Clinical and pathological analysis of pulmonary endometriosis: Three cases report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YUAN Dan , XIA Jinhua , JI Qing ,  WANG Jinjing

Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, P. R. China;

Corresponding author：

WANG Jinjing, Email: jinjingw2018@163.com

Keywords：

Pulmonary endometriosis; catamenial hemoptysis; pathological characteristics; pulmonary wedge resection; case report

DOI：

10.7507/1007-4848.202306005

Video：

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Pulmonary endometriosis (PEM) is a rare disease with diverse clinical manifestations, most commonly presenting as hemoptysis, while patients presenting solely with pulmonary nodules are less common. Here, we report three female patients (aged 32, 19, and 46 years, respectively). One patient sought medical attention due to hemoptysis during menstruation, while the other two had no obvious symptoms and were found to have pulmonary nodules during routine physical examinations. Two patients had a history of cesarean section, and one had a history of miscarriage. Pathologically, one patient of PEM showed extensive hemorrhage in the alveolar spaces, with fragmented endometrial glandular epithelium observed within the hemorrhagic foci. The other two patients exhibited proliferative endometrial glands and stroma, surrounded by old hemorrhage. Immunohistochemistry revealed that the endometrial glands and stroma in all three patients were positive for estrogen receptor, progesterone receptor, and vimentin, with CD10 positivity in the endometrial stroma. All three patients were definitively diagnosed as PEM by pathology and underwent thoracoscopic pulmonary wedge resection. Follow-up periods were 18, 31, and 49 months, respectively, with no recurrence observed in any of the patients.

Citation： YUAN Dan, XIA Jinhua, JI Qing, WANG Jinjing. Clinical and pathological analysis of pulmonary endometriosis: Three cases report. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(6): 882-886. doi: 10.7507/1007-4848.202306005 Copy

1.	Rzewuska AM, Żybowska M, Sajkiewicz I, et al. Gonadotropin-releasing hormone antagonists: A new hope in endometriosis treatment? J Clin Med, 2023, 12(3): 1008.
2.	Chauhan S, More A, Chauhan V, et al. Endometriosis: A review of clinical diagnosis, treatment, and pathogenesis. Cureus, 2022, 14(9): e28864.
3.	Andres MP, Arcoverde FVL, Souza CCC, et al. Extrapelvic endometriosis: A systematic review. J Minim Invasive Gynecol, 2020, 27(2): 373-389.
4.	Tong SS, Yin XY, Hu SS, et al. Case report of pulmonary endometriosis and review of the literature. J Int Med Res, 2019, 47(4): 1766-1770.
5.	Nezhat C, Lindheim SR, Backhus L, et al. Thoracic endometriosis syndrome: A review of diagnosis and management. JSLS, 2019, 23(3): e2019.00029.
6.	Mecha E, Makunja R, Maoga JB, et al. The importance of stromal endometriosis in thoracic endometriosis. Cells, 2021, 10(1): 180.
7.	Yovich JL, Rowlands PK, Lingham S, et al. Pathogenesis of endometriosis: Look no further than John Sampson. Reprod Biomed Online, 2020, 40(1): 7-11.
8.	Hilaris GE, Payne CK, Osias J, et al. Synchronous rectovaginal, urinary bladder, and pulmonary endometriosis. JSLS. 2005; 9(1): 78-82.
9.	Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: A review. Reprod Med Biol, 2020, 19: 323-333.
10.	Verhulst E, Bafort C, Tomassetti C, et al. Endometriotic lung cyst causing catamenial hemoptysis; a case report and review of literature. Acta Chir Belg, 2022, 122(6): 432-437.
11.	Leonardo-Pinto JP, Benetti-Pinto CL, Quagliato I, et al. Hemoptysis and endometriosis: An unusual association: Case report and review of the literature. Rev Bras Ginecol Obstet, 2018, 40(5): 300-303.
12.	Huang Q, Huang S, Jiang J, et al. Clinical and radiographic characteristics in pulmonary endometriosis: Based on five cases. Clin Exp Obstet Gynecol, 2015, 42(3): 336-338.
13.	Zanetti G, Hochhegger B, Marchiori E. Pulmonary endometriosis: An unusual cause of hemoptysis. J Bras Pneumol, 2020, 46(4): e20190335.
14.	Mulette P, Jacquet A, Durlach A, et al. Pulmonary cavitations with increased 18F-FDG uptake revealing a thoracic endometriosis: A case report. Medicine (Baltimore), 2021, 100(42): e27550.
15.	Fukuda S, Hirata T, Neriishi K, et al. Thoracic endometriosis syndrome: Comparison between catamenial pneumothorax or endometriosis-related pneumothorax and catamenial hemoptysis. Eur J Obstet Gynecol Reprod Biol, 2018, 225: 118-123.
16.	魏建国, 张小伟, 王华, 等. 无呼吸系统症状的肺子宫内膜异位症一例. 中华病理学杂志, 2020, 49(10): 1077-1079.Wei JG, Zhang XW, Wang H, et al. Pulmonary endometriosis without respiratory symptoms: Report of a case. Chin J Pathol, 2020, 49(10): 1077-1079.
17.	张帆, 吴斌, 方威, 等. 子宫切除术后肺子宫内膜异位症1例并文献复习. 临床肺科杂志, 2021, 26(11): 1777-1779.Zhang F, Wu B, Fang W, et al. Pulmonary endometriosis after hysterectomy: A case report and literature review. J Clin Pulm Med, 2021, 26(11): 1777-1779.
18.	Azizad-Pinto P, Clarke D. Thoracic endometriosis syndrome: Case report and review of the literature. Perm J, 2014, 18(3): 61-65.
19.	Scarfone G, Bergamini A, Noli S, et al. Characteristics of clear cell ovarian cancer arising from endometriosis: A two center cohort study. Gynecol Oncol, 2014, 133(3): 480-484.
20.	Kim CH, Lee DY, Moon DH, et al. Percutaneous cryoablation of multiple pulmonary endometriosis. J Chest Surg, 2021, 54(1): 75-78.
21.	Hwang SM, Lee CW, Lee BS, et al. Clinical features of thoracic endometriosis: A single center analysis. Obstet Gynecol Sci, 2015, 58(3): 223-231.

