Endometriosis causes
Endometriosis is a benign lesion, however the incidence of why and how such a broad formation of lesions, at present this can not be determined, but under the condition of the actual situation, the following types of pathogenic factors.
1. Plant theory put forward in 1921 Sampson endometrial menstruation through the fallopian tube with countercurrent plant doctrine. So far the theory of reflux menstruation still being accepted by the majority, which was based on pelvic reflux of menstrual blood in can be found in the survival of endometrial cells in the surgical scar endometriosis endometrium plant are strong evidence of the doctrine. But Sampson theory can not explain outside of pelvic endometriosis. In addition, iatrogenic disseminated theory also support the plant, such as a typical example is the palace from fetal autopsy after the abdominal wall scar endometriosis accounted for abdominal wall scar endometriosis about 90%.
2. Blood - the lymphatic spread of the doctrine of endometrial tissue through blood and lymph to distant metastasis, but the whole body of endometriosis should not be so rare. Is it related to the immune function, and so far no final conclusion.
3. Coelom metaplasia theory so far this theory has not been sufficient clinical reports and experimental evidence.
4. Immunological theory of immune mechanisms in endometriosis of the occurrence and development play an important role in such aspect. In recent years, studies have shown that the incidence of endometriosis may promote immune suppression and immune imbalance caused by out-of-control immune cause. The development of the disease at an early performance of the active body's immune response, when the NK-macrophage increase in the number of lymphocytes increased, enhanced cytotoxicity, start a number of ways to clear ectopic endometrial fragments. However, the harmful release of endometrial tissue factor (such as immune inhibitory factor) and the interaction between growth and decline of the immune system process, induced by the immune system to release a series of feedback factor, the synergies to further suppression of the immune activity of cells to the removal of ectopic endometrium, and the immune system to promote the situation reversed for immunization, that is, by the immune cells to release a series of active factor to promote endometriotic the plant, adhesion hyperplasia clinical characteristics of the disease and its possible for the monoclonal antibody activation model, indicating that it is autoimmune disease characteristics.
Pathogenesis:
Endometriosis as the main pathological changes in ectopic endometrium with ovarian hormones happen cyclical bleeding, accompanied by the surrounding fibrous tissue proliferation and adhesion formation. Endometriosis usually multiple lesions, there is superficial, and it can have deeper invasion, deep infiltration and extensive lesions, can cause pelvic organs, peritoneal surfaces and bowel adhesions agglomerans. Can be seen in the lesion area purple-brown spots or vesicles, may eventually develop into a size ranging from violet blue nodule or mass in real terms. Endometriosis lesions performance depends primarily on the appearance of lesions The length of time, location, size and depth of invasion vary. Endometriosis well site.
1. Ovarian endometriosis ovarian endometriosis most often, it was reported that occurred in ovarian endometriosis is 40% ~ 50%, about 80% involved the side of the ovary, 50% at the same time involved in the early ovariectomy can be seen in the ovarian surface ash red, brown, blue lesion area. With the development of disease, ectopic endometrium to invasive endometriotic ovarian cortex from repeated bleeding may be single or multiple cyst formation, but for mostly single, known as ovarian endometriosis, cysts within the dark brown paste containing old blood, like liquid chocolate, it is also known as the ovarian chocolate cyst. At the initial stage because of this cyst perforation characteristics often are generally not grown large, the general diameter of more than 5 ~ 6cm at the following, very few but there is more than 10cm in diameter about 25cm, the cyst increases the surface blue may have brown patch mosaic. Increased menstrual bleeding cyst, intracystic increased wall stress may be a small fracture, and there is a very small amount of blood leakage, cracks were caused by leakage of peritoneal local inflammatory reaction and fibrosis of the closure, resulting in ovarian and surrounding tissue such as the uterus, broad ligament or the sigmoid colon, rectum, etc. adhesions were fixed in pelvic inside. Separation surgery is often the breakdown of the process of cyst endometriosis ovarian cyst characteristics.
2. Lower segment uterine wall, uterosacral ligament, uterine rectum, recto-vaginal septum endometriosis in these areas are in the lower pelvic areas, and menstruation endometrial debris in contact with the most opportunities, and are thus Endometriosis good site. Lesions at these sites for blue, brown or black nodules or fibrosis of the plaque adhesion. When the nodule or plaque located in uterosacral ligament separated from the rectum or vagina, even smaller lesions can still hit. With the development of lesions may be involved ovariectomy, vaginal septum rectum and causing extensive pelvic adhesions, so that the uterus rectum shallow or disappeared. Uterosacral ligament and rectal sites invasive lesions can develop into the rectum and vagina, Vagina inspection form may be found in nodules, to the vaginal vault or rectum after the prominent involvement of the muscularis rectum can be caused by the formation of adhesions adhesions lumen, but rarely penetrate the rectal mucosa.
3. Cervix, vagina, genitals of endometriosis these parts of endometriosis generally rare, and generally not typical symptoms of vaginal endometriosis rectal possible by uterine lesions spread COME. Cervical lesions of endometriosis by the former probably because of the cervix, such as electrocautery or laser surgery wound not healing and menstrual by plant detritus due to endometriosis, cervical deep lesions may also be the Department of rectal uterine ectopic foci directly from the spread. Genitals of endometriosis may also be because of childbirth endometrial genital wounds in the plant due. Cervical part of the surface of ectopic cervical lesions can be seen small particles of blue or purple; Vagina Department of lesions for the purple blue hardware section or more polypoid protrusions; genital lesions at the lesion site could be hit hard section, and with the menstrual cycle and changes in menstrual increased pain by narrowing after symptoms disappear.
