The DOI matches its Crossref record; 152 of the 153 references it cites were found in a registry or an index.
The Role of the Lymphatic System in Endometriosis: A Comprehensive Review of the Literature1
Abstract
Endometriosis is a benign gynecological disorder characterized by the presence of tissue resembling the endometrium in locations outside the uterus. The pathogenesis of endometriosis is still unknown; however, it is believed that the lymphatic system plays major roles in the development and progression of the disease. The lymphatic dissemination theory has been proposed to explain the presence of endometrial and/or endometriotic tissue in lymphatic vessels, lymph nodes, and rare sites, as well as high reoccurrence rates following treatment. Despite the importance of the lymphatic system in many aspects of endometriosis, there has been no previous thorough scientific update on its role in the disease. A review of scientific literature on the lymphatic system, lymphangiogenesis, and immunological changes associated with endometriosis was conducted. Lymphangiogenic potential is disturbed and lymphatic vessel density increased in the eutopic endometrium of women with endometriosis, likely promoting the entry of endometrial tissues into the lymphatic circulation. Endometriotic lesions and endometrial-like cells are present in uterine-draining nodes and various other pelvic lymph nodes. Immune responses are impaired in uterine-draining nodes, likely favoring the survival of endometrial cells and lesion establishment. In addition, lymphangiogenesis in endometriotic lesions may contribute to lesion growth and persistence, and promote the spread of endometrial cells to draining lymph nodes. The evidence reviewed in this paper supports the theory of lymphatic dissemination of endometriosis and highlights the roles of the lymphatic system in the pathogenesis and persistence of endometriosis. Understanding these roles is crucial for establishment of novel therapeutic approaches.
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In the citing paper
“In most bowel lesions lymph nodes are invaded (17,18).”
From Pathogenesis of deep endometriosis (2017) · cites this paper as [18]
Citations
Cites
Detection of Circulating Tumor DNA in Early- and Late-Stage Human Malignancies
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The physiology of the lymphatic system
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Cited by
Sorted by citations
Zondervan, K. T., Becker, C. M., & Missmer, S. A. (2020) · New England Journal of Medicine · doi:10.1056/nejmra1810764 · Cited by 2,249
Rethinking mechanisms, diagnosis and management of endometriosis
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The endometrial immune environment of women with endometriosis
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Pathogenesis of endometriosis: The genetic/epigenetic theory
Koninckx, P. R., Ussia, A., Adamyan, L., Wattiez, A., Gomel, V., & Martin, D. C. (2019) · Fertility and Sterility · doi:10.1016/j.fertnstert.2018.10.013 · Cited by 427
“These lesions are generally unique, larger than 1 cm in diameter, with frequent invasion into the muscle of the bowel wall, and with occasional nerve invasion (22), a neurotropic effect (23, 24), and some 20% lymph node involvement (25, 26).”
BackgroundThe Main Theories on the Pathogenesis of Endometriosis
Lamceva, J., Uljanovs, R., & Strumfa, I. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24054254 · Cited by 324
“The benefit of a benign metastasis theory is that this pathogenetic mechanism can explain the occurrence of endometriosis in lymphatic nodes and distant locations such as lungs, because lymphatic capillaries are found in almost all organs [14].”
Background
Metadata
- Authors
- Jerman, L. F., & Hey-Cunningham, A. J.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Jerman, Laila F.
- Venue
- Biology of Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-03-01
- Volume
- 92
- Issue
- 3
- Pages
- 64-64
- ISSN
- 0006-3363 (ISSN-L)
- 1529-7268
- OpenAlex
- W2152401059
- Cited by
- 122
- References
- 153
- Citations by year
- 2026: 13 · 2025: 13 · 2024: 13 · 2023: 12 · 2022: 16 · 2021: 14 · 2020: 14 · 2019: 9 · 2018: 7 · 2017: 4 · 2016: 5 · 2015: 2
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biology of Reproduction (publishedVersion)
- PubMed (publishedVersion)
- BioOne Complete (BioOne) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Infectious Diseases › Diagnosis and treatment of tuberculosis
- Keywords
- endometriosis, lymphatic system, lymphangiogenesis, lymphatic vessel density, pelvic lymph nodes, endometriotic lesions, immune response, endometriosis pathogenesis, endometriosis recurrence, eutopic endometrium
- MeSH terms
- Animals, Disease Models, Animal, Endometriosis, Endometrium, Female, Humans, Lymphatic System, Pelvis, Uterus, Disease Progression
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