Endosalpingiosis: The Evil Cousin of Endometriosis

A patient’s guide to this lesser well known entity

By: Dr. Mallory Stuparich, Endometriosis (and Endosalpingiosis) Surgeon, Orange County, Southern California

Endosalpingiosis is a benign yet clinically relevant gynecologic condition. It is characterized by the presence of fallopian tube-like ciliated epithelium located outside the fallopian tubes. Endosalpingiosis continues to draw growing interest in the field due to its debated relationship with chronic pelvic pain, endometriosis, and gynecologic malignancy.^[1][2][3][4]

How often does it occur?

Studies report endosalpingiosis in up to 22% of gynecologic surgical specimens with prevalence increasing with age and in postmenopausal women. It is present in 34.5–40% of cases with concurrent endometriosis. Women with endosalpingiosis are also at increased risk for uterine and ovarian cancers, with a stronger association seen especially for serous borderline, clear cell, and mucinous ovarian tumor subtypes.^{[5][3][4][6][7][1]}

What symptoms does it cause?

Endosalpingiosis is most often asymptomatic and discovered as an incidental finding during gynecologic surgery for other reasons. When symptoms do occur, they may include:^[8][4]

• Chronic pelvic pain (less frequent and less severe than in endometriosis)^[2][9]
• Dyspareunia (painful intercourse)
• Vaginal discharge (in rare cases, such as vaginal endosalpingiosis)^[10]
• Mass effect from cystic lesions that mimic neoplastic tumors^[11]

A retrospective case-control study found that most patients with endosalpingiosis do not undergo surgery for pain, and rates of persistent postoperative pain are similar to those with endometriosis.^[9][2]

How do I know if I have it?

The gold standard for diagnosing endosalpingiosis is histopathological evaluation of excised tissue, typically after surgical biopsy. Lesions consist of cysts lined by benign ciliated epithelium resembling fallopian tube mucosa, lacking the hemorrhage or inflammatory features typical of endometriosis. Transvaginal or abdominal ultrasound may reveal cystic pelvic masses but cannot reliably distinguish endosalpingiosis from other peritoneal pathologies; histology is essential for definitive diagnosis.^[12][13][11]

How it is managed?

For asymptomatic cases, no treatment may be required. If symptomatic or when lesions mimic ovarian neoplasia, surgical excision is appropriate both for diagnosis and relief. There is no evidence supporting routine hysterectomy for isolated endosalpingiosis. Ongoing surveillance and individualized management are recommended in cases with concurrent gynecologic malignancy or suspicious lesions.^{[4][14][15][1][10][12][9]}

Key Takeaways for Patients

• Endosalpingiosis is a benign gynecological finding that may sometimes cause pelvic pain, mimic endometriosis, or coexist with uterine/ovarian cancer.^[3][1][4]
• Diagnosis requires biopsy and histopathological confirmation.^[13][12]
• Most cases require no treatment, but excision may be warranted for symptoms or to rule out malignancy.^[10][12]
• Ask your clinician about regular follow-up if you have other pelvic conditions or if endosalpingiosis is discovered during surgery.^[15][1]

At ESSI, we prioritize a patient-centered, multidisciplinary approach to identify and treat all contributors to pelvic pain, including endosalpingiosis and endometriosis. Timely diagnosis and coordinated care are essential for an enhanced quality of life for patients dealing with these complex, often overlapping conditions.

References:

1. https://pubmed.ncbi.nlm.nih.gov/35909004/
2. https://pubmed.ncbi.nlm.nih.gov/36847525/
3. https://pubmed.ncbi.nlm.nih.gov/32401810/
4. https://pubmed.ncbi.nlm.nih.gov/27261327/
5. https://pubmed.ncbi.nlm.nih.gov/22819185/
6. https://pubmed.ncbi.nlm.nih.gov/25371889/
7. https://pubmed.ncbi.nlm.nih.gov/32146389/
8. https://pubmed.ncbi.nlm.nih.gov/12039470/
9. https://pubmed.ncbi.nlm.nih.gov/9736803/
10. https://pubmed.ncbi.nlm.nih.gov/35411260/
11. https://pubmed.ncbi.nlm.nih.gov/9989843/
12. https://pmc.ncbi.nlm.nih.gov/articles/PMC11772137/
13. https://pubmed.ncbi.nlm.nih.gov/34986982/
14. https://pubmed.ncbi.nlm.nih.gov/7360453/
15. https://pubmed.ncbi.nlm.nih.gov/15533512/
16. https://pubmed.ncbi.nlm.nih.gov/39724883/
17. https://pmc.ncbi.nlm.nih.gov/articles/PMC5491413/
18. https://pubmed.ncbi.nlm.nih.gov/7102891/