Vascularization of endometrial tissue in abdominal cavity – the most important link in the pathogenesis of endometriosis or its vulnerable spot in terms of treatment? (review of literature)

Р. В. Украинец, Yu. S. Korneva
In: Regional blood circulation and microcirculation · 2019 · vol. 18(2) , pp. 12–18 · doi:10.24884/1682-6655-2019-18-2-12-18 · W2958815475
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-12 ⓘ

This review details endometrial tissue vascularization in endometriosis, involving stem cell-macrophage interactions, angiogenic factors, and immature vessel formation, which is crucial for pathogenesis and potential treatment targets.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 · read from full text ⓘ

This review examines the stepwise vascularization of retrogradely deposited endometrial tissue in the abdominal cavity, emphasizing how formation of a specific microenvironment and functional remodeling of endometrial tissue depends on interactions between endometrial mesenchymal stem cells and peritoneal macrophages. It argues that these adaptations to hypoxia and survival in ectopic sites resemble tumor-like growth, and it describes the roles and sequence of angiogenic factor activation, increased microvessel density around implantation, angiogenesis-driven vascularization, and later vasculogenesis via circulating endothelial progenitor cells. The authors note that angiogenic factor synthesis continues to remodel and increase vessel density, particularly through immature pericyte-uncoupled microvasculature, and they highlight as a caveat the literature-based, mechanistic nature of the review rather than new experimental data. Relevance to endometriosis: the paper is centrally about endometriosis pathogenesis as it focuses on how endometrial tissue vascularizes in the peritoneal cavity (including examples tied to peritoneal localization and vessel changes) and discusses potential diagnostic/treatment angles around angiogenic factors and angiostatic effects, and it also cites adenomyosis by referencing VEGF/HIF-1α and microvessel density in endometrial tissue from women with adenomyosis.

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Abstract

In this review, the stepwise mechanism of vascularization of retrogradely torn away endometrial tissue into the abdominal cavity during the formation of endometrioid heterotopy is described. The necessity of the formation of a specific microenvironment and functional rearrangement of endometrial tissue, based on the interaction of endometrial mesenchymal stem cells with peritoneal macrophages, is shown, which is the basis of adaptation to hypoxia and survival in new conditions. Attention is also paid to the similarity of tissue adaptation for endometriosis and tumor growth. The activation mechanisms for the synthesis of a number of angiogenic factors and their significance in the process of vascularization of endometrial tissue, as one of the key links in the pathogenesis of endometriosis, are highlighted. In addition, the example of the peritoneal localization of the endometriosis focus reflects the sequence of the formation of the vascular component of the communication system: an increase in vascular density in the tissue of the implantation area; vascularization of endometrioid heterotopy tissue due to angiogenesis; and the final stage of formation of the vascular network of the endometrial focus - vasculogenesis (as a mechanism for the formation of the microvasculature with the participation of circulating endothelial progenitor cells). Subsequently, the synthesis of angiogenic factors continues and actively contributes to the remodeling and increase in vascular density in the heterotopic tissue. The most important is that the increase in vascular density occurs mainly due to the immature pericyte-unprotected vessels of the microvasculature. These features constitute a fundamental basis for the diagnosis of endometriosis through the qualitative and quantitative determination of some factors in the peritoneal fluid, reflecting activation of vascularization, and for future methods of treating endometriosis by activating an angiostatic effect in the area of the pathologycal focus.
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Васкуляризация ткани эндометрия в условиях брюшной полости – важнейшее звено патогенеза эндометриоза или его «ахиллесова пята» с точки зрения лечения? (обзор литературы) https://doi.org/10.24884/1682-6655-2019-18-2-12-18 Аннотация Рассмотрен поэтапный процесс васкуляризации ретроградно заброшенной ткани эндометрия в брюшную полость. Показана необходимость формирования специфического микроокружения и функциональной перестройки ткани эндометрия, основанной на взаимодействии мезенхимальных стволовых клеток эндометрия с перитонеальными макрофагами, что является основой адаптации к гипоксии и их выживания в новых условиях. Авторы делают акцент на сходстве адаптации ткани гетеротопии при эндометриозе с опухолевым ростом. Освещены механизмы запуска синтеза ряда ангиогенных факторов и их значимость в процессе васкуляризации ткани эндометрия как одного из ключевых звеньев патогенеза эндометриоза. Помимо этого, отражена последовательность становления сосудистого компонента коммуникационной системы: нарастание сосудистой плотности в области имплантации (показано на примере брюшинной локализации очага эндометриоза); васкуляризация ткани эндометриоидной гетеротопии за счет ангиогенеза; финальная стадия становления сосудистой сети эндометриоидного очага – васкулогенез (как механизм формирования микроциркуляторного русла с участием циркулирующих эндотелиальных прогениторных клеток). В последующем синтез ангиогенных факторов продолжается и активно способствует ремоделированию и увеличению плотности сосудов в ткани гетеротопии преимущественно за счет незрелых перицит-незащищенных сосудов микроциркуляторного русла. Эти особенности представляют собой фундаментальную основу как для диагностики эндометриоза путем качественного и количественного определения факторов перитонеальной жидкости, отражающих активацию васкуляризации, так и для перспективных методов лечения эндометриоза путем активации ангиостатического эффекта в зоне патологического очага. Об авторах Р. В. УкраинецРоссия Украинец Роман Вадимович – ординатор кафедры патологической анатомии Ю. С. Корнева Россия Корнева Юлия Сергеевна – канд. мед. наук, доцент кафедры патологической анатомии Список литературы 1. Pittatore G, Moggio A, Benedetto C, Bussolati B, Revelli A. Endometrial adult/progenitor stem cells: pathogenetic theory and new antiangiogenic approach for endometriosis therapy. Reprod Sci. 2014;21(3):296–304. Doi: https:// doi.org/10.1177/1933719113503405. 2. Kao AP, Wang KH, Chang CC, Lee JN, Long CY, Chen HS, Tsai CF, Hsieh TH, Tsai EM. 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Hum Reprod Update. 2012;18(6):682–702. Doi: https://doi.org/10.1093/humupd/dms026. 59. Matsuzaki S, Canis M, Murakami T, Dechelotte P, Bruhat MA, Okamura K. Immunohistochemical analysis of the role of angiogenic status in the vasculature of peritoneal endometriosis. Fertil Steril. 2001;76(4):712–716. Рецензия Для цитирования: Украинец Р.В., Корнева Ю.С. Васкуляризация ткани эндометрия в условиях брюшной полости – важнейшее звено патогенеза эндометриоза или его «ахиллесова пята» с точки зрения лечения? (обзор литературы). Регионарное кровообращение и микроциркуляция. 2019;18(2):12-18. https://doi.org/10.24884/1682-6655-2019-18-2-12-18 For citation: Ukrainets R.V., Korneva Yu.S. Vascularization of endometrial tissue in abdominal cavity – the most important link in the pathogenesis of endometriosis or its vulnerable spot in terms of treatment? (review of literature). Regional blood circulation and microcirculation. 2019;18(2):12-18. 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