Insufficient immunohistochemical testing may be missing early-stage neoplasms and producing misleading endometriosis diagnoses: A Call to Action to Standardize Endometriosis Histology Protocols:
In this age of spectacular AI, omics, and single-cell molecular medicine breakthroughs, surely there’s no better time than now to call for similarly awesome breakthroughs in endometriosis histology, an often overlooked yet critical field of diagnostics. Specifically, we would like to propose that endometriosis thought leaders of the world work together to establish endometriosis-specific histology protocols, so that immunohistochemical testing of surgical biopsies can finally be modernized, standardized, and democratized.
An international consensus statement with updated guidelines would be game-changing for millions of endometriosis sufferers. Not only could it help reduce histologic misdiagnoses that contribute to the lengthy diagnostic delays endometriosis patients already face, but it could also aid in the early detection of occult neoplasms, potentially lowering mortality linked to endometriosis-associated cancers. With endometriosis also still reigning as one of the world’s leading causes of severe disability and hospitalization, along with mounting evidence linking endometriosis to a significantly heightened risk for ovarian cancer, one of the deadliest gynecological cancers worldwide, surely the time has come to do everything in our power to help galvanize change in the often forgotten field of histology.
A bridge to nowhere
Of course, endometriosis is a whole-body (systemic) inflammatory chronic condition that is much more than the lesions alone. However, if we fail to establish rigorous standards for investigating these excruciatingly destructive, pathological cells at their single-cell molecular, genomic, epigenetic, and immunohistochemical levels, we’ll never escape our current heartbreaking circumstances, where unconscionably substandard ‘shoot in the dark’ practices continue to cause ruinous outcomes to millions of people worldwide who deserve better.
Before diving in: A Look Back at Histology Milestones Through the Ages
It’s been nearly 150 years since hematoxylin and eosin (H&E) staining first emerged as the cornerstone of the then-nascent field of histology. Little would the histology pioneers back then have guessed just how much of a profound impact those two tiny letters would have on millions of endometriosis sufferers around the world, whose H&E pathology reports confirmed that their struggle to survive one of the most potentially devastating chronic conditions known to medicine, was, in fact, real.
H&E: “Pirates’s most desired treasure”
The two H&E dyes both derive from the Palo de Campeche Logwood tree (ek in the Mayan language), “mesoamerica’s gift to histopathology”*, as one historian described what even pirates of the actual Carribean found irresistible at one time. With roots stretching back to the pre-classical Mayans of circa 400 BCE, these “pirates’ most desired treasure” dyes feature into the story of endometriosis as well, because H&E stains black and green, respectively, in the presence of normal, eutopic endometrial glands and stroma, but also in the pathological, ectopic forms found in endometriosis. (*The word gift was used euphemistically to describe what was more like a plundering of resources, but that’s a topic for a different post).
However, of perhaps most importance, H&E staining provided the field with among the earliest clues that endometriosis was not the endometrium, due to observable substantial histopathological differences when compared to normal eutopic endometrium. For example, in endometriosis, ectopic glands often present as inactive and with some resemblance to the basalis or proliferative endometrium. H&E also allowed for higher levels of apoptosis in endometriotic glandular cells than is generally observed in normal endometrium. A variation of ectopic gland cell sizes can also be identified in H&E staining, which pathologists categorize as small, medium, and large. Important cell shape differences can be detected as well, such as canalicular or collapsed shapes, which can provide important diagnostic clues. Immune and inflammatory markers, like neutrophils, lymphocytes, macrophages, and plasmocytes, also react to H&E staining, making H&E useful for potentially providing additional insight into disease severity. (Compared to normal endometrium, elevated levels of these immune markers are often seen in endometriosis and are potentially associated with more severe disease).
