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Pathology – Endometriosis
Definition • The existence of endometrial tissue outside the confines of the uterine cavity. The majority of cases arise within the pelvis, predominantly affecting the ovaries, uterine sacral ligaments, pelvic peritoneum, pouch of Douglas, and sigmoid colon. Endometriosis is also identified in locations beyond the pelvis, including surgical scars and the lungs, but this occurrence is less common.
Epidemiology • Prevalent, impacting up to 10% of women.
Pathogenesis Implantation theory posits that endometrial glands are expelled into the peritoneal cavity during menstruation and subsequently adhere to the peritoneal surface. This notion is supported by experiments that induce endometriosis in animals through the placement of endometrial tissue in the peritoneal cavity.
The metaplastic theory states that endometriosis develops from the metaplasia of the peritoneal surface epithelium into endometrial-type epithelium. Considering that the peritoneum and female genital tract originate from same embryological cells (coelomic epithelium), this is feasible and would explain the presence of endometriotic deposits in regions where implantation is improbable. The metastatic theory posits that endometriosis develops from the hematogenous dissemination of endometrial tissue that enters the bloodstream during menstruation. This would explain instances occurring in areas where implantation and metaplasia are unlikely, such as the lung.
Presentation: Dysmenorrhea resulting from the inflammation of endometriotic lesions during menstruation. • Subfertility due to ambiguous mechanisms, with implantation failure and/or endocrine disruption suggested as potential causes. There is scant evidence to substantiate tubal distortion as a causative factor in the majority of women.
Macroscopy • Ovarian involvement generally results in cysts with dark brown altered blood, referred to as 'chocolate cysts.' Peritoneal involvement results in tiny nodules that frequently manifest as brown or black.
Histopathology • Microscopic examination is diagnostic, revealing the presence of endometrial glands and endometrial stromal cells in tissues beyond the uterine body. Surrounding hemorrhage is frequently copious.
Prognosis: Endometriosis is chronic and progressive in 50% of instances. Ovarian endometriosis is considered a precursor to ovarian endometrioid carcinomas.
Definition • The existence of endometrial tissue outside the confines of the uterine cavity. The majority of cases arise within the pelvis, predominantly affecting the ovaries, uterine sacral ligaments, pelvic peritoneum, pouch of Douglas, and sigmoid colon. Endometriosis is also identified in locations beyond the pelvis, including surgical scars and the lungs, but this occurrence is less common.
Epidemiology • Prevalent, impacting up to 10% of women.
Pathogenesis Implantation theory posits that endometrial glands are expelled into the peritoneal cavity during menstruation and subsequently adhere to the peritoneal surface. This notion is supported by experiments that induce endometriosis in animals through the placement of endometrial tissue in the peritoneal cavity.
The metaplastic theory states that endometriosis develops from the metaplasia of the peritoneal surface epithelium into endometrial-type epithelium. Considering that the peritoneum and female genital tract originate from same embryological cells (coelomic epithelium), this is feasible and would explain the presence of endometriotic deposits in regions where implantation is improbable. The metastatic theory posits that endometriosis develops from the hematogenous dissemination of endometrial tissue that enters the bloodstream during menstruation. This would explain instances occurring in areas where implantation and metaplasia are unlikely, such as the lung.
Presentation: Dysmenorrhea resulting from the inflammation of endometriotic lesions during menstruation. • Subfertility due to ambiguous mechanisms, with implantation failure and/or endocrine disruption suggested as potential causes. There is scant evidence to substantiate tubal distortion as a causative factor in the majority of women.
Macroscopy • Ovarian involvement generally results in cysts with dark brown altered blood, referred to as 'chocolate cysts.' Peritoneal involvement results in tiny nodules that frequently manifest as brown or black.
Histopathology • Microscopic examination is diagnostic, revealing the presence of endometrial glands and endometrial stromal cells in tissues beyond the uterine body. Surrounding hemorrhage is frequently copious.
Prognosis: Endometriosis is chronic and progressive in 50% of instances. Ovarian endometriosis is considered a precursor to ovarian endometrioid carcinomas.
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