Digestive system deep infiltrating endometriosis: What do we know
Wenze Yin1, Xiaoqing Li2, Peng Liu3
1Department of Hepatic Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Journal of Cellular and Molecular Medicine
|August 26, 2023
Summary
Digestive system infiltrating endometriosis (DSIE) is a rare condition mimicking cancer. Understanding its unique mechanisms, like nerve recruitment and fibrosis, is crucial for developing new treatments beyond surgery.
Area of Science:
- Gastroenterology
- Gynecology
- Oncology
Background:
- Digestive system infiltrating endometriosis (DSIE) is an uncommon manifestation of endometriosis.
- It commonly affects the intestines, liver, gallbladder, and pancreas.
- DSIE shares symptoms with general endometriosis but includes unique gastrointestinal issues like obstruction and bleeding.
Purpose of the Study:
- To elucidate the unique biological behavior and pathophysiological mechanisms of DSIE.
- To highlight DSIE's distinct characteristics compared to general endometriosis.
- To underscore the need for novel therapeutic strategies.
Main Methods:
- Review of DSIE pathophysiology, including deep invasive characteristics.
- Analysis of angiogenesis patterns (angiogenesis, vasculogenesis, inosculation) and their regulation.
- Examination of neurofibril recruitment, fibrosis, and repeated tissue injury and repair (ReTIAR) mechanisms.
- Investigation of cell migration pathways (E-cadherin, N-cadherin) contributing to aggressiveness.
- Comparison of DSIE's clinical presentation and behavior to malignant tumors.
Main Results:
- DSIE exhibits deep invasive properties with lymph node metastasis, angiogenesis, nerve recruitment, and fibrosis.
- Angiogenesis in DSIE follows three patterns regulated by hypoxia-hormone cytokines.
- Nerve growth factors drive neurofibril recruitment, causing severe pain and contributing to fibrosis and aggressiveness.
- ReTIAR mechanisms, inflammation, and oxidative stress accelerate fibrosis and potential cancer-related mutations.
- DSIE's collective cell migration via E-cadherin and N-cadherin contributes to aggressiveness, leading to misdiagnosis as malignancy.
Conclusions:
- DSIE possesses unique pathophysiological mechanisms distinct from general endometriosis.
- Its aggressive behavior, nerve involvement, and potential for misdiagnosis necessitate further research.
- Novel treatments are urgently needed to effectively manage DSIE, given its complexity and resemblance to cancer.
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