Tao Xiang, Xie Yan, Wang Li, Gu Weiyong, Yu Xiaolei, Zhou Xianrong
Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University (X.T., L.W., W.G., X.Y. X.Z.) Department of Obstetrics and Gynecology, Yangpu Central Hospital (Y.X.), Shanghai, PR China.
Int J Gynecol Pathol. 2014 Jul;33(4):411-7. doi: 10.1097/PGP.0000000000000080.
The ectopic endometrial tissues lining the lumen of the fallopian tubes are currently defined as either "endometrial colonization" or "endometriosis" on the basis of their location within or beyond the isthmic portion of the fallopian tubes. The underlying etiology is unclear. The goal of this study was to define the fallopian endometrial lesions pathogenetically rather than anatomically. We investigated 39 cases of the ectopic endometrial tissues within the fallopian tubes, most of which exceeded the isthmus. Immunohistochemical analysis was performed to evaluate the expression of Cox-2, NF-κB, and VEGF, which are specifically expressed by classic endometriosis. Other clinicopathologic parameters were also recorded. The results indicated that the lesions that were confined to the mucosa might differ from those observed in the muscular or serosal layers, which showed significantly less surrounding inflammatory reaction and less concurrent salpingitis and other endometriotic lesions. The expression of Cox-2, NF-κB, and VEGF of the ectopic endometrial stromal cells tended to increase in the progression from the inner to the outer part of the tubes with significance. The expression of NF-κB and VEGF correlates with the microscopic findings of inflammation. Sterilization by tubal ligation exhibited a unique pattern of distribution. Except in those patients with tubal ligation, considering the different expression patterns observed in the tubal ectopic endometrial lesions, the mucosal type should be diagnosed as "endometrial colonization" wherever the lesion occurs. The others should be diagnosed as "endometriosis" to reveal the etiology identical to typical endometriotic lesions.
根据输卵管峡部内或外的位置，输卵管腔内的异位子宫内膜组织目前被定义为“子宫内膜种植”或“子宫内膜异位症”。其潜在病因尚不清楚。本研究的目的是从发病机制而非解剖学角度定义输卵管子宫内膜病变。我们调查了39例输卵管内的异位子宫内膜组织病例，其中大多数超过了峡部。进行免疫组织化学分析以评估Cox-2、NF-κB和VEGF的表达，这些因子在典型子宫内膜异位症中特异性表达。还记录了其他临床病理参数。结果表明，局限于黏膜层的病变可能与肌层或浆膜层的病变不同，后者周围炎症反应明显较少，同时合并输卵管炎和其他子宫内膜异位病变的情况也较少。异位子宫内膜基质细胞中Cox-2、NF-κB和VEGF的表达在输卵管从内到外的进程中倾向于显著增加。NF-κB和VEGF的表达与炎症的微观表现相关。输卵管结扎绝育呈现出独特的分布模式。除了输卵管结扎的患者外，考虑到在输卵管异位子宫内膜病变中观察到的不同表达模式，无论病变发生在何处，黏膜型均应诊断为“子宫内膜种植”。其他类型应诊断为“子宫内膜异位症”，以揭示与典型子宫内膜异位病变相同的病因。
