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Current thinking on the pathogenesis of endometriosis
Jacques Donnez1, Anne Van Langendonckt, Françcoise Casanas-Roux
1Department of Gynecology, Catholic University of Louvain, Cliniques Universitaires St-Luc, Brussels, Belgium. donnez@gyne.ucl.ac.be
Gynecologic and Obstetric Investigation
|November 21, 2002
Summary
This review explores endometriosis pathogenesis, explaining peritoneal endometriosis via transplantation theory and retroperitoneal adenomyosis via Müllerian remnant metaplasia. Understanding these distinct origins is key for endometriosis research.
Area of Science:
- Gynecology
- Pathology
- Reproductive Medicine
Background:
- Endometriosis pathogenesis remains incompletely understood.
- Peritoneal endometriosis and retroperitoneal adenomyosis have distinct proposed origins.
- Existing theories require refinement to explain observed lesion characteristics.
Purpose of the Study:
- To review and synthesize novel concepts on the pathogenesis of peritoneal endometriosis and retroperitoneal adenomyosis.
- To elucidate the evolutionary stages of peritoneal endometriosis based on lesion appearance.
- To differentiate the histopathogenesis of retroperitoneal adenomyosis from endometrial implantation.
Main Methods:
- Review of current literature and emerging hypotheses on endometriosis.
- Analysis of the transplantation theory for peritoneal endometriosis.
- Examination of Müllerian remnant metaplasia as a mechanism for retroperitoneal adenomyosis.
Main Results:
- Peritoneal endometriosis progression (black, red, white lesions) aligns with transplantation theory, with red lesions representing the initial, highly vascularized stage.
- Retroperitoneal adenomyosis arises from metaplasia of Müllerian remnants in the rectovaginal septum, not endometrial cell implantation.
- This metaplasia leads to smooth muscle proliferation, mimicking endometrial adenomyosis.
Conclusions:
- The transplantation theory provides a framework for understanding peritoneal endometriosis evolution.
- Retroperitoneal adenomyosis pathogenesis involves Müllerian remnant metaplasia, distinct from endometriosis implantation.
- Clarifying these distinct pathways is crucial for advancing endometriosis and adenomyosis research.