Time to redefine endometriosis including its pro-fibrotic nature

Paola Viganò, P Vigano, Massimo Candiani, M Candiani, A Monno, Antonella Monno, Elisa Giacomini, E Giacomini, Paolo Vercellini, P Vercellini, Edgardo Somigliana, E Somigliana
Human Reproduction · 2017 · vol. 33(3) , pp. 347–352 · doi:10.1093/humrep/dex354 · PMID:29206943 · W2773156221
article OA: bronze CC0 ⤵ 195 in-corpus citations
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This paper argues for redefining endometriosis to include its consistent fibrotic nature, reflecting that fibrosis is a more prevalent feature than endometrial stroma and epithelium in lesions.

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Abstract

Endometriosis is currently defined as presence of endometrial epithelial and stromal cells at ectopic sites. This simple and straightforward definition has served us well since its original introduction. However, with advances in disease knowledge, endometrial stromal and glands have been shown to represent only a minor component of endometriotic lesions and they are often absent in some disease forms. In rectovaginal nodules, the glandular epithelium is often not surrounded by stroma and frequently no epithelium can be identified in the wall of ovarian endometriomas. On the other hand, a smooth muscle component and fibrosis represent consistent features of all disease forms. Based on these observations, we believe that the definition of endometriosis should be reconsidered and reworded as 'A fibrotic condition in which endometrial stroma and epithelium can be identified'. The main reasons for this change are: (1) to foster the evaluation of fibrosis in studies on endometriosis pathogenesis using animal models; (2) to limit potential false negative diagnoses if pathologists stick stringently to the current definition of endometriosis requiring the demonstration of endometrial stromal and glands; (3) to consider fibrosis as a potential target for treatment in endometriosis. This opinion article is aimed at boosting the attention paid to a largely neglected aspect of the disease. We hope that targeting the fibrotic process might increase success in developing new therapeutic approaches.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometrium Fibrosis Endometriosis Endometriosis Endometrium Epithelial Cells Epithelial Cells Female Fibrosis Fibrosis Humans Stromal Cells Stromal Cells

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (42)

Cited by (50)

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