An endometrial gland is located in the superficial stroma. Note that the glandular epithelium may be mitotically active, depending on the stage of the woman's menstrual cycle. The key to diagnosing endometriosis in any location is the presence of endometrial stroma (spindled stromal cells). In this particular case, the endometrial stroma is very subtle, as the stromal cells can blend in with the cervical stroma.
Endometriosis involving the cervix can be located superficially or deep in the stroma. One of causes of endocervical endometriosis may be attributed to surgical procedures (ie. D/C, cone biopsies), which introduce endometrial tissue into the cervix. It is clincally significant as it may mimic adenocarcinoma in situ or endometrioid adenocarcinoma. However, the key feature to recognizing this entity is that the endometrial glands are accompanied by endometrial stroma.
Endometriosis may appear as blue or reddish nodules on the cervix. Usually an incidental finding, but may present with abnormal uterine bleeding and pelvic pain.
Treatment for endometriosis depends on symptoms and reproductive goals. Medical treatments consist of analgesic therapy and hormonal suppressive therapies. Surgical treatments can consist of excision or ablation of lesions depending on location. Definitive therapy for endometriosis consists of hysterectomy with bilateral oophorectomy.
Recurrence rates of endometriosis are high. Very rarely endometriosis can progress to endometrioid adenocarcinoma.
1 Sternberg SS, ed. Diagnostic Surgical Pathology.4th Ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004: 2407-9.
2 Rosai, J. Rosai and Ackerman's Surgical Pathology. 9th Ed. Philadelphia, PA: Elsevier; 2004: 1530.