Dating endometriotic ovarian cysts based on the content of cyst fluid and its potential clinical implications
Open accessAbstract
This study was undertaken to test the hypotheses that, due to gradual accumulation of dead erythrocytes and their ingested products resulting from repeated hemorrhage, older endometriomas (whitish in color) contain chocolate fluid with higher iron content than younger (brownish/blackish in color) ones with concomitant higher collagen content and more adhesions. We recruited 30 premenopausal women with histologically confirmed ovarian endometriomas and collected samples of their endometriotic lesions and chocolate fluid and measured the viscosity, density, and the concentration of total bilirubin, ferritin, and free iron of the chocolate fluid. We also evaluated the lesion color and adhesion scores. In addition, we performed Masson trichrome and Picro-Sirius red staining on all endometriotic cysts and evaluated the extent of fibrosis in the lesions. We found that fluids taken from white-colored endometriomas had significantly higher concentration of total bilirubin, ferritin, and free iron, respectively, than black/brown-colored ones. In addition, older cysts had fluids that had significantly higher density and viscosity. Fluid density correlated positively with the concentrations of total bilirubin, ferritin, and free iron. Older lesions had significantly more collagen content and higher adhesion scores. Taken together, these data supports the notion that older cysts, having experienced more bleeding episodes, contain chocolate fluid that is higher in viscosity, density, and iron content and higher fibrotic content than younger ones. This provides another piece of evidence that endometriotic lesions are wounds that undergo repeated injury and repair, resulting ultimately fibrotic lesions that are resistant to hormonal treatment.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The extent of lesional fibrosis is a proxy for lesional developmental stage.
“Since the extent of lesional fibrosis is a proxy for lesional developmental stage (Guo et al., 2015; Liu et al., 2016; Shen et al., 2016; Zhang et al., 2016)”
From Progressively diminished estrogen signaling concordant with increased fibrosis in ectopic endometrium (2025) · cites this paper as Guo et al., 2015
The extent of fibrosis in ectopic endometrium is associated with lesional developmental stage and severity of dysmenorrhea, and is implicated in heavy menstrual bleeding in adenomyosis, yet refractory to medical treatment.
“the extent of fibrosis in ectopic endometrium is associated with the lesional developmental stage (Guo et al., 2015; Zhang et al., 2016) and severity of dysmenorrhea (Liu et al., 2018a; Nie et al., 2022), and is implicated to be responsible for heavy menstrual bleeding in adenomyosis (Huang et al., 2022a), yet refractory to medical treatment (Liu et al., 2018b; Shen et al., 2025).”
From Progressively diminished estrogen signaling concordant with increased fibrosis in ectopic endometrium (2025) · cites this paper as Guo et al., 2015
Endometriotic lesions are essentially wounds undergoing repeated tissue injury and repair (ReTIAR).
“accumulating evidence suggests that endometriotic lesions are essentially wounds undergoing repeated tissue injury and repair (ReTIAR)19–22”
From Platelets induce increased estrogen production through NF-κB and TGF-β1 signaling pathways in endometriotic stromal cells (2020) · cites this paper as [20]
Ectopic endometrium is essentially wounds that go through repeated tissue injury and repair (ReTIAR).
“Consequently, they are essentially wounds that go through repeated tissue injury and repair (ReTIAR)20,21.”
