Correlación Clínico-Inmunohistopatológica en Piezas de Histerectomía por Endometriosis: Asociación con Severidad de la Enfermedad, Inflamación y Marcadores Inmunológicos

María Cruz
In: Ibero Ciencias - Revista Científica y Académica - ISSN 3072-7197 · 2026 · vol. 5(1) , pp. 3646–3672 · doi:10.63371/ic.v5.n1.a855 · W7138848461
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This paper investigates the clinicopathological correlation in hysterectomy specimens from endometriosis patients, analyzing associations with disease severity, inflammation, and immunological markers to identify biomarkers explaining clinical discrepancies.

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The paper studies clinicopathologic and immunohistopathologic correlations in hysterectomy specimens from patients with endometriosis, evaluating how tissue inflammation and immune marker profiles relate to disease severity, quantified using the RASRM system. Using tissue analyses focused on inflammatory and immune components such as macrophage-related markers, the authors report associations between more severe endometriosis and higher inflammatory/immunological marker expression, suggesting that tissue-level immune changes track with clinical severity. A key limitation stated in the study context is that the findings are based on post-surgical tissue specimens, which may not fully capture disease dynamics over time and across anatomical sites. This paper is centrally about endometriosis — it specifically correlates hysterectomy tissue immune-inflammatory markers with endometriosis severity.

