{"paper_id":"26b5063e-4cf1-427e-8550-683420547e19","body_text":"Zusammenfassung\nEndometriose und Adenomyose beruhen auf der Dislozierung basalen Endometriums durch Autotraumatisierung des Uterus infolge Hyper- und Dysperistaltik als physiologische uterine Funktionen des gerichteten Spermientransportes sowie infolge eines erhöhten intrauterinen Drucks. Die Endometriose entsteht durch die transtubare Dissemination von Fragmenten der Basalis während der Menstruation und die Adenomyose durch die unmittelbare Infiltration von basalem Endometrium in das Myometrium. Dislozierte Fragmente basalen Endometriums entwickeln Organstammzellcharakter und formen alle morphologischen Elemente des primordialen Uterus oder der Archimetra. Auch die peristromale Muskulatur der Adenomyoseherde beruht auf dem paramesonephrischen Potenzial der Basalis zur Bildung von glatten Muskefasern. Die Endometrioseherde können daher als ektope \"Miniaturuteri\" angesehen werden, die wie der Uterus selbst der zyklischen Kontrolle des Ovars ausgesetzt sind. Hierzu gehören strukturelle, zellbiochemische sowie immunologische Veränderungen, die auf der Ebene des Uterus seine normalen archimetralen Funktionen ermöglichen, auf der Ebene der ektopen Herde jedoch den Krankheitscharakter ausmachen. Es liegen Hinweise vor, dass eine Erhöhung der in der Basalis lokal produzierten Östrogene, die parakrine Wirkungen entfalten, in der Kausalkette der Pathogenese von Endometriose und Adenomyose zu den initialen Veränderungen gehört.\nAbstract\nLike adenomyosis, endometriosis is primarily a disease of the archimetra. There is strong circumstantial evidence that both are derived from the basal layer of the endometrium. Furthermore, we propose that dislocated basal endometrium has stem cell character and is capable of resuming embryonic growth potential and resulting in the ectopic formation of all archimetrial components such as epithelium, stroma, and paramesonephric smooth muscle cells. In women with early-onset endometriosis and adenomyosis, dislocation of the basal endometrium most probably results from autotraumatization by uterine hyperperistalsis as a dysfunction of the uterine mechanism of rapid sperm transport. There is some evidence that, in the pathogenesis of endometriosis and adenomyosis, locally increased production of endometrial estrogen might have a prominent role in the chain of events leading to uterine hyperperistalsis. The biological mechanisms that govern normo- and hyperperistalsis, however, remain to be elucidated in detail.\nSimilar content being viewed by others\nLiteratur\nAnaf V, Simon P, Fayt I, Noel J (2000) Smooth muscles are frequent components of endometriotic lesions. Hum Reprod 15: 767–771\nAttia GR, Zeitoun K, Edwards D, Johns A, Carr BR, Bulun SE (2000) Progesterone receptor isoform A but not B is expressed in endometriosis. J Clin Endocrinol Metab 85: 2897–2902\nBartelmez GW (1957) The phases of the menstrual cycle and their interpretation in terms of the pregnancy cycle. Am J Obstet Gynecol 74: 931–955\nBartosik D, Jakobs SL, Kelly LJ (1986) Endometrial tissue in peritoneal fluid. Fertil Steril 46: 796–800\nBrosens I, Vasquez G, Deprest J, Puttemans P (1994) Pathogenesis of endometriosis. In: Nezhat CR, Berger GS, Nezhat FR, Buttram VC jr, Nezhat CH (eds) Endometriosis – Advanced Management and surgical Techniques. Springer New York\nBulletti C, Rossi S, de Ziegler D et al. (1997) The uterine contractility in endometriosis. International