Diagnosis: Endometriosis
The diagnosis is endometriosis (option c), confirmed by the classic triad of secondary dysmenorrhea, hemorrhagic nodules on the ovaries and uterine surface at laparoscopy, and histopathological demonstration of endometrial glands and stroma outside the uterine cavity. 1, 2
Definitive Diagnostic Features
The histopathological finding of endometrial glands and stroma outside the uterine cavity is the defining characteristic of endometriosis and represents the gold standard for diagnosis. 1, 2
- Endometriosis is specifically defined as the presence of endometrial-like tissue (glands and stroma) located outside of the endometrial cavity, associated with inflammation and fibrosis, on or extending below the peritoneal surface. 1
- The hemorrhagic nodules visualized at laparoscopy represent endometriotic lesions containing functional ectopic endometrial tissue that undergoes cyclic bleeding, creating the characteristic hemorrhagic appearance. 3
- Laparoscopy with histological confirmation remains the definitive diagnostic method, though direct visual assessment alone has poor correlation with histological findings without tissue confirmation. 4
Why Other Options Are Incorrect
Leiomyoma (option a): Leiomyomas are benign smooth muscle tumors of the myometrium that do not contain endometrial glands and stroma on histopathology. 5
Endometrial polyp (option b): Endometrial polyps are localized overgrowths of endometrial tissue that remain within the uterine cavity, not on the ovarian or uterine surface. 6
Endometritis (option d): Endometritis is an inflammatory/infectious condition of the endometrium within the uterine cavity, not characterized by ectopic endometrial tissue or hemorrhagic nodules on pelvic structures. 1
Ectopic pregnancy (option e): Ectopic pregnancy would show chorionic villi and trophoblastic tissue on histopathology, not endometrial glands and stroma, and would not present with multiple bilateral hemorrhagic nodules. 1
Clinical Context
- Secondary dysmenorrhea (painful menses developing after years of painless periods) is a hallmark presentation of endometriosis, distinguishing it from primary dysmenorrhea. 7
- Endometriosis affects approximately 10% of women of reproductive age and is the most common cause of secondary dysmenorrhea. 1, 7
- The disease typically occurs in predictable pelvic locations including the ovaries, uterine surface, and peritoneum, exactly as described in this case. 1
- Approximately 50% of patients with endometriosis experience infertility, though this patient's fertility status is not mentioned. 1
Critical Diagnostic Pitfall
Never rely on laparoscopic visualization alone without histological confirmation. The correlation between laparoscopic observations and histological findings is often poor, and definitive diagnosis requires tissue examination showing endometrial glands and stroma. 4