Multifocal polypoid endometriosis in a young woman simulating vaginal and pelvic neoplasm

Abstract

A 27-year-old nulliparous woman presented with large finger-like projections protruding from her vagina. Intraoperatively there were deposits in the pouch of Douglas. Clinical presentation and history of vaginal bleeding suggested malignancy. Histopathology of both the vaginal and pouch of Douglas masses showed endometrial glands and stroma. There was no architectural complexity or cytological atypia of glands or stroma. Immunohistochemistry for oestrogen receptor, progesterone receptor and CD10 was positive. Based on morphological and immunohistochemical findings, multifocal polypoid endometriosis was diagnosed; this is a recently described entity having a clinical presentation and age range completely different from conventional or non-polypoid endometriosis. Although an association between tamoxifen use, unopposed oestrogen therapy and polypoid endometriosis has been suggested, the patient had no history of tamoxifen or oestrogen intake. Polypoid endometriosis should be part of the differential diagnosis in young women presenting with vaginal growth.

Huge polypoid endometriosis: report of a case and review of the literature

“…Compared to literature cases [1][2][3][4][5][6][7][8][9][10][11][12] (Table 1), our case was younger, considerably huge in size, and the lesions developed in the pelvis rapidly as soon as there was a break of hormonal therapy. The cause of this rapid growth of lesions is uncertain, but interruption of hormonal treatment could have contributed to hyperestrinism and raised polypoid masses in this case.…”

Two Cases of Polypoid Endometriosis: An Uncommon Variant of Endometriosis

“…Its pathogenesis is related in general to the use of hormone therapy (estrogen therapy) or tamoxifen [1,5]. While the clinical manifestations of endometriosis are dysmenorrhea, dyspareunia, chronic pelvic pain and infertility, polypoid endometriosis is related to clinical manifestation such as mass effect [6]. The most common clinical manifestation for polypoid endometriosis, in cervical or vaginal regions, is increased vaginal bleeding, which were found in our cases [1].…”

Clinicopathological and immunohistological features of polypoid endometriosis

“…These age differences could partly explain the previously documented associations of PE with hormonal therapy, including tamoxifen treatment . It is worth noting that PE can mimic a malignant neoplasm clinically and radiologically, and that it may be multifocal in distribution . Occasional cases have also been misinterpreted as histologically malignant …”