A multidisciplinary diagnostic approach to thoracic endometriosis syndrome: Insights from CT imaging, surgery, and pathology

BACKGROUND: Thoracic endometriosis syndrome (TES) is the most common extrapelvic manifestation of endometriosis, yet its classification, diagnosis, and treatment remain debated. Thoracic endometriosis syndrome has recently been proposed to be categorized into 3 types: pleural, bronchopulmonary, and diaphragmatic. OBJECTIVES: Our study aims to propose a 3-step approach - computed tomography (CT) imaging, careful intraoperative assessment, and targeted pathology - to enhance the diagnostic process and optimize the management of TES-related pneumothorax. MATERIAL AND METHODS: We retrospectively analyzed 3 cases of recurrent right-sided catamenial pneumothorax in female patients with a history of pelvic endometriosis, managed surgically at the Department of Thoracic Surgery, Medical University of Gdansk, between 2021 and 2024. All included patients underwent video-assisted thoracoscopic surgery (VATS), with comprehensive preoperative CT imaging, intraoperative lesion mapping, and postoperative histopathological examination, improving diagnostic accuracy in TES, with a possible impact on therapeutic results. RESULTS: Chest CT is essential for detecting bullous lesions, aiding in intraoperative identification and surgical treatment. Immunohistochemistry (IHC), assessing estrogen receptor (ER) and CD10 for stromal identification, improves pathological accuracy. CONCLUSIONS: This study underlines the diagnostic value of integrating imaging, intraoperative assessment, and targeted histopathology, as well as clear communication between surgeons, radiologists, and pathologists to ensure accurate diagnosis and an improved therapeutic process for patients in clinical practice.