Modern Directions in the Study OF the Etiology AND Pathogenesis OF Endometriosis

endometriosis, diagnostics, proteins, genes, mikro RNK. Relevance. Endometriosis is a tumor pathological process in which benign tiss ue growth occurs outside the uterine cavity, similar in morphological and functiona l properties to the endometrium. In the structure of gynecological diseases, endometriosis is in third place, following inflammatory diseases of the uterine appendages and fibroids. If at the beginning of the twentieth century. S. Menge and E. Oritz in the <Manual of Gynecology= (1914) wrote that <...genital endometriosis is not of particular practical importance,= then already at the end of the century, due to the widespread increase in the frequency of this pathology, endometri osis began to be considered as a new disease of civilization. Currently, endometriosis is reasonably recognized as the most common and severe disease of women of reproductive age, negat ively affecting the general condition, performance and quality of life of patients [1 –4]. According to population studies of the World Endometriosis Research Foundation (WERF), cur rently more than 176 million women in the world suffer from endometriosis (up to 10% of women of reproductive age) [5], and the economic costs of its treatment, rehabilitation and compensation for disability amount to more than $76 billion/year. Moreover, the costs associated with compensation for loss of ability to work are 2 times higher than the costs directly for medical c are. Clinical manifestations of endometriosis depend on the localization of the process, the degree of dam age to the genitals and adjacent organs, and the individual pain threshold. Painless (asymptoma tic) forms of endometriosis occur even with severe infiltrative lesions, but this is always the exception. The <calling card= of endometriosis is symptoms directly related to menstruation and most pronounced during this period: dysmenorrhea (mainly algomenorrhea) - 82.7 –83.4%; pain syndrome of varying severity - 48.3 –50%; dyspareunia - 33.4 –34.5%. Bleeding with endometriosis is also predominantly cyclical in nature - as a rule, hyper- and polymenorrhea a re noted, and prolonged perimenstrual bleeding and anemia are also characteristic. Dysur ia (urinary disorders) and dyschezia (painful and/or difficult defecation) are observed with infiltrative lesions of adjacent organs (bladder and/or ureters and intestines, respectively). The literature describes the <four dis= 731 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us syndrome (dysmenorrhea, dyspareunia, dysuria, dyschezia), observed during me nstruation in patients with endometriosis. Infertility is one of the most signifi cant (including socially) and painful symptoms of endometriosis; its frequency is 35–40%. Thus, the fertility rate (the ratio of the number of childbirths to the number of women of reproductive age) in healthy women is 0.15– 0.20, in patients with endometriosis – 0.02–0.1, i.e. it is an order of magnitude lower [6] . Endometriosis is the only disease in which a benign proliferative proc ess affects the unchanged tissue of neighboring organs. The characteristic features of endometri osis are the ability for infiltrative growth, the absence of a pronounced capsule around the endometrioid lesion (with the exception of endometrioid cysts), and the possibility of metastasis to dis tant organs. The severity of the disease, the ambiguity of tactical approaches and the lack of pathogenetic treatment methods have predetermined the interest of many domestic and world researchers in a comprehensive study of this disease, however, despite numerous studies, the results remain unsa tisfactory: 35–50% of patients with endometriosis suffer from pain or infertility, rela pses are observed in almost half (40–45%) of patients during the first 5 years after surgical treatme nt [7]. Although several pathogenetic hypotheses have been proposed, the exact pathogenesis of endometrios is remains unclear. At the same time, it is obvious that endometriosis develops as a result of dissemination of the endometrium into ectopic areas with the subsequent formation of ec topic endometrial complexes [1]. It is the presence of these ectopic lesions that is thought to give rise to the symptoms associated with the disease. Ectopic tissue of endometrial origin consists of glandular epithelium and stroma and is characterized by a predominance of benign characteristics combined wi th features (invasion and neoangiogenesis) that make it similar to malignant neoplasms. Many theories have been proposed to explain the causes of the development of endometriosis [5], depending on the fac tors causing its development: retrograde menstruation, genetic predisposition, perit oneal cell metaplasia and impaired immunological control. Sampson's theory is the most popular and generally accepted theory of the origin of endometriosis: it is assumed that endometrioid implants arise as a result of retrograde menstrual reflux of endometrial tissue into the abdominal cavity through the fallopian tubes, whi ch is confirmed by the detection of endometrial fragments. The spontaneous development of endom etriosis only in humans and primates supports the assumption that this disease can only affect menstruating species. At the same time, retrograde menstruation is probably a very c ommon phenomenon, but endometriosis develops only in a part of women, which indirectly indicates the role of other factors in its development (immunological, genetic, disturbances in the biochemica l composition of the environment in the abdominal cavity). In addition, the alternative embryonic germ theory suggests that endometriosis may develop from Müllerian cells scattered in the peritoneal cavity, which, when exposed to certain biochemical stimuli, can become activated and for m endometrial tissue. Another hypothesis, which also helps explain the extraperitoneal localizat ion of the disease, suggests that the origin of endometrioid lesions may be associated wi th metaplasia of peritoneal cells and differentiation of mesothelial cells into endometrial cells. Finally, it has been suggested that blood and lymphatic vessels may play a role in the dissemination of endometrial cells over long distances. The human endometrium contains a small population of cells that have functional stem cell properties with corresponding markers and functional chara cteristics, which has suggested a role in the pathogenesis of endometriosis. Under physiological conditions, endometrial stem cells undergo cyclical monthly regeneration after menstruation. The se cells are presumably responsible for the proliferation and cyclic regeneration of endometrial tissue after menstruation. According to this hypothesis, endometriosis may result from the migrati on of endometrial stem 732 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us cells into the peritoneal cavity, their proliferation, peritoneal invas ion, and differentiation into endometrial cells in ectopic locations.

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