Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milano, Italy.
Hum Reprod Update. 2014 Mar-Apr;20(2):217-30. doi: 10.1093/humupd/dmt053. Epub 2013 Oct 14.
Clinical data suggest that the presence of an ovarian endometrioma may cause per se damage to the surrounding otherwise healthy ovarian tissue. However, the basic research has so far done a limited job in trying to understand the potential detrimental effect of an endometrioma presence in the context of the ovarian physiology. We have reviewed the literature with the aim of characterizing the pathophysiology of the endometrioma focusing mostly on factors and mechanisms potentially affecting the surrounding, otherwise normal, ovarian tissue.
Comprehensive searches of PUBMED were conducted to identify human studies published from 1991 to 2013 in the English language on the cellular and molecular characterization of the various endometrioma components.
An endometrioma contains free iron, reactive oxygen species (ROS), proteolytic enzymes and inflammatory molecules in concentrations from tens to hundreds of times higher than those present in peripheral blood or in other types of benign cysts. The cyst fluid causes substantial changes in the endometriotic cells that it baths from gene expression modifications to genetic mutations The physical barrier between the cyst contents and the normal ovarian tissue is a thin wall composed of the ovarian cortex itself or fibroreactive tissue. ROS potentially permeating the surrounding tissues and proteolytic substances degrading the adjacent areas are likely to cause the substitution of normal ovarian cortical tissue with fibrous tissue in which the cortex-specific stroma is reduced. The fibrosis is associated with smooth muscle metaplasia and followed by follicular loss and intraovarian vascular injury. Follicular density in tissue surrounding the endometriotic cyst was consistently shown to be significantly lower than in healthy ovaries but this pathological change does not appear to be caused by the stretching of surrounding tissues owing to the presence of a cyst.
There is sufficient molecular, histological and morphological evidence, in part deriving from knowledge of the pathophysiology, to support a deleterious effect of the endometrioma on the adjacent ovarian cortical tissue, independent of the mere mechanical stretching owing to its size.
临床数据表明，卵巢子宫内膜异位症的存在本身可能会对周围健康的卵巢组织造成损害。然而，基础研究在试图理解在卵巢生理学背景下子宫内膜异位症存在的潜在有害影响方面所做的工作有限。我们回顾了文献，旨在描述子宫内膜异位症的病理生理学，主要关注可能影响周围正常卵巢组织的因素和机制。
对 PUBMED 进行了全面检索，以确定从 1991 年到 2013 年以英语发表的关于各种子宫内膜异位症成分的细胞和分子特征的人类研究。
子宫内膜异位症囊肿内含有游离铁、活性氧（ROS）、蛋白水解酶和炎症分子，其浓度比外周血或其他类型良性囊肿中的浓度高数十至数百倍。囊液使囊内细胞发生实质性变化，从基因表达修饰到基因突变。囊内容物与正常卵巢组织之间的物理屏障是由卵巢皮质本身或纤维反应性组织组成的薄壁。潜在渗透到周围组织的 ROS 和降解邻近区域的蛋白水解物质可能导致正常卵巢皮质组织被纤维组织取代，其中皮质特异性基质减少。纤维化与平滑肌化生有关，随后是卵泡丢失和卵巢内血管损伤。组织学研究表明，子宫内膜异位症囊肿周围的卵泡密度明显低于健康卵巢，但这种病理变化似乎不是由于囊肿存在导致周围组织拉伸引起的。
部分源于病理生理学知识的分子、组织学和形态学证据足以支持子宫内膜异位症对相邻卵巢皮质组织的有害影响，而不仅仅是由于其大小引起的机械拉伸。