H&E and Hemosiderin-laden macrophages
Remarkably, H&E can also stain for the presence of hemosiderin-laden macrophages, which are white blood cells filled with hemosiderin, a by-product of hemoglobin after rupture of red blood cells (hemolysis). Hemosiderin-laden-macrophages, HLMs for short, are commonly found in many other disease processes, including in liver and lung disease. Composed of lysosomes and partially digested ferritin moledules (essentially storage containers for iron), the presence of hemosiderin is considered a putative sign of hemorrhage* that may have occurred at some point in a lesion’s history. (This is not to suggest that endometriosis lesions bleed like menstruation: the source of hemorrhage, and hemorrhagic endometriotic lesions in general, are all topics of intense debate, which we will explore further in upcoming posts).
So far, all of this means that H&E seems to be hitting just the right notes for capturing a histologically-confirmed endometriosis diagnosis, composed of what pathologists refer to as the “diagnostic triad”: positive staining for endometrial-like glands, endometrial-like stroma, and hemosidin-laden macrophages.
With H&E staining alone, the coloring of hemosiderin-laden macrophages can vary, from golden yellow to brown, but will appear as blue granule-like pigments when Prussian blue dye is included.
The ability to detect hemosiderin-laden macrophages is a particularly useful advantage of H&E, as not all biopsied lesions, which end up being classified as suggestive of endometriosis, actually stain positive for ectopic glands and stroma; unusual subtypes are recognized, which fall outside this classical diagnostic criteria. In fact, some studies suggest that only 50-70%* of endometriosis lesions, test fully positive for both glands and stroma, when evaluated histologically. More comprehensive panels would improve our understanding of some of these anomolous findings, but, without established guidelines, it’s unlikely that profit-driven hospital systems will pursue such investments of time and money without prompting from advocacy groups.
Stromal Endometriosis
Stromal endometriosis is an example of a predominantly stromal-only unusual subtype, which, as the name implies, is composed primarily of stroma, with either completely negative or only faint staining for glands discernible. In such cases, pathologists instead look for other signs that are considered highly suggestive of endometriosis, including the presence of macrophages engorged with hemosiderin, as well as fibrosis and signs of chronic inflammation.
Perls Prussian Blue: still going strong since 1867
As useful as H&E has turned out to be, considering that it’s an older technology, one can’t help but wonder whether it’s really the most reliable immunohistochemical marker available. As it turns out, the Perls Prussian Blue staining technique (mentioned above) is actually preferred by many pathologists for the detection of hemosiderin, as it generally (but not always) demonstrates greater sensitivity and specificity. In one study, for example, nearly 20% of tissue samples with hemosiderin were missed with H&E, but were found when the Perls method was applied. Yet, even the Perls Prussian Blue test is not new, but in fact was introduced in 1867, by its eponymous German founder, Max Perls.
Stromal Endometriosis Again: but are we sure?
Circling back to cases in which lesions appear to be without glands, like stromal endometriosis, in an ideal world, these would be retested with more modern antibodies that provide better predictive value for detecting glandular elements which may not being showing up using standard protocols. These are very important distinctions to make, as stromal and/or glandular irregularities may indicate early signs of potential malignant transformation. For example, In one case of misclassified stromal endometriosis involving the bowel, a customized immunohistochemical panel including CK7, as well as CK20, CDX2, and ER, was performed, which helped identify glands in the previously misdiagnosed stromal endometriosis, but a previously misclassified malignancy was also discovered in the process as well.
Decidualized/pseudodecidualized endometriosis
Another subtype with a putatively stromal-predominant or inconclusive histologic staining pattern is decidualized endometriosis, a clinically challenging presentation involving the decidualization of ectopic stromal cells during pregnancy. (Decidualization occurs monthly with menstruation with or without pregnancy, but is shed if no pregnancy occurs. There are also cases of pseudodecidualization, covered below). In an obstetric setting, decidualized endometriomas in particular can mimic ovarian malignancy in imaging, thereby triggering a series of potentially devastating clinical decision based on an incorrect initial diagnosis. Although one literature review from 2016 found only 60 cases of decidualized endometriomas during pregnancy in the literature, this is nevertheless an important potential presentation of endometriosis that more obstetricians should be trained to recognize.
