Endometriosis
Definition
The presence of endometrial stroma with or without glands.
Clinical Features
Superficial endometriosis may present with vaginal bleeding. Deep endometriosis, associated with pelvic endometriosis, presents with pain, dyspareunia, and sometimes pressure symptoms. Rarely, polypoid vaginal masses may be seen (Parker et al., 2004).
Incidence
Deep vaginal endometriosis is more common.
Age
Most women present premenopausally.
Site
The upper half of the vagina is the common location. Polypoid endometriosis presents in the posterior wall.
Treatment
Treatment with hormones or excision of the lesion is the initial treatment. Deep endometriosis may require complex surgery (Angioli et al., 2014).
Macroscopy
Tissue may appear polypoid and/or hemorrhagic. They may also present as polypoid, pink, or tan-colored masses.
Microscopy
Endometrial-type glands and/or stroma are seen. Lesions in pregnant women or in hormone-treated cases may show stromal decidualization.
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References and Further Reading
Angioli, R., De Cicco Nardone, C., Cafà, E. V., Plotti, F., Muzii, L., Montera, R., Guzzo, F., Luvero, D., & Terranova, C. (2014). Surgical treatment of rectovaginal endometriosis with extensive vaginal infiltration: Results of a systematic three-step vagino-laparoscopic approach. European Journal of Obstetrics & Gynecology and Reproductive Biology, 173, 83–87.
Cebesoy, F. B., Kutlar, I., & Aydin, A. (2007). Vaginal adenosis successfully treated with simple unipolar cauterization. Journal of National Medical Association, 99(2), 166–167.
Han, T., Jin, Y., Li, Y., Bi, Y., & Pan, L. (2018). Clinicopathologic features and outcomes of primary vaginal adenosis as a dermatologic and gynecologic burden: A retrospective study. Medicine (Baltimore), 97(49), e13470.
Herbst, A. L., Poskanzer, D. C., Robboy, S. J., Friedlander, L., & Scully, R. E. (1975). Prenatal exposure to stilbestrol. A prospective comparison of exposed female offspring with unexposed controls. New England Journal of Medicine, 292(7), 334–339.
Parker, R. L., Dadmanesh, F., Young, R. H., & Clement, P. B. (2004). Polypoid endometriosis: A clinicopathologic analysis of 24 cases and a review of the literature. American Journal of Surgical Pathology, 28(3), 285–297.
Robboy, S. J., Szyfelbein, W. M., Goellner, J. R., Kaufman, R. H., Taft, P. D., Richard, R. M., Gaffey, T. A., Prat, J., Virata, R., Hatab, P. A., McGorray, S. P., Noller, K. L., Townsend, D., Labarthe, D., & Barnes, A. B. (1981). Dysplasia and cytologic findings in 4,589 young women enrolled in diethylstilbestrol-adenosis (DESAD) project. American Journal of Obstetrics and Gynecology, 140(5), 579–586.
Wong, R. W., Moore, M., Talia, K. L., Ganesan, R., & McCluggage, W. G. (2018). Primary vaginal gastric-type adenocarcinoma and vaginal Adenosis exhibiting gastric differentiation: Report of a series with detailed Immunohistochemical analysis. American Journal of Surgical Pathology, 42(7), 958–970.
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Ganesan, R. (2022). Benign Glandular Lesions, Pathology of the Vagina. In: van Krieken, J. (eds) Encyclopedia of Pathology. Encyclopedia of Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-28845-1_5594-1
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DOI: https://doi.org/10.1007/978-3-319-28845-1_5594-1
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