The infiltrating ability of abdominal wall endometriosis is associated with ectopic endometrial glandular activity

Abstract

The infiltrating ability of abdominal wall endometriosis is associated with ectopic endometrial glandular activity Xiao Zhang1,† , Ying-Ying He2,† , Nan Jiang3 , Zhi-Gang Sun3 , Feng Yan3 , Cidanyangzong4 , Fang Long4 , Fang-Xin Shi5 , Xiao-Guang Xu6, *, Zhen Xiao5,7, * 1Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, 116000 Liaoning; Institute of High Altitude Medicine, People’s Hospital of Naqu affiliated to Dalian Medical University, P. R. China 2Department of Pathology, Dalian Maternal and Children Health Care Hospital, Dalian, 116000 Liaoning, P. R. China 3Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, 116000 Liaoning, P. R. China 4Department of Obstetrics and Gynecology, Institute of High Altitude Medcine, People’s Hospital of Naqu affiliated to Dalian Medical University, 852000 Tibet, P. R. China 5Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, 100086 Liaoning, P. R. China 6 Institute of High Altitude Medicine, People’s Hospital of Naqu affiliated to Dalian Medical Univeristy, 852000 Tibet, P. R. China 7Department of Obstetrics and Gynecology, Institute of High Altitude Medicine, People’s Hospital of Naqu affiliated to Dalian Medical University, Naqu, 852000 Tibet, P. R. China *Correspondence: drxgxu@163.com (Xiao-Guang Xu);seriousdoc@163.com (Zhen Xiao) † These authors contributed equally. DOI:10.31083/j.ceog.2021.01.2192 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: February 13, 2020 Revised: June 18, 2020 Accepted: August 06, 2020 Published: February 15, 2021 Introduction: The infiltration pattern of endometriosis is one of the most important pathophysiological features of this lesion. Recent studies indicate the infiltrating nature of endometriosis is associated with a lesion's genetic characteristics. However, related research regarding abdominal wall endometriosis (AWE) is limited. The aim of this study is to investigate whether AWE lesions with diȞferent infiltrating depth have diȞferent clinical and pathological features. Material and methods: A retrospective review of all cases of surgically excised AWE from 2001 to 2018 was performed from the records at Dalian Medical University and its aȞfiliated hospitals. Descriptive data were collected and analyzed. Hematoxylin-eosin stained (H&E) slides were re-evaluated by pathologists for the density of ectopic endometrial glands (DOG). Results: Ninety-one cases were included in this study. Cases were divided into three types according to the depth of infiltration of the lesion: the fascia type (38 cases), the muscle type (40 cases) and the peritonieum type (13 cases). The primary analysis showed that mass size (P = 0.009), serum CA125 levels (P = 0.04) and operation time (P = 0.02) were significantly diȞferent among the three groups. Analysis showed that the diameter of the lesion was positively correlated with the infiltrating depth of the lesion, as well as the level of serum CA125 and the operation time. Even for lesions larger than 3 cm, serum CA125 levels and operation time still showed positive correlation with the lesion diameter (P = 0.02 and P < 0.01, respectively). Further histological research indicated that ectopic endometrial glands in deep lesions were more active and had higher density compared to masses in the superficial layers. Conclusion: This study suggests the three types of AWEs have diȞferent clinical and pathological features. When a lesion infiltrates deep into the abdominal wall, it has a larger size, is associated with increased serum CA125 levels, and needs longer time for surgical excision. The diȞferent infiltrating ability of AWEs is associated with diȞferent activities of ectopic endometrial glands. Keywords Abdominal wall endometriosis; Infiltrating ability; Glandular activity