Recto vaginal septum adenomyotic nodules: a series of 500 cases

TLDR

The study aimed to evaluate laparoscopic excision of deep rectovaginal septum endometriotic nodules and analyze their histology. The study was conducted at an academic teaching hospital and included 500 women undergoing laparoscopy for pelvic pain or infertility. Laparoscopic excision of the nodules provided substantial pain relief, and histology revealed that the rectovaginal nodules resembled adenomyomas with distinct hormone receptor profiles, supporting their classification as a separate entity originating from Müllerian rests.

Abstract

Objective Laparoscopic procedure with excision of deep fibrotic endometriotic nodules of the rectovaginal septum and histological study of the lesions. Setting An academic teaching hospital. Participants A series of 500 women undergoing laparoscopy for pelvic pain or infertility. Results Laparoscopic ( n = 497) and laparotomic ( n = 3) excision of endometriotic nodules resulted in considerable pain relief. Histologically the rectovaginal nodule was similar to an adenomyoma as it was a circumscribed nodular aggregate of smooth muscle and endometrial glands and stroma. The variations in oestrogen receptor and progesterone receptor content suggested a regulatory mechanism different from that of eutopic endometrium. Conclusion This form of disease should be considered as an entity distinct from peritoneal and ovarian endometriosis, and originating from the Miillerian rests present in the rectovaginal septum.