Pathogenesis of deep endometriosis
Pathogenesis of deep endometriosis
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DOI：
10.1016/j.fertnstert.2017.08.036
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发表时间：
2017-12-01
影响因子：
6.7
通讯作者：
Brosens, Ivo
中科院分区：
文献类型：
--
作者：
Gordts, Stephan;Koninckx, Philippe;Brosens, Ivo
(深层)子宫内膜异位症的病理生理机制仍不清楚。按照库伦最初的建议，将“深度超过5毫米”的定义改为“外部子宫腺肌病”。随着欧洲关于5%-10%的新生儿子宫出血的古老文献的发现，以及组织学证据表明出血是蜕膜脱落，推测出生后植入盆腔的子宫内膜干细胞/祖细胞可能是青春期甚至偶尔的初潮前盆腔子宫内膜异位症的起源。青少年子宫内膜异位症以血管生成和出血性腹膜和卵巢病变为特征。深部子宫内膜异位症在晚年的发展表明，深层浸润性子宫内膜异位症是子宫内膜异位症的延迟阶段。另一种假说是，子宫内膜异位症细胞经历了遗传或表观遗传的改变，这些特定的改变决定了发展为深部子宫内膜异位症。这符合遗传性，也符合卵巢深部囊性子宫内膜异位症的克隆性。它解释了二恶英或辐射的易感性和最终的因果影响。特殊的遗传/表观遗传改变可以解释不同的表现，因此典型的、囊性的和深部的子宫内膜异位症成为三种不同的疾病。在表观(基因)变化发生之前，细微的病变不会成为疾病。分类应反映深部子宫内膜异位症是一种特殊的疾病。总之，深部子宫内膜异位症的病理生理机制仍然存在争议，疾病进展的机制以及遗传学和表观遗传学在这一过程中的作用仍然需要揭开。((C)美国生殖医学会2017年。)
The pathophysiology of (deep) endometriosis is still unclear. As originally suggested by Cullen, change the definition "deeper than 5 mm'' to "adenomyosis externa.'' With the discovery of the old European literature on uterine bleeding in 5%-10% of the neonates and histologic evidence that the bleeding represents decidual shedding, it is postulated/hypothesized that endometrial stem/progenitor cells, implanted in the pelvic cavity after birth, may be at the origin of adolescent and even the occasionally premenarcheal pelvic endometriosis. Endometriosis in the adolescent is characterized by angiogenic and hemorrhagic peritoneal and ovarian lesions. The development of deep endometriosis at a later age suggests that deep infiltrating endometriosis is a delayed stage of endometriosis. Another hypothesis is that the endometriotic cell has undergone genetic or epigenetic changes and those specific changes determine the development into deep endometriosis. This is compatible with the hereditary aspects, and with the clonality of deep and cystic ovarian endometriosis. It explains the predisposition and an eventual causal effect by dioxin or radiation. Specific genetic/epigenetic changes could explain the various expressions and thus typical, cystic, and deep endometriosis become three different diseases. Subtle lesions are not a disease until epi(genetic) changes occur. A classification should reflect that deep endometriosis is a specific disease. In conclusion the pathophysiology of deep endometriosis remains debated and the mechanisms of disease progression, as well as the role of genetics and epigenetics in the process, still needs to be unraveled. ((C) 2017 by American Society for Reproductive Medicine.)