S2k-Leitlinie Diagnostik und Therapie der Endometriose – Anforderungen an die Pathologie

Lars-Christian Horn, Lars‐Christian Horn, Anne Kathrin Höhn, Stefanie Burghaus, Sebastian Daniel Schäfer, Uwe Andreas Ulrich, U. Ulrich, Dietmar Schmidt, Mitglieder der AWMF-Leitlinienkommission zur Erstellung der S2k-Leitlinie Endometriose
Der Pathologe · 2021 · vol. 43(2) , pp. 117–125 · doi:10.1007/s00292-021-00978-x · W3203593501
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This guideline outlines pathological requirements for diagnosing and treating endometriosis, including histopathological evaluation of biopsies and resections, defining adenomyosis, assessing resection margins, and analyzing associated carcinomas.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This overview summarizes the German S2k clinical guideline on diagnosis and therapy of endometriosis, focusing on what pathologists should document and how to process biopsy and resection specimens, including quality statements and pathology–clinic requirements. It defines uterine endometriosis (adenomyosis uteri) histologically as endometriotic foci in the myometrium located ≥2.5 mm from the endomyometrial border (one 100× field), and distinguishes it from reactive perilesional myometrial proliferation, while noting that this distinction is diagnostically and therapeutically considered irrelevant in practice. The paper also highlights histologic differential diagnoses, recommends an immunohistochemical panel when endometrial glands/stroma are scarce, and discusses criteria relevant to avoiding misclassification of cancers that may mimic endometriosis involvement. This paper is centrally about endometriosis — it provides pathology-specific requirements for diagnosing endometriosis/adenomyosis in uterine tissue and other anatomical sites.

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Abstract

Zusammenfassung Die vorliegende Übersicht fasst die relevanten Aspekte der S2k-Leitlinie Endometriose zusammen. Die Empfehlungen umfassen die Aufarbeitung und Befunderhebung bei Biopsien und Resektaten, die bei der klinischen Diagnose einer Endometriose entnommen wurden. Die Leitlinie berücksichtigt neben praktischen Aspekten der Pathologie ebenso die klinischen Notwendigkeiten an die Histopathologie für eine optimale Diagnostik und Therapie der Patientinnen. Basierend auf der in der pathologischen Literatur gebräuchlichsten Definition der Endometriose des Corpus uteri (Adenomyosis uteri) wurde diese in der Leitlinie definiert als der Nachweis des Endometrioseherdes im Myometrium in einem Abstand zur endomyometranen Grenze von einem mittelgroßen Gesichtsfeld (100fache Vergrößerung), was metrisch rund 2,5 mm entspricht. Bei Darmresektaten soll zum Status der Resektionsränder Stellung genommen werden. Ebenso definiert werden Anforderungen im Kontext endometrioseassoziierter Karzinome (z. B. Hormonrezeptorbestimmungen, immunhistochemische Untersuchung auf Ausfall der DNA-Mismatch-Reparaturproteine).
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Abstract

S2kguidelinesforthediagnosisandtreatmentof endometriosis—Recommendationsforpathology The present article summarises the recommendations forthe handling, histopa- thologicalworkup,diagnosticsand reporting in surgical pathologyofbiopsiesand resectionspecimensinpatientswiththeclinicaldiagnosisofendometriosis.Inaddition topractical aspects ofpathology,the guidelines alsotake into accountthe clinical requirementsforhistopathologyfortheoptimaldiagnosisandtherapyofthepatients. Basedonthedefinitionofendometriosisofthecorpusuteri(adenomyosisuteri)most commonlyusedin the pathologicalliterature, this wasdefinedin the guidelines as thedetection ofthe endometriosisfocusin themyometrium atadistancefromthe endomyometrialborderofamedium-sizedvisualfield(100×magnification),whichin metricunitscorrespondstoaround2.5mm.Inbowelresectionspecimens,thestatus oftheresectionmarginshadtobedocumentedwithinthehistopathologicalreport. Alsomentionedaretherequirementsforthereportingofcarcinomasassociatedwith endometriosis,including the immunohistochemical evaluationofsteroid hormone receptorsandmismatchrepairproteins.

Keywords

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mesh:D004715adenomyosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Endometriosis Endometriosis Female Humans Myometrium Myometrium Uterus Uterus

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