From Neuropeptides Substance P and Calcitonin Gene Related Peptide Accelerate the Development and Fibrogenesis of Endometriosis (2019) · cites this paper as [20]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Cellular and molecular mechanisms of fibrosis
Wynn, T. (2008) · The Journal of Pathology · doi:10.1002/path.2277 · Cited by 4,495 · see citing works
Mechanisms of fibrosis: therapeutic translation for fibrotic disease
Wynn, T. A., & Ramalingam, T. R. (2012) · Nature Medicine · doi:10.1038/nm.2807 · Cited by 3,541 · see citing works
Revised American Society for Reproductive Medicine classification of endometriosis: 1996
American Society for Reproductive Medicine (1997) · Fertility and Sterility · doi:10.1016/s0015-0282(97)81391-x · Cited by 3,018 · see citing works
Junqueira, L. C. U., Bignolas, G., & Brentani, H. (1979) · The Histochemical Journal · doi:10.1007/bf01002772 · Cited by 2,570 · see citing works
Klinge, U., Park, J.-K., & Klosterhalfen, B. (2013) · Pathobiology · doi:10.1159/000348446 · Cited by 1,791 · see citing works
Liver fibrosis – from bench to bedside
Friedman, S. L. (2003) · Journal of Hepatology · doi:10.1016/s0168-8278(02)00429-4 · Cited by 1,780 · see citing works
FERRITIN: STRUCTURE, GENE REGULATION, AND CELLULAR FUNCTION IN ANIMALS, PLANTS, AND MICROORGANISMS
Theil, E. C. (1987) · Annual Review of Biochemistry · doi:10.1146/annurev.bi.56.070187.001445 · Cited by 1,337 · see citing works
Rac1b and reactive oxygen species mediate MMP-3-induced EMT and genomic instability
Radisky, D. C., Levy, D. D., Littlepage, L. E., Liu, H., Nelson, C. M., Fata, J. E., Leake, D., Godden, E. L., Albertson, D. G., Angela Nieto, M., et al. (2005) · Nature · doi:10.1038/nature03688 · Cited by 1,284 · see citing works
Nisolle, M., & Donnez, J. (1997) · Fertility and Sterility · doi:10.1016/s0015-0282(97)00191-x · Cited by 1,279 · see citing works
Renal fibrosis: New insights into the pathogenesis and therapeutics
Liu, Y. (2006) · Kidney International · doi:10.1038/sj.ki.5000054 · Cited by 1,088 · see citing works
Blood Rheology and Hemodynamics
Baskurt, O. K., & Meiselman, H. J. (2003) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-2003-44551 · Cited by 1,022 · see citing works
Ghosh, A. K., & Vaughan, D. E. (2011) · Journal of Cellular Physiology · doi:10.1002/jcp.22783 · Cited by 679 · see citing works
Vercellini, P., Fedele, L., Aimi, G., Pietropaolo, G., Consonni, D., & Crosignani, P. G. (2007) · Human Reproduction · doi:10.1093/humrep/del339 · Cited by 547 · see citing works
Vascular endothelial growth factor (VEGF) in endometriosis
Donnez, J., Smoes, P., Gillerot, S., Casanas-Roux, F., & Nisolle, M. (1998) · Human Reproduction · doi:10.1093/humrep/13.6.1686 · Cited by 531 · see citing works
Rhyu, D. Y., Yang, Y., Ha, H., Lee, G. T., Song, J. S., Uh, S., & Lee, H. B. (2005) · Journal of the American Society of Nephrology · doi:10.1681/asn.2004050425 · Cited by 523 · see citing works
Sanchez, A. M., Viganò, P., Somigliana, E., Panina-Bordignon, P., Vercellini, P., & Candiani, M. (2014) · Human Reproduction Update · doi:10.1093/humupd/dmt053 · Cited by 357 · see citing works
Yamaguchi, K., Mandai, M., Toyokuni, S., Hamanishi, J., Higuchi, T., Takakura, K., & Fujii, S. (2008) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-07-1614 · Cited by 324 · see citing works
Matsuzaki, S., & Darcha, C. (2012) · Human Reproduction · doi:10.1093/humrep/der442 · Cited by 216 · see citing works
Age-related evolution in color appearance of endometriosis
Redwine, D. B. (1987) · Fertility and Sterility · doi:10.1016/s0015-0282(16)59611-3 · Cited by 214 · see citing works
Potential involvement of iron in the pathogenesis of peritoneal endometriosis
Defrere, S., Lousse, J. C., Gonzalez-Ramos, R., Colette, S., Donnez, J., & Van Langendonckt, A. (2008) · Molecular Human Reproduction · doi:10.1093/molehr/gan033 · Cited by 204 · see citing works
The endoscopic localization of endometrial implants in the ovarian chocolate cyst
Brosens, I. A., Puttemans, P., & Deprest, J. A. (1994) · Fertility and Sterility · doi:10.1016/s0015-0282(16)56752-1 · Cited by 199 · see citing works
Endometriosis: Correlation between histologic and visual findings at laparoscopy
Walter, A. J., Hentz, J. G., Magtibay, P. M., Cornella, J. L., & Magrina, J. F. (2001) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2001.115747 · Cited by 197 · see citing works
Involvement of the nuclear factor-κB pathway in the pathogenesis of endometriosis
González-Ramos, R., Van Langendonckt, A., Defrère, S., Lousse, J.-C., Colette, S., Devoto, L., & Donnez, J. (2010) · Fertility and Sterility · doi:10.1016/j.fertnstert.2010.01.013 · Cited by 179 · see citing works
REVIEW: Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic quantitative review
Wykes, C. B., Clark, T. J., & Khan, K. S. (2004) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2004.00433.x · Cited by 177 · see citing works
Subtle appearance of pelvic endometriosis