In the setting of histology, misdiagnoses can also occur because decidualized endometriosis can stain negatively for glands, due to mutations that cause the glandular components to become flattened and therefore potentially undetectable using the standard H&E + CD10 panel. Pseudodecidualized endometriosis can occur outside of pregnancy and is thought to be triggered by exogenous progesterone-based medications that are so commonly prescribed to people with endometriosis. In this case especially, it’s important to make these histopathological distinctions, as this is a prime example of when the treatment itself may be upstaging endometriosis, thereby causing more pain and suffering. (We touch on this topic more below, under the Progesterone & Estrogen Receptors section).
Ectopic decidua, also referred to as deciduosis, is a benign condition – some even refer to as a natural, physiological phenomenon – that occurs in pregnancy or can occur in the setting of progesterone medications, as noted above. With the availability of AI-enhanced histopathology, this is another potentially related condition that deserves a closer look, since some of these cases may actually be endometriosis being triggered and/or upstaged during pregnancy. (Contrary to popular myth, there are some patients who experience a worsening of their endometriosis symptoms during pregnancy and/or immediately after giving birth). Like decidualized endometriosis/endometriomas, ectopic decidua can even be mistaken for metastatic disease, mesothelioma, diffuse peritoneal carcinomatosis, or granulomas during pregnancy. As such, differentiating these vastly different conditions is critical for the fetus and mother. AI-enhanced histology, plus next generation pan-cytokeratin-based antibodies, could also potentially help differentiate between countless cases of potential neoplasms and other clinically questionable lesions.
These are just a few examples, but there are numerous case studies of H&E-based tests which are likely contributing to countless false negatives and positives, with potentially adverse impact on millions of patients. In fact, if we were to extrapolate data from multiple studies, it certainly appears that as many as 20-30% (maybe more) of today’s immunohistochemical results may be, at the very least, significantly misleading or substantially inaccurate. As you’ve probably noticed, too, current histology conventions are often getting it wrong where it matters the most: identifying ectopic endometrial-like glands and stroma, the two main cell types that are literally foundational to a histologically-confirmed endometriosis diagnosis. (Speaking of the official definition of endometriosis, there’s an excellent social media campaign, started by @reythewarrior, which provides the accurate definition as a shareable post in many different languages).
1919: Cullen & Zenker’s Fixative
We’ll address these issues in more detail below, but returning to the historical review, it turns out that, back in 1919, the acclaimed endometriosis pioneer, Dr. Thomas Cullen, was also keen to adopt the latest in histology technologies. Cullen noted his particular fondness for Zenker’s Fixative, a relatively new breakthrough in histology in the early 20th Century, which had fast-acting properties that aided in the collection and storage of surgical biopsies in an era before modern refrigeration became widely available.
Despite being derived from one of the most toxic of all mercury salts—mercuric chloride—Cullen and his contemporaries somehow survived the compound’s choking, malodorous fumes, and remained captivated instead by its remarkable ability to not only stabilize tissue structures and cellular components quickly, but also effectively stain for chromatin and nucleoli within cell nuclei. Though Cullen was one of the world’s leading endometriosis surgeons at the time, he credited this lowly, toxic mordant, nearly lost to history by now, as the single most important factor in allowing for his routine histologic analysis of endometriotic surgical biopsies.
2002-2004: The Introduction of CD10
Of course, many significant advancements have been made in histology since the days of Zenker’s Fixative, but few have been as impactful for the diagnosis of endometriosis as the groundbreaking 2002 work of Sumathi and McCluggage, who were among the earliest to introduce the CD10 immunohistochemical test as an important new method for detecting ectopic endometrial-like stroma in endometriosis. Other early investigators working in this space include Groisman and Meir in 2003, and Potlog-Nahari and colleagues, who added to the literature in 2004 with crucial new insights. The CD10 protein is highly expressed in normal endometrial stromal cells, but is also present in varying degrees in ectopic and neoplastic endometrial stroma. In the early 2000s, investigators hypothesized that the ectopic endometrial-like stroma found in endometriosis would also respond positively to the CD10 antibody, which turned out to be correct in most cases.
