Fig 1.
A scattered blue area (arrow) after a dye test (A) that was biopsied (B).
Fig 2.
Laparoscopic images during a tubal dye test.
The uterus showed a transient scattered blue color and unilateral right tubal permeability was demonstrated (A). A deep blue color of the endometriosis nodule of the right uterosacral ligament appeared after a few seconds (B) along with a progressive staining of lymphatic vessels of the infundibulopelvis ligament (C). A blue spot was seen where lymph nodes of the internal iliac vein lie (D).
Fig 3.
The photo sequence (A to D) shows the methylene blue solution that seeped through the tubes and that permeated the uterine wall (A); after a short while, only sub-perimetrial vessels remained dyed (B) and a few seconds later, a clear staining of the lymphatics surrounding di utero-ovarian artery and vein was evident (C). The dye took some minutes to reach the ovary that showed a faint blue color of the cortex beneath the tunica albuginea (D). Photo E shows an endometriosis lesion within a lymphatic vessel of the lateral abdominal wall (the inset at the lower right corner shows a higher magnification thereof) as demonstrated at immunohistochemistry. Two endometriosis foci deeply invaded the peritoneum that lined the right diaphragm (F).
Fig 4.
Laparoscopic and histologic images.
Clustered areas of the uterus were permeated by the methylene blue during a dye test that showed bilateral permeability of the tubes (A). After opening the peritoneum of the anterior broad ligament, a blue staining of the connective tissue beneath the round ligament (*) was found (B). In this case, a deep biopsy of the uterine wall where the color changed was taken and adenomyosis with ectatic lymphatic vessels was demonstrated. Deparaffinized 4-μm sections were immunostained with antibodies against CD34 and podoplanin (C and D, respectively) to confirm that the ectatic vessels were lymphatics.
Fig 5.
An apparently normal uterus (A) shaded into a peculiar blue color during a methylene blue test in a case of diffuse adenomyosis (C). Bilateral tubal permeability was demonstrated (B).
Table 1.
Patients who underwent laparoscopy for endometriosis in the study period.