Stripling, M. C., Martin, D. C., Chatman, D. L., Zwaag, R. V., & Poston, W. M. (1988) · Fertility and Sterility · doi:10.1016/s0015-0282(16)59767-2 · Cited by 167 · see citing works
Postoperative Adhesions: From Formation to Prevention
Alpay, Z., Saed, G. M., & Diamond, M. P. (2008) · Seminars in Reproductive Medicine · doi:10.1055/s-0028-1082389 · Cited by 156 · see citing works
Nuclear factor-kappa B is constitutively activated in peritoneal endometriosis
González-Ramos, R., Donnez, J., Defrère, S., Leclercq, I. A., Squifflet, J. P., Lousse, J., & Langendonckt, A. V. (2007) · Molecular Human Reproduction · doi:10.1093/molehr/gam033 · Cited by 154 · see citing works
Patterns of and Risk Factors for Recurrence in Women With Ovarian Endometriomas
Liu, X., Yuan, L., Shen, F., Zhu, Z., Jiang, H., & Guo, S.-W. (2007) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000265215.87717.8b · Cited by 146 · see citing works
Self-citationGuo, S. (2006) · Gynecologic and Obstetric Investigation · doi:10.1159/000096047 · Cited by 140 · see citing works
Self-citationDing, D., Liu, X., Duan, J., & Guo, S.-W. (2015) · Human Reproduction · doi:10.1093/humrep/dev025 · Cited by 139 · see citing works
Self-citationMatsuzaki, S., & Darcha, C. (2013) · PLoS ONE · doi:10.1371/journal.pone.0076808 · Cited by 138 · see citing works
Iron overload in the peritoneal cavity of women with pelvic endometriosis
Van Langendonckt, A., Casanas-Roux, F., & Donnez, J. (2002) · Fertility and Sterility · doi:10.1016/s0015-0282(02)03346-0 · Cited by 137 · see citing works
Lousse, J., Defrère, S., Langendonckt, A. V., Gras, J. M., González-Ramos, R., Colette, S., & Donnez, J. (2008) · Fertility and Sterility · doi:10.1016/j.fertnstert.2008.02.103 · Cited by 137 · see citing works
Histologic analysis of endometriomas: what the surgeon needs to know
Muzii, L., Bianchi, A., Bellati, F., Cristi, E., Pernice, M., Zullo, M. A., Angioli, R., & Panici, P. B. (2006) · Fertility and Sterility · doi:10.1016/j.fertnstert.2006.06.055 · Cited by 128 · see citing works
Busacca, M., & Vignali, M. (2003) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/01.gco.0000084247.09900.4f · Cited by 128 · see citing works
Endometriosis: What a Pain It Is
Vercellini, P. (1997) · Seminars in Reproductive Medicine · doi:10.1055/s-2008-1068755 · Cited by 120 · see citing works
Endometriosis classification: an update
Adamson, G. D. (2011) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0b013e328348a3ba · Cited by 119 · see citing works
Defrère, S., Langendonckt, A. V., Vaesen, S., Jouret, M., Ramos, R., González, D., & Donnez, J. (2006) · Human Reproduction · doi:10.1093/humrep/del261 · Cited by 109 · see citing works
Automated quantification of renal fibrosis with Sirius Red and polarization contrast microscopy
Street, J. M., Souza, A. C. P., Álvarez-Prats, A., Horino, T., Hu, X., Yuen, P. S. T., & Star, R. A. (2014) · Physiological Reports · doi:10.14814/phy2.12088 · Cited by 101 · see citing works
Potential involvement of hemoglobin and heme in the pathogenesis of peritoneal endometriosis
Van Langendonckt, A., Casanas-Roux, F., Dolmans, M.-M., & Donnez, J. (2002) · Fertility and Sterility · doi:10.1016/s0015-0282(01)03211-3 · Cited by 91 · see citing works
Increased Angiogenesis and Expression of Vascular Endothelial Growth Factor during Scarless Repair
Colwell, A. S., Beanes, S. R., Soo, C. B., Dang, C., Kang, T., Longaker, M. T., Atkinson, J. B., & Lorenz, H. P. (2005) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000138252.51581.22 · Cited by 88 · see citing works
Deep endometriosis conundrum: evidence in favor of a peritoneal origin
Vercellini, P., Aimi, G., Panazza, S., Vicentini, S., Pisacreta, A. M., & Crosignani, P. G. (2000) · Fertility and Sterility · doi:10.1016/s0015-0282(00)00420-9 · Cited by 87 · see citing works
De novo formation of adhesions in endometriosis: the role of iron and free radical reactions
Arumugam, K., & Dip, Y. C. Y. (1995) · Fertility and Sterility · doi:10.1016/s0015-0282(16)57655-9 · Cited by 84 · see citing works
Mechsner, S., Bartley, J., Loddenkemper, C., Salomon, D. S., Starzinski-Powitz, A., & Ebert, A. D. (2005) · Fertility and Sterility · doi:10.1016/j.fertnstert.2004.11.038 · Cited by 79 · see citing works
Wim, A., Willems, S., Verleden, S. E., Vanaudenaerde, B. M., Wynants, M., Christophe, D., Jonas, Y., Jana, S., Eric, K., & Verleden, G. M. (2013) · Annals of Thoracic Medicine · doi:10.4103/1817-1737.105718 · Cited by 78 · see citing works
Smooth muscle metaplasia in ovarian endometriosis
Fukunaga (2000) · Histopathology · doi:10.1046/j.1365-2559.2000.00845.x · Cited by 74 · see citing works
Location, color, size, depth, and volume may predict endometriosis in lesions resected at surgery
Stratton, P., Winkel, C. A., Sinaii, N., Merino, M. J., Zimmer, C., & Nieman, L. K. (2002) · Fertility and Sterility · doi:10.1016/s0015-0282(02)03337-x · Cited by 72 · see citing works
Preventing adhesions in obstetric and gynecologic surgical procedures.
