Definition/General
Introduction:
Cervical endometriosis is the presence of ectopic endometrial tissue (glands and stroma) within the cervical wall
It represents implantation of functional endometrial tissue outside its normal location in the uterine cavity.
Origin:
Results from retrograde menstruation, lymphatic or hematogenous spread, or direct implantation of endometrial tissue
May also arise from metaplastic transformation of cervical tissues.
Classification:
WHO Classification categorizes as benign ectopic endometrial tissue
Part of endometriosis spectrum involving extra-uterine locations
May be superficial or deep cervical involvement.
Epidemiology:
Affects 5-15% of reproductive-age women with endometriosis
Peak incidence 25-35 years
Associated with pelvic endometriosis in majority of cases
Often underdiagnosed.
Clinical Features
Presentation:
Cyclic pelvic pain corresponding to menstrual periods
Abnormal vaginal bleeding
Dyspareunia
Blue or purple nodular lesions on cervical examination.
Symptoms:
Cyclical pelvic pain (most common)
Dysmenorrhea
Post-coital bleeding
Intermenstrual bleeding
Dyspareunia
Lower back pain during menstruation.
Risk Factors:
Reproductive age
Family history of endometriosis
Nulliparity
Early menarche
Short menstrual cycles
Retrograde menstruation
Previous cervical procedures.
Screening:
Pelvic examination may reveal blue-black nodules
Transvaginal ultrasound
MRI for deep endometriosis
Laparoscopy for definitive diagnosis.
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Gross Description
Appearance:
Blue, purple, or dark red nodular lesions on cervical surface
Cystic areas containing old blood ("chocolate cysts")
Firm, indurated areas.
Characteristics:
Size variable (few mm to several cm)
Blue-black to red-brown coloration
Firm to cystic consistency
May have surface ulceration.
Size Location:
Usually located on posterior cervical lip
May involve anterior cervix or lateral aspects
Can extend into cervical stroma
Single or multiple foci.
Multifocality:
Often multifocal lesions
May be associated with vaginal or uterine endometriosis
Can involve multiple pelvic organs.
Microscopic Description
Histological Features:
Ectopic endometrial glands and stroma within cervical tissue
Glands lined by endometrial-type epithelium
Surrounding endometrial stroma with evidence of cyclic hormonal changes.
Cellular Characteristics:
Endometrial glands: columnar epithelium with basally located nuclei
Endometrial stroma: spindle-shaped cells with oval nuclei
Hemosiderin-laden macrophages.
Architectural Patterns:
Irregular endometrial glands surrounded by endometrial stroma
Cystic dilatation of glands common
Hemorrhage and hemosiderin deposition.
Grading Criteria:
Benign condition (no grading system)
Severity assessed by extent of involvement and degree of fibrosis and adhesions.
Immunohistochemistry
Positive Markers:
CD10 positive in endometrial stroma
Estrogen receptor (ER) positive
Progesterone receptor (PR) positive
CK7 positive in glandular epithelium.
Negative Markers:
p16 typically negative
CEA usually negative
TTF-1 negative
PAX8 may be positive but not specific.
Diagnostic Utility:
CD10 is most useful marker for endometrial stroma identification
Hormone receptors confirm endometrial nature
CK7 highlights glandular component.
Molecular Subtypes:
No specific molecular subtypes
Hormone-responsive tissue similar to eutopic endometrium.
Molecular/Genetic
Genetic Mutations:
Similar genetic alterations to eutopic endometrium
PTEN mutations reported
ARID1A mutations in some cases
KRAS mutations occasionally present.
Molecular Markers:
Hormone receptors (ER, PR) expressed
CD10 positive stroma
Normal p53 expression
Variable Ki-67 depending on cycle phase.
Prognostic Significance:
Benign condition with excellent prognosis
May cause fertility issues
Risk of malignant transformation extremely low (<1%).
Therapeutic Targets:
Hormonal suppression (GnRH agonists, progestins)
Surgical excision
Anti-inflammatory therapy
Pain management strategies.
Differential Diagnosis
Similar Entities:
Adenomyosis
Cervical adenocarcinoma
Mesonephric remnants
Endocervical glands
Metastatic endometrial adenocarcinoma.
Distinguishing Features:
Endometriosis: CD10+ stroma, hormone receptors+
Adenocarcinoma: malignant features, invasion
Mesonephric: CD10-, hormone receptors-.
Diagnostic Challenges:
Small biopsies may lack stromal component
Distinction from reactive endocervical glands
Differentiation from adenocarcinoma.
Rare Variants:
Polypoid endometriosis
Endometriosis with smooth muscle metaplasia
Endometriosis with malignant transformation.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[specimen type], measuring [size] cm in greatest dimension
Diagnosis
[diagnosis name]
Classification
Classification: [classification system] [grade/type]
Histological Features
Shows [architectural pattern] with [nuclear features] and [mitotic activity]
Size and Extent
Size: [X] cm, extent: [local/regional/metastatic]
Margins
Margins are [involved/uninvolved] with closest margin [X] mm
Lymphovascular Invasion
Lymphovascular invasion: [present/absent]
Lymph Node Status
Lymph nodes: [X] positive out of [X] examined
Special Studies
IHC: [marker]: [result]
Molecular: [test]: [result]
[other study]: [result]
Prognostic Factors
Prognostic factors: [list factors]
Final Diagnosis
Final diagnosis: [complete diagnosis]