Study On The Pathogenesis Of Endometriosis

Objective: To compare the different ultrastructural characteristics of eutopic and ectopic endometrium of endometriosis with normal endometrium. And to study the roles of attachment, aggression and angiogenesis in the pathogenesis of endometriosis.Methods: normal endometria, eutopic and ectopic endometria from patients with adenomyosis and ovarian endometriosis were studied with transmission electron microscope. Cell adhesion molecules, matrix proteolytic enzymes and vascular endothelial growth factor(VEGF) in above samples were also examined by means of immunohistochemical study and image analysis.Results:1. infrastructure of eutopic and ectopic endometrium in endometriosis1.1. infrastructure of glandular epithelium of normal human endometrium in the early proliferative phase5 normal endometria were all in the early proliferative phase. The glands were composed of regular columnar epithelial cells which laid on the basement membrane to form glandular lumen. The intercellular spaces were narrow. Occluding junctions and desmosomes were seen. The glandular epithelium was mostly composed of secretory cells. The microvilli on the free surface of secretory cells were short and small in number. Diffusely distributed electron-densed granules of different sizes were visible in the supranuclear area of the cells. Numerous round-shapedmitochondria appeared in the cytoplasm. Rough endoplasmic reticulum(RER) with short and narrow cisternae was diffusely distributed. The glandular cells contained many randomly distributed free ribosomes. The Golgi apparatus was seen frequently. The lipid droplets were rare. The nuclei were located in the mid-portion of the cells. They were usually rounded to oval with a smooth contour and finely distributed chromatin. The nucleoli were well developed. A few ciliated cells were usually scattered between the secretory cells. Short cilia were found on the apical aspect of these cells. Longitudinally sectioned cilia were projected from the lumen cell surface. The cilia showed the fine structure of the axoneme, such as central and peripheral microtubules. The mitochondria, RER and Golgi apparatus were similar to those of secretory cells. Free ribosomes, electron-densed granules and lipid droplets were scattered in cytoplasm. Apoptotic cell death occurred in certain glandular epithelium cells. A basement membrane which separated the epithelium from the underlying stroma was uninterrupted and straight.1.2. infrastructure of eutopic endometrium of endometriosis in the early proliferative phase6 eutopic endometrium of endometriosis were all in the early proliferative phase. In comparison to normal human endometrium, the ultrastructural features of eutopic glandular epithelium of endometriosis showed the following differences: The microvilli covering the surface of secretory cells were longer and numerous. The cilia of ciliated cells were increased and elongated remarkably. In the cytoplasm of the epithelial cell, the number of mitochondria and RER were increased obviously and RER cisternae were dilated. Diffusely distributed electron-densed granules and lipid droplets were prominent. The nuclear membrane of epithelial cells near the basement membrane showed irregularity. The basement membrane became markedly tortuous.1.3. infrastructure of ectopic glandular epithelium in adenomyosisIn comparison to normal human endometrium, the ultrastructural features of ectopic glandular epithelium of adenomyosis showed the following differences: The epithelial secretory cells of different sizes laid irregularly on the basement membrane to form glandular lumen. The microvilli covering the surface of secretory cells wereshort and numerous. The cilia of ciliated cells were increased and elongated remarkably and lined in disorder, projecting into the lumen. A lot of microvilli and cilia broke off from cell surface and shed into the lumen. The intercellular spaces between the epithelial cells became wide. Occluding junctions and desmosomes were seen. Abundent organells were found in t...