Histological landmarks for choosing a therapeutic route in patients with overlap syndrome of genital endometriosis and benign breast disease

SV Konovalenko, A.D. Neborets, V.V. Protsenko, D.S. Androsov, A.V. Khmel, A.S. Lunko
In: INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine) · 2026 · vol. 22(1) , pp. 28–34 · doi:10.22141/2224-0721.22.1.2026.1671 · W7132852656
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This study identified proliferative mesothelial cells and atypical ductal hyperplasia in breast tissue, alongside histological signs of malignancy in 15% of endometrial samples, in women with overlap syndrome of genital endometriosis and benign breast disease.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-06 · read from full text ⓘ

This paper studied 148 women with an overlap syndrome of genital endometriosis and benign breast disease, using ultrasound-guided fine-needle aspiration biopsy of endometrioid foci and breast tissue, followed by cytological analysis and light microscopy. The authors reported that most breast/endometriosis overlap samples showed proliferative activity of mesothelial cells, and that atypia consistent with atypical ductal hyperplasia was present in 47.3% of breast tissue histological samples, while no malignant transformation was seen in any breast samples. They also found histological signs of malignancy in endometrial samples in 15% of patients, prompting immediate referral to a gynecological oncologist for surgery and adjuvant therapy; a key caveat is that the paper relies on findings from biopsy samples. This paper is centrally about endometriosis—specifically, it examines histological landmarks in patients with overlap syndrome of genital endometriosis and benign breast disease to guide diagnostic and management decisions.

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Abstract

Background. Genital endometriosis (GE) remains a very common disease, occurring in 0.5–5 % of fertile women and in 25–40 % of infertile women. Benign breast diseases (BBD) are common throughout life, from early reproductive age to the postmenopausal period, making them a potential health problem for a large number of women. The histological characteristics of endometrial and breast tissues in patients suffering from the overlap syndrome of GE and BBD are of interest, since this condition carries an increased risk of endometrial, ovarian and breast cancer. The purpose was to study and identify the most characteristic features of endometrioid tissue and ductal hyperplasia tissue of the breast in women with overlap syndrome of GE and BBD using light microscopy. Materials and methods. Histological preparations of endometrioid foci and breast hyperplasia tissues of 148 wo­men with overlap syndrome of GE and BBD were studied. The material was obtained by the method of fine-needle aspiration puncture biopsy, which was performed under ultrasound control. Cytological analysis and microphotography were performed using an Olympus CX23 microscope with different magnifications (×40, ×100 (immersion)). Results. The study showed that in the selected cohort of patients with overlap syndrome of GE and BBD, most histological samples showed proliferative activity of mesothelial cells. At the same time, morphological signs of atypia of cellular elements of atypical ductal hyperplasia were observed in 47.3 % of histological samples of breast tissue. Cells with signs of malignant transformation were not found in any of the provided breast tissue samples. It is important to note that in 15 % of patients, histological signs of malignancy were found in endometrial samples, which led to their immediate referral to a gynecological oncologist for surgical intervention and the necessary adjuvant therapy. Conclusions. In the prognosis of the clinical course of GE and BBD overlap syndrome, histological confirmation of the diagnosis and detection of signs of atypia in biopsy samples play a key role. The finding of atypi­cal cells requires clinical consultation with the participation of a gynecologist, a mammologist and a gynecological oncologist, during which a decision is made regarding surgical intervention and the necessary pharmacotherapy.
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Histological landmarks for choosing a therapeutic route in patients with overlap syndrome of genital endometriosis and benign breast disease DOI: https://doi.org/10.22141/2224-0721.22.1.2026.1671Keywords: endometriosis, benign breast disease, atypical ductal hyperplasia, overlap syndrome, endometrioid carcinoma, breast cancer, metabolic syndrome, bone metastasesAbstract Background. Genital endometriosis (GE) remains a very common disease, occurring in 0.5–5 % of fertile women and in 25–40 % of infertile women. Benign breast diseases (BBD) are common throughout life, from early reproductive age to the postmenopausal period, making them a potential health problem for a large number of women. The histological characteristics of endometrial and breast tissues in patients suffering from the overlap syndrome of GE and BBD are of interest, since this condition carries an increased risk of endometrial, ovarian and breast cancer. The purpose was to study and identify the most characteristic features of endometrioid tissue and ductal hyperplasia tissue of the breast in women with overlap syndrome of GE and BBD using light microscopy. Materials and methods. Histological preparations of endometrioid foci and breast hyperplasia tissues of 148 women with overlap syndrome of GE and BBD were studied. The material was obtained by the method of fine-needle aspiration puncture biopsy, which was performed under ultrasound control. Cytological analysis and microphotography were performed using an Olympus CX23 microscope with different magnifications (×40, ×100 (immersion)). Results. The study showed that in the selected cohort of patients with overlap syndrome of GE and BBD, most histological samples showed proliferative activity of mesothelial cells. At the same time, morphological signs of atypia of cellular elements of atypical ductal hyperplasia were observed in 47.3 % of histological samples of breast tissue. Cells with signs of malignant transformation were not found in any of the provided breast tissue samples. It is important to note that in 15 % of patients, histological signs of malignancy were found in endometrial samples, which led to their immediate referral to a gynecological oncologist for surgical intervention and the necessary adjuvant therapy. Conclusions. In the prognosis of the clinical course of GE and BBD overlap syndrome, histological confirmation of the diagnosis and detection of signs of atypia in biopsy samples play a key role. The finding of atypical cells requires clinical consultation with the participation of a gynecologist, a mammologist and a gynecological oncologist, during which a decision is made regarding surgical intervention and the necessary pharmacotherapy. Downloads References

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