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In human women, oogenesis produces one mature egg cell or ovum for every precursor cell that enters meiosis. This process differs in two unique ways from the equivalent procedure of spermatogenesis in males. First, meiotic divisions during oogenesis are asymmetric, meaning that a large oocyte (containing most of the cytoplasm) and minor polar body are produced as a result of meiosis I, and again following meiosis II. Since only oocytes will go on to form embryos if fertilized, this unequal...
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Pathogenesis of deep endometriosis.

Stephan Gordts1, Philippe Koninckx2, Ivo Brosens1

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|November 5, 2017
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The pathophysiology of deep endometriosis remains unclear. New hypotheses suggest neonatal decidual shedding may seed pelvic endometriosis, with genetic/epigenetic changes driving disease progression.

Keywords:
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Area of Science:

  • Gynecology
  • Pathophysiology
  • Reproductive Medicine

Background:

  • The exact pathophysiology of deep endometriosis is not fully understood.
  • Existing definitions of endometriosis depth may require revision.
  • Neonatal uterine bleeding suggests a potential origin for early-stage endometriosis.

Purpose of the Study:

  • To explore novel hypotheses regarding the origin and progression of deep endometriosis.
  • To propose a redefinition of deep endometriosis as "adenomyosis externa."
  • To investigate the role of genetic and epigenetic factors in endometriosis development.

Main Methods:

  • Review of historical European literature on neonatal uterine bleeding.
  • Histological analysis of decidual shedding in neonates.
  • Postulation of stem/progenitor cell implantation and subsequent genetic/epigenetic modifications.

Main Results:

  • Neonatal uterine bleeding, representing decidual shedding, may provide endometrial stem/progenitor cells.
  • These cells could implant in the pelvic cavity, leading to adolescent endometriosis.
  • Genetic/epigenetic changes in endometriotic cells may drive progression to deep endometriosis.

Conclusions:

  • Deep endometriosis pathophysiology requires further elucidation.
  • Neonatal endometrial cell implantation is a plausible hypothesis for endometriosis origin.
  • Genetic and epigenetic alterations are critical in endometriosis manifestation and progression, potentially differentiating disease subtypes.