Endometriosis＆Adenomyosis.ppt

2003-11-3 Endometriosis  ＆ Adenomyosis Endometriosis Definition: Abnormal growth of endometrial tissue outside the uterine cavity. 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 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. Immunologic Theory： Lose control of immunologic balance Both cellular immunity and humoral immunity change. Macrophage↑ release IL–1、IL–6、TNF、EGF、FGF etc. stimulate T、B lymphocyte proliferation and activation Activity of killer cell（NK cell and T cell）↓ Produce anti–endometrium antibody Abnormal expression of CAMs（cell adhesion molecules） The pathogenesis is unclear. multifactor Pathology – macroscopic appearance（1）： The commonest sites： Ovary（chocolate cyst） Peritoneum of the recto–vaginal cul–de–sac of the Pouch of Douglas Utero–sacral ligaments Sigmoid colon Broad ligament 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. Pathology – macroscopic appearance （2）： Less common sites： Cervix Round ligament Urinary system（bladder、ureter） Umbilicus Appendix Laparotomy scars Multiple appearances of endometriosis implants： Brownish，discolored peri