González-Quintero, V. H., & Cruz-Pachano, F. (2009) · PubMed · Cited by 69 · see citing works
Arumugam, K. (1994) · Human Reproduction · doi:10.1093/oxfordjournals.humrep.a138649 · Cited by 58 · see citing works
Smooth muscle metaplasia and innervation in interstitium of endometriotic lesions related to pain
Odagiri, K., Konno, R., Fujiwara, H., Netsu, S., Yang, C., & Suzuki, M. (2008) · Fertility and Sterility · doi:10.1016/j.fertnstert.2008.08.101 · Cited by 57 · see citing works
Martin, D. C., & BERRY, J. D. (1990) · Journal of Gynecologic Surgery · doi:10.1089/gyn.1990.6.43 · Cited by 55 · see citing works
Delima, R. D., Chua, A. C. G., Tirnitz‐Parker, J. E. E., Gan, E. K., Croft, K. D., Graham, R. M., Olynyk, J. K., & Trinder, D. (2012) · Hepatology · doi:10.1002/hep.25689 · Cited by 54 · see citing works
The current staging system for endometriosis: does it help?
Roberts, C. P., & Rock, J. A. (2003) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/s0889-8545(02)00056-6 · Cited by 50 · see citing works
Pulmonary hypertension, interstitial lung fibrosis, and lung iron deposition in thalassaemia major
Zakynthinos, E. G. (2001) · Thorax · doi:10.1136/thorax.56.9.737 · Cited by 46 · see citing works
Iron toxicity mediated by oxidative stress enhances tissue damage in an animal model of diabetes
Sampaio, A. F. S., Silva, M., Dornas, W. C., Costa, D. C., Silva, M. E., dos Santos, R. C., de Lima, W. G., & Pedrosa, M. L. (2014) · BioMetals · doi:10.1007/s10534-014-9717-8 · Cited by 45 · see citing works
HONG, J.-P., Li, X., Li, M., & Fa-lei, Z. (2013) · International Journal of Molecular Medicine · doi:10.3892/ijmm.2013.1337 · Cited by 41 · see citing works
Danazol in the management of ureteral obstruction secondary to endometriosis
Rivlin, M. E., Krueger, R. P., & Wiser, W. L. (1985) · Fertility and Sterility · doi:10.1016/s0015-0282(16)48751-0 · Cited by 38 · see citing works
Lian, Y.-G., Zhou, Q., Zhang, Y., & Fa-lei, Z. (2011) · Acta Pharmacologica Sinica · doi:10.1038/aps.2011.111 · Cited by 37 · see citing works
Chemical Assay of Iron in Ovarian Cysts: A New Diagnostic Method to Evaluate Endometriotic Cysts
Iizuka, M., Igarashi, M., Abe, Y., Ibuki, Y., Koyasu, Y., & Ikuma, K. (1998) · Gynecologic and Obstetric Investigation · doi:10.1159/000009999 · Cited by 37 · see citing works
Magnetic resonance relaxation time in evaluating the cyst fluid characteristics of endometrioma
Takahashi, K., Okada, S., Okada, M., Kitao, M., Kaji, Y., & Sugimura, K. (1996) · Human Reproduction · doi:10.1093/oxfordjournals.humrep.a019266 · Cited by 36 · see citing works
The endometriosis cycle and its derailments
Brosens, I. A., Puttemans, P., Deprest, J. A., & Rombauts, L. J. F. (1994) · Human Reproduction · doi:10.1093/oxfordjournals.humrep.a138594 · Cited by 34 · see citing works
Classification of endometriosis:Improving the classification of endometriotic ovarian cysts
NEZHAT, C. R., Nezhat, F. R., NEZHAT, C. R., & Seidman, D. S. (1994) · Human Reproduction · doi:10.1093/oxfordjournals.humrep.a138423 · Cited by 30 · see citing works
The value of magnetic resonance relaxation time in staging ovarian endometrial cysts
Sugimura, K., Takemori, M., Sugiura, M., Okizuka, H., Kono, M., & Ishida, T. (1992) · British Journal of Radiology · doi:10.1259/0007-1285-65-774-502 · Cited by 25 · see citing works
Nisolle, M. (2002) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/00001703-200206000-00006 · Cited by 23 · see citing works
Clinical value of components of the plasminogen activation system in ovarian cyst fluid.
