Written by Arifa Shabbar
Edited by Anirudh Koneru
Published on 8/14/2020
Endosalpingiosis is a rare and painful reproductive condition in which fallopian-like tissue is found outside of the fallopian tubes (a.k.a. the uterine tubes
Description
Endosalpingiosis is the presence of ectopic, cystic glands outside the fallopian tubes (better known as the uterine tubes) which are lined with a specific type of epithelial cells. Essentially, tissue from the fallopian tubes is found outside of the fallopian tubes.
It occurs in the pelvic organs, lower abdominal peritoneum, as well as the bladder and the axillary lymph node. This disease can spread quite aggressively and is presumed to be an asymptomatic benign entity i.e an illness with no visible or felt symptoms, though some symptoms are presumed according to past cases of endosalpingiosis, but these can not always be trusted.
Endosalpingiosis can be easily associated with conditions such as salpingitis (inflation of fallopian tubes), endometriosis (growth of an unwanted tissue in the uterus) and serous tumors (type of tumor present in ovaries). First described in 1930 by Sampson, it is a disease that is related to both clinical diseases and pathological diseases, occuring only in women and is more common in the ages 31-50.
Signs and Symptoms
Many cases of endosalpingiosis may be asymptomatic, leaving them undetected. Therefore, the disease itself is extremely under-reported.
Common signs and symptoms according to past cases include...
Pelvic pain
Infertility
Menstrual irregularities
Dyspareunia (pain during sexual intercourse)
Chronic back pain
Pelvic pain, infertility, menstrual irregularities, and dyspareunia are a few helpful symptoms in detecting endosalpingiosis. Continuous chronic back pain for a couple of years can also be viewed as a sign of endosalpingiosis. But as said above these symptoms can not always be trusted.
Endosalpingiosis is almost always an incidental finding normally through other gynecologic problems. It is mostly by luck that endosalpingiosis is detected in its early stages. Mostly, by the time it is detected, it is too severe and the cure through surgery becomes risky.
Etiology
Endosalpingiosis is a largely understudied area because it was traditionally viewed as an incidental finding, resulting in a limited understanding of its etiology and clinical significance.
It is classified as a lesion (a region in an organ which has suffered damage) of the secondary Mullerian system and is the second most common cause of peritoneal proliferation in the lower abdomen.
It is a rare gynaecological condition usually seen in females in reproductive age and is present in 7% of premenopausal women. It is often associated with Endometriosis, Endocervicosis and cancer although it often appears alone.
Even as it is mostly common in ages 31-50 and above, younger ages also face this issue. A study from the Netherlands conducted by Hermens et al. stated that 2,490 women were found with a histological diagnosis of endosalpingiosis between January 1, 1990 and December 31, 2015, out of which 1005 women (40.4%) had concurrent endometriosis. Moreover, another study showed that 27 out of 73 women of ages 31-50 and 27 out of 41 women above the age of 50 had endosalpingiosis.
Diagnosis
The disease is commonly found through microscopic examinations, and is then confirmed by pathologists for excision and biopsy (the removal of a sample of tissue). The diagnosis is made by microscopic anatomy i.e the presence of tube-like epithelium cells containing three types of cells in an abnormal location.
Macroscopically, endosalpingiosis may be composed of simple cysts or may demonstrate a more complex structure like a papillary. Microscopically, it has been associated with psammoma bodies (a round collection of calcium).
Endosalpingiosis is occasionally misinterpreted; for example, a case of endosalpingiosis found in lymph nodes may be misinterpreted as an adenocarcinoma metastasis (a type of cancer).
Rarity
Endosalpingisosis is extremely understudied as it was traditionally viewed as just an incidental finding.
Therefore the prevalence is unknown as there is very little data, and even as it is known to be a rare disease, there are no clear statistics measuring its rarity.
In addition, as mentioned before, endosalpingiosis is underdetected as asymptomatic cases are not easily found or reported.
However, it is known that this condition is usually seen in females in reproductive age, and is present in 7% of premenopausal women.
Resources
Below is a list of support groups and organizations with resources for those affected by Endosalpingiosis.
Organizations:
Facebook Groups:
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Citations
BURMEISTER, RONALD E., ROBERT E. FECHNER, and ROBERT R. FRANKLIN. "Endosalpingiosis of the peritoneum." Obstetrics & Gynecology 34.3 (1969): 310-318.
DeHoop, T. A., J. Mira, and M. A. Thomas. "Endosalpingiosis and chronic pelvic pain." The Journal of reproductive medicine 42.10 (1997): 613.
Chui, Michael Herman, and Ie‐Ming Shih. "Oncogenic BRAF and KRAS mutations in endosalpingiosis." The Journal of Pathology 250.2 (2020): 148-158.
Edmondson, John D., et al. "Endosalpingiosis of bladder." The Journal of urology (2002).
Esselen, K., & Barbieri, R. L. (2018, December 7). Endosalpingiosis. Retrieved September 15, 2020, from https://www.uptodate.com/contents/endosalpingiosis
Frank, T. L. (2020). Rare Disease: Endosalpingiosis Foundation INC. Retrieved September 15, 2020, from https://www.endosalfoundation.org/
Heatley, M. K., and P. Russell. "Florid cystic endosalpingiosis of the uterus." Journal of clinical pathology 54.5 (2001): 399-400.
Hermens M, van Altena AM, Bulten J, Siebers AG, Bekkers RLM. Increased association of ovarian cancer in women with histological proven endosalpingiosis. Cancer Epidemiol. 2020;65:101700. doi:10.1016/j.canep.2020.101700
Holmes, Michael D., Howard S. Levin, and L. A. Ballard Jr. "Endosalpingiosis." Cleveland Clinic Quarterly 48.3 (1981): 345-352.
Keltz, Martin D., et al. "Endosalpingiosis found at laparoscopy for chronic pelvic pain." Fertility and sterility 64.3 (1995): 482-485.
Park, J., Kim, T., Lee, H., Chung, S., & Jeon, D. (2014, April 28). Endosalpingiosis in Postmenopausal Elderly Women. Retrieved September 15, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4217568/
Prentice, Lucy, et al. "What is endosalpingiosis?." Fertility and sterility 98.4 (2012): 942-947.
Sunde, J., Wasickanin, M., Katz, T., Wickersham, E., Steed, D., & Simper, N. (2020, May 13). Prevalence of endosalpingiosis and other benign gynecologic lesions. Retrieved September 15, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219775/
Tutschka, BARBARA G., and STUART C. Lauchlan. "Endosalpingiosis." Obstetrics and gynecology 55.3 Suppl (1980): 57S-60S.
Zangmo, R., Singh, N., Kumar, S., & Vatsa, R. (2017, August 7). Second Look of Endosalpingiosis: A Rare Entity. Retrieved September 15, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491413/