However, what captured the attention of endometriosis specialists the most was the ability of CD10 tests to detect endometriosis where H&E tests alone had failed. Although CD10 staining is not infallible, nevertheless this was an absolute breakthrough in endometriosis diagnostics and no doubt has played a significant role in recognizing the now higher prevalence estimates of 1 in 5-7, compared to the older statistics of 5-6%, which were more common at the time. As a result, since the early 2000s, CD10 plus H&E testing has been the standard protocol most pathologists have adopted for endometriosis. (Note: The introduction of video laparoscopy in the late 1970s/early 1980s is the technological breakthrough which has contributed the most to deepening our understanding of the true magnitude of prevalence, with the CD10 test later further enhancing diagnostic efforts).
Of course, CD10 testing is not bulletproof. For example, ovarian endometriomas may not always consistently test positive with CD10 staining. In other cases, endometriotic lesions may only be sparsely populated with stroma, which may lead to false negatives. CD10 is also not a specific immunohistochemical market just for endometriosis, meaning false positives are also possible. This is because the CD10 protein is abundant in many different types of cells throughout the human body, in both males and females. As a result, it’s commonly applied to detect a substantial array of tissue, including prostate cancer and normal breast tissue alike. Due to this non-specific nature of CD10 in particular, experienced pathologists recommend that other antibodies be included as part of a more comprehensive panel.
PGP9.5
As to which additional antibodies are recommended, opinions have varied widely over the years.
Several promising new immunohistochemical tests have been identified just in the last several years that deserve to be considered as part of a recommended endometriosis-specific histology panel. One such promising candidate is the PGP9.5 antibody (protein gene product 9.5), which can detect aberrant nerve cells / nerve bundles in both endometriosis and the eutopic myometrium. Its utility is especially notable, as it can differentiate several important characteristics, including nerve fiber density, nerve fiber type, Since its introduction, the unexpected presence of various types of nerve cells in endometriosis shook up the world of endometriosis research, by introducing a previously unknown puzzle piece which has likely been contributing to the extreme pain symptoms that often occur, even in the presence of so-called minimal, stage I disease.
In other words, patients have been vindicated yet again, though this small victory is bittersweet, considering just how tragically ‘too little, too late’ this breakthrough has been for so many millions around the world.
Ki-67
Our next candidate for inclusion into a potential histological arsenal for enhancing the detection of endometriosis subtypes associated more strongly with cancer, is the Ki67 antibody, which is showing promise for identifying early-stage cellular atypia associated with malignant transformation. Ki-67 testing is used to measure the mitotic index in cells that are proliferating. In the context of atypical endometriosis, for example, the Ki-67 test will indicate a higher level of Ki-67-positive staining than in typical endometriosis. In cancer cells, a high mitotic index indicates a poor prognosis, especially in tumors exhibiting aggressive characteristics. In view of recent findings, which suggest ovarian cancer may be significantly more likely in endometriosis patients than previously reported, we do hope more endometriosis specialists will consider including Ki-67 in the pathology panels.
Other immunohistochemical markers used in endometriosis histology
Other staining antibodies that leading pathologists have known to include in their endometriosis-specific immunohistochemical panels are as follows: ERα (estrogen receptor alpha), ERβ (estrogen receptor beta), PRα (progesterone receptor alpha), PRβ (progesterone receptor beta), CK7, CD44, CD133, P53, CA125, PAX8, HOXA11, CA199, WT1, HNF-1β, P450A, BAF250a, COX-2, MIB1, BCl2, and P16.
