Stereometric evaluation of peritoneal endometriosis and endometriotic nodules of the rectovaginal septum

Abstract

A computerized morphometrical investigation was performed on endometriotic tissue from the peritoneum (n = 225) and rectovaginal nodules (n = 65) to compare histologically and stereologically the rectovaginal septum endometriotic nodule to peritoneal endometriosis. Mitotic activity, stromal vascularization and the epithelium/stroma ratio were found to be significantly different in peritoneal and rectovaginal endometriosis. The evaluation revealed a major role of glandular epithelium in rectovaginal nodules where the stroma sometimes appeared absent around glandular epithelium. The study demonstrated opposite effects of gonadotrophin-releasing hormone agonists (GnJRHa) and lynestrenol on the two lesions. Indeed, in peritoneal endometriosis, after GnRHa therapy, our study demonstrated a lower rate of mitosis and poor stromal vascularization. The same drug was unable to induce the same effects in the nodule although, in contrast, lynestrenol has a strong effect on nodule vascularization. In conclusion, it is suggested that the rectovaginal adenomyotic nodule is a specific disease, different from peritoneal endometriosis. It is not the consequence of 'deep infiltrating' endometriosis but can probably develop from Mtillerian rests present in the rectovaginal septum.

Patients with adenomyosis are more likely to have deep endometriosis

“…When the three different forms of endometriosis, peritoneal, ovarian, and that affecting the rectovaginal septum were defined, Nisolle and Donnez [43] attributed different etiopathogenies to the peritoneal form of the disease (implants resulting from retrograde menstruation) and to the deep lesions, said to correspond to an adenomyotic nodule originating from Müllerian remnants by means of metaplasia [40,41,44]. These resemble an adenomyoma, an accumulation of smooth muscle tissue and endometrial glands with scarce stroma [40,41,44].…”

“…These resemble an adenomyoma, an accumulation of smooth muscle tissue and endometrial glands with scarce stroma [40,41,44]. Well-grounded studies have shown that the nodules of deep retrocervical, and bowel endometriosis are not the result of deep infiltrative endometriosis but are similar to the nodules of adenomyosis that develop from Müllerian remnants by metaplasia [40,41,44].…”

Endometriose vesical: aspectos diagnósticos e terapêuticos

“…Recentemente, estudou-se a possibilidade de que a endometriose peritoneal e os nódulos endometrióticos no septo retovaginal fossem duas entidades distintas e foi proposto designá-las de adenomiose retovaginal 10,11 .…”

Laparoscopic management of the advanced and rectovaginal endometriosis with gastrointestinal involvement: A review of the current literature

“…Donnez et al [1] have first proposed the definition that described peritoneal and rectovaginal endometriosis as two distinct entities. They pointed that only 10% of the rectovaginal endometriosis cases result from metaplasia of the mullerian rests within the rectovaginal septum and majority of the cases stem from posterior part of the cervix.…”