Endosalpingiosis and Ovarian Cancer: Is There a Real Link?

Endosalpingiosis has traditionally been described as a benign incidental finding on pathology. But that older view is no longer sufficient. Over the last several years, multiple studies have reported an association between endosalpingiosis and ovarian cancer, raising important questions about whether this finding has greater clinical significance than previously believed.

At the same time, the evidence must be interpreted carefully. An association does not prove that endosalpingiosis is a direct precursor to ovarian cancer, and it does not mean every patient with endosalpingiosis should undergo aggressive surgery. The science is evolving, and the most responsible message is a balanced one: take it seriously, but do not overstate what has been proven.

What Is Endosalpingiosis?

Endosalpingiosis refers to the presence of glands lined by fallopian tube-type epithelium outside the fallopian tube. Unlike endometriosis, it does not contain endometrial stroma and does not fit the classic inflammatory picture associated with endometriosis. For years, it was often regarded as an incidental pathologic curiosity with little clinical relevance.

That assumption is now being challenged.

Is Endosalpingiosis Associated With Ovarian Cancer?

The short answer is yes, there is evidence of an association.

One of the most important studies on this topic came from a large Dutch nationwide pathology registry. Investigators evaluated 2,490 women with histologically confirmed endosalpingiosis and found a significantly increased association with ovarian cancer. Even after excluding women with concurrent endometriosis and excluding synchronously diagnosed cases, the association remained, although it became smaller. The strongest signal in that study was seen with endometrioid and clear cell ovarian cancer subtypes.

Another retrospective study also found that endosalpingiosis was significantly associated with gynecologic malignancy, including ovarian cancer, reinforcing the idea that this finding should not simply be dismissed.

Why the Data Must Be Interpreted Carefully

Although the association is real, that does not mean causation has been established.

One of the major limitations in this literature is detection bias. Patients undergoing surgery for malignancy often have much more extensive pathology review, which increases the likelihood that endosalpingiosis will be found and documented. That means some of the reported association may reflect more thorough specimen processing rather than a direct biologic cancer pathway.

This issue becomes even more important when looking at prevalence studies. Research has shown that when more detailed pathology protocols are used, the reported prevalence of endosalpingiosis rises dramatically. In other words, endosalpingiosis may be far more common than previously recognized, and its apparent rarity may have been partly an artifact of underdetection.

Could Some Cases Be Biologically Relevant?

Possibly.

Molecular studies have identified BRAF and KRAS mutations in a subset of endosalpingiosis lesions, particularly in lesions associated with low-grade serous tumors. In some paired cases, the mutation profile in the endosalpingiosis matched that of the associated ovarian tumor. That does not mean all endosalpingiosis is premalignant, but it suggests that at least some lesions may have biologic relevance.

Still, the picture is not simple. The strongest epidemiologic associations have been reported with clear cell and endometrioid ovarian cancers, while some molecular data point more toward serous pathways. That inconsistency suggests endosalpingiosis may not represent one single biologic entity with one single meaning. Some lesions may be incidental. Others may reflect a broader Müllerian field effect. A smaller subset may eventually prove to be part of a neoplastic continuum.

What This Means for Patients

The most accurate conclusion at this time is: Endosalpingiosis is associated with ovarian cancer, but it has not been proven to be a universal premalignant lesion.

That distinction matters. It means the finding deserves attention, but it should not automatically trigger fear-based decision-making or unnecessary removal of reproductive organs in every patient.

Our Approach at ESSI: Conservative and Fertility-Preserving When Appropriate

At ESSI, we take a conservative approach to endosalpingiosis, particularly in patients who wish to preserve fertility. While the literature suggests that endosalpingiosis may have more significance than once believed, the available evidence does not justify treating every case as if it were an established cancer precursor.

For women who desire future pregnancy, preserving the fallopian tubes and protecting reproductive potential remain important priorities. In the absence of a clear oncologic indication, incidental or limited endosalpingiosis alone does not automatically justify removal of the tubes.

Our philosophy is to evaluate the finding in the full clinical context. That includes symptoms, imaging, ovarian architecture, fertility goals, surgical findings, ovarian reserve, and the presence or absence of suspicious adnexal pathology. We believe treatment decisions should be based on the total picture, not on the pathology label alone.

This is especially important in patients who have already endured years of pelvic pain, infertility, hormonal treatment, failed IVF, or prior surgery. In these cases, preserving anatomy whenever safely possible is not passive care. It is disciplined, individualized medicine.

Conservative management does not mean ignoring endosalpingiosis. It means documenting it carefully, understanding its possible significance, and avoiding overtreatment when the science does not support aggressive intervention.

Featured Snippet: Frequently Asked Questions

• Can endosalpingiosis cause ovarian cancer? Current evidence shows that endosalpingiosis is associated with ovarian cancer, but it has not been proven to directly cause ovarian cancer in most patients.

• Should endosalpingiosis be removed? Not necessarily. Management should depend on the overall clinical situation, including symptoms, imaging, fertility goals, and whether there are concerning ovarian or adnexal findings.

• Does ESSI remove the tubes for endosalpingiosis? Not automatically. At ESSI, we often take a conservative, fertility-preserving approach when there is no clear oncologic indication for more aggressive surgery.

Dr. Andrea Vidali Commentary “At ESSI, we believe endosalpingiosis should be taken seriously, but not exaggerated. The literature supports an association with ovarian cancer, yet that is not the same as proof of causation. In women who still desire fertility, our approach is thoughtful and conservative whenever it is medically appropriate. The goal is to treat the patient intelligently, preserve reproductive options when possible, and avoid unnecessary overtreatment.”

References

• Hermens M, van Altena AM, Bulten J, Siebers AG, Bekkers RLM. Increased association of ovarian cancer in women with histological proven endosalpingiosis. Cancer Epidemiology. 2020;65:101700. doi:10.1016/j.canep.2020.101700.

• Lewis GK, Ghaith S, Craver EC, et al. The association of endosalpingiosis with gynecologic malignancy. Gynecologic Oncology. 2022;167(1):81-88. doi:10.1016/j.ygyno.2022.07.025.

• Sunde J, Wasickanin M, Katz TA, et al. Prevalence of endosalpingiosis and other benign gynecologic lesions. PLoS One. 2020;15(5):e0232487. doi:10.1371/journal.pone.0232487.

• Chui MH, Shih IM. Oncogenic BRAF and KRAS mutations in endosalpingiosis. The Journal of Pathology. 2020;250(2):148-158. doi:10.1002/path.5353.

• Endosalpingiosis. StatPearls. NCBI Bookshelf. Updated April 8, 2025.