4. Tubal endometriosis fallopian tubes are generally less directly involved, even in its wall serosal layer to see the purple blue spots or small nodules, fallopian tubes and adhesions around the lesions, resulting in fallopian tube fallopian tube affected by the twist peristalsis, but the general tubal patency. It has been reported in the literature of tubal endometriosis, 10% mesangial tubal endometriosis accounted for 10%.
5. Bowel endometriosis intestinal endometriosis is rare, can be extended to the appendix, cecum and sigmoid colon, rectum, such as one of appendiceal endometriosis accounted for intestinal endometriosis 17 % 7% of the cecum and colorectal 71% of the site. Pelvic endometriosis involving the appendix at the same time, about 1%. It has been reported in the literature abroad in endometriosis rectal endometriosis accounted for 5% ~ 10% of appendectomy and other intestinal,endometriosis accounted for 2% ~ 5%. Lesions at these sites, first of all violations of the intestinal serosa layer, muscular layer depth, forming hard nodules, scars, intestinal adhesions caused deformation, narrow, but generally do not violated mucosa, the integrity of intestinal mucosa.
6. Urinary tract endometriosis Urinary tract endometriosis, including bladder, ureter, urethra and kidney endometriosis. Urinary tract endometriosis all about endometriosis involving one of the 1.2% accounted for 84 percent of bladder, ureter and 15%, kidney and urethra rarely. Lesions involving the bladder trigone, the patient may be frequent urination, urgency,urinate pain,because of non-infringement of bladder mucosa, are generally not associated with hematuria. However, if the lesions, and menstrual period because of congestive mucosa may have a slight hematuria. Microscope at the bladder, the majority of patients can show submucosal mass was protruding purple blue, purple menstrual deepened. Endometriosis is when the transgression and ureteral lesions can happen ureteral obstruction; if the ureter surrounding tissue such as uterosacral ligament, Organize beside uterus,happen endometriosis, the lesions may be involved ureter, may be caused by partial ureteral happened twist , narrow, obstruction, and subsequent expansion of the ureter, hydronephrosis, etc..
7. Abdominal wall endometriosis is generally seen in the post-operative abdominal wall scar endometriosis surgery are directly caused by plant. Generally occurred in a few months after surgery to several years of abdominal surgery scar at the site of emergence of hard-Day happened menstrual period pain, increase hardware section. Many lesions often located around the rectus sheath and rectus sheath involving the rectus abdominis, the abdominal wall skin lesions such as abuse, can puncture skin, menstrual bleeding, when visible lesions. Cut surface lesions slightly off-white or yellow, can be seen in more than a brown liquid containing a small capsule.
8. Other parts of endometriosis Endometriosis may happen in the above-mentioned location outside, but also occurred in other parts of the body such as inguinal, umbilical lungs, diaphragm and other parts, but on very rare clinical. Happened in these parts of endometriosis lesions can occur cyclical pain, and touch on mass if parts of the lung or diaphragmatic lesions, can be found, such as film or CT. Exacerbate symptoms in the menstrual period, increased lesion. If the umbilical endometriosis may have umbilical pain, Purple-blue subcutaneous nodules, and there is menstrual blood or brown liquid from the umbilical outflow occurred in the lungs such as endometriosis, may appear cyclical hemoptysis
Endoscopic examination endometriosis typical structure can be seen in the lesions of endometrial epithelium, endometrial glands or adenoid structure of endometrial stromal and bleeding. Lesions smaller regions to see a more normal endometrial tissue, and hemosiderin macrophages in late cases, because of repeated bleeding, the typical organizational structure may be damaged and difficult to discover, and clinical and endoscopic disease seized seen inconsistent situation, a very typical clinical manifestations and pathological characteristics of endometriosis rarely. Vervon et al (1986) in accordance with the naked eye can see lesions seen color combination of microscopy and the amount of hemosiderin, the endometriosis is divided into 4 groups: ① color red, or translucent, often microscopic examination of endometrial glands and interstitial hemosiderin no or only a small amount; ② color red brown, microscopic examination also found glands and stroma, hemosiderin is less than 25%; ③ microscope dark brown color was seen scattered in the endometrial samples cells, hemosiderin for 25% ~ 50%; ④ black lesions, microscopic examination can not see endometrial cells, and hemosiderin more than 50%. Ectopic endometrium at the role of ovarian hormone secretion, it is also happen to cyclical changes, but the change is not necessarily synchronous endometrial changes, and often for many proliferative phase changes are because the surrounding ectopic endometrial tissue caused by insufficient blood supply of the relevant
9. Endometriosis variants of malignant disease cases malignant transformation are rare malignant transformation rate of <1%, the collection of world literature 100 cases of dissatisfaction. More prone to malignant transformation in the ovarian chocolate cyst, usually malignant transformation to adenocarcinoma. Benign ovarian chocolate cyst wall red or dark brown mixed, according to the scope and duration of bleeding may be; probably thin wall or thick smooth velvet-like may, in accordance with fibrous tissue or function of the number of the endometrium. Such as found in intracavitary papillary or polypoid lesions should be considered for possible malignant pathological diagnostic criteria are as follows: ① to be benign ovarian endometriosis sites. ② really must be one of the adenocarcinoma. ③ must be confirmed from the benign to malignant transition zone exist.