endometriosis＆adenomyosis上海交通大学医学院精….pptxVIP

Endometriosis ＆ Adenomyosis Zhao aimin M.D., Ph.D., Professor Department Of Obstetrics Gynecology Renji Hospital Affiliated to SJTU School of MedicineEndometriosisDefinition: Abnormal growth of endometrial tissue outside the uterine cavity.Incidence and Prevalence:Increase significantlyRange from 1～ 50% General population:1～ 2% Infertile women:30～ 50%Occurs primarily in women in 25～ 45sPathogenesis:Implantation Theory Retrograde Menustration Theory Sampson，1921Lymphatic and Vascular Dissemination Theory Javert，1952Coelomic Theory MeyerGenetic TheoryImmune 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 balanceBoth cellular immunity and humoral immunity change.Macrophage↑ release IL–1、IL–6、TNF、EGF、FGF etc. stimulate T、B lymphocyte proliferation and activationActivity of killer cell（NK cell and T cell）↓ Produce anti–endometrium antibodyAbnormal expression of CAMs（cell adhesion molecules）The pathogenesis is unclear.multifactorPathology – macroscopic appearance（1）：The commonest sites：Ovary（chocolate cyst）Peritoneum of the recto–vaginal cul–de–sac of the Pouch of DouglasUtero–sacral ligaments Sigmoid colonBroad 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：CervixRound ligamentUrinary system（bladder、ureter）UmbilicusAppendixLaparotomy scarsMultiple appearances of endometriosis implants：Brownish，discolored peritoneumSuperficial peritoneal ecchymosisRai