Endosalpingiosis refers to the presence of ciliated, glandular epithelium resembling the inner lining of the fallopian tube located in an ectopic location. The condition may present as cystic structures usually implanted on the peritoneal serosa 1.
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Epidemiology
Endosalpingiosis is considered a rare condition, although it may be underreported as it is often asymptomatic or misdiagnosed as endometriosis. Targeted laparoscopic studies have shown that the condition is present in 7% of women of childbearing age 2. Generally, the condition does not affect pediatric or menopausal patients 3.
Clinical presentation
Endosalpingiosis is a predominantly asymptomatic benign entity. The condition may sporadically result in chronic pelvic pain mimicking endometriosis, however, which coexists in 38% of the cases 2,3.
Pathology
Endosalpingiosis is considered a disorder of the secondary Müllerian system (components of the Müllerian system that do not participate in organogenesis) and is thought to have a pathogenesis similar to that of endometriosis 3.
Etiology
The exact mechanism is debated, but the most accepted theories suggest either a direct ectopic implantation of fallopian tube tissue or a metaplastic change in multipotential peritoneal cells 3,4.
Macroscopic appearance
Endosalpingiosis is usually not macroscopically discernable, however when obvious may appear as white or yellow granular fluid-filled peritoneal nodules resembling endometriosis 2.
Microscopic appearance
Microscopically it is possible to recognize simple cysts lined by a fallopian tube-like epithelium made up of ciliated and non-ciliated columnar cells and peg cells (secretory cells). Other features include the presence of psammomatous bodies, and the absence of stroma and hemorrhage (in contrast to endometriosis) 2,3.
Location
Ectopic tissue is usually located along the peritoneal serosa that lines the pelvis and covers the uterus, ovaries, bladder or the Douglas pouch. Rarely, foci are found along the parietal peritoneum, lymph nodes and skin 1.
Radiographic feature
Typical imaging features consist of clusters of multiple non enhancing small cysts, usually along the serous surface lining the organs of the pelvis. The only way to diagnose the condition with certainty however is via histopathology 2.
Plain radiograph
Calcified peritoneal deposits may be detected on plain radiograph 3.
Ultrasound
Transvaginal ultrasound shows multiple anechoic cystic structures with bunch-of-grapes appearance adhering to the pelvis organs 3. Sometimes solid hyperechogenic nodules are reported 3.
CT
CT typical appearance shows multiple simple cystic components. Occasionally, pelvic masses with mixed cystic and variable enhancement soft tissue density masses may be reported 3. Moreover, psammomatous bodied and dystrophic calcifications may reveal a picture of multiple disseminated pelvic calcifications 5.
MRI
Endosalpingiosis reflects the signal of serous contents; nonenhancing simple cysts with T1 hypointense and T2 hyperintense signal 6. DWI and ADC may show t2 shine through effect 6.
Treatment and prognosis
Endosalpingiosis is a benign condition, although it can coexist with endometriosis and it is under debate whether it can be a precursor of or be associated with serous low-grade and borderline tumors 7. Since the condition is predominantly asymptomatic, no treatment is required. In the cases of chronic pelvic pain there are no precise guidelines.
Differential diagnosis
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hemorrhage signal on imaging and presence of stroma on histopathology differentiates from endosalpingiosis
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