1、Endometriosis AdenomyosisZhao aimin M.D., Ph.D., Professor Department Of Obstetrics & GynecologyRenji Hospital Affiliated to SJTU School of Medicine 1Endometriosis2Definition:Abnormal growth of endometrial tissue outside the uterine cavity.3Incidence and Prevalence: Increase significantly Range from
2、 1 50%General population:1 2%Infertile women:30 50% Occurs primarily in women in 25 45s4Pathogenesis: Implantation Theory Retrograde Menustration TheorySampson， 1921 Lymphatic and Vascular Dissemination TheoryJavert， 1952 Coelomic TheoryMeyer Genetic Theory Immune System Dysfunction（ immunologic the
3、ory） 5Genetic factors： Familial clustering of endometriosis is a common clinical observation. In families with endometriosis， the disease is often confined to the maternal line， and is 7 times more common in first-degree relatives than in the general population. In future studies， evaluation of DNA
4、polymorphism may identify specific genes involved in the development of endometriosis.6Immunologic Theory ： Lose control of immunologic balance Both cellular immunity and humoral immunity change. Macrophage release IL1、 IL6、 TNF、 EGF、FGF etc. stimulate T、 B lymphocyte proliferation and activation Ac
5、tivity of killer cell（ NK cell and T cell） Produce antiendometrium antibody Abnormal expression of CAMs（ cell adhesion molecules）7The pathogenesis is unclear.multifactor8Pathology macroscopic appearance （ 1）： The commonest sites： Ovary（ chocolate cyst） Peritoneum of the rectovaginal culdesac of the Pouch of Douglas Uterosacral ligaments Sigmoid colon Broad ligament9This is a section through an enlarnged 12 cm ovary to demonstrate a cystic cavity filled with old blood typical for endometriosis with formation of an endometriotic, or “chocolate“, cyst. 10
