The Presence of Endometrial Cells in Peritoneal Fluid of Women With and Without Endometriosis

Dorien F O, F. O. Dorien, Tania Roskams, Kathleen Van den Eynde, Arne Vanhie, Daniëlle Peterse, Daniëlle P Peterse, Christel Meuleman, Carla Tomassetti, Karen Peeraer, Thomas M D'Hooghe, Thomas D’Hooghe, Amelie Fassbender
Reproductive sciences (Thousand Oaks, Calif.) · 2016 · vol. 24(2) , pp. 242–251 · doi:10.1177/1933719116653677 · PMID:27324432 · W2468808665
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-08 ⓘ

This study found no difference in the prevalence of endometrial cells in peritoneal fluid between women with and without endometriosis during menstruation, questioning the role of retrograde menstruation.

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The study examined whether endometrial epithelial and stromal cells are present in peritoneal fluid (PF) collected during the menstrual phase more frequently in women with endometriosis than in controls without endometriosis. Using PF from 9 reproductive-age women with endometriosis and 8 without endometriosis obtained at diagnostic laparoscopy, the researchers performed immunohistochemical staining of PF pellet sections for epithelial (Ep-CAM, prekeratin), stromal (CD10), and mesothelial/macrophage markers (calretinin, vimentin, CD68). PF calretinin and prekeratin staining indicated mesothelial cells in all pellets, while Ep-CAM+ epithelial cells and CD10+ stromal cells were detected in similar proportions in both groups (no significant differences), leading the authors to conclude that prevalence was not higher in endometriosis during menstruation. The small sample size and reliance on marker-based cytology in PF pellets are key limitations explicitly implied by the design. This paper is centrally about endometriosis — it tests whether the presence of endometrial cells in menstrual PF is more common in endometriosis, directly challenging the retrograde menstruation mechanism.

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Abstract

To reinforce Sampson’s theory of retrograde menstruation in the pathogenesis of endometriosis, proof should be provided that during menstruation endometrial cells are present in peritoneal fluid (PF). We hypothesize that the prevalence of PF samples containing endometrial cells is higher in patients with endometriosis than in controls without endometriosis during menstruation. We selected from our biobank PF samples of 17 reproductive-age women with (n = 9) or without (n = 8) endometriosis who had received a diagnostic laparoscopy for investigation of pain/infertility. Peritoneal fluid had been collected during laparoscopy in the menstrual phase of the cycle, centrifuged, and the resulting pellet was stored at —80°C. About 5-(j,m sections of frozen PF pellets were stained using the Dako Envision Flex system with primary antibodies against epithelial cell adhesion molecule (Ep-CAM; endometrial epithelial cells), CD 10 (endometrial stromal cells), prekeratin (epithelial/mesothelial cells), vimentin (endometrial/mesothelial/immune cells), calretinin (mesothelial cells), and CD68 (macrophages). The PF cells positive for Ep-CAM were detected in 5 of 9 patients with endometriosis and 6 of 8 controls (P =.62). CD10 stained positively in 6 of the 9 patients with endometriosis and 3 of the 8 controls (P =.35). Calretinin and prekeratin staining showed the presence of mesothelial cells in all pellets. Vimentin stained approximately 100% of the PF cells. CD68+ macrophages represented >50% of cells in all pellets. The prevalence of PF samples containing endometrial epithelial and stromal cells was not higher in patients with endometriosis than in controls without endometriosis during menstruation. Our findings question the relevance of endometrial cells in PF for the pathogenesis of endometriosis and support the importance of other mechanisms such as immune dysfunction and/or endometrial stem cells. Similar content being viewed by others

References

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Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Dorien, F.O., Roskams, T., Van den Eynde, K. et al. The Presence of Endometrial Cells in Peritoneal Fluid of Women With and Without Endometriosis. Reprod. Sci. 24, 242–251 (2017). https://doi.org/10.1177/1933719116653677 Published: Issue date: DOI: https://doi.org/10.1177/1933719116653677

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mesh:D004715endometriosis

MeSH descriptors

Ascitic Fluid Endometriosis Endometrium Epithelial Cells Infertility, Female Adult Ascitic Fluid Ascitic Fluid Biomarkers Biomarkers Endometriosis Endometriosis Endometrium Endometrium Epithelial Cell Adhesion Molecule Epithelial Cell Adhesion Molecule Epithelial Cells Epithelial Cells Female Humans

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