Estrogen & Progesterone Receptor Abnormalities
In the case of estrogen and progesterone receptors, testing in endometriosis should be done as part of a standard protocol, as it would help clinicians identify many potentially useful clinical features, including the progesterone resistance & estrogen resistance (hormone-resistant disease). Similar protocols have been in place for years in oncology, to help detect the most effective treatments depending on the specific tumor histotype involved. Without the crucial insights that ER & PR testing would yield in endometriosis diagnostics, patients will continue to suffer needlessly, effectively treated like guinea pigs as their often well-meaning healthcare providers chase after one futile lead after another in search of an elusive elixer that never existed in the first place.
As one of the earliest reports by Bulun et al. in 2012 highlighted, endometriotic lesions frequently exhibit significant abnormalities in steroid receptors. For instance, endometriosis often contains much higher levels of the ERβ estrogen receptor isoform compared to the ERα receptor found in normal eutopic endometrium, with Bulen et al detecting up to 100 times greater levels of ERβ than normal endometrium. Researchers suspect this profoundly mutated steroid receptor functionality is likely a key culprit involved in the secondary progesterone resistance that endometriosis often exhibits as well.
Analogous insights from oncology are helpful to keep in mind as well, concerning steroid receptor dysfunction. For example, inactivated or dysregulated ERα is widely recognized as a key driver in the development of certain cancers, as disruption of this critical regulatory receptor can trigger uncontrolled cell growth and tumor progression. In the case of endometriosis, similar pathomechanisms are believed to play a major role in the onset and progression, although with significantly lower rates of mitosis and progression compared to cancers.
Loss of progesterone receptors is also associated with more aggressive tumors and worse prognoses for endometrial cancer, while ER-negative tumors are predictive of poor prognoses in breast cancer. Might similar histologic patterns found in endometriosis also hold crucial potential predictive power? Could there be the equivalent of a triple negative endometriosis subtype sitting right under our collective noses, waiting to be included as an important new update to the current subtype classifications? (Nezhat et al original research, publication-in-progress). Unfortunately, we’ll never be able to answer these critical questions, if we don’t even routinely test for the presence of two of the most recognized consequential steroid receptors in endometriosis.
The whole-body impact of endometriosis, beyond just its lesions or reproductive tract
As a quick side note (though one of critical importance), mutant estrogen receptors can also profoundly affect the expression of thousands of genes and co-factors throughout the body, which can significantly impact crucial physiological functions in all 12 organ systems of the human body, even beyond those typically assumed to be regulated by estrogen. If there’s one statement that effectively sums up the concept of endometriosis as a whole-body (systemic) chronic disease, with potential to cause body-wide symptoms beyond the visible lesions and beyond the reproductive tract, then this most certainly is it.
As for the other antibodies in the above list, the role they may play in optimizing histological testing is still under investigation in some cases, so this list is not intended as an endorsement at this time. Rather, we hope this brief overview of some of the customized panels that have been used recently to successfully differentiate between clinically challenging presentations of endometriotic lesions, may be useful in your own health advocacy efforts. (To follow this developing research further, you could click here to join our mailing list and receive our forthcoming ‘part 2’, more thorough evaluation of histology best practices for endometriosis, but hopefully this is enough preliminary information to kickstart your own research).
Slippery when wet: Other endometriosis diagnostic pitfalls
Our analysis for this particular blog centers predominantly on antibodies used in immunohistochemical tests, but there are a host of other deeply problematic deficiencies vexing endometriosis diagnostics, including issues of inexperienced surgeons missing large areas of endometriosis during surgery in the first place, which would mean pathologists would not even receive the right type or number of surgical biopsies to begin with. In an earlier blog, we also covered the topic of improper risk stratification by endometriosis subtypes, which has led to the decades-long systematic underreporting of cancer risk in endometriosis patients. Even contaminated reagents have figured into incorrect immunohistochemical test results before.
