Severe endosalpingiosis: Case reports and a literature review

Abstract

Endosalpingiosis is an understudied gynaecological condition with limited knowledge of its prevalence and clinical significance. We report two rare cases of severe endosalpingiosis aged 25 and 30 highlighting their clinical, laparoscopic and histological features, as well as treatment outcomes. Both cases presented with severe and intractable chronic pelvic pain (CPP) with a pattern like endometriosis pain. Initially, they received standard medical management for CPP, including hormonal therapy and pain modulators, with limited or no improvement. They were then offered laparoscopy, which revealed widely spread superficial vesicular lesions on ovaries, pelvic peritoneum, uterus and bowel. Wide excision of affected peritoneum was performed, and multiple biopsies were obtained from ovarian lesions. Histology revealed endosalpingiosis in both cases. In case 2, histology also revealed a neuroendocrine tumour, which was likely from a gastrointestinal (GI) primary malignancy. This case was referred to the GI team for further management. In both cases, surgery resulted in 6-month relief of pelvic pain followed by gradual recurrence of severe symptoms. These cases highlight the clinical dilemma of severe endosalpingiosis, which appears to be associated with intractable pain that is resistant to all standard hormonal and surgical treatments. Whether the association with the neuroendocrine tumour in the second case was incidental or a true link remains uncertain. Further research is required to identify effective treatment strategies for ES.