Histopathologic evaluation of the inflammatory factors and stromal cells in the endometriosis lesions: A case-control study

Mohebbi A, Alireza Mohebbi, Ali Mohebbi, Vida Hojati, Masoumeh Majidi Zolbin, Majidi Zolbin M, Reza Aflatoonian
International journal of reproductive biomedicine · 2022 · vol. 20(10) , pp. 819–830 · doi:10.18502/ijrm.v20i10.12266 · PMID:36381357 · PMC9644650 · W4308318399
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⚙ AI-generated summary by claude@2026-06, 2026-06-28 ⓘ

This case-control study found significantly higher numbers of stromal cells, vessels, and inflammatory cells in ectopic endometriosis lesions compared to normal endometrium.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-11 · read from full text ⓘ

This case-control study investigated histopathology of inflammatory factors, stromal cell populations, blood vessels, and proliferation marker expression (PCNA) in women undergoing laparoscopic surgery or laparotomy at Nikan hospital in Tehran. After exclusions, it compared ectopic samples from 10 women with stage 3–4 endometriosis to eutopic endometrium from 10 control women (5 in secretory and 5 in proliferative phases), using immunohistochemistry, H&E staining, and quantification of stromal cells, inflammatory cells, and PCNA-positive nuclei. Ectopic endometriosis lesions showed stromal cells dominated by mesenchymal stem cells, with a higher incidence than in eutopic and control endometrium, and stromal cell counts in the eutopic group also differed significantly from controls. A key limitation is that the final analysis included only 10 cases and 10 controls, after substantial exclusion criteria, which may constrain generalizability. This paper is centrally about endometriosis—specifically the histopathologic characterization of inflammatory factors, stromal cells/MSC presence, vascularity, and PCNA expression within ectopic lesions.

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Abstract

BACKGROUND: Endometriosis is a multifaceted gynecological disorder defined as a benign estrogen-dependent chronic inflammatory process in which endometrial glands and stroma-like tissues are located outside the uterine cavity. It affects around 2-10% of all women during their reproductive years. OBJECTIVE: This study aimed to evaluate the traffic of mesenchymal stem cells and inflammatory factors toward the lesions. MATERIALS AND METHODS: Ten samples of normal endometrium and eutopic endometrium were studied as a control group and 10 ectopic samples were considered as a case group. Hematoxylin and eosin staining was used to evaluate stromal cells and inflammatory cells. Immunohistochemical staining was performed to show the presence of proliferating cell nuclear antigen in the lesions. The cells were digested and cultured in the laboratory to study cell proliferation. The number of cells and vessels were counted with Image J software, and data analysis was performed with Prism software. RESULTS: Data analysis showed that the number of stromal cells and vessels in ectopic tissue were significantly higher than the control group (p < 0.001). Also, the number of inflammatory cells, including neutrophils, monocytes, lymphocytes, and macrophages, in the ectopic group was much higher than in the control group (p < 0.005). CONCLUSION: By expanding the number of blood vessels, blood flow increases, and cell migration to tissues is facilitated. The accumulation of inflammatory cells, especially macrophages, stimulates the growth of stem cells and helps implant cells by creating an inflammatory process.
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Section

Endometriosis is a common disease in women at fertility age as a social and welfare problem. Classical theories in the pathophysiology of this disease alone cannot justify all types and variations in disease severity. Our histopathological examination showed that stem cells in ectopic tissue and high expression of PCNA increases the growth rate of this tissue. On the other hand, increased angiogenesis in ectopic tissue, and increasing blood flow to these tissues, allow stem cells to migrate from other parts of the body to this site. The presence of many inflammatory cells can also stimulate the angiogenic factors in these tissues. Identification of a large number of these inflammatory cells, especially macrophages in ectopic tissue, shows that these cells not only perform their main function as xenophagous and destroy foreign cells but also themselves as a stimulus for the growth of these cells. Increased inflammation can facilitate the implantation of migrating cells and retrograde blood cells, so it is necessary to characterize the type of these cells to design the therapeutic targets. Identifying and blocking these immune factors with a pharmaceutical approach can shed light on future potential treatments.

Coi Statement

The authors declare that they have no competing interest.

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endometriosis

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