The presence of living endometrial cells in ovarian endometriotic cyst fluid may contribute to the recurrence of endometriosis after surgical excision of endometriomas

Xinxin Xu, Yichen Chen, Qin Yu, Jianzhang Wang, Ping Xu, Libo Zhu, Qiong Xu, Jing Zhang, Shuling Cui, Kewen Yu, Tiantian Li, Xinyue Guo, Xinmei Zhang
Journal of ovarian research · 2022 · vol. 15(1) , pp. 89 · doi:10.1186/s13048-022-01018-9 · PMID:35907907 · W4288758338
article OA: gold CC0 ⤵ 9 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Living endometrial cells with high adhesion ability were found in ovarian endometriotic cyst fluid, suggesting they may contribute to endometriosis recurrence after surgical cyst removal.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

Xu et al. studied whether living endometrial cells are present in ovarian endometriotic cyst fluid and related postoperative drainage fluid, using samples from 39 patients with ovarian endometriomas and a control drainage-fluid group from 14 patients without endometriosis; they assessed cell presence via in vitro culture and immunostaining, and examined cyst-fluid properties by transcriptome sequencing and apparent diffusion coefficients. They found endometrium-like tissues in 71.8% of cyst-fluid samples and epithelial endometrial fragments in 71.4% of drainage-fluid samples, with living cyst-fluid endometrial cells showing high adhesion ability that was higher than fragments from cyst walls, and capable of adhering and remaining alive in an animal model. They also reported that cyst-fluid viscosity related to ADC values and that endometrial fragments from cyst fluid differed in gene expression from ectopic cyst-wall tissue and eutopic endometrium, with pathways including cell adhesion, lysosome-related genes, and oxidative phosphorylation upregulated in the cyst-fluid group. This paper is centrally about endometriosis — it demonstrates living endometrial cells in ovarian endometriotic cyst fluid as a potential contributor to recurrence after surgical excision of endometriomas.

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Abstract

BACKGROUND: Many factors can affect the recurrence of endometriosis after surgery, however, whether endometriotic cyst fluid contributes to endometriosis recurrence after surgical excision of ovarian endometriomas remains unclear. The objective of this study was to determine the presence of endometrial cells in ovarian endometriosis cyst fluid and the potential differences between these cells and those in the cyst wall. METHODS: Samples of cyst fluid (n = 39) and drainage fluid (n = 14) were collected from patients with ovarian endometriomas undergoing laparoscopic surgery. Drainage fluid from 14 patients without endometriosis was used as a control. The presence of endometrial cells in cyst fluid and drainage fluid was determined by cell culture in vitro and immunostaining. In addition, cyst fluid endometrial fragments and viscosity were analysed by transcriptome sequencing analysis and apparent diffusion coefficients, respectively. An animal model was used to confirm the ability of endometrial cells in cyst fluid to form new lesions. RESULTS: We found endometrium-like tissues in 71.8% (28/39) of cyst fluid and 71.4% (10/14) of drainage fluid samples by histopathological examination, and the presence of endometrioid tissue in cyst fluid was related to the viscosity of the cyst fluid. The living endometrial cells in cyst fluid and drainage fluid were confirmed by cell culture in vitro and immunostaining. Moreover, the adhesion ability of endometrial fragments in cyst fluid was significantly higher than that of ectopic tissues in the cyst wall (P < 0.05). In addition, living endometrial cells in the cyst fluid were able to adhere and alive in the animal model. CONCLUSIONS: The existence of living endometrial cells with high adhesion ability in ovarian endometriotic cyst fluid may contribute to the recurrence of endometriosis after surgical excision of endometriomas due to cyst fluid outflow during the surgical procedure.

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Cysts Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Laparoscopy Laparoscopy

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