Stereometric evaluation of peritoneal endometriosis and endometriotic nodules of the rectovaginal septum
Abstract
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.
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Red endometriotic lesions are very active, with high proliferative activity and VEGF and MMP content, explaining their frequent bleeding and remodeling during the menstrual period.
“Red lesions were found to be very active, with high proliferative activity and vascular endothelial growth factor (VEGF) and matrix metalloproteinase (MMP) content, explaining their frequent bleeding and remodeling during the menstrual period [46,47,48].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [46]
Red lesions are resistant to progestin therapy, which may induce some decidualization, but not atrophy.
“These red lesions are resistant to progestin therapy, which may induce some decidualization, but not atrophy [46,47,48].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [46]
Progesterone resistance is an explanation for why 33% of patients do not respond to OCPs and progestins, with this percentage climbing even higher in women with deep nodular endometriosis.
“In the present paper, we thoroughly scrutinized the concept of progesterone resistance as an explanation for why 33% of patients do not respond to OCPs and progestins, with this percentage climbing even higher in women with deep nodular endometriosis [46,47,56,58].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [46]
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- Authors
- Donnez, J., Nisolle, M., Casanas-Roux, F., Brion, P., & DaFerreira, N. C.
- Affiliations
- Cliniques Universitaires Saint-Luc (BE)
- Corresponding author
- Donnez, J.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 1996-01-01
- Volume
- 11
- Issue
- 1
- Pages
- 224-228
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2154320004
- Cited by
- 65
- References
- 24
- Citations by year
- 2026: 1 · 2025: 3 · 2023: 4 · 2022: 3 · 2021: 5 · 2020: 4 · 2019: 1 · 2018: 4 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 1 · 2013: 2 · 2012: 1
- FWCI
- 4.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- DIAL (Catholic University of Leuven) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- peritoneal endometriosis, rectovaginal septum, stereology, mitotic activity, glandular epithelium, GnRH agonist, lynestrenol, deep infiltrating endometriosis, Müllerian remnants
- MeSH terms
- Biopsy, Endometriosis, Endometrium, Epithelium, Female, Humans, Gonadotropin-Releasing Hormone, Lynestrenol, Mitosis, Peritoneum, Vagina
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