Endometriosis Externa or Endometriosis

Endometriosis externa or endometriosis - is a disease characterized by presence of tissues morphologically, biologically and functionally similar to normal endometrium (i.e. it contains functional end glands & stroma) at ectopic locations other than the uterine mucosa - is a disease of contrast because it is benign, not a neoplastic condition but however it is locally invasive, disseminates widely & also has malignant transformation potential - Prevalence: 10% ; 30-40% in infertile women; increased prevalence due to: Real increase Delayed marriage Postponement of 1st conception

Apparent increase ed diagnostic procedures (laparoscopy, laparotomy) ed awareness about disease complex among gynaecologists

Small family norm - Sites of endometriosis: Abdominal Ovary (+nce of gonadal steroids) Pelvic peritoneum

Pouch of Douglas / Cul-de-sac / rectovaginal pouch Uterosacral ligament Broad ligament

Extra-abdominal Umbilicus

Remote Lungs

Abdominal scar of hysterectomy, myomectomy, tubectomy, caesarean section Episiotomy scar

Pleura

Vagina

Deep tissues of thighs Nasal mucosa

Cervix

Deep tissues of arms

Rectovaginal septum Rectum Pelvic lymph nodes Gut, appendix KUB Abdominal: Extrabdominal: structures below uncommon; only in the level of susceptible women umbilicus; most common site; uncommon ones are KUB, gut, appendix

Remote: rare

- Pathogenesis: Theory Retrograde menstruation (Sampson's theory)

Coelomic metaplasia (Meyer & Ivanoff)

Direct implantation

Description Menstruation-RM per se thru UTs + genetic factors—implantation (ovaries, USL) --- + ovarian hormones--cyclic growth & shedding— endometriosis Chronic irritation of peritoneum by blood + mullerian t/s remnants in peritoneum -------CM------normal endometrium Implantation & growth of endometrial & decidual t/s at ectopic

Applicable to Pelvic endometriosis

Endometriosis of umbilicus, abdominal viscera, pelvic peritoneum, RVS Endometriosis of abdominal scar, episiotomy scar,

Lymphatic theory (Halban)

Vascular theory

sites in susceptible women Normal endometrium---metastasize thru draining lymphatic channels of uterus---to pelvic LNs Hematogenous spread

Environment theory

Somatic mutations of cells due to environmental pollutants, dioxins

Genetic & immunological factors

Genetic factors: