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Abstract
To review the histogenesis of peritoneal, ovarian, and rectovaginal endometriotic
lesions.
The comparison of morphologic, morphometric, and histochemical data observed in each
type of lesion.
A university hospital department of gynecology.
Patients complaining of infertility or pelvic pain with laparoscopically proved endometriosis.
Laparoscopy was performed, and biopsy specimens from the endometriotic lesions were
histologically studied.
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 müllerian origin.
Peritoneal, ovarian and rectovaginal endometriotic lesions must be considered as three
separate entities with different pathogeneses.