Euscher ED, Hoang LN. Female Genital Tumours: WHO Classification of Tumours. 5th ed. WHO Classification of Tumours Editorial Board, editor. Vol. 4. 2020. 1–631 p.
2. 2. Bougie O, Yap MaI, Sikora L, Flaxman T, Singh S. Influence of race/ethnicity on prevalence and presentation of endometriosis: a systematic review and meta‐analysis. BJOG.2019 Aug 29;126(9):1104–15. doi: 10.1111/1471-0528.15692.
3. 3. Alexandrino G, Lourenço LC, Carvalho R, Sobrinho C, Horta DV, Reis J. Endometriosis: A rare cause of large bowelobstruction. GE Port J Gastroenterol. 2018 Mar;25(2):86-90. doi: 10.1159/000480707.
4. 4. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020 Mar 26;382(13): 1244-56. doi: 10.1056/NEJMra1810764.
5. 5. Matalliotakis M, Goulielmos GN, Kalogiannidis I,Koumantakis G, Matalliotakis I, Arici A. Extra pelvicendometriosis: Retrospective analysis on 200 cases in two different countries. Eur J Obstet Gynecol Reprod Biol. 2017 Oct;217: 34-7. doi: 10.1016/j.ejogrb.2017.08.019.
6. 6. Chamié LP, Ribeiro DMFR, Tiferes DA, De Macedo Neto AC,Serafini PC. Atypical sites of deeply infiltrative endometriosis: Clinical characteristics and imaging findings. Radiographics. 2018 Jan-Feb;38(1):309-28. doi: 10.1148/rg.2018170093.
7. 7. Rana R, Sharma S, Narula H, Madhok B. A case of recto-sigmoid endometriosis mimicking carcinoma. Springerplus. 2016 May 17;5: 643.doi: 10.1186/s40064-016-2221-6.
8. 8. Guadagno A, Grillo F, Vellone VG, Ferrero S, Fasoli A, FioccaR, et al. Intestinal Endometriosis: Mimicker of Inflammatory Bowel Disease? Digestion. 2015 Aug 20;92(1):14–21. doi: 10.1159/000430908.

9. 9. Jiang W, Roma AA, Lai K, Carver P, Xiao SY, Liu X.Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases. Mod Pathol. 2013 Sep;26(9):1270-8. doi: 10.1038/modpathol.2013.51.
10. 10. Yantiss RK, Clement PB, Young RH. Endometriosis of theIntestinal Tract: A Study of 44 Cases of a Disease That MayCause Diverse Challenges in Clinical and Pathologic Evaluation. Am J Surg Pathol. 2001 Apr;25(4):445-54. doi: 10.1097/00000478-200104000-00003.
11. 11. Shafrir AL, Farland L V., Shah DK, Harris HR, Kvaskoff M, Zondervan K, et al. Risk for and consequences ofendometriosis: A critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol. 2018 Aug;51: 1-15. doi: 10.1016/j.bpobgyn.2018.06.001.
12. 12. Leibson CL, Good AE, Hass SL, Ransom J, Yawn BP,O’Fallon WM, et al. Incidence and characterization of diagnosed endometriosis in a geographically definedpopulation. Fertil Steril. 2004 Aug;82(2):314–21. doi: 10.1016/j.fertnstert.2004.01.037.
13. 13. Charatsi D, Koukoura O, Ntavela IG, Chintziou F, Gkorila G,Tsagkoulis M, et al. Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of Extrapelvic Endometriosis. Adv Med. 2018 Sep;2018: 3461209. doi: 10.1155/2018/3461209.
14. 14. Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: Areview. Reprod Med Biol. 2020 Jul 16;19(4):323-33. doi: 10.1002/rmb2.12340.
15. 15. Clement PB. The Pathology of Endometriosis A Survey of theMany Faces of a Common Disease Emphasizing Diagnostic Pitfalls and Unusual and Newly Appreciated Aspects. AdvAnat Pathol. 2007 Jul;14(4):241-60. doi: 10.1097/PAP.0b013e3180ca7d7b.
16. 16. Langlois NEI, Park KGM, Keenan RA. Mucosal changes in the large bowel with endometriosis: A possible cause of misdiagnosis of colitis? Hum Pathol. 1994 Oct;25(10):1030-4. doi: 10.1016/0046-8177(94)90061-2.
17. 17. Misdraji J, Lauwers GY, Irving JA, Batts KP, Young RH.Appendiceal or Cecal Endometriosis With Intestinal Metaplasia A Potential Mimic of Appendiceal Mucinous Neoplasms. Am J Surg Pathol. 2014 May;38(5):698-705. doi: 10.1097/PAS.0000000000000167.