Endometriosis: The presence of endometrial glands and stromal tissue outside the uterus.
The presence of this ectopic tissue evokes an estrogen-dependent chronic inflammatory process.

Pathological Types
Peritoneal endometriosis: (superficial implant)
Ovarian endometriomas: (Chocolate Cyst)
Deeply infiltrating disease: (extend >5 mm beneath the peritoneum) usually affects bowel, bladder and ureters.

What Are The Suggestive Signs of Endometriosis?
Pelvic tenderness                            
Fixed retroverted uterus
Tender uterosacral ligaments                
Enlarged ovaries

The diagnosis is more certain if:
Deeply infiltrating nodules are palpated on the US ligament or in the D. pouch.
Visible lesions are seen in the vagina or on the cervix.

Non Invasive Diagnosis
The use of transvaginal ultrasound is helpful in diagnosing ovarian endometriomas.
The use of serum CA-125 testing has limited value as a screening test for endometriosis.

Invasive Diagnosis(Laparoscopy)
Laparoscopy is the 'gold standard' diagnostic test in endometriosis
Less Invasive Method Mini-laparoscopy

Is Histological Confirmation Necessary for Diagnosis of Endometriosis?
Visual inspection is usually adequate but histological confirmation of at least one lesion is ideal.
In cases of ovarian endometrioma (> 3 cm in diameter), and in deeply infiltrating disease, histology should be obtained to identify endometriosis and to exclude rare instances of malignancy.

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