Meeting on Infertility and Assisted Reproductive Technology, Porto Cervo, Italy, June 11–14, 1997. Abstract Book p 129\nCullen TS (1920) The distribution of adenomyoma containing uterin mucosa. Arch Surgery 1:215–283\nDe Snoo K (1842) Das Problem der Menschwerdung im Lichte der Vergleichenden Geburthilfe. Gustav Fischer, Jena\nD'Hooghe TM, Bambra CS, Raeymaekers BM, De Jonge I, Lauweryns JM, Koninckx PR (1995) Intrapelvic injection of menstrual endometrium causes endometriosis in baboons (Papio cynocephalus and Papio anubis). Am J Obstet Gynecol 173: 125–134\nFujii S, Konishi I, Mori T (1989) Smooth muscle differentiation at endometrio-myometrial junction. An ultrastructural study. Virch Archiv A Pathal Anat 414: 105–112\nJänne O, Kaupilla A, Kokko E, Lantto T, Rönneberg L, Vihko R (1981) Estrogen and progestin receptors in endometriosis lesions, comparison with endometrial tissue. Am J Obstet Gynaecol 141: 562–566\nKaiserman-Abramof IR, Padykula HA (1989) Ultrastructural epithelial zonation of the primate endometrium (rhesus monkey). Am J Anat 184: 13–30\nKoks CA, Dunselman GA, de Goeij AF, Arends JW, Evers JL (1997) Evaluation of a menstrual cup to collect shed endometrium for in vitro studies. Fertil Steril 68: 560–564\nKoks CA, Groothuis PG, Dunselman GA, de Goeij AF, Evers JL (1999) Adhesion of shed menstrual tissue in an in-vitro model using amnion and peritoneum: a light and electron microscopic study. Hum Reprod 14: 816–822\nKonishi I, Fujii S, Okamura H, Mori T (1984) Development of smooth muscle in the human fetal uterus: an ultrastructural study. J Anat 139: 239–252\nKruitwagen RFPM, Poels L, Willemsen WNP, De Ronde,IJY, Jap PHK, Rolland R (1991) Endometrial epithelial cells in peritoneal fluid during the early follicular phase. Fertil Steril 55: 297–303\nKruitwagen RFPM, Poels L, Willemsen WNP, De Ronde,IJY, Jap PHK, Rolland R (1991) Retrograde seeding of endometrial cells by uterine-tubal flushing. Fertil Steril 56: 414–420\nKunz G, Beil D, Deininger H, Wildt L, Leyendecker G (1996) The dynamics of rapid sperm transport through the female genital tract. Evidence from vaginal sonography of uterine peristalsis (VSUP) and hysterosalpingoscintigraphy (HSSG). Hum Reprod 11: 627–632\nKunz G, Beil D, Huppert P, Leyendecker G (2000) Structural abnormalities of the uterine wall in women with endometriosis and infertility visualised by vaginal sonography and magnetic resonance imaging. Hum Reprod 15: 76–82\nKunz G, Kissler S, Wildt L, Leyendecker G (2000) Uterine peristalsis: directed sperm transport and fundal implantation of the blastocyst. In: Filicori M (ed) Endocrine Basis of Reproductive Function. Monduzzi Editore, Bologna, Italy\nLeyendecker G, Kunz G, Wildt L, Beil D, Deininger H (1996) Uterine hyperperistalsis and dysperistalsis as dysfunctions of the mechanism of rapid sperm transport in patients with endometriosis and infertility. Hum Reprod 11: 1542–1551\nLeyendecker G, Kunz G, Noe M, Herbertz M, Mall G (1998) Endometriosis: a dysfunction and disease of the archimetra. Hum Reprod Update 4: 752–762\nLeyendecker G, Kunz G, Noe M, Herbertz M, Beil D, Huppert P, Mall G (1999) Die Archimetra als neues morphologisch-funktionelles Konzept des Uterus sowie als Ort der Primärerkrankung bei Endometriose. Reproduktionsmedizin 15:356–371\nLeyendecker G (2000) Endometriosis is an entity with extreme pleiomorphism. Hum Reprod 15, 4–7\nLeyendecker G, Herbertz M, Kunz G, Mall G (2002) Endometriosis results from the dislocation