{"paper_id":"d491b2e2-7af6-48d2-9440-6f9b1a3a9024","body_text":"Zusammenfassung\nÄtiölogie und Pathogenese der Endometriose sind seit ihrer Erstbeschreibung bis heute Gegenstand intensiver wissenschaftlicher Forschung. Die von John. A. Sampson (1921) entwickelte Theorie der intraperitonealen Dissemination von endometrialem Gewebe durch retrograde Menstruation stellt heute die vorherrschende Sicht der Pathophysiologie der Endometriose dar, wie sie auch von einflussreichen wissenschaftlichen Gesellschaften, wie der Amercain Society of Reproductive Medicine (ASRM) und der European Society of Human Reproduction (ESHRE) vertreten wird. Sampsons Theorie hatte de facto die Trennung von pelviner Endometriose und uteriner Adenomyose in verschiedene Krankheitsbilder ohne gemeinsame Pathophysiologie zur Folge. Ursache war zunächst der Tatbestand, dass das gemeinsame Vorkommen von pelviner Endometriose und uteriner Adenomyose, ein Faktum, das durch unzählige Eingriffe und histologische Aufarbeitung des Operationsmaterials führender Kliniker und Gynäkopathologen als absolut gesichert galt, nicht mit der Sampsonschen Theorie kompatibel war. Er behalf sich mit der Auffassung, dass die uterine Adenomyose, die er als »interne Endometriose« bezeichnete, die Folge von vaskulärer Transmission sei. Obwohl sich seine Terminologie schnell international einbürgerte, konnte sich die Theorie auf Grund schwerwiegender Gegenargumente anfänglich nur schwer durchsetzen. Eine deutliche Akzeptanz erlangte seine Theorie allerdings erst dann, als die Laparoskopie zunächst als diagnostische und sehr schnell auch als operative Behandlungsmethode eingeführt wurde. Dem Operateur präsentierten sich im Wesentlichen nur noch die peritonealen Herde, während sich der Uterus zwangsläufig einer genauen Analyse entzog. Damit war die Möglichkeit einer systematischen klinischen Fehlbeurteilung (clinical bias) gegeben. Während die altvorderen Lehrmeister unseres Faches wahrscheinlich nur schwerwiegende Fälle operierten und sich ihnen oft das Vollbild der Erkrankung bot, präsentierten sich nunmehr, z. B. im Rahmen einer Sterilitätsdiagnostik oder Abklärung von Schmerzzuständen, vermehrt Frühfälle. Hinzu kam eine unvollständige Sicht der Histomorphologie. Gängige Meinung war, dass die pelvine Endometriose im Wesentlichen nur aus endometrialen Drüsen und Stroma bestünde, während die Adenomyose zusätzlich und vorwiegend durch die fibromuskuläre Komponente charakterisiert sei, die, da sie auch bei der tief infiltrierenden Endometriose vorhanden ist, dort zwangsläufig als proliferative Reaktion des umgebenden Gewebes angesehen wurde.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nPreview\nUnable to display preview. Download preview PDF.\nSimilar content being viewed by others\nLiteratur\nAbsenger Y, Hess-Stumpp H, Kreft B et al. (2004) Cyr61, a deregulated gene in endometriosis. Mol Hum Reprod 10:399–407\nAckermann PW, Salo PT, Hart DA (2009) Neuronal pathways in tendon healing. Front Biosci 14:5165–87\nAghajanova L, Hamilton A, Kwintkiewicz J et al. (2009) Steroidogenic enzyme and key decidualization marker dysregulation in endometrial stromal cells from women with versus without endometriosis. Biol Reprod 80:105–114\nAnaf V, Simon P, Fayt I et al. (2000) Smooth muscles are frequent components of endometriotic lesions. Hum Reprod 15, 767–771\nAshcroft GS, Ashworth JJ (2003) Potential role of estrogens in wound healing. Am J