Use of other treatment before hysterectomy for benign conditions - what about PCS and CD 10? — YRD
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Use of other treatment before hysterectomy for benign conditions - what about PCS and CD 10? (1457)

Roger McMaster-Fay 1
  1. Central Clinical School, University of Sydney, Sydney, NSW, Australia

Corona et al [Corona LE, Swenson CW, Sheetz KH, et al. Am J Obstet Gynecol 2014;212:x.ex-x.ex. Use of other treatments before hysterectomy in benign conditions in a state wide hospital collaborative.]  in a large retrospective review of the histopathological findings after hysterectomy found that: the frequency of unsupportive pathology was higher in women aged <40 and highest among women with endometriosis or chronic pain.

Pelvic Congestion Syndrome (PCS) was first described by Taylor in 1949 and is a well recognised cause chronic pelvic pain . Beard’s review of PCS found the mean age of their patients was 32.4 years. Abnormal adenexal vascularity was not an outcome in the study of Corona et al.

Traditional histological preparation of tissues in cases of suspected endometriosis has a significant false negative rate. Published series from respectable units have found that over one third of surgically obtained biopsies of endometriosis are histologically negative on H&E staining, with higher rates of negativity with lower graded disease.

 Ivo Brosens reported that in up to one third of ’chocolate cysts’ no specific pathology can be found. We (10th World Congress of Endometriosis, 2008, Melbourne:  www.rfay.com.au/docs/cd10poster.pdf ) and others have described ovaries with ’chocolate cysts’ and negative for endometrial epithelium yet positive immunohistochemical staining for CD 10, a marker for endometrial stromal cells.

Groisman and Meir2 retrospectively studied 20 cases of histologically equivocal endometriosis (‘suspicious of’, ‘suggestive of’ or ‘compatible with’) and found that 85% stained positive for CD10, confirming the diagnosis. Potlog-Nahari et al3 using CD10 immunohistochemical staining in 31 women with chronic pelvic pain, found the technique almost doubled their diagnosis of Stage I endometriosis. We found that of the 31 histologically (H&E) negative patients, 24 (77%) were found to be CD10 positive.

These facts, I believe, call into question the therapeutic conclusions in the study of Corona et al.

References: 1.       Beard RW, Reginald PW, Wadsworth J. Clinical features of women with chronic lower abdominal pain and pelvic congestion. BJOG 1988;95:153-61. 2.       Groisman GM, Meir A. CD 10 is helpful in detecting occult or inconspicuous endometrial stromal cells in cases of presumptive endometrosis. Arch Pathol Lab Med 2003;127:1003-6. 3.       Potlog-Nahari C, Feldman AL, Stratton P, et al. CD 10 immunohistochemical staining enhances the histological detection of endometriosis. Fertility & Sterility 2004;82:86-92.