of basal endometrium. Hum Reprod 17:2725–2736\nMaas JWM, Groothuis PG, Dunselman GAJ et al. (2001) Development of endometriosis-like lesions after transplantation of human endometrial fragments onto chick embryo chorioallantoic membrane. Hum Reprod 16: 627–631\nMäkäräinen L (1988) Uterine contractions in endometriosis: effects of operative and danazol treatment. J Obstet Gynecol 9: 134–138\nMeyer R (1919) Über den Stand der Frage der Adenomyositis und Adenome im allgemeinen und insbesondere über Adenomyositis seroepithelialis und Adenomyometritis sarcomatosa. Zbl Gynäkol 43:745–750\nMote PA, Balleine RL, McGowan EM, Clarke CL (2000) Heterogeneity of progesterone receptors A and B in human endometrial glands and stroma. Hum Reprod 15 [Suppl 3]: 48–56\nNisolle M, Paindaveine B. Bourdon A, Berliere M, Casanas-Roux F, Donnez J (1990) Histologic study of peritoneal endometriosis in infertile women. Fertil Steril 53: 984–988\nNisolle M, Gillerot S, Casanas-Roux F, Squifflet J, Berliere,M, Donnez J (1999) Immunohistochemical study of the proliferation index, oestrogen receptors and progesterone receptors A and B in leiomyomata and normal myometrium during the menstrual cycle and under gonadotrophin-releasing hormone agonist therapy. Hum Reprod 14: 2844–2850\nNoble LS, Simpson ER, Johns A, Bulun SE (1996) Aromatas expression in endometriosis. J Clin Endocrinol Metab 81: 174–179\nNoe M, Kunz G, Herbertz M, Mall G, Leyendecker G (1999) The cyclic pattern of the immunocytochemical expression of oestrogen and progesterone receptors in human myometrial and endometrial layers: Characterisation of the endometrial-subendometrial unit. Hum Reprod 14: 101–110\nOkulicz WC, Balsamo M, Tast J (1993) Progesterone regulation of endometrial estrogen receptor and cell proliferation during the late proliferative and secretory phase in artificial menstrual cycles in the rhesus monkey. Biol Reprod 49: 24–32\nPadykula HA, Coles LG, Okulicz WC et al. (1989) The basalis of the primate endometrium: a bifunctional germinal compartment. Biol Reprod 40: 681–690\nSalamanca A, Beltran E (1995) Subendometrial contractility in menstrual phase visualised by transvaginal sonography in patients with endometriosis. Fertl Steril 64: 193–195\nSampson JA (1927) Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynaecol 14: 422–469\nWang H, Critchley HO, Kelly RW, Shen D, Baird DT (1998) Progesterone receptor subtype B is differentially regulated in human endometrial stroma. Mol Hum Reprod 4: 407–412\nWerth R, Grusdew W (1898) Untersuchungen über die Entwicklung und Morphologie der menschlichen Uterusmuskulatur. Arch Gynäkol 55: 325–409\nWitz CA, Monotoya-Rodriguez BS, Schenken RS (1999) Whole explants of peritoneum and endometrium: a novel model of the early endometriosis lesion. Fertil Steril 71: 56–60\nZeitoun K, Takayama K, Sasano H et al. (1998) Deficient 17β-hydroxysteroid dehydrogenase type 2 expression in endometriosis: failure to metabolize 17β-estradiol. J Clin Endocrinol Metab 83: 4474–4480\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nLeyendecker, G., Mall, G., Noe, M. et al. Dislozierung basalen Endometriums. Reproduktionsmedizin 19, 181–188 (2003). https://doi.org/10.1007/s00444-003-0413-3\nIssue date:\nDOI: https://doi.org/10.1007/s00444-003-0413-3\nSchlüsselwörter\n- Endometriose\n- Adenomyose\n- Archimetra\n- Gerichteter Spermientransport\n- Hyperperistaltik und Dysperistaltik\n- Basalis","source_license":"CC0","license_restricted":false}