Clin Dermatol 4:737–743\nAttar E, Bulun SE (2006) Aromatase and other steroidogenic genes in endometriosis: translational aspects. Hum Reprod Update 12:49–56\nAttar E, Tokunaga H, Imir G et al. (2009) Prostaglandin E2 via steroidogenic factor-1 coordinately regulates transcription of steroidogenic genes necessary for estrogen synthesis in endometriosis. J Clin Endocrinol Metab 94:623–631\nBarrier BF, Malinowski IVLJ, Dick EJ jr et al. (2004) Adenomyosis in the baboon is associated with primary infertility. Fertil Steril 82, Suppl 3:1091–1094\nBird CC, Willis RA (1965) The production of smooth muscle by the endometrial stroma of the adult human uterus. J Path Bact 90, 75–81\nBrosens IA, Brosens JJ (2000) Redefining endometriosis: is deep endometriosis a progressive disease? Hum Reprod 15:1–3\nBulletti C De Ziegler D, Polli V et al. (2002) Characteristics of uterine contractility during menses in women with mild to moderate endometriosis. Fertil Steril 77:156–1161\nBulun SE, Cheng YH, Yin P et al. (2006) Progesterone resistance in endometriosis: link to failure to metabolize Ost-radiol. Mol Cell Endocrinol 248:94–103\nBulun SE (2009) Endometriosis. N Engl J Med 360:268–279\nBurney RO, Talbi S, Hamilton AE et al. (2007) Gene expression analysis of endometrium reveals progesterone resistance and candidate susceptibility genes in women with endometriosis. Endocrinology 148:3814–26\nCullenTS. (1920) The distribution of adenomyoma containing uterine mucosa. Arch Surgery 1: 215–283\nDelvoux B, Groothuis P, D'Hooghe T et al. (2009) Increased production of 17beta-Östradiol in endometriosis lesions is the result of impaired metabolism J Clin Endocrinol Metab 94:876–883\nD'Hooghe TM, Bambra CS, Raeymaekers BM et al. (1995) Intrapelvic injection of menstrual endometrium causes endometriosis in baboons (Papio cynocephalus and Papio anubis). Am J Obstet Gynecol 173,125–134\nDonnez O, Jadoul P, Squifflet J et al. (2006) latrogenic peritoneal adenomyoma after laparoscopic subtotal hysterectomy and uterine morcellation. Fertil Steril 86:1511–1512\nDueholm M, Lundorf E, Hansen ES et al. (2001) Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis. Fertil Steril 76: 588–594\nDueholm M, Lundorf E (2007) Transvaginal ultrasound or MRI for diagnosis of adenomyosis. Curr Opin Obstet Gynecol 19:505–512\nEiner-Jensen N (1988) Countercurrent transfer in the ovarian pedicle and its physiological implications. Oxford Rev Reprod Biol 10: 348–381\nEmge LA (1962) The elusive adenomyosis of the uterus. Its historical past and its present state of recognition. Am J Obste Gynecol 83:1541–1563\nESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group (2005) ESHRE guideline for the diagnosis and treatment of endometriosis Hum Reprod 20: 2698–2704\nFazleabas AT, Brudney A, Chai D et al. (2003) Steroid receptor and aromatase expression in baboon endometriotic lesions. Fertil Steril, 80 Suppl 2:820–827\nFujii S, Konishi I, Mori T (1989) Smooth muscle differentiation at endometrio-myometrial junction. An ultrastructu-ral study. Virch Archiv A Pathal Anat 414:105–112\nGarcia-Segura LM, Wozniak A, Azcoitia I et al. (1999) Aromatase expression by astrocytes after brain injury: Implications for local estrogen formation in brain repair. Neuroscience 89:567–578\nGarcia-Segura LM (2008) Aromatase in the brain: not just for reproduction anymore. J Neuroendocrinol 20:705–712\nGashaw I, Hastings JM, Jackson KS et al. (2006) Induced