Thoracic endometriosis: Pathogenesis, epidemiology, and pathology
- Jose Joseph-Vempilly, MD
Jose Joseph-Vempilly, MD
- Professor of Medicine
- UCSF, Fresno
Endometriosis most commonly involves the pelvis, particularly the ovaries, cul-de-sac, broad ligaments, and uterosacral ligaments. However, endometrial tissue can be found outside of the pelvis in the abdomen, thorax, brain, and skin . Thoracic involvement is the most frequent extra-pelvic location of endometriosis .
The pathogenesis, epidemiology, and pathology of thoracic endometriosis will be reviewed here. Details regarding the clinical presentation, diagnosis, and treatment of thoracic and pelvic endometriosis are discussed separately. (See "Clinical features, diagnostic approach, and treatment of adults with thoracic endometriosis" and "Endometriosis: Pathogenesis, clinical features, and diagnosis" and "Endometriosis: Treatment of pelvic pain".)
Endometriosis is defined as the presence of ectopic endometrial tissue (glands and stroma) outside the confines of the uterine cavity and musculature. Thoracic endometriosis is that which involves components of thoracic cavity (eg, pleura, parenchyma, diaphragm, bronchus). The following terms apply:
Thoracic endometriosis — The term ”thoracic” endometriosis is used when endometrial tissue is identified on histological specimens (hormone-receptor positive endometrial stroma and glands) obtained from chest tube aspirate, thoracotomy, or bronchoscopy.
Probable thoracic endometriosis — The term “probable” thoracic endometriosis refers to the identification of tissue within the thorax that is suggestive but not definitively diagnostic of endometrium (eg, stroma only or hormone negative tissue) .
- Jubanyik KJ, Comite F. Extrapelvic endometriosis. Obstet Gynecol Clin North Am 1997; 24:411.
- Bagan P, Berna P, Assouad J, et al. Value of cancer antigen 125 for diagnosis of pleural endometriosis in females with recurrent pneumothorax. Eur Respir J 2008; 31:140.
- Alifano M, Jablonski C, Kadiri H, et al. Catamenial and noncatamenial, endometriosis-related or nonendometriosis-related pneumothorax referred for surgery. Am J Respir Crit Care Med 2007; 176:1048.
- Vinatier D, Orazi G, Cosson M, Dufour P. Theories of endometriosis. Eur J Obstet Gynecol Reprod Biol 2001; 96:21.
- Leong AC, Coonar AS, Lang-Lazdunski L. Catamenial pneumothorax: surgical repair of the diaphragm and hormone treatment. Ann R Coll Surg Engl 2006; 88:547.
- Redwine DB. Diaphragmatic endometriosis: diagnosis, surgical management, and long-term results of treatment. Fertil Steril 2002; 77:288.
- Funatsu K. Catamenial pneumothorax: an example of porous diaphragm syndromes? Chest 2002; 122:1865; author reply 1865.
- Cooper MJ, Russell P, Gallagher PJ. Diaphragmatic endometriosis. Med J Aust 1999; 171:142.
- Cowl CT, Dunn WF, Deschamps C. Visualization of diaphragmatic fenestration associated with catamenial pneumothorax. Ann Thorac Surg 1999; 68:1413.
- Korom S, Canyurt H, Missbach A, et al. Catamenial pneumothorax revisited: clinical approach and systematic review of the literature. J Thorac Cardiovasc Surg 2004; 128:502.
- Yamashita J, Iwasaki A, Kawahara K, Shirakusa T. Thoracoscopic approach to the diagnosis and treatment of diaphragmatic disorders. Surg Laparosc Endosc 1996; 6:485.
- Soderberg CH, Dahlquist EH. Catamenial pneumothorax. Surgery 1976; 79:236.
- Joseph J, Reed CE, Sahn SA. Thoracic endometriosis. Recurrence following hysterectomy with bilateral salpingo-oophorectomy and successful treatment with talc pleurodesis. Chest 1994; 106:1894.
- Visouli AN, Darwiche K, Mpakas A, et al. Catamenial pneumothorax: a rare entity? Report of 5 cases and review of the literature. J Thorac Dis 2012; 4 Suppl 1:17.
- Alifano M, Legras A, Rousset-Jablonski C, et al. Pneumothorax recurrence after surgery in women: clinicopathologic characteristics and management. Ann Thorac Surg 2011; 92:322.
