Department of Gynaecology, Women's Hospital, School of Medicine, Zhejiang University, 310006, Hangzhou, P.R. China.
Department of Drug and Pharmacology, Ningbo Institute of Medical Science, Ningbo, 315000, P.R. China.
J Ovarian Res. 2022 Jul 30;15(1):89. doi: 10.1186/s13048-022-01018-9.
Many factors can affect the recurrence of endometriosis after surgery, however, whether endometriotic cyst fluid contributes to endometriosis recurrence after surgical excision of ovarian endometriomas remains unclear. The objective of this study was to determine the presence of endometrial cells in ovarian endometriosis cyst fluid and the potential differences between these cells and those in the cyst wall.
Samples of cyst fluid (n = 39) and drainage fluid (n = 14) were collected from patients with ovarian endometriomas undergoing laparoscopic surgery. Drainage fluid from 14 patients without endometriosis was used as a control. The presence of endometrial cells in cyst fluid and drainage fluid was determined by cell culture in vitro and immunostaining. In addition, cyst fluid endometrial fragments and viscosity were analysed by transcriptome sequencing analysis and apparent diffusion coefficients, respectively. An animal model was used to confirm the ability of endometrial cells in cyst fluid to form new lesions.
We found endometrium-like tissues in 71.8% (28/39) of cyst fluid and 71.4% (10/14) of drainage fluid samples by histopathological examination, and the presence of endometrioid tissue in cyst fluid was related to the viscosity of the cyst fluid. The living endometrial cells in cyst fluid and drainage fluid were confirmed by cell culture in vitro and immunostaining. Moreover, the adhesion ability of endometrial fragments in cyst fluid was significantly higher than that of ectopic tissues in the cyst wall (P < 0.05). In addition, living endometrial cells in the cyst fluid were able to adhere and alive in the animal model.
The existence of living endometrial cells with high adhesion ability in ovarian endometriotic cyst fluid may contribute to the recurrence of endometriosis after surgical excision of endometriomas due to cyst fluid outflow during the surgical procedure.
许多因素会影响手术后子宫内膜异位症的复发，但手术切除卵巢子宫内膜异位囊肿后，囊液是否有助于子宫内膜异位症的复发尚不清楚。本研究的目的是确定卵巢子宫内膜异位囊肿液中是否存在子宫内膜细胞，以及这些细胞与囊壁细胞之间的潜在差异。
收集腹腔镜手术治疗的卵巢子宫内膜异位囊肿患者的囊液（n=39）和引流液（n=14）样本。14 例无子宫内膜异位症的引流液作为对照。通过体外细胞培养和免疫染色法检测囊液和引流液中是否存在子宫内膜细胞。此外，通过转录组测序分析和表观扩散系数分别分析囊液中子宫内膜碎片和粘度。使用动物模型来验证囊液中的子宫内膜细胞形成新病灶的能力。
组织学检查发现，71.8%（28/39）的囊液和 71.4%（10/14）的引流液样本中存在类似子宫内膜的组织，囊液中存在子宫内膜样组织与囊液的粘度有关。通过体外细胞培养和免疫染色证实了囊液和引流液中存在活的子宫内膜细胞。此外，囊液中子宫内膜碎片的黏附能力明显高于囊壁异位组织（P<0.05）。此外，囊液中的活子宫内膜细胞在动物模型中能够黏附和存活。
卵巢子宫内膜异位囊肿液中存在具有高黏附能力的活子宫内膜细胞，可能是由于手术过程中囊液流出，导致手术后子宫内膜异位症复发。