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Abstract

Endometriosis is a chronic, estrogen-dependent inflammatory disease characterized by the presence and ectopic proliferation of functional endometrial tissue outside the uterine cavity, primarily affecting the peritoneum, ovaries, and deep pelvic structures. It is estimated to affect approximately 10% of women of reproductive age and represents a major cause of chronic pelvic pain and infertility. Its pathophysiology is complex and multifactorial, involving hormonal alterations, abnormal implantation phenomena, progesterone resistance, and, importantly, dysregulation of the immune system. In this context, the identification and analysis of tissue and immunological biomarkers may help explain clinicopathological discrepancies, define more aggressive or inflammatory phenotypes, and guide more precise and standardized therapeutic strategies based not only on anatomical findings but also on the patient’s individual biological profile.
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Correlación Clínico-Inmunohistopatológica en Piezas de Histerectomía por Endometriosis: Asociación con Severidad de la Enfermedad, Inflamación y Marcadores Inmunológicos DOI: https://doi.org/10.63371/ic.v5.n1.a855Palabras clave: endometriosis, inflamación crónica, macrófagos, RASRM, biomarcadores tisularesResumen La endometriosis es una enfermedad inflamatoria crónica, dependiente de estrógenos, caracterizada por la presencia y proliferación ectópica de tejido endometrial funcional fuera de la cavidad uterina, principalmente en peritoneo, ovarios y estructuras pélvicas profundas. Se estima que afecta a aproximadamente el 10% de las mujeres en edad reproductiva y constituye una causa importante de dolor pélvico crónico e infertilidad. Su fisiopatología es compleja y multifactorial, involucrando alteraciones hormonales, fenómenos de implantación anómala, resistencia a la progesterona y, de manera relevante, una desregulación del sistema inmunológico. En este contexto, la identificación y análisis de biomarcadores tisulares e inmunológicos podría contribuir a explicar las discrepancias clínico-patológicas, definir fenotipos más agresivos o inflamatorios y orientar estrategias terapéuticas más precisas y estandarizadas, basadas no solo en la anatomía, sino también en el perfil biológico individual de la paciente. Descargas Referencias Alotaibi, F. T. (2025). Pathophysiology of endometriosis: Insights from immunohistochemical analysis of ectopic and eutopic tissues. International Journal of Molecular Sciences, 26(13), Artículo 5998. https://doi.org/10.3390/ijms26135998 Bao, C., He, Y., Zhang, Q., Li, Y. y Li R. (2022). Genomic evidence supports recognition of endometriosis as an inflammatory systemic disease. Frontiers in Immunology, 13, Artículo 758440. https://doi.org/10.3389/fimmu.2022.758440 Cano-Herrera, G., et al. (2024). Endometriosis: A comprehensive analysis of inflammatory and immune pathways. Biomedicines, 12(7), Artículo 1476. https://doi.org/10.3390/biomedicines12071476 Chu, X., Xu, Y., Zhang, Y. y Wang, X. (2024). Extracellular vesicles in endometriosis: Role and potential. Frontiers in Endocrinology, 15, Artículo 1365327. https://doi.org/10.3389/fendo.2024.1365327 Dai, Y., Chen, Y. y Wang, J. (2025). Immunopathological insights into endometriosis. Seminars in Immunopathology. Publicación anticipada en línea. https://doi.org/10.1007/s00281-025-01058-5 Didžiokaitė, G., Tamošiūnas, A. y Tamelis, A. (2023). Oxidative stress and endometriosis: Potential mechanisms and clinical impact. International Journal of Molecular Sciences, 24(4), Artículo 3809. https://doi.org/10.3390/ijms24043809 Ferreira, N. R., Almeida, T. B., Neves, E. S., et al. (2025). Role of macrophage polarization in endometriosis progression and clinical severity: A histopathological study. Clinical Pathology, 78, 54-62. García, J. M. G., García, S. V. y Sarmiento, J. (2022). 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Insights into EMT signaling in endometriosis: Clinical and molecular implications. International Journal of Molecular Sciences, 26(15), Artículo 7460. https://doi.org/10.3390/ijms26157460 Jackson, L. W., Schisterman, E. F., Dey-Rao, R., Browne, R. y Armstrong, D. (2024). Endometriosis diagnostic markers: CA-125 and beyond. Diagnostics, 14(3), Artículo 312. https://doi.org/10.3390/diagnostics14030312 Krygere, L., et al. (2024). Diagnostic potential of cytokine biomarkers in endometriosis: A comprehensive analysis. Journal of Cytokine Research. Lee, J. Y., Park, E. Y., Lee, S. J., et al. (2024). Peritoneal macrophage phenotypes and their association with clinical severity in deep infiltrating endometriosis. Clinical and Experimental Reproductive Medicine, 51(2), 105-113. https://doi.org/10.5653/cerm.2023.06411 Li, K., Xu, X., Lin, J., Qian, Y. y Deng, L. (2025). Interleukin-17 as a marker correlated with endometriosis severity and infertility. Scientific Reports, 15, Artículo 86164. https://doi.org/10.1038/s41598-025-86164-y Martínez-García, M. A., Gómez-Pérez, J. L., et al. (2025). NLR, LMR, and PLR as predictive indices of clinical severity in women with endometriosis. Journal of Obstetrics and Gynaecology, 45(2), 142-150. Morales-Rodríguez, W., García-Murillo, J., et al. (2024). Differential expression of adhesion markers (CD44, integrins) in endometriotic lesions: Clinical correlations. The Journal of Pathology: Clinical Research, 10(8), 1425-1435. Oală, I. E. (2024). Endometriosis and the role of pro-inflammatory and anti-inflammatory cytokines in pathophysiology: A narrative review. Diagnostics, 14(3), Artículo 312. https://doi.org/10.3390/diagnostics14030312 Okoli, U., Morris, E. P., Gupta, P. y Riemersma, R. (2023). Endometriosis and cardiovascular disease risk: Systematic review and meta-analysis. Journal of Women's Health, 32(11), 1313-1325. https://doi.org/10.1089/jwh.2023.0234 Ramírez-Pavez, T. N., Marín-Sánchez, P., Nebot, A., et al. (2025). Systemic immune and tumor marker profiles in ovarian and deep infiltrating endometriosis: Associations with disease severity and symptom burden. International Journal of Molecular Sciences, 26(19), Artículo 9581. https://doi.org/10.3390/ijms26199581 Rodriguez Gutierrez, D., Astourian, A., Spalinger, M., et al. (2025). Multiplex plasma cytokine profiling improves detection of stage-specific endometriosis patterns. npj Women's Health, 3, Artículo 60. Santos, C. M. A. M., Sousa, J. y Ferreira, R. (2025). Exosomal microRNAs as epigenetic biomarkers for endometriosis. International Journal of Molecular Sciences, 26(10), Artículo 4564. https://doi.org/10.3390/ijms26104564 Shifon, S. (2025). Endometriosis as an immune-mediated disease: Immunopathogenesis and clinical implications. Frontiers in Immunology, 12, Artículo 1727183. Smith, K. A., Taylor, E. N., Daniels, K. R., et al. (2024). Neutrophil and monocyte surface markers in endometriotic tissue immunophenotyping. Journal of Reproductive Immunology, 152, Artículo 103513. Spagnolo, E., Martinez, A., Mascarós-Martínez, A., et al. (2023). Evaluation of immune infiltrates in ovarian endometriosis and endometriosis-associated ovarian cancer: Relationship with histological and clinical features. International Journal of Molecular Sciences, 24(15), Artículo 12083. https://doi.org/10.3390/ijms241512083 Tanaka, Y., Sugimoto, Y., et al. (2025). Immunohistochemical characterization of CD8+ T cells and macrophages in deep infiltrating endometriosis lesions and correlation with clinical symptoms. Histopathology, 86(1), 112-121. Torres-Mendoza, M., Sánchez-Pérez, I., Cortés-Martínez, R., et al. (2024). Expression of Cox-2 and PGE2 pathways in peritoneal endometriosis: Association with pain severity. Inflammation Research, 73(3), 245-253. Vallvé-Juanico, J., George, A. F., Sen, S., et al. (2022). Deep immunophenotyping reveals endometriosis is marked by dysregulation of the mononuclear phagocytic system in endometrium and peripheral blood. BMC Medicine, 20, Artículo 158. https://doi.org/10.1186/s12916-022-02359-w Wang, D., Liu, Y., Li, S., et al. (2025). Serum IL-6, TNF-α, and VEGF levels in endometriosis patients: Correlation with revised ASRM stage. Clinica Chimica Acta, 549, 25-30. Xu, X., et al. (2025). TGF-b1 and soluble endothelial markers as severity biomarkers in endometriosis. Frontiers in Immunology. Publicación anticipada en línea. https://doi.org/10.3389/fimmu.2025.1638604 Yaseen, B. R., Mohammed, J. J., Salman, S. A. y Alredha, R. D. A. (2025). Integrative analysis of inflammatory biomarkers and clinical features in endometriosis: Insights into pain severity and diagnostic utility. Anaesthesia, Pain & Intensive Care, 29(4), 276-282. https://doi.org/10.35975/apic.v29i4.2812 Zheng, R., Gao, X., Sun, J., et al. (2025). Inflammatory mediator profiles in peritoneal fluid from women with endometriosis: Correlations with lesion severity. American Journal of Obstetrics and Gynecology. Publicación anticipada en línea. Zhou, Y., Liu, G., Yuan, L., et al. (2025). Evaluating systemic immune-inflammation indices as predictive markers for endometriosis diagnosis. Journal of Reproductive Immunology. Publicación anticipada en línea. Zhao, S., Wu, H., Sang, X., et al. (2024). Peritoneal fluid immune profiles in ovarian endometriosis and their correlation with symptom severity. Reproductive Sciences, 31(9), 2401-2410. Publicado Número Sección Categorías Licencia Derechos de autor 2026 María Paulina Arreola Cruz (Autor/a) Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0. Los contenidos publicados en esta revista están bajo una licencia Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0). 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endometriosischronic_pelvic_paininfertility

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