- Nezhat C, King LP, Paka C, et al. Bilateral thoracic endometriosis affecting the lung and diaphragm. JSLS 2012; 16:140.
- Redwine DB. Was Sampson wrong? Fertil Steril 2002; 78:686.
- Bouquet De Jolinière J, Ayoubi JM, Gianaroli L, et al. Endometriosis: a new cellular and molecular genetic approach for understanding the pathogenesis and evolutivity. Front Surg 2014; 1:16.
- Joseph J, Sahn SA. Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med 1996; 100:164.
- PARK WW. The occurrence of decidual tissue within the lung; report of a case. J Pathol Bacteriol 1954; 67:563.
- Duke R, Fawcett P, Booth J. Recurrent subarachnoid hemorrhage due to endometriosis. Neurology 1995; 45:1000.
- Channabasavaiah AD, Joseph JV. Thoracic endometriosis: revisiting the association between clinical presentation and thoracic pathology based on thoracoscopic findings in 110 patients. Medicine (Baltimore) 2010; 89:183.
- Bagan P, Le Pimpec Barthes F, Assouad J, et al. Catamenial pneumothorax: retrospective study of surgical treatment. Ann Thorac Surg 2003; 75:378.
- Alifano M, Roth T, Broët SC, et al. Catamenial pneumothorax: a prospective study. Chest 2003; 124:1004.
- O'Connell JT, Mutter GL, Cviko A, et al. Identification of a basal/reserve cell immunophenotype in benign and neoplastic endometrium: a study with the p53 homologue p63. Gynecol Oncol 2001; 80:30.
- Mok-Lin EY, Wolfberg A, Hollinquist H, Laufer MR. Endometriosis in a patient with Mayer-Rokitansky-Küster-Hauser syndrome and complete uterine agenesis: evidence to support the theory of coelomic metaplasia. J Pediatr Adolesc Gynecol 2010; 23:e35.
- Marshall MB, Ahmed Z, Kucharczuk JC, et al. Catamenial pneumothorax: optimal hormonal and surgical management. Eur J Cardiothorac Surg 2005; 27:662.
- Guo SW, Wang Y. The prevalence of endometriosis in women with chronic pelvic pain. Gynecol Obstet Invest 2006; 62:121.
- Viganò P, Parazzini F, Somigliana E, Vercellini P. Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 2004; 18:177.
- Rousset-Jablonski C, Alifano M, Plu-Bureau G, et al. Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors. Hum Reprod 2011; 26:2322.
- Schrodt GR, Alcorn MO, Ibanez J. Endometriosis of the male urinary system: a case report. J Urol 1980; 124:722.
- Hope-Gill B, Prathibha BV. Catamenial haemoptysis and clomiphene citrate therapy. Thorax 2003; 58:89.
- Blanco S, Hernando F, Gómez A, et al. Catamenial pneumothorax caused by diaphragmatic endometriosis. J Thorac Cardiovasc Surg 1998; 116:179.
- Visouli AN, Zarogoulidis K, Kougioumtzi I, et al. Catamenial pneumothorax. J Thorac Dis 2014; 6:S448.
- Legras A, Mansuet-Lupo A, Rousset-Jablonski C, et al. Pneumothorax in women of child-bearing age: an update classification based on clinical and pathologic findings. Chest 2014; 145:354.
- Haga T, Kumasaka T, Kurihara M, et al. Immunohistochemical analysis of thoracic endometriosis. Pathol Int 2013; 63:429.
- Sevinç S, Unsal S, Oztürk T, et al. Thoracic endometriosis syndrome with bloody pleural effusion in a 28 year old woman. J Pak Med Assoc 2013; 63:114.
- Zaatari GS, Gupta PK, Bhagavan BS, Jarboe BR. Cytopathology of pleural endometriosis. Acta Cytol 1982; 26:227.
- Wang HC, Kuo PH, Kuo SH, Luh KT. Catamenial hemoptysis from tracheobronchial endometriosis: reappraisal of diagnostic value of bronchoscopy and bronchial brush cytology. Chest 2000; 118:1205.
- Granberg I, Willems JS. Endometriosis of lung and pleura diagnosed by aspiration biopsy. Acta Cytol 1977; 21:295.