Department of Obstetrics and Gynecology, Dalian Municipal Women and Children's Medical Center (Group), Dalian City, China.
Department of Pathology, Dalian Municipal Women and Children's Medical Center (Group), Dalian City, China.
Ann Med. 2023;55(2):2244877. doi: 10.1080/07853890.2023.2244877.
The present study aims to investigate the clinical and histopathological features of peritoneal endometriosis (PEM) and deep infiltrating endometriosis (DIE).
A total of 100 patients with PEM and DIE admitted to Dalian Women and Children's Hospital/Dalian Women and Children's Medical Center between October 2018 and December 2021 were selected as the study subjects. One hundred and thirty-one PEM specimens and 37 DIE were collected, 22 cases of these patients' eutopic endometrium were used as control (15 in PEM, seven in DIE). The present study mainly analysed the pelvic distribution, the histopathological and immunohistochemical features and peritoneal invasion of PEM and DIE.
The main distribution of PEM and DIE was located in the posterior pelvic cavity ( < .001). The histopathological characteristics of different PEM forms were different: the contents of endometrioid glands, endometrioid stroma, smooth muscle, fibrous tissue and blood vessels in different lesions were statistically significant (all < .050). Estrogen receptor (ER) of PEM and DIE was highly expressed in endometrioid glandular epithelium and endometrioid stroma, without statistical significance ( = .330/.113). Progesterone receptor (PR) was also highly expressed in endometrioid glandular epithelium and endometrioid stroma without statistical significance ( = .757/.798). Ki-67 expression of DIE in endometrioid glandular epithelium was significantly higher than that in brown and white lesions ( < .001), while its expression in the endometrioid stroma was not statistically significant in red lesions ( = .070), but higher than that in other PEM lesions ( < .001). Different morphological lesions had different invasiveness rates and depths of invasion to the peritoneum. White lesions had a deeper subperitoneal invasion level than transparent and vesicular lesions.
Although different morphological appearance of PEM is a degenerative process, some active brown lesions of PEM have invasive effects during the process and may further develop into DIE. PEM and DIE may be different developmental stages of the same disease.
本研究旨在探讨腹膜子宫内膜异位症（PEM）和深部浸润性子宫内膜异位症（DIE）的临床和组织病理学特征。
选取 2018 年 10 月至 2021 年 12 月大连妇女儿童医疗中心收治的 PEM 和 DIE 患者 100 例为研究对象，采集 PEM 标本 131 例，DIE 标本 37 例，患者在位内膜 22 例作为对照（PEM 中 15 例，DIE 中 7 例）。本研究主要分析 PEM 和 DIE 的盆腔分布、组织病理学和免疫组织化学特征及腹膜浸润情况。
PEM 和 DIE 的主要分布部位均位于后盆腔（<0.001）。不同 PEM 类型的组织病理学特征不同：不同病变中子宫内膜样腺体、子宫内膜样间质、平滑肌、纤维组织和血管含量差异均有统计学意义（均<0.050）。PEM 和 DIE 的雌激素受体（ER）在子宫内膜样腺上皮和子宫内膜样间质中高表达，差异无统计学意义（=0.330/0.113）。孕激素受体（PR）在子宫内膜样腺上皮和子宫内膜样间质中也高表达，差异无统计学意义（=0.757/0.798）。DIE 的子宫内膜样腺上皮 Ki-67 表达在棕色和白色病变中显著高于红色病变（<0.001），而在红色病变中红色病变的子宫内膜样间质表达差异无统计学意义（=0.070），但高于其他 PEM 病变（<0.001）。不同形态病变的腹膜浸润率和浸润深度不同。白色病变的腹膜下浸润水平比透明和囊泡病变深。
尽管 PEM 的不同形态表现是一种退行性过程，但 PEM 的一些活跃的棕色病变在这个过程中具有侵袭性作用，可能进一步发展为 DIE。PEM 和 DIE 可能是同一疾病的不同发展阶段。
