"Ectopic endometrium in human foetuses is a common event and sustains the theory of müllerianosis in the pathogenesis of endometriosis, a disease that predisposes to cancer."

Pietro G Signorile; Feliciano Baldi; Rossana Bussani; Mariarosaria D'Armiento; Maria De Falco; Alfonso Baldi

doi:10.1186/1756-9966-28-49

Endometriosis Pathophysiology

"Ectopic endometrium in human foetuses is a common event and sustains the theory of müllerianosis in the pathogenesis of endometriosis, a disease that predisposes to cancer."

Signorile PG, Baldi F, Bussani R, D'Armiento M, De Falco M, Baldi A

Published April 9, 2009 Journal of Experimental & Clinical Cancer Research, 28(1)

DOI 10.1186/1756-9966-28-49 PMID 19358700 PMC PMC2671494

RRM Academy Synopsis

Endometrial-like tissue found outside the uterus in 4 of 36 fetuses

Four of 36 female fetuses had endometrial-like tissue outside the uterus, a 2009 autopsy study found. Researchers stained the pelvic organs for two markers. The authors say this supports the müllerianosis theory of endometriosis.

Key Findings

The study collected 36 human female fetuses at autopsy, none with visible alteration of the pelvic organs.
Four fetuses (11% of cases) carried organoid structures outside the uterine cavity that resembled primitive endometrium.
The structures expressed both CA125 and the estrogen receptor.
Locations were the recto-vaginal septum, the area near the Douglas pouch, tissue behind the uterus, the muscle layer of the rectum, and the uterine wall.
The authors compare the 11% with endometriosis prevalence in the general female population, given as 6–10%.

Interpretation

This autopsy study examined fetal pelvic organs under a microscope. The authors say the tissue found was endometrial tissue misplaced before birth, supporting the müllerianosis theory of endometriosis. The authors note that 36 fetuses are too few for firm conclusions. They say other causes cannot be ruled out. The findings support larger studies of fetal pelvic tissue.

RRM Context

Restorative reproductive medicine looks for where disease starts. The authors point to evidence against retrograde menstruation as the cause. Most women have retrograde flow, about 90%. Fewer than 15% develop endometriosis. The authors say complete surgical excision can be curative.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Endometriosis is a gynecological disease defined by the histological presence of endometrial glands and stroma outside the uterine cavity. Women with endometriosis have an increased risk of different types of malignancies, especially ovarian cancer and non-Hodgkin's lymphoma. Though there are several theories, researchers remain unsure as to the definitive cause of endometriosis. Our objective was to test the validity of the theory of müllerianosis for endometriosis, that is the misplacing of primitive endometrial tissue along the migratory pathway of foetal organogenesis

Methods

We have collected at autopsy 36 human female foetuses at different gestational age. We have performed a morphological and immunohistochemical study (expression of oestrogen receptor and CA125) on the pelvic organs of the 36 foetuses included en-block and totally analyzed.

Results

In 4 out of 36 foetuses we found presence of misplaced endometrium in five different ectopic sites: in the recto-vaginal septum, in the proximity of the Douglas pouch, in the mesenchimal tissue close to the posterior wall of the uterus, in the rectal tube at the level of muscularis propria, and in the wall of the uterus. All these sites are common location of endometriosis in women.

Conclusion

We propose that a cause of endometriosis is the dislocation of primitive endometrial tissue outside the uterine cavity during organogenesis.

Read the guide

Endometriosis Explained: Diagnosis, Excision Surgery, and the RRM Approach

Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.

22 min read

Topics

Endometriosis › Pathophysiology › Origin Theories · General Gynecology › Gynecologic Oncology › Endometrial Cancer

Pietro G Signorile, Feliciano Baldi, Rossana Bussani, Mariarosaria D'Armiento, Maria De Falco, Alfonso Baldi

P Signorile, F Baldi, R Bussani, M D'Armiento, M Falco, A Baldi

PMID 19358700 19358700 DOI 10.1186/1756-9966-28-49 10.1186/1756-9966-28-49 Signorile et al. 2009, Signorile 2009

"Ectopic endometrium in human foetuses is a common event and sustains the theory of müllerianosis in the pathogenesis of endometriosis, a disease that predisposes to cancer."

Endometrial-like tissue found outside the uterus in 4 of 36 fetuses

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Endometriosis Explained: Diagnosis, Excision Surgery, and the RRM Approach

Topics

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