Abstract
Endosalpingiosis (ES) is a condition in which fallopian tube-like tissue is present in aberrant locations. Histopathologically, it is defined by ciliated glandular epithelium without any endometrial stroma that is located outside of the endosalpinx. ES has a high rate of concurrent endometriosis and may be a source of pelvic pain.
A 15-year-old teenager presented to the gynecology clinic with a chronic abdominal and pelvic pain. Her pain began at the age of 6. It occurred in the lower quadrants and extended to her right lower back. She described it as constant. It was sometimes more mild, and other times acutely caused a sharp and stabbing sensation. Menarche began at age 11 and she had dysmenorrhea that was well controlled with medroxyprogesterone acetate for menstrual suppression. However, it did not help with the pain outside of her menstrual cycle.
A GI work-up including endoscopy and h. pylori testing was negative. She had a normal pelvic ultrasound.
She underwent a diagnostic laparoscopy to evaluate for endometriosis. No endometriosis was identified, however she was noted to have a 2-3 cm cystic lesion on a long stalk originating from the posterior peritoneum near the cecum. The cyst contained clear yellow fluid and pathology revealed endosalpingiosis. No other lesions were identified on laparoscopy.
Post operatively she has done well, and the previous abdominopelvic pain has completely resolved.
Endosalpingiosis is most commonly found in reproductive aged women and located in the pelvis. The true prevalence is unknown, however in a study by Sunde et. Al in 2021, ES prevalence was 4.7 fold higher in women over age 30 compared to women younger than 30 years old. It is rare to see this diagnosis in a teenager. ES outside of the pelvis is also rare and uncommonly reported as a cause of pelvic pain.
In a study in older women by Sajnani, it was reported that 43% of subjects experienced pelvic pain, 79% had a single lesion present in an abdominal or pelvic lymph node (38%), ovary (21%), or peritoneum (14%). All 98 of these adult women had additional pathology including endometriosis in 19% and gyn malignancies in 29%.
The presence of ES should be considered in the differential diagnosis of a teenager with pelvic pain. Our patient had no endometriosis or malignancy present as is common in adults and the lesion was present above the pelvic brim.