Ea, B., Massuger, L. F. A. G., Cm, T., Geurts-Moespot, A. J., Jh, V. S., Boonstra, H., & Sweep, F. C. G. J. (2002) · PubMed · Cited by 20 · see citing works
Expression of platelet endothelial cell adhesion molecule-1 in red and black endometriotic lesions
Langendonckt, A. V., Eggermont, J., Casanas‐Roux, F., Scholtes, H. É., & Donnez, J. (2004) · Fertility and Sterility · doi:10.1016/j.fertnstert.2004.05.075 · Cited by 13 · see citing works
Pulmonary hypertension, interstitial lung fibrosis, and lung iron deposition in thalassaemia major
Zakynthinos, E. G., Vassilakopoulos, T. P., Kaltsas, P., et al. (2001) · Thorax · doi:10.1136/thx.56.9.737 · Cited by 12 · see citing works
[Ferritin levels in the peritoneal fluid--a new endometriosis marker?].
Polak, G., Wertel, I., Tarkowski, R., Morawska, D., Nowakowski, A. M., & Kotarski, J. (2006) · PubMed · Cited by 7 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Sampson JA. Perforating hemorrhagic (chocolate) cysts of the ovary. Tr Am Gynec Soc. 1921;46(1):162-236.
- Ding D, Liu X, Duan J, Guo SW. Platelets are a unindicted culprit in the development of endometriosis. Hum Reprod. In press.
Cited by
Sorted by citations
Pathogenesis of adenomyosis, an update on molecular mechanisms
Vannuccini, S., Tosti, C., Carmona, F., Huang, S. J., Chapron, C., Guo, S.-W., & Petraglia, F. (2017) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2017.06.016 · Cited by 326 · see citing works
Self-citationZhang, Q., Duan, J., Liu, X., & Guo, S.-W. (2016) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2016.03.015 · Cited by 211 · see citing works
Self-citationLiu, X., Shen, M., Qi, Q., Zhang, H., & Guo, S.-W. (2016) · Human Reproduction · doi:10.1093/humrep/dew018 · Cited by 190 · see citing works
Self-citationZhang, Q., Duan, J., Olson, M., Fazleabas, A., & Guo, S.-W. (2016) · Reproductive Sciences · doi:10.1177/1933719116641763 · Cited by 149 · see citing works
Self-citationDing, D., Liu, X., Duan, J., & Guo, S.-W. (2015) · Human Reproduction · doi:10.1093/humrep/dev025 · Cited by 139 · see citing works
Self-citationEndometriosis: Cellular and Molecular Mechanisms Leading to Fibrosis
Garcia, J. M. G., Vannuzzi, V., Donati, C., Bernacchioni, C., Bruni, P., & Petraglia, F. (2022) · Reproductive Sciences · doi:10.1007/s43032-022-01083-x · Cited by 145 · see citing works
The role of fibrosis in endometriosis: a systematic review
Vissers, G., Giacomozzi, M., Verdurmen, W. P. R., Peek, R., & Nap, A. W. (2024) · Human Reproduction Update · doi:10.1093/humupd/dmae023 · Cited by 130 · see citing works
Shen, M., Liu, X., Zhang, H., & Guo, S.-W. (2015) · Human Reproduction · doi:10.1093/humrep/dev314 · Cited by 124 · see citing works
Self-citationThe M2a macrophage subset may be critically involved in the fibrogenesis of endometriosis in mice
Duan, J., Liu, X., Wang, H., & Guo, S.-W. (2018) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2018.05.017 · Cited by 121 · see citing works
Self-citationGuo, S.-W. (2018) · Human Reproduction · doi:10.1093/humrep/dey015 · Cited by 116 · see citing works
Self-citationLiu, X., Zhang, Q., & Guo, S.-W. (2018) · Reproductive Sciences · doi:10.1177/1933719117718275 · Cited by 110 · see citing works
Self-citationIs it time for a paradigm shift in drug research and development in endometriosis/adenomyosis?
