Visual findings and histologic diagnosis of pelvic endometriosis under laparoscopy and laparotomy.

Abstract

Objective: To assess the diagnostic value of visual findings in the diagnosis of endometriosis from the histological point of view.

Study design: 212 specimens from 107 patients with benign (74.8%) or malignant (25.2%) disease were obtained by biopsy or resection under laparoscopy (65 patients) or laparotomy (42 patients). Ages ranged from 19 to 62 (mean age 36.4). Visual findings were classified according to the criteria established by the Endometriosis Committee of the Japan Society of Obstetrics and Gynecology in 1993. Specimens were stained with hematoxylin-eosin, and 15 cases with periodic acid-Schiff stain or silver impregnation stain.

Results: Among pigmented lesions, endometriosis was found in 73.0% of specimens from the pelvic peritoneum and in 56.4% of those from the ovaries. Blueberry spots in the pelvic peritoneum as well as ovarian chocolate cysts showed the highest positive rate. In the presence of multiple or complex pigmented lesions of the pelvic area, the rate was still higher (88.6%). Those rates were due to our inclusion of inaccurate and incomplete biopsy specimens. Endometriosis of nonpigmented lesions was found in only 11 patients (12.0%) who also had pigmented lesions and/or adenomyosis.

Conclusion: The laparoscopic diagnosis of endometriosis can be made only when multiple complex pigmented lesions are observed, but, otherwise, histopathological confirmation is necessary.