Diagnostic failures collectively contribute to staggering diagnostic delays globally
And, we haven’t even begun to discuss the notorious imaging deficiencies that are among the most damaging initial diagnostic blunders contributing to the appalling 7 to 11-year* diagnostic delays endometriosis sufferers face, despite Herculean efforts to increase awareness in recent years. (Ranges vary by country: a recent preliminary finding from 2024 reported an average 11-year delay in the USA, while a staggering 27 years has been suggested by researchers from the University of York).
2024: ‘Tis But a Scratch’
Often concerns about potentially harmful practices in medicine are brushed off for decades, until a crisis erupts that helps mobilize a community into action. At this point, we are not only far beyond the crucible of crisis, but have practically entered an interminable doom loop of one spectacular failure after another, a cruel summer year after bloody year. It’s truly unbearable to think of all the millions of people around the world, who are trapped in this never-ending Hobbesian hellscape: losing lives because a preventable deadly cancer was missed due to outdated, inaccurate tests; suffering irreparable harm to fertility because all tests came back normal; losing 6, 7, 8 organs, all unnecessarily, resulting in permanent disability; barely surviving multiple, egregious medical errors, like actual wrong organ surgeries, resulting in even more crippling pain than before; clinging to life by one final, intolerable thread, yet all casually dismissed as imaginary illusions because all the tests and experts and authorities said everything was A-Okay. And, to think, much of this soul-crushing suffering would have been largely avoidable, had we only believed patients in the first place.
Patients Deserve Gold Standard Care, including in Histology
Unless we act now to insist that endometriosis-specific histology standards be updated, the painful reality is that we will likely remain years away from seeing any meaningful widespread adoption of the available new advances in histology, which hold so much potential for reducing diagnostic errors and catching occult malignancies at much earlier stages than we do today. While the veneer of modern-day immunohistochemical tests may seem fancy and unfathomably advanced, it’s important to remember that many are still rooted in century-old technologies.
Better than AI: Together, we are the best neural network in the world
With so many deeply entrenched deficiencies plaguing the landscape of endometriosis histology, the challenges seem nearly insurmountable: where do we even begin to untangle these knowledge gaps that have persisted for decades?
Updated histology protocols could help reduce endometriosis-associated cancer mortality
In situations like this, going back to the basics could be transformative. Take, for example, just the one enigma mentioned earlier, that only 50-70% of endometriotic lesions test positive for ectopic glands and stroma. With such a significant portion of lesions potentially falling outside of the actual current definition of endometriosis, it’s clear this is an area in dire need of a systematic, first principles reassessment. This is especially true, considering that mutations in stroma and glands are, as mentioned, often associated with early stage neoplasms that are not being caught with the conventional histological staining practices. Left untreated, this particular festering scientific sinkhole will remain an inscrutable black box of mystery – and misery – that will continue to reign untold preventable suffering upon tens of thousands of endometriosis patients each year, whose early stage malignancies may be at risk for being missed due to outdated protocols.
As it turns out, we’re at a pivotal moment in history, where the advanced technologies available now present one of the greatest opportunities we’ve had in years to finally make strides toward achieving meaningful progress. AI, in particular, is uniquely positioned to unravel the seemingly impenetrable complexities of endometriosis by analyzing billions of data points with unprecedented precision. (You can check out AI for Endo now, with our Endo Bot, the Human-AI joint venture our Nezhat et al team has already launched on the nezhat.org website, which is helping to answer many complex questions about endometriosis, based off of our vetted library of peer-reviewed literature).
However, the true power lies in the global endometriosis community, our own OG and unmatched neural network of beautiful minds that, collectively, can surpass any AI alone. By working together, this resilient community holds the key to solving these seemingly insoluble quandaries that have stood in the way of progress for decades.
Team End Endo Forever, Let’s Shoot the Shot!
