Die Archimetra als neues morphologisch-funktionelles Konzept des Uterus sowie als Ort der Primärerkrankung bei Endometriose

G. Leyendecker, Georg Kunz, M Noe, M. Herbertz, D. Beil, Peter Huppert, G. Mall
In: Reproduktionsmedizin · 1999 · vol. 15(5) , pp. 356–371 · doi:10.1007/s004440050126 · W2090522982
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This paper proposes the uterus comprises an archimetra (endometrium and subendometrial myometrium) and neometra (outer myometrium), with endometriosis considered a disease of the archimetra.

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The paper proposes a new morphological–functional concept of the uterus in which the uterus is divided into an inner paramesonephric archimetra (including the endometrium and subendometrial myometrium) and an outer non-paramesonephric neometra (outer myometrial muscle layers). It describes the archimetra as the site for early reproductive functions such as implantation preparation, uterine peristalsis for directed sperm transport, and inflammatory defense, while the neometra is framed as providing forces for childbirth. The authors argue that endometriosis is a disease of the archimetra, occurring as a non-obligatory consequence of uterine adenomyosis or its early manifestations, supporting this with reported eutopic endometrial alterations, archimetrial hyper- and dysperistalsis in affected uteri, and proliferative/infiltrative expansion of archimetral elements into outer myometrial layers that resemble adenomyosis on MR imaging, while noting that expansion does not correlate with endometriosis grade but with age. This paper is centrally about endometriosis—specifically the hypothesis that endometriosis is an archimetra-centered condition linked to adenomyosis/early adenomyotic manifestations.

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Zusammenfassung Der menschliche Uterus setzt sich aus einer inneren paramesonephrischen Archimetra und einer äußeren nicht-paramesonephrischen Neometra zusammen. Die Archimetra besteht aus dem Endometrium und dem Stratum subvasculare des Myometrium und erfüllt verschiedene vom Ovar gesteuerte Funktionen im frühen Prozeß der Reproduktion wie Aufbau des Endometriums für die Implantation, uterine Peristaltik für den gerichteten Spermientransport und die hohe fundale Implantation sowie die Infektabwehr. Die Neometra besteht aus den beiden äußeren Muskelschichten, dem Stratum vasculare und supravasculare. Die wesentliche Funktion besteht im Aufbringen der Kräfte für die Geburt. Die Endometriose wird als Folge einer Adenomyosis oder deren Frühmanifestationen und somit als eine Erkrankung der Archimetra angesehen. Dieses Konzept stützt sich auf spezifische Veränderungen des eutopen Endometriums bei Frauen mit Endometriose, auf archimetrale Funktionsstörungen wie Hyper- und Dysperistaltik sowie auf eine archimetrale Infiltration in das darunter liegende Myometrium mit dem Bild einer Adenomyosis uteri. Summary The human uterus is composed of the paramesonephric archimetra and the non-paramesonephric neometra. The archimetra consists of the glandular as well as stromal part of the endometrium and the subendometrial myometrium and meets several fundamental functions in the early process of reproduction such as providing the site of implantation, uterine directed sperm transport and high fundal implantation of the embryo by uterine peristalsis as well as inflammatory defence. The neometra is composed of the stratum vasculare and stratum supravasculare. Its main function is to provide the forces for expulsion of the fetus. Endometriosis is considered a disease of the archimetra in that it constitutes a non-obilgatory consequence of uterine adenomyosis or its early manuifestations. This view is supported by several lines of evidence. First: The eutopic endometrium shows alterations similar to those seen in endometriotic lesions that are not found in the endometrium of women free of disease. Second: Uteri of women with endometriosis display hyper- and dysperistalsis of which the extent does not correlate with the severity of the disease. This dysfunction results in a break down of rapid and sustained directed sperm transport and may explain sterility and subfertility in women with mild-to-moderate endometriosis. Third: In women with endometriosis there is a proliferative and infiltrative expansion of all elements of the archimetra into the outer myometrial layers. There is no correlation of the extent of the infiltrative expansion with the grade of endometriosis but with the age of the patients. In MR imaging these findings are similar or identical with those found in adenomyosis. Author information Authors and Affiliations Rights and permissions About this article Cite this article Leyendecker, G., Kunz, G., Noe, M. et al. Die Archimetra als neues morphologisch-funktionelles Konzept des Uterus sowie als Ort der Primärerkrankung bei Endometriose. Reproduktionsmedizin 15, 356–371 (1999). https://doi.org/10.1007/s004440050126 Published: Issue date: DOI: https://doi.org/10.1007/s004440050126

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