endometriosis in the baboon (Papio anubis) increases the expression of the proangiogenic factor CYR61 (CCN1) in eutopic and ectopic endometria. Biol Reprod 74:1060–1066\nGilliver SC, Ashworth JJ, Ashcroft GS (2007) The hormonal regulation of cutaneous wound healing. Clin Dermatol 25:56–62\nGoji K (1993) Twenty-four-hour concentration profiles of gonadotropin and Östradiol (E2) in prepubertal and early pubertal girls: the diurnal rise of E2 is opposite the nocturnal rise of gonadotropin. J Clin Endocrinol Metab 77:1629–1635\nGreene R, Stratton P, Cleary SD et al. (2009) Diagnostic experience among 4.334 women reporting surgically diagnosed endometriosis. 1: Fertil Steril 91:32–39\nGurates B, Bulun SE (2003) Endometriosis: the ultimate hormonal disease. Semin Reprod Med 21:125–134\nHadfield R M, Yudkin P L, Coe C L et al. (1997) Risk factors for endometriosis in the rhesus monkey (Macaca mulat-ta): a case-control study. Hum Reprod Update 3:109–15\nHarada M, Osuga Y, Hirota Y et al. (2005) Mechanical stretch stimulates interleukin-8 production in endometrial stromal cells: possible implications in endometrium-related events. J Clin Endocrinol Metab Feb;90(2):1144–1148\nHadjiargyrou M, Ahrens W, Rubin CT (2000) Temporal expression of the chondrogenic and angiogenic growth factor CYR61 during fracture repair. J Bone Miner Res 15:1014–1023\nHudelist G, Czerwenka K, Keckstein J et al. (2007) Expression of aromatase and estrogen sulfotransferase in eutopic and ectopic endometrium: evidence for unbalanced Östradiol production in endometriosis. Reprod Sei 14:798–805\nHudelist G, Keckstein J, Wright JT (2009) The migrating adenomyoma: past views on the etiology of adenomyosis and endometriosis. Fertil Steril 92:1536–1543\nJeffrey JE, Aspden RM (2007) Cyclooxygenase inhibition lowers prostaglandin E2 release from articular cartilage and reduces apoptosis but not proteoglycan degradation following an impact load in vitro. Arthritis ResTher 9:R129\nKaiserman-Abramof IR, Padykula HA (1989) Ultrastructural epithelial zonation of the primate endometrium (rhesusmonkey). Am J Anat 184:13–30\nKindermann (1988) Endometriose. Wesen und Entstehung. In: Käser O, Friedberg V, Ober KG et al (Hrsg) Gynäkologie und Geburtshilfe, Bd III, Teil 2. Georg Thieme Verlag, Stuttgart, 13.1–13.11\nKissler S, Schmidt M, Keller N et al. (2005) Real-time PCR analysis for estrogen receptor beta and progesterone receptor in menstrual blood samples – a new approach to a non-invasive diagnosis for endometriosis. Hum Reprod, 20 (Suppl): i179 (P-496)\nKissler S, Hamscho N, Zangos S et al. (2006) Uterotubal transport disorder in adenomyosis and endometriosis-acause for infertility. BJOG 113:902–908\nKissler S, Zangos S, Wiegratz I et al. (2007) Utero-tubal sperm transport and its impairment in endometriosis and adenomyosis. Ann N Y Acad Sei 1101:38–48\nKitawaki J, Noguchi T, Amatsu T et al. (1997) Expression of aromatase cytochrome P450 protein and messenger ribonucleic acid in human endometriotic and adenomyotic tissues but not in normal endometrium. Biol Reprod 57: 514–519\nKoninckx PR, Braet P, Kennedy SH et al. (1994) Dioxin pollution and endometriosis in Belgium. Hum Reprod 9:1001–1002\nKunz G, Beil D, Deininger H et al. (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\nKunzG, HerbertzM, Noe M etal. (1998) Sonographic evidence of a direct impact of the ovarian dominant structure on uterine function during the