1. Rzewuska AM, Żybowska M, Sajkiewicz I, et al. Gonadotropin-releasing hormone antagonists: A new hope in endometriosis treatment? J Clin Med, 2023, 12(3): 1008.
2. Chauhan S, More A, Chauhan V, et al. Endometriosis: A review of clinical diagnosis, treatment, and pathogenesis. Cureus, 2022, 14(9): e28864.
3. Andres MP, Arcoverde FVL, Souza CCC, et al. Extrapelvic endometriosis: A systematic review. J Minim Invasive Gynecol, 2020, 27(2): 373-389.
4. Tong SS, Yin XY, Hu SS, et al. Case report of pulmonary endometriosis and review of the literature. J Int Med Res, 2019, 47(4): 1766-1770.
5. Nezhat C, Lindheim SR, Backhus L, et al. Thoracic endometriosis syndrome: A review of diagnosis and management. JSLS, 2019, 23(3): e2019.00029.
6. Mecha E, Makunja R, Maoga JB, et al. The importance of stromal endometriosis in thoracic endometriosis. Cells, 2021, 10(1): 180.
7. Yovich JL, Rowlands PK, Lingham S, et al. Pathogenesis of endometriosis: Look no further than John Sampson. Reprod Biomed Online, 2020, 40(1): 7-11.
8. Hilaris GE, Payne CK, Osias J, et al. Synchronous rectovaginal, urinary bladder, and pulmonary endometriosis. JSLS. 2005; 9(1): 78-82.
9. Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: A review. Reprod Med Biol, 2020, 19: 323-333.
10. Verhulst E, Bafort C, Tomassetti C, et al. Endometriotic lung cyst causing catamenial hemoptysis; a case report and review of literature. Acta Chir Belg, 2022, 122(6): 432-437.
11. Leonardo-Pinto JP, Benetti-Pinto CL, Quagliato I, et al. Hemoptysis and endometriosis: An unusual association: Case report and review of the literature. Rev Bras Ginecol Obstet, 2018, 40(5): 300-303.
12. Huang Q, Huang S, Jiang J, et al. Clinical and radiographic characteristics in pulmonary endometriosis: Based on five cases. Clin Exp Obstet Gynecol, 2015, 42(3): 336-338.
13. Zanetti G, Hochhegger B, Marchiori E. Pulmonary endometriosis: An unusual cause of hemoptysis. J Bras Pneumol, 2020, 46(4): e20190335.
14. Mulette P, Jacquet A, Durlach A, et al. Pulmonary cavitations with increased 18F-FDG uptake revealing a thoracic endometriosis: A case report. Medicine (Baltimore), 2021, 100(42): e27550.
15. Fukuda S, Hirata T, Neriishi K, et al. Thoracic endometriosis syndrome: Comparison between catamenial pneumothorax or endometriosis-related pneumothorax and catamenial hemoptysis. Eur J Obstet Gynecol Reprod Biol, 2018, 225: 118-123.
16. 魏建国, 张小伟, 王华, 等. 无呼吸系统症状的肺子宫内膜异位症一例. 中华病理学杂志, 2020, 49(10): 1077-1079.Wei JG, Zhang XW, Wang H, et al. Pulmonary endometriosis without respiratory symptoms: Report of a case. Chin J Pathol, 2020, 49(10): 1077-1079.
17. 张帆, 吴斌, 方威, 等. 子宫切除术后肺子宫内膜异位症1例并文献复习. 临床肺科杂志, 2021, 26(11): 1777-1779.Zhang F, Wu B, Fang W, et al. Pulmonary endometriosis after hysterectomy: A case report and literature review. J Clin Pulm Med, 2021, 26(11): 1777-1779.
18. Azizad-Pinto P, Clarke D. Thoracic endometriosis syndrome: Case report and review of the literature. Perm J, 2014, 18(3): 61-65.
19. Scarfone G, Bergamini A, Noli S, et al. Characteristics of clear cell ovarian cancer arising from endometriosis: A two center cohort study. Gynecol Oncol, 2014, 133(3): 480-484.
20. Kim CH, Lee DY, Moon DH, et al. Percutaneous cryoablation of multiple pulmonary endometriosis. J Chest Surg, 2021, 54(1): 75-78.
21. Hwang SM, Lee CW, Lee BS, et al. Clinical features of thoracic endometriosis: A single center analysis. Obstet Gynecol Sci, 2015, 58(3): 223-231.

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