[en] OBJECTIVES: To compare histologically and stereologically the endometriotic nodule of the rectovaginal septum to peritoneal endometriosis.
DESIGN:
Morphometric investigation, cytokeratin and vimentin content, and steroid receptor evaluation were performed on endometriotic tissue from the peritoneum (n = 52) and rectovaginal nodules (n = 68).
SETTING:
An academic teaching hospital.
PATIENTS:
Biopsies were taken from 120 patients undergoing a laparoscopy for infertility and/ or pelvic pain (52 from typical black peritoneal endometriotic implants and 68 from endometriotic nodule of the rectovaginal septum). None of the patients were treated.
RESULTS:
Mitotic activity was found to be significantly different in peritoneal and rectovaginal endometriosis. The evaluation suggested that the stroma is not mandatory for the invasion of glandular epithelium in the rectovaginal nodule, which is, like a adenomyoma, a circumscribed nodular aggregate of smooth muscle and glandular elements. Cytokeratin and vimentin content as well as the estrogen receptor (ER) and P receptor (PR) content were significantly lower in both types of lesion when compared with eutopic endometrium. But vimentin immunoreactivity in epithelium, as well as the ER and PR content, were significantly lower in nodules when compared with black peritoneal lesions.
CONCLUSION:
It is suggested that the rectovaginal endometriotic nodule is a different disease from peritoneal endometriosis and must be called rectovaginal adenomyosis or rectovaginal adenomyoma. Its histopathogenesis probably is not related to the implantation of regurgitated endometrial cells but to the metaplasia of Müllerian rests.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Donnez, Jacques
NISOLLE, Michelle ; Centre Hospitalier Universitaire de Liège - CHU > Gynécologie-Obstétrique CHR
Smoes, Pierre
Gillet, Nadine
Beguin, Sandrine
Casanas-Roux, Françoise
Language :
English
Title :
Peritoneal endometriosis and "endometriotic" nodules of the rectovaginal septum are two different entities.
R.P.S. Jansen P. Russel Non-pigmented endometriosis: clinical laparoscopic and pathologic definition Am J Obstet Gynecol 155 1986 1154 1158
D.B. Redwine The distribution of endometriosis in the pelvis by age groups and fertility Fertil Steril 47 1987 173 175
M.C. Stripling D.C. Martin D.L. Chatman R. Vander Zwaag W.M. Poston Subtle appearances of pelvic endometriosis Fertil Steril 49 1988 427 431
D.C. Martin G.D. Hubert R. Vander Zwaag F.A. El-Zeky Laparoscopic appearances of peritoneal endometriosis Fertil Steril 51 1989 63 67
M. Nisolle B. Paindaveine A. Bourdon M. Berliere F. Casanas-Roux J. Donnez Histologic study of peritoneal endometriosis in infertile women Fertil Steril 53 1990 984 988
J. Donnez M. Nisolle F. Casanas-Roux S. Bassil V. Anaf Rectovaginal septum, endometriosis or adenomyosis: laparoscopic management in a series of 231 patients Hum Reprod 10 1995 630 635
J. Donnez M. Nisolle F. Casanas-Roux Three-dimensional architectures of peritoneal endometriosis Fertil Steril 57 1992 980 983
M. Nisolle F. Casanas-Roux V. Anaf J.M. Mine J. Donnez Morphometric study of the stromal vascularization in peritoneal endometriosis Fertil Steril 59 1993 681 684
P.R. Koninckx D.C. Martin Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril 58 1992 924 928
I.A. Brosens Is mild endometriosis a progressive disease? Hum Reprod 9 1995 2209 2211
J. Donnez M. Nisolle F. Casanas-Roux P. Brion N. Da Costa Stereometric evaluation of peritoneal endometriosis and endometriotic nodules of the recto-vaginal septum Hum Reprod 11 1995 224 228
J. Donnez F. Casanas-Roux J. Caprasse J. Ferin K. Thomas Cyclic changes in ciliation, cell height, and mitotic activity in human tubal epithelium during reproductive life Fertil Steril 43 1985 554 559
M. Nisolle F. Casanas-Roux J. Donnez Coexpression of cytokeratin and vimentin in eutopic endometrium and endometriosis throughout the menstrual cycle: evaluation by a computerized method Fertil Steril 64 1995 69 75
M. Nisolle F. Casanas-Roux C. Wyns Y. de Menten P.-E. Mathieu J. Donnez Immunohistochemical analysis of estrogen and progesterone receptors in endometrium and peritoneal endometriosis: a new quantitative method Fertil Steril 62 1994 751 759
J.A. Sampson Intestinal adenomas of endometrial type Arch Surg 5 1922 217 280
H. Reich F. McGlynn J. Salvat Laparoscopic treatment of cul-de-sac obliteration secondary to rectocervical deep fibrotic endometriosis Reprod Med 36 1991 516 522
C. Zaloudek H.J. Norris Mesenchymal tumors of the uterus R. Kurman Blaustein’s pathology of the female genital tract 1987 Springer-Verlag New York 373 480
J.W. Roddick C. Conkey E.J. Jacobs The hormonal response of endometrium in endometriotic implants and its relationship to symptomatology Am J Obstet Gynecol 79 1960 1173 1177
A. Bergqvist O. Ljungberg E. Myhre Human endometrium and endometriotic tissue obtained simultaneously: a comparative histological study Int J Gynecol Pathol 3 1984 135 145
T. Mazur R.J. Kurman Normal endometrium and infertility evaluation T. Mazur R.J. Kurman Diagnosis of endometrial biopsies and curettings. A practical approach 1995 Springer-Verlag New York 7 32
L. Nakopoulou D. Minaretzia C. Tsionou M. Mastrominas Value of immunohistochemical demonstration of several epithelial markers in hyperplasia and neoplastic endometrium Gynecol Oncol 37 1990 346 353
Ph. Bouchard J. Marraoui M.R. Massai D.A. Medalie D. De Ziegler M. Perrot-Applanat Immunocytochemical localization of oestradiol and progesterone receptors in human endometrium: a tool to assess endometrial maturation Baillieres Clin Obstet Gynaecol 5 1991 107 115
Y. Hirama K. Ochiai Estrogen and progesterone receptors of the out-of-phase endometrium in female infertile patients Fertil Steril 63 1995 984 988
D.A. Metzger Cyclic changes in endometriosis implants I.A. Brosens J. Donnez The current status of endometriosis. Research and management 1993 Parthenon Publishing Carnforth, United Kingdom 89 108
P.B. Clement Endometriosis, lesions of the secondary Müllerian system, and pelvic mesothelial proliferations R.S. Kurman Blausteins’s pathology of the female genital tract 1987 Springer-Verlag New York 516 559