menstrual cycle. Hum Reprod Update 4: 667–672\nKunz G, Noe M, Herbertz M et al. (1998) Uterine peristalsis during the follicular phase of the menstrual cycle. Effects of oestrogen, antioestrogen and oxytocin. Hum Reprod Update 4:647–654\nKunz G, Beil D, Huppert P et al. (2000) Structural abnormalities of the uterine wall in women with endometriosis and infertility visualized by vaginal sonography and magnetic resonance imaging. Hum Reprod 15: 76–82\nKunz G, Kissler S, Wildt L et al. (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\nKunz G, Leyendecker G (2002) Uterine peristaltic activity during the menstrual cycle: characterization, regulation, function and dysfunction. Reprod Biomed Online 4 Suppl 3:5–9\nKunz G, Beil D, Huppert P et al. (2005) Adenomyosis in endometriosis – prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod 20: 2309–2316\nKunz G, Herbertz M, Beil D et al. (2007) Adenomyosis as a disorder of the early and late human reproductive period. Reprod Biomed Online 15:681–5\nLavaque E, Sierra A, Azcoitia I et al. (2006) Steroidogenic acute regulatory protein in the brain. Neuroscience 138:741–7\nLeyendecker G, Wildt L, Hansmann M (1980) Pregnancies following chronic intermittent (pulsatile) administration of GnRH by means of a portable pump (»Zyklomat«) – A new approach to the treatment of infertility in hypothalamic amenorrheaJ. Clin Endocrinol Metab 51:1214\nLeyendecker G, Wildt L (1983) Induction of ovulation with chronic-intermittent (pulsatile) administration of GnRHin hypothalamic amenorrhea. J Reprod Pert 69: 397\nLeyendecker G, Kunz G, Wildt L et al. (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 et al. (1998) Endometriosis: A dysfunction and disease of the archimetra. Hum Reprod Update 4: 752–762\nLeyendecker G, Kunz G, Noe M et al. (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 (2002) Neue Aspekte zur Pathogenese von Endometriose und Adenomyose. Frauenarzt 43: 297–307\nLeyendecker G, Herbertz M, Kunz G et al. (2002) Endometriosis results from the dislocation of basal endometrium. Hum Reprod 17:2725–2736\nLeyendecker G, Kunz G, Herbertz M et al. (2004) Uterine peristaltic activity and the development of endometriosis. Ann NY Acad Sei 1034: 338–355\nLeyendecker G, Kunz G, Kissler S et al. (2006) Adenomyosis and reproduction. Best Pract Res Clin Obstet Gynaecol 20:523–546\nLeyendecker G, Wildt L, Mall G (2009) The pathophysiology of endometriosis and adenomyosis. Tissue injury and repair. Arch Gynecol Obstet (31st of July; Epub ahead)\nLyons EA, Taylor PJ, Zheng, XH et al. (1991) Characterisation of subendometrial myometrial contractions throughout the menstrual cycle in normal fertile women. Fertil Steril 55: 771–775\nMäkäräinen L (1988) Uterine contractions in endometriosis: effects of operative and danazol treatment. Obstet Gynecol 9:1344–138\nMahmood TA, Templeton A (1990) Pathophysiology of mild endometriosis: review of literature. Hum Reprod 5:765–784\nMarsh EE, Laufer MR (2005) Endometriosis in premenarcheal girls who do not have an obstructive anomaly. Fertil Steril 83: 758–760\nMcBean JH, Gibson M, Brumsted JR (1996) The association of intrauterine filling defects on hysterosalpingogram with endometriosis. Fertil Steril 66:522–526\nMechsner S, Schwarz J, Thode J et al. (2007) Growth-associated protein 43-positive sensory nerve fibers accompanied by immature vessels are located in or near peritoneal endometriotic lesions. Fertil