The positive staining for progesterone receptor (PR), estrogen receptor (ER), and vimentin (VIM), alongside negative markers such as P40, GATA3, and CK20, supported the diagnosis of endometriosis by highlighting its hormonal dependency and mesenchymal origin, while excluding epithelial malignancies such as urothelial carcinoma. This evidence concerns the gene ESR1 and endometriosis.