上海交通大学医学院：《妇产科学》（双语） 7 Endometriosis Adenomyosis

三 endometriosis Adenomyosis 2003-11-3

2003-11-3 1 Endometriosis ＆ Adenomyosis

三 ndometriosis 2003-11-3 2

2003-11-3 2 Endometriosis

Definition Abnormal growth of endometrial tissue outside the uterine cavity. 2003-11-3

2003-11-3 3 Definition: Abnormal growth of endometrial tissue outside the uterine cavity

Incidence and Prevalence Increase significantl Range from 1 50% General population: 12%o Infertile women: 30 50% Occurs primarily in women in 25 45s 2003-11-3

2003-11-3 4 Incidence and Prevalence: • Increase significantly • Range from 1～ 50% General population:1～ 2% Infertile women:30～ 50% • Occurs primarily in women in 25～ 45s

Pathogenesis Implantation Theory Retrograde Menstration Theory Sampson, 1921 Lymphatic and vascular dissemination Theory Javert, 1952 · Coelomic Theory Meyer Genetic Theory Immune System Dysfunction (immunologic theory 2003-11-3

2003-11-3 5 Pathogenesis: • Implantation Theory Retrograde Menustration Theory Sampson，1921 • Lymphatic and Vascular Dissemination Theory Javert，1952 • Coelomic Theory Meyer • Genetic Theory • Immune System Dysfunction（immunologic theory）

Genetic factors Familial clustering of endometriosis is a common clinical observation In families with endometriosis the disease is often confined to the maternal line, and is 7 times more common in first-degree relatives than in the general population In future studies, evaluation of dNa polymorphism may identify specific genes involved in the development of endometriosis 2003-11-3 6

2003-11-3 6 Genetic factors： • Familial clustering of endometriosis is a common clinical observation. • In families with endometriosis，the disease is often confined to the maternal line，and is 7 times more common in first-degree relatives than in the general population. • In future studies，evaluation of DNA polymorphism may identify specific genes involved in the development of endometriosis

Immunologic Theory: Lose control of immunologic balance Both cellular immunity and humoral immunity change 1) Macrophage↑- release l-1、IL6、TNF、EGF、 FGF etc.- stimulate t b lymphocyte proliferation and activation 2) Activity of killer cell (nK cell and T cell) 3)Produce anti-endometrium antibody 4) Abnormal expression of CAMs(cell adhesion molecules 2003-11-3

2003-11-3 7 Immunologic Theory： • Lose control of immunologic balance • Both cellular immunity and humoral immunity change. 1) Macrophage↑ release IL–1、IL–6、TNF、EGF、 FGF etc. stimulate T、B lymphocyte proliferation and activation 2) Activity of killer cell（NK cell and T cell）↓ 3) Produce anti–endometrium antibody 4) Abnormal expression of CAMs（cell adhesion molecules）

The pathogenesis Is unclear multifactor 2003-11-3

2003-11-3 8 • The pathogenesis is unclear. • multifactor

Pathology macroscopic appearance (1): The commonest sites 1. Ovary chocolate cyst) 2. Peritoneum of the recto-vaginal cul-de- sac of the pouch of douglas 3. Utero-sacral ligaments 4. Sigmoid colon 5. Broad ligament 2003-11-3

2003-11-3 9 Pathology – macroscopic appearance（1）： • The commonest sites： 1. Ovary（chocolate cyst） 2. Peritoneum of the recto–vaginal cul–de– sac of the Pouch of Douglas 3. Utero–sacral ligaments 4. Sigmoid colon 5. Broad ligament

This is a section through an enlarged 12 cm ovary to demonstrate a cystic cavity filled with old blood typical for endometriosis with formation of an endometriotic. or chocolate, cyst 2003-11-3

2003-11-3 10 This is a section through an enlarnged 12 cm ovary to demonstrate a cystic cavity filled with old blood typical for endometriosis with formation of an endometriotic, or "chocolate", cyst