Lymph node involvement and lymphovascular invasion in deep infiltrating rectosigmoid endometriosis

Objective: To analyze the lymph node involvement by endometriotic foci in rectosignioid endometriosis and to correlate it with clinical and histological parameters including the presence of lymphovascular invasions, which could explain this lymph node involvement. Design: A prospective study of 26 consecutive cases of rectosignioid endometriosis between January 2005 and January 2007. Setting: A multidisciplinary study including clinical and pathological data. Patient(s): Twenty-six patients with symptomatic rectosigmoid endometriosis. Intervention(s): Laparoscopic surgery with pathological analysis of each specimen. Main Outcome Measure(s): Involvement of lymph nodes by endometriotic foci was correlated with the size and the wall layers affected by endometriotic lesions, the number of lymph nodes retrieved, and the presence of lymphovascular invasions demonstrated by D2-40, a specific antibody to lymphatic vessels. Result(s): Lymph node involvement by endometriosis was observed in 11 of the 26 patients (42.3%) and correlated with the size of the lesions, the number of lymph nodes retrieved, and the presence of lymphovascular invasions, which were observed in 36.3% of cases. Conclusion(s): Our data confirm that lymph node involvement by endometriotic foci is a frequent event in rectosigmoid endometriosis and may result at least partially from a lymphatic spread of the disease.