Remarks on ENDOMETRIOSIS AND ENDOMETRIOMATA

It is just ten years since J. A. Sampson read his epoch-making paper on perforating haemorrhagic cysts of the ovary,1 and a sufficient interval has now elapsed to enable us to take stock of the position and assign these endometriomatous tumours to their proper place in gynaecological pathology and practice. This is easier to-day, because the novelty and glamour surrounding these tumours has largely disappeared, and the more adventurous spirits in gynaecology are turning their attention to other problems. I cannot pretend to discuss the subject adequately in the time at my disposal, but I will endeavour to place before you the principal etiologica!, pathological, and clinical features, reinforcing them as far as I can by statistics from a series of 137 cases operated on by myself during the past five years. By endometriosis is meant the pathological state brought about when fragments of endometrium leave their proper situation in the uterus and implant themselves in neighbouring tissues, and by endometriomata the tumours which develop if conditions are favourable for the growth of these implants. In my opinion the vast majority of endometriomata arise in this way, but possibly a small number may be derived from M?llerian rests. An endometrioma is therefore a tumour containing endometrial elements, or, at any rate, elements which look and behave like endometrium. Gland tubules in a richly cellular stroma are the histol?gica! criteria, but there may also be present a variable quantity of effused blood, cystic spaces lined by columnar or flattened epithelium and containing tarry blood, or hyperplasia of the muscular or fibrous tissue of the organs invaded. Physiologically these endometrial elements betray their origin by passing through the various phases of the menstrual cycle, includ ing that of menstrual haemorrhage, and by undergoing a decidual change during pregnancy, though the latter, of course, is not specific to endometrium, but found constantly in the ovaries, and frequently in the peritoneal covering of the other pelvic organs.