Steril 88:581–7\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\nMoen MH, Muus KM (1991) Endometriosis in pregnant and non-pregnant women at tubal Sterilisation. Hum Reprod 6:699–702\nMontgomery GW, Nyholt DR, Zhao ZZ et al. (2008) The search for genes contributing to endometriosis risk. Hum Reprod Update 14:447–457\nMowa CN, Hoch R, Montavon CL et al. (2008) Estrogen enhances wound healing in the penis of rats. Biomed Res 29:267–70\nMitzumoto Y, Furuya K, Makimura N et al. (1995) Gene expression of oxytocin receptor in human eutopic endometrial tissues. Adv Exp. Med. Biol. 395:491–493\nNoble LS, Simpson ER, Johns A et al. (1996) Aromatas expression in endometriosis. J Clin Endocrinol Metab 81:174–179\nNoble LS, Takayama K, Zeitoun KM et al. (1997) Prostaglandin E2 stimulates aromatase expression in endometrio-sis-derived stromal cells. J Clin Endocrinol Metab 82:600–606\nNoe M, Kunz G, Herbertz M et al. (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\nNyachieo A, Chai DC, Deprest J et al. (2007) The baboon as a research model for the study of endometrial biology, uterine receptivity and embryo implantation. Gynecol Obstet Invest 64:149–155\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. BiolReprod 49:24–32\nPadykula HA, Coles LG, Ökulicz WC et al. (1989) The basalis of the primate endometrium: a bifunctional germinal compartment. Biol Reprod 40: 681–690\nParazzini F, Vercellini P, Panazza S et al. (1997) Risk factors for adenomyosis. Hum Reprod 12:1275–1279\nParazzini F, Chiaffarino F, Surace M et al. (2004) Selected food intake and risk of endometriosis. Hum Reprod 19:1755–1759\nPeters H (1977) The human ovary in childhood and early maturity. Eur J Obstet Gynec Reprod Biol 9:137–144\nPhilipp E, Huber H (1939) Die Entstehung der Endometriose. Gleichzeitig ein Beitrag zur Pathologie des interstitiellen Tubenabschnittes. Zbl Gynäkol 63:7–39\nRevised American Fertility Society classification of endometriosis (1985) Fertil Steril 43:351–352\nRidley JH (1968) The histogenesis of endometriosis. Obstet Gynec Surv 23:1–35\nSalamanca A, Beitran E (1995) Subendometrial contractility in menstrual phase visualised by transvaginal sonography in patients with endometriosis. Fertl Steril 64:193–195\nSchmiedehausen K, Kat S, Albert N et al. (2003) Determination of velocity of tubar transport with dynamic hysterosalpingoscintigraphy. Aug Nucl Med Commun 24:865–70\nSalo PT, Beye JA, Seerattan RA et al. (2008) Plasticity of peptidergic innervation in healing rabbit medial collateral ligament. Can J Surg 51:167–72\nSampson JA (1927) Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynaecol 14:422–429\nShioyama R, Aoki Y, Ito H et al. (2008) Long-lasting breaches in the bladder epithelium lead to storage dysfunction with increase in bladder PGE2 levels in the rat Ann J Physiol Regul Integr Comp Physiol 295:R714–718\nSierra A, Lavaque E, Perez-Martin M et al. (2003) Steroidogenic acute regulatory protein in the rat brain: cellular distribution, developmental regulation and overexpression after injury. Eur J Neurosci 18:1458–67\nSimon C, Gutierrez A, Vidal A et al. (1994) Outcome of patients with endometriosis in assisted reproduction: results from in-vitro fertilization and oocyte donation. Hum Reprod 9: 725–729\nTakahashi K, Nagata H (1989) Clinical usefulness of determination of Östradiol levels in the menstrual blood for patients with endometriosis. Acta Obstet Gynecol Jpn 