Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities
Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities
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DOI：
10.1016/s0015-0282(97)00191-x
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发表时间：
1997-10-01
影响因子：
6.7
通讯作者：
Donnez, J
中科院分区：
文献类型：
--
作者：
Nisolle, M;Donnez, J
目的：回顾腹膜、卵巢和直肠阴道异位性病变的组织发生。设计：比较每种类型病变的形态学、形态测量学和组织化学数据。设置：一所大学医院妇科。患者：主诉不孕或盆腔疼痛并经腹腔镜证实子宫内膜异位症的患者。干预：结果：腹腔镜下诊断卵巢癌有三种类型：腹膜型、卵巢型和直肠阴道型。形态学和形态测量学数据显示在位子宫内膜和红色腹膜病变之间的相似性，表明这些病变是子宫内膜腺体和间质早期着床的第一阶段。部分脱落后，红色病变不断再生。脱落引起炎症反应，引起划痕，病变变黑。随后的纤维化导致不活跃的白色混浊区域。卵巢腺瘤的发病机制一直存在争议。虽然内陷学说似乎已达成共识，但植入学说与化生学说之间仍存在矛盾。我们最近发现覆盖在卵巢上的间皮可以内陷到卵巢皮质中，将原始卵泡推回。间皮内陷与卵巢上皮性病变组织连续存在，提示卵巢上皮性病变发生化生组织发生。直肠阴道增生性结节必须考虑为腺肌瘤，由平滑肌和活跃的腺上皮组成，间质稀少。免疫细胞化学结果显示，这些病变的分化差和激素的独立性，并表明其中胚层苗勒origin.Conclusions（S）的密切关系：腹膜，卵巢和直肠阴道炎性病变必须被认为是三个独立的实体与不同的发病机制。(C)1997年，美国生殖医学会。
Objective: To review the histogenesis of peritoneal, ovarian, and rectovaginal endometriotic lesions.Design: The comparison of morphologic, morphometric, and histochemical data observed in each type of lesion.Setting: A university hospital department of gynecology.Patient(s): Patients complaining of infertility or pelvic pain with laparoscopically proved endometriosis.Intervention(s): Laparoscopy was performed, and biopsy specimens from the endometriotic lesions were histologically studied.Result(s): Three types of endometriotic lesions must be considered: peritoneal, ovarian, and rectovaginal. Morphologic and morphometric data show similarities between eutopic endometrium and red peritoneal lesions, suggesting that these lesions are the first stage of early implantation of endometrial glands and stroma. After partial shedding, the red lesions regrow constantly. The shedding induces an inflammatory reaction, provoking scarification, and the lesions become black. The subsequent fibrosis leads to areas of white opacification that are inactive. The pathogenesis of ovarian endometriomas is a source of controversy. Although there seems to be a consensus concerning the invagination theory, there is still a contradiction between the implantation theory and the metaplasia theory. We recently showed that the mesothelium covering the ovary can invaginate into the ovarian cortex, pushing back the primordial follicles. The presence of mesothelial invagination in continuum with endometriotic tissue suggests that metaplastic histogenesis of ovarian endometriotic lesions occurs. Rectovaginal endometriotic nodules must be considered adenomyomas, consisting of smooth muscle with active glandular epithelium and scanty stroma. Immunocytochemical results show poor differentiation and hormonal independence of these lesions and indicate a close relation with their mesodermal mullerian origin.Conclusion(s): Peritoneal, ovarian and rectovaginal endometriotic lesions must be considered as three separate entities with different pathogeneses. (C) 1997 by American Society for Reproductive Medicine.