Histopathologic Analysis of Intestinal Endometriosis after Laparoscopic Low Anterior Resection

Study Objective: To determine how intestinal endometriosis spreads, and, thus, to improve outcomes of curative surgery. Design: Descriptive study (Canadian Task Force classification II-2). Setting: University hospital. Patients: Ten patients who underwent laparoscopic low anterior resection of intestinal endometriosis at our hospital between January 1999 and August 2007. Intervention: Laparoscopic low anterior resection of intestinal endometriosis. Measurements and Main Results: Mapping of endometriotic foci, degree of vertical infiltration to the intestinal layers, and longitudinal spread of endometriotic foci to the intestinal plane were defined using hematoxylin-eosin, estrogen receptor, progesterone receptor, and CD10 staining. Results: Endometriotic foci tended to spread concentrically around a primary lesion that comprised most of a resected specimen. The deepest layer containing endometriotic foci at the primary lesion was the submucosal layer in 7 specimens (70%), and the internal circular muscle layer in 3 (30%). Satellite lesions comprising thickened areas that were independent of the primary lesion were detected in 5 specimens (50%). Multiple endometriotic foci were confirmed in all satellite lesions. Conclusions: Endometriotic foci might not only infiltrate the primary lesion in intestinal endometriosis but also disseminate to other areas. Thus, the primary lesion of intestinal endometriosis with a large margin must be excised via low anterior resection. Journal of Minimally Invasive Gynecology (2011) 18, 48-53 Crown Copyright (C) 2010 Published by Elsevier Inc., on behalf of the AAGL. All rights reserved.