Fast Five Quiz: Key Aspects of Endometriosis

Michel E. Rivlin, MD

Disclosures

October 23, 2017

Gross visualization of endometrial implants remains the definitive method of diagnosis. In this era of minimally invasive surgery, laparoscopy is the procedure of choice. Laparotomy can be another method of diagnosis. This is usually performed when another cause of pain is suspected.

Routine radiography is not recommended unless other disease entities requiring these studies are in the differential diagnosis. Pelvic ultrasonography, CT scanning, and MRI are only useful in the case of advanced disease with endometrial cyst formation or severe anatomic distortion.

The most common sites of involvement found during laparoscopy are the following, in descending order:

  • Ovaries

  • Posterior cul-de-sac

  • Broad ligament

  • Uterosacral ligament

  • Rectosigmoid colon

  • Bladder

  • Distal ureter

Histologic demonstration of both endometrial glands and stroma in biopsy specimens obtained from outside the uterine cavity is required to make the diagnosis of endometriosis. Occasionally, the finding of fibrosis in combination with hemosiderin-laden macrophages is sufficient for a presumptive diagnosis.

For more on the workup of endometriosis, read here.

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