**13. Gross features of endometriosis**

The location and the age of the endometriotic lesion and the patients' age affect the morphological appearance of endometriosis and may lead to diagnostic difficulties. Gross appearance of endometriotic lesions is affected by their age and this is reflected by the various colors they present. Red color characterizes early lesions and yellow-red color reflect the breakdown of blood products. These lesions eventually progress into old or advanced lesions presenting black color. Hemosiderin is indicated by a yellowish color and occasionally white lesions may be observed indicating the presence of fibrosis. It is possible that the same patient presents endometriotic foci in various stages of development. The size of the lesions varies as well. In early stages blister-like blebs are observed measuring 0.2-0.3 cms in diameter, corresponding to the early red lesion observed mainly in adolescents .As the lesions age, they may enlarge up to 1 cms in diameter and are pigmented , bluish-red, black and eventually white and puckered because of fibrosis. Endometriotic foci are frequently associated with adhesions. The older the patient the more fibrotic the endometriotic lesion is and eventually it atrophies with obliteration of its components Endometriotic lesions become grossly cystic only in the ovaries reaching a diameter up to 15 cms. Ovarian endometriotic cysts present a fibrous wall of various thickness and are filled by chocolate-like contend. The interior surface may be smooth or shaggy. Rarely, endometriosis obtains the form of polypoid masses projecting from serosal surfaces and is referred as polypoid endometriosis.

Pathological Aspects of Endometriosis 107

usually of endocervical type. It is reported that in cases with extensive metaplastic changes in endometriosis an association with an ovarian epithelial tumor is observed. Glandular epithelium may present hyperplastic changes due to endogenous or exogenous hormonal action resembling hyperplastic endometrial changes from simple cystic to complex atypical hyperplasia. In cases of ovarian endometrioid adenocarcinoma remnants of endometriosis with hyperplastic changes are observed. Metaplastic changes are observed in the endometriotic stroma as well, of smooth muscle type. Concomitant hyperplastic changes may create endomyometriotic nodules or uterus–like masses, in the ovary, broad ligament,

The presence of stromal elements in the absence of glandular epithelium in foci of endometriosis constitutes the stromal endometriosis. This is encountered in the ovary, in the cervix and the peritoneum and usually is associated with a focus of typical endometriosis.

In endometriotic glands and stroma, estrogen and progesterone receptors are present in lower concentrations and without the cyclical variation observed in the normal endometrium. There is not correlation between the hormonal receptor status of

The American Society for Reproductive Medicine proposed a classification of endometriosis with the aim to predict the chance of conception based on the severity of the disease. This system proposes a point score that assesses: the extend of endometriosis among organs and within an organ, scoring the superficial versus the invasive disease, the size of endometriomas, the development of endometriosis uni-or bilaterally in ovaries ,and the type of adhesions. The cumulative score results in a stage designation of the disease, from minimal (stage 1) to extensive (stage 4). The reproducibility of the classification system is limited, according the operative method used and the surgeon's experience (Hoeger &

These rings are acellular eosinophilic structures composed from colloidal solutions, encountered in endometrioid cysts, in areas of inflammation and necrosis. On histological examination, these structures look like parasites and foreign material and may be recognized by their association to endometriosis and lack of staining by specific

This is a form of tubal inflammation characterized histologically by the presence of histiocytes filled with lipofuscin and hemosiderin. In multiple sections there is always a

**17. Histological characteristics of stromal endometriosis** 

**18. Hormonal receptor status in endometriosis** 

**20. Morphology and histogenesis of Liesegang rings** 

**21. Histological features of pseudoxanthomatous salpingitis** 

typical focus of endometriosis of the fallopian tube and /or the ovary.

endometriosis and the severity of symptoms.

**19. Classification of endometriosis** 

Guzick, 1997).

histochemical methods.

the bowel and lymph nodes.
