Stereometric evaluation of peritoneal endometriosis and endometriotic nodules of the rectovaginal septum.
A computerized morphometrical investigation was performed on endometriotic tissue from the peritoneum (n = 225) and rectovaginal nodules (n = 65) to compare histologically and stereologically the rectovaginal septum endometriotic nodule to peritoneal endometriosis. Mitotic activity, stromal vascularization and the epithelium/stroma ratio were found to be significantly different in peritoneal and rectovaginal endometriosis. The evaluation revealed a major role of glandular epithelium in rectovaginal nodules where the stroma sometimes appeared absent around glandular epithelium. The study demonstrated opposite effects of gonadotrophin-releasing hormone agonists (GnRHa) and lynestrenol on the two lesions. Indeed, in peritoneal endometriosis, after GnRHa therapy, our study demonstrated a lower rate of mitosis and poor stromal vascularization. The same drug was unable to induce the same effects in the nodule although, in contrast, lynestrenol has a strong effect on nodule vascularization. In conclusion, it is suggested that the rectovaginal adenomyotic nodule is a specific disease, different from peritoneal endometriosis. It is not the consequence of 'deep infiltrating' endometriosis but can probably develop from Mullerian rests present in the rectovaginal septum.
Donnez
J
J
Department of Gynaecology, Universite Catholique de Louvain, Cliniques Universitaires St Luc, Avenue Hippocrate 10, B-1200 Brussels, Belgium.
Nisolle
M
M
Casanas-Roux
F
F
Brion
P
P
Da Costa Ferreira
N
N
D001706:Biopsy; D004715:Endometriosis / Q000188:drug therapy / Q000473:pathology*; D004717:Endometrium / Q000098:blood supply; D004848:Epithelium / Q000473:pathology; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008234:Lynestrenol / Q000627:therapeutic use; D008938:Mitosis; D010537:Peritoneum / Q000473:pathology*; D014621:Vagina / Q000473:pathology*
D007987:Gonadotropin-Releasing Hormone; D008234:Lynestrenol