But, bold action will be required to move forward and certainly we’ll have to brace for some uncomfortable turbulence. Even so, there’s nothing more unstoppable than a united force for change: Indeed, something we already proved, from Team USA to Team Algeria, Argentina, Barbados, Botswana, Brazil, Cameroon, Colombia, Cyprus, Czech Republic, Democratic Republic of Congo, Ecuador, France, Germany, Greece, Guadelope Island, Hungary, India, Ireland, Israel, Italy, Jamaica, Kenya, Malaysia, Mexico, Nigeria, Northern Ireland, Panama, Peru, Poland, Portugal, Singapore, Spain, Switzerland, Sweden, Trinidad & Tobago, Uruguay, Venezuela, Zimbabwe, and 70+ more, along with Chelsea in Ohio, Nioma in California, Chandelis & Judy of Virginia Hope in Virginia, Karla in Wales, and countless other Endo Fighters of the World, there is no doubt we are destined to shake up the world and make that Mars Shot in Medicine shot of the Century, to finally free endometriosis survivors from this centuries-long saga of unconscionable indifference to the suffering of millions.
From there, we could finally have a fighting chance to fundamentally shift endometriosis healthcare in our own lifetimes, with AI-enhanced precision diagnostics guiding the way toward optimized clinical decisions and helping set the field on course toward early-stage disease detection, cancer prevention, more effective treatments, and potentially even preventive therapies. What an incredible moment this would be, to finally move beyond ineffective mouse models and outdated theoretical frameworks that have been failing patients for decades. In other words, the kind of progress patients have been calling for all along: improved patient outcomes and hope for a better future. Now that’s a future worth fighting for. – Barbara Page
Join us to help build this future
To start the ball rolling in addressing these challenges, you can join in on these conversations by clicking here to learn how you can participate in the 12th Annual Worldwide EndoMarch Conference (now ENDOMARCH-AGCES), taking place on March 28-30, 2025, where the world’s leading endometriosis experts and patient advocates will be weighing in on the subject of standardized and updated endometriosis histology protocols. For patients especially, having a platform to join in on these discussions about standards, can better equip you to take an active role in these normally inaccessible medical decisions, which exert outsized impact on your health, yet currently offer no meaningful way of participating in the sometimes irreversibly fateful outcomes. Of course, we know this is quite the Hail Mary, to presuppose that your healthcare provider would actually order additional tests for you that were requested by you (that’s a subject for a different blog). All the same, we’ll take the shot & remain hopeful that, one day soon, true patient-practitioner shared decision-making could be possible, even in spaces that have traditionally been kept under lock and key from the discerning gaze of world-wise endometriosis patients, who now know to check under the hood when it comes to all that glitters in the ever-illusory landscape of modern medicine.
Do you have a histology experience you’d like to share?
If you’d like to add to these discussions, but can’t make the live or Virtual EndoMarch conference next year, you could also share you views, or simply stay in the loop on these and other topics by clicking here to join our mailing list & receive a forthcoming full summary on best practices for endometriosis-specific immunohistochemical testing. In the interim, we’ve also compiled below a preliminary list of articles, which provide additional background on emerging advances in the field of histology and endometriosis.
Free, online endometriosis screening test
And, finally, if you suspect you or a loved one may have endometriosis, but haven’t been able to access a formal diagnosis, there’s a free screening test you can take, to at least assess your risk (with more than 90% accuracy) until you’re able to see a specialist. While this diagnostic screening tool is not meant to replace a formal diagnosis through the gold standard of video laparoscopic evaluation with biopsy, thousands of people with suspected cases of endometriosis (and/or adenomyosis) from around the world have found the test to be very helpful for determining next steps in their diagnostic journey.
Recommended reading: Recent advances in the field of endometriosis histology / immunohistochemistry:
- Endometriosis Nerve Involvement: A standardized protocol is presented to measure PGP9.5 nerve bundle density in endometriosis;
- Endometriosis Mitotic Rate: Ki-67 immunohistochemical staining to detect the rate of mitosis in endometriosis;
- Atypical Endometriosis: Prognostic importance of architectural atypia vs cytologic atypia
- HOXA11 & CD10: This combined antibody panel enhances histological detection of endometriosis, with potential for early detection of malignant transformation in progress.
