Not All Glandular Structures in Lymph Nodes Draining Ovarian Neoplasms Equate to Metastasis: Epiphany Taught by Endosalpingiosis!

ABSTRACT Endosalpingiosis is characterized by the presence of the ectopic tubal epithelium and is known to occur in pelvic organs, peritoneum, urinary bladder, and retroperitoneal nodes. Occurrence in pelvic lymph nodes must be differentiated from metastasis. We present a case of 30-year-old female who underwent staging laparotomy for suspected bilateral ovarian cancer. Histopathology revealed bilateral borderline serous tumor with two pelvic nodes having benign glandular structures of fallopian tubal morphology. WTI was positive in ovarian tumor and nodal structures but with pattern difference. The Ki-67 labeling index was 2% in nodal lesions as compared to 9% in ovarian tumor, confirming endosalpingiosis. Nodal endosalpingiosis must not be misdiagnosed as “metastasis” to avoid overtreatment in ovarian neoplasms. It is pertinent to recognize this entity rightly as it has a definitive role in clinical decision and treatment protocols. Glandular structures in lymph nodes must undergo a thorough workup, especially when associated with neoplastic lesions elsewhere.