Endometriosis＆Adenomyosis上海交通大学医学院精….pptxVIP

会计学1Endometriosis＆Adenomyosis上海交通大学医学院精… 2Endometriosis第1页/共45页 3Definition: Abnormal growth of endometrial tissue outside the uterine cavity.第2页/共45页 4Incidence and Prevalence:Increase significantlyRange from 1～ 50% General population:1～ 2% Infertile women:30～ 50%Occurs primarily in women in 25～ 45s第3页/共45页 5Pathogenesis:Implantation Theory Retrograde Menustration Theory Sampson，1921Lymphatic and Vascular Dissemination Theory Javert，1952Coelomic Theory MeyerGenetic TheoryImmune System Dysfunction（immunologic theory）第4页/共45页 6Genetic 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.第5页/共45页 7Immunologic 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）第6页/共45页 8The pathogenesis is unclear.multifactor第7页/共45页 9Pathology – 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第8页/共45页 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. 第9页/共45页 11第10页/共45页 12Pathology – macroscopic appearance （2）：Less common sites：CervixRound ligamentUrinary system（bladder、ureter）UmbilicusAppendixLaparotomy scars第11页/共45页 13Multiple appearances of