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Background
Endosalpingiosis is a rare benign condition of the Mullerian system characterised by the presence of glands lined by ciliated tubal-type epithelium and involves the peritoneum, subperitoneal tissues, omentum, retroperitoneal nodes, etc. It was first described by Sampson, 1 who found epithelium resembling the fallopian tube in the ectopic locations. The most accepted pathogenesis is metaplastic change of the coelomic epithelium into tubal-like epithelium. Endosalpingiosis is associated with dysmenorrhoea and chronic pelvic pain. It is important to differentiate it with papillary serous adenocarcinoma due to presence of papillary and grapes like excrescences on the pelvic peritoneum, ovary and uterus as the management of this condition is primarily conservative. The other differential diagnosis includes benign cystic mesothelioma and multiple peritoneal inclusion cysts.
We have encountered this case for the first time in our practice. Proper histopathological diagnosis of the condition is crucial because its gross appearance mimics ovarian or primary peritoneal malignancies in most situations. The previous case studies have reported the condition in relatively older women. Our patient was different in this respect as she was 31 years old.
Case presentation
A 31-year-old woman presented to the outpatient department of our hospital in June 2012 with a history of heavy bleeding during menses and pain in the lower abdomen for 2 years. She had two living issues, both were born by lower segment caesarian sections; postoperative period was uneventful, and she was not on any contraceptives. The last childbirth was 3 years ago. General examination was normal; on pelvic examination, her uterus was normal in size, the right fornix was free but the left fornix was full and tender.
Investigations
An ultrasound of the pelvis was performed in which the uterus and the right ovary were normal and the left ovary had a cyst of 4.3x3.2 cm with multiple septations. CA 125 was 25 U/mL.
Hysteroscopy and endometrial aspiration were performed in view of her symptoms of heavy menstrual bleeding; the results were normal with secretory pattern of the endometrium...