41:1849–1850\nTokushige N, Markham R, Russell P et al. (2006) High density of small nerve fibres in the functional layer of the endometrium in women with endometriosis. Hum Reprod 21:782–787\nTokushige N, Markham R, Russell P et al. (2009) Effect of progestogens and combined oral contraceptives on nerve fibers in peritoneal endometriosis. Fertil Steril 92:1234–9\nTseng JF, Ryan IP, Milam TD et al. (1996) Interleukin-6 secretion in vitro is up-regulated in ectopic and eutopic endometrial stromal cells from women with endometriosis. J Clin Endocrinol Metab 81:1118–22.\nU. S. National Library of Medicine. www.ncbi.nlm.nih.gov/PubMed/\nVercellini P, Aimi G, Panazza S et al (2000) Deep endometriosis conundrum: evidence in favor of a peritoneal origin.Fertil Steril 73:1043–1046\nDe Vries K, Lyons EA, Ballard G et al. (1990) Contractions of the inner third of the myometrium. Am J Obstet Gynaecol 162:679–682\nWeiss G, Maseelall P, Schott LL et al. (2009) Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the Study of Women's Health Across the Nation (SWAN). Fertil Steril 91:201–206\nWerth R, Grusdew W (1898) Untersuchungen über die Entwicklung und Morphologie der menschlichen Uterusmuskulatur. Arch Gynäkol 55:325–409\nWetzstein R (1965) Der Uterusmuskel: Morphologie. Arch Gynecol 202:1–13\nWildt L, Kissler S, Licht P et al. (1998) Sperm transport in the human female genital tract and its modulation by oxitocin ass assessed by hystrosalpingography, hysterotonography, electrohysterography and Doppler sonography. Hum Reprod Update 4: 655–666\nWilliams M, Hill CJ, Scudamore I et al. (1993) Sperm numbers and distribution within the human fallopian tube around ovulation. Hum Reprod 8: 2019–2026\nYamamoto T, Noguchi T, Tamura T et al. (1993) Evidence for oestrogen synthesis in adenomyotic tissues. Am J Obstet Gynecol 169: 734–738\nYang G, Im HJ, Wang JH (2005) Repetitive mechanical stretching modulates IL-1beta induced COX-2, MMP-1 expression, and PGE2 production in human patellar tendon fibroblasts. Gene 363:166–172\nZeitoun K, Takayama K, Sasano H et al. (1998) Deficient 17ß-hydroxysteroid dehydrogenase type 2 expression in endometriosis: failure to metabolize 17ß-Östradiol. J Clin Endocrinol Metab 83:4474–4480\nZervomanolakis I, Ott HW, Hadziomerovic D et al. (2007) Physiology of upward transport in the human female genital tract. Ann N Y Acad Sei 1101:1–20\nZervomanolakis I, Ott HW, Müller J et al. (2009) Uterine mechanisms of ipsilateral directed spermatozoa transport:Evidence for a contribution of the utero-ovarian countercurrent system. Eur J Obstet Gynecol Reprod Biol 144Suppl 1:S45–49\nZingg HH, Rosen F, Chu K et al. (1995) Oxytocin and oxytocin receptor gene expression in the uterus. Recent ProgrHormone Res 50:255–273\nAuthor information\nAuthors and Affiliations\nRights and permissions\nCopyright information\n© 2011 Springer-Verlag Berlin Heidelberg\nAbout this chapter\nCite this chapter\nLeyendecker, G., Wildt, L. (2011). Die Pathophysiologie von Endometriose und Adenomyose. Morphologische, funktionelle und molekularbiologische Grundlagen. In: 125 Jahre Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-15012-8_9\nDownload citation\nDOI: https://doi.org/10.1007/978-3-642-15012-8_9\nPublisher Name: Springer, Berlin, Heidelberg\nPrint ISBN: 978-3-642-15011-1\nOnline ISBN: 978-3-642-15012-8\neBook Packages: Medicine (German Language)","source_license":"CC0","license_restricted":false}