Higher activity by opaque endometriotic lesions than nonopaque lesions.
BACKGROUND
Higher activity by early endometriosis than advanced endometriosis has been reported. However, the pattern of activity in individual colored endometriotic lesions in pelvic cavity is unknown. We investigated the variation in activity of the different colored morphologic lesions as proposed by the current revised American Society of Reproductive Medicine (ASRM) classification in women with endometriosis.


METHODS
Peritoneal fluid (PF) and biopsies were collected during laparoscopy from 45 infertile women with pelvic endometriosis and 15 women without endometriosis. PF concentrations of hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and monocyte chemotactic protein-1 (MCP-1) were measured by enzyme-linked immunosorbent assay (ELISA). The immunohistochemical staining of HGF and proliferating cell nuclear antigen (PCNA) in opaque and nonopaque endometriotic lesions was examined using respective antibodies, and a computer-analyzed modified quantitative-histogram score (Q-H score) was used to quantify the immunoreaction.


RESULTS
Opaque red lesions were defined as nontransparent lesions, including polypoid excrescence, blood bleb or ecchymosis, and nonopaque lesions were defined as translucent or transparent lesions, including vesicular bleb or clear papule. The women with endometriosis containing dominant opaque red lesions showed significantly higher PF concentrations of HGF, VEGF, IL-6 or MCP-1 than those with either nonopaque lesions or black lesions or control women. There was no difference in any of these cytokine or chemokine levels between women harboring nonopaque lesions and black lesions. Interestingly, PF concentrations of all these markers were significantly reduced in women containing true black lesions and true white lesions after excluding the presence of coexisting red spot from dominant black or white lesions. In a parallel fashion, the immunoexpressions of HGF and PCNA in intact tissue as shown by the Q-H score were significantly stronger in the opaque red lesions than in the nonopaque lesions or black lesions.


CONCLUSIONS
Opaque red lesions display a higher activity than with nonopaque red lesions in both PF and intact tissue. This indicates different histogenesis in their generation in the pelvic cavity.
Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, Nagasaki, Japan. nemokhan@net.nagasaki-u.ac.jp
Khaleque Newaz
KN
Khan
Hideaki
H
Masuzaki
Akira
A
Fujishita
Michio
M
Kitajima
Ichiro
I
Sekine
Tadayuki
T
Ishimaru
D000328:Adult; D001202:Ascitic Fluid / Q000378:metabolism; D016022:Case-Control Studies; D018932:Chemokine CCL2 / Q000378:metabolism; D004715:Endometriosis / Q000378:metabolism* / Q000473:pathology*; D005260:Female; D017228:Hepatocyte Growth Factor / Q000378:metabolism; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D010535:Laparoscopy; D008597:Menstrual Cycle / Q000378:metabolism; D010532:Peritoneal Diseases / Q000378:metabolism* / Q000473:pathology*; D018809:Proliferating Cell Nuclear Antigen / Q000378:metabolism; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
D018932:Chemokine CCL2; D015850:Interleukin-6; D018809:Proliferating Cell Nuclear Antigen; D042461:Vascular Endothelial Growth Factor A; D017228:Hepatocyte Growth Factor