Guo, S., & Groothuis, P. G. (2018) · Human Reproduction Update · doi:10.1093/humupd/dmy020 · Cited by 93 · see citing works
Self-citationThe role of iron in the pathogenesis of endometriosis: a systematic review
Wyatt, J. N. R., Fernando, S. M. C., Powell, S. G., Hill, C. J., Arshad, I., Probert, C. S., Ahmed, S., & Hapangama, D. K. (2023) · Human Reproduction Open · doi:10.1093/hropen/hoad033 · Cited by 95 · see citing works
Yan, D., Liu, X., & Guo, S.-W. (2019) · Scientific Reports · doi:10.1038/s41598-019-39170-w · Cited by 82 · see citing works
Self-citationZhang, Q., Liu, X., & Guo, S.-W. (2017) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2016.11.006 · Cited by 76 · see citing works
Self-citationGuo, S. (2015) · Fertility and Sterility · doi:10.1016/j.fertnstert.2015.08.006 · Cited by 73 · see citing works
Self-citationBirbas, E., Kanavos, T., Gkrozou, F., Skentou, C., Daniilidis, A., & Vatopoulou, A. (2023) · Children · doi:10.3390/children10071114 · Cited by 81 · see citing works
Origins and Progression of Adolescent Endometriosis
Brosens, I. A., Gargett, C. E., Guo, S., Puttemans, P., Gordts, S., Brosens, J. J., & Benagiano, G. (2016) · Reproductive Sciences · doi:10.1177/1933719116637919 · Cited by 73 · see citing works
Self-citationNanomedicines for Endometriosis: Lessons Learned from Cancer Research
Moses, A. S., Demessie, A. A., Taratula, O. R., Korzun, T., Slayden, O. D., & Taratula, O. (2021) · Small · doi:10.1002/smll.202004975 · Cited by 66 · see citing works
Peritoneal Fluid Cytokines Reveal New Insights of Endometriosis Subphenotypes
Zhou, J., Chern, B. S. M., Barton‐Smith, P., Phoon, J. W. L., Tan, T. Y., Viardot-Foucault, V., Ku, C. W., Tan, H. H., Chan, J. K. Y., & Lee, Y. H. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21103515 · Cited by 65 · see citing works
Anti-platelet therapy holds promises in treating adenomyosis: experimental evidence
Zhu, B., Chen, Y., Shen, X., Liu, X., & Guo, S. (2016) · Reproductive Biology and Endocrinology · doi:10.1186/s12958-016-0198-1 · Cited by 61 · see citing works
Self-citationProgress in the diagnosis and management of adolescent endometriosis: an opinion
Benagiano, G., Guo, S., Puttemans, P., Gordts, S., & Brosens, I. A. (2017) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2017.09.015 · Cited by 61 · see citing works
Self-citationEvidence in Support for the Progressive Nature of Ovarian Endometriomas
Ding, D., Wang, X., Chen, Y.-S., Benagiano, G., Liu, X., & Guo, S. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa189 · Cited by 49 · see citing works
Self-citationYan, D., Liu, X., & Guo, S. (2016) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2016.06.017 · Cited by 48 · see citing works
Self-citationThe establishment of a mouse model of deep endometriosis
Yan, D., Liu, X., & Guo, S.-W. (2019) · Human Reproduction · doi:10.1093/humrep/dey361 · Cited by 47 · see citing works
Self-citationQi, Q., Liu, X., Zhang, Q., & Guo, S.-W. (2020) · Scientific Reports · doi:10.1038/s41598-020-57997-6 · Cited by 44 · see citing works
Self-citationFurther Evidence for Hypercoagulability in Women With Ovarian Endometriomas
Ding, D., Liu, X., & Guo, S. (2018) · Reproductive Sciences · doi:10.1177/1933719118799195 · Cited by 44 · see citing works
Self-citationYan, D., Liu, X., Xu, H., & Guo, S. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa550 · Cited by 44 · see citing works
Self-citationSpotlight on iron overload and ferroptosis: Research progress in female infertility
Zhang, J., Su, T., Fan, Y., Cheng, C., Xu, L., & Li-tian (2023) · Life Sciences · doi:10.1016/j.lfs.2023.122370 · Cited by 44 · see citing works
Platelets induce endothelial–mesenchymal transition and subsequent fibrogenesis in endometriosis
Yan, D., Liu, X., Xu, H., & Guo, S. (2020) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2020.03.020 · Cited by 39 · see citing works
Self-citationActivated Platelets Induce Estrogen Receptor β Expression in Endometriotic Stromal Cells
Zhang, Q., Ding, D., Liu, X., & Guo, S.-W. (2015) · Gynecologic and Obstetric Investigation · doi:10.1159/000377629 · Cited by 38 · see citing works
Self-citationNie, J., Zhao, C., Laganà, A. S., Liu, X., & Guo, S. (2022) · Fertility and Sterility · doi:10.1016/j.fertnstert.2022.04.016 · Cited by 39 · see citing works
Self-citationAnti-platelet therapy is efficacious in treating endometriosis induced in mouse
Guo, S., Ding, D., & Liu, X. (2016) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2016.07.007 · Cited by 34 · see citing works
Self-citationCao, Y., Liu, X., & Guo, S. (2019) · Scientific Reports · doi:10.1038/s41598-019-45785-w · Cited by 36 · see citing works
Self-citationDing, D., Cai, X., Zheng, H., Guo, S., & Liu, X. (2018) · Reproductive Sciences · doi:10.1177/1933719118817661 · Cited by 32 · see citing works
Self-citationImmune Dysregulation in Endometriomas: Implications for Inflammation
Dymanowska-Dyjak, I., Terpiłowska, B., Morawska, I., Michalski, A., Polak, G., Terpiłowski, M., Rahnama, M., & Grywalska, E. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25094802 · Cited by 31 · see citing works
Hao, M., Liu, X., Rong, P., Li, S., & Guo, S. (2021) · Scientific Reports · doi:10.1038/s41598-020-79750-9 · Cited by 30 · see citing works
Self-citationLupean, R.-A., Ștefan, P.-A., Csutak, C., Lebovici, A., Măluţan, A. M., Buiga, R., Melincovici, C. S., & Mihu, C. M. (2020) · Medicina · doi:10.3390/medicina56100487 · Cited by 27 · see citing works
Possible involvement of neuropeptide and neurotransmitter receptors in Adenomyosis
Xu, X., Cai, X., Liu, X., & Guo, S. (2021) · Reproductive Biology and Endocrinology · doi:10.1186/s12958-021-00711-6 · Cited by 29 · see citing works
Self-citationVarious types of adenomyosis and endometriosis: in search of optimal management
Guo, S. (2023) · Fertility and Sterility · doi:10.1016/j.fertnstert.2023.03.021 · Cited by 24 · see citing works
Self-citationCai, X., Shen, M., Liu, X., & Guo, S. (2017) · Reproductive Sciences · doi:10.1177/1933719117702248 · Cited by 19 · see citing works
Self-citationFeng, X., Qi, L., Xu, X., Feng, Y., Gong, X., Aili, A., Chen, Y., Xue, Z., Xue, J., & Tong, X. (2021) · PeerJ · doi:10.7717/peerj.11045 · Cited by 17 · see citing works
Qi, Q.-M., Guo, S.-W., & Liu, X.-S. (2019) · Reproductive and Developmental Medicine · doi:10.4103/2096-2924.262390 · Cited by 15 · see citing works
“endometriotic lesions are essentially wounds undergoing repeated tissue injury and repair,[13-16] and many nonendometriotic cells in the lesional microenvironment, such as platelets,[15,17] macrophages,[13,18] natural killer cells,[19,20] and nerve fibers,[21,22] are involved in facilitating the development of endomet…”
BackgroundSelf-citationKellers, F., Lützen, U., Verburg, F. A., Lebenatus, A., Tesch, K., Yalçın, F., Jesinghaus, M., Stoll, V., Grebe, H., Röcken, C., et al. (2025) · Human Reproduction Open · doi:10.1093/hropen/hoaf003 · Cited by 15 · see citing works
Xu, X., Chen, Y., Yu, Q., Wang, J., Xu, P., Zhu, L., Xu, Q., Zhang, J., Cui, S., Yu, K., et al. (2022) · Journal of Ovarian Research · doi:10.1186/s13048-022-01018-9 · Cited by 15 · see citing works
Drug Development in Endometriosis and Adenomyosis: It Takes More Than Just Good Science
Groothuis, P. G., & Guo, S.-W. (2018) · Reproductive Sciences · doi:10.1177/1933719118785767 · Cited by 13 · see citing works
Self-citationNie, J., Yi, Y., Liu, X., & Guo, S.-W. (2025) · Human Reproduction Open · doi:10.1093/hropen/hoaf028 · Cited by 11 · see citing works
Self-citationFrom Inflammation to Malignancy: The Link Between Endometriosis and Gynecological Cancers
Kłodnicka, K., Michalska, A., Januszewski, J., Forma, A., Teresiński, G., Flieger, J., Bogucki, J., Maciejewski, M., Syty, K., & Baj, J. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms262411816 · Cited by 11 · see citing works
Circulating CD56+ NKG2D+ NK cells and postoperative fertility in ovarian endometrioma
Liu, Z.-Q., Lu, M.-Y., & Liu, B. (2020) · Scientific Reports · doi:10.1038/s41598-020-75570-z · Cited by 9 · see citing works
Towards an understanding of the molecular mechanisms of endometriosis-associated symptoms (Review)
Imanaka, S., Maruyama, S., Kimura, M., Nagayasu, M., & Kobayashi, H. (2020) · World Academy of Sciences Journal · doi:10.3892/wasj.2020.53 · Cited by 9 · see citing works
Pharmacologic treatment of the ovarian endometrioma
Benagiano, G., Guo, S., Bianchi, P., Puttemans, P., Gordts, S., Petraglia, F., & Brosens, I. A. (2016) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2016.1229305 · Cited by 9 · see citing works
Self-citationShen, M., Liu, X., Ding, D., & Guo, S.-W. (2025) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2025.104880 · Cited by 7 · see citing works
Self-citationChen, Y.-S., Liu, X.-S., & Guo, S.-W. (2021) · Reproductive Biomedicine Online · doi:10.1016/j.rbmo.2021.04.017 · Cited by 4 · see citing works
Self-citationEarly maternal separation accelerates the progression of endometriosis in adult mice
Long, Q., Liu, X., & Guo, S. (2020) · Reproductive Biology and Endocrinology · doi:10.1186/s12958-020-00600-4 · Cited by 7 · see citing works
Self-citationColgrave, E. M., Keast, J. R., Nowell, C. J., Healey, M., Rogers, P. A. W., Holdsworth‐Carson, S. J., & Girling, J. E. (2023) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2023.103610 · Cited by 6 · see citing works
Ye, W., Sun, Y. K., Cai, J., Yin, J., Liu, J., Liu, Y., Zhang, S., Xia, S., & Song, Y. (2024) · Advanced Biology · doi:10.1002/adbi.202300711 · Cited by 6 · see citing works
Yi, Y., Nie, J., Liu, X., & Guo, S. (2024) · Reproductive Sciences · doi:10.1007/s43032-024-01658-w · Cited by 6 · see citing works
Self-citationLupean, R.-A., Ștefan, P.-A., Lebovici, A., Csutak, C., Rusu, M., & Mihu, C. M. (2020) · Current Medical Imaging Formerly Current Medical Imaging Reviews · doi:10.2174/1573405616999201027211132 · Cited by 6 · see citing works
A protocol for creating endometriosis in rhesus macaques (Macaca mulatta)
Slayden, O. D., Luo, F., & Martin, L. D. (2023) · Journal of Medical Primatology · doi:10.1111/jmp.12681 · Cited by 6 · see citing works
Janssens, P. M. W. (2017) · Clinica Chimica Acta · doi:10.1016/j.cca.2017.05.005 · Cited by 5 · see citing works
Somatic driver mutations in endometriosis as possible regulators of fibrogenesis (Review)
Kobayashi, H. (2019) · World Academy of Sciences Journal · doi:10.3892/wasj.2019.12 · Cited by 4 · see citing works
Overexpression of miR-21-5p as a potential pathogenesis marker for ovarian endometriosis
Mahmoud, M., WalyEldeen, A. A., samie, M. A., Sadek, A. M., ElAkhras, S., Samir, M., Ahmed, O., Sayed, R. M. S., Baiomy, A. A., Ibrahim, S., et al. (2025) · The Journal of Basic and Applied Zoology · doi:10.1186/s41936-024-00414-5 · Cited by 4 · see citing works
Teworte, S., Behrens, M. C., Widhe, M., Gurzeler, L., Hedhammar, M., & Luciani, P. (2025) · Small · doi:10.1002/smll.202409126 · Cited by 3 · see citing works
Endometriosis-associated pain and adhesions — new pathogenetic aspects and therapeutic approach
Yarmolinskaya, M. I., & Adamyan, L. V. (2023) · Russian Journal of Human Reproduction · doi:10.17116/repro20232902193 · Cited by 3 · see citing works
Huang, Y., Su, X., Chen, K., Zhang, L., Xu, W., Pu, Y., Xu, F., Gong, R., Zhang, J., Nie, Y., et al. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-074488 · Cited by 2 · see citing works
Liu, L., Yin, J., Liu, Y., Li, B., Kang, S., & Du, N. (2024) · Medicine · doi:10.1097/md.0000000000040690 · Cited by 2 · see citing works
Hassanein, H. H., WalyEldeen, A. A., Sayed, R. M. S., Taha, A., Ibrahim, S., & Hassan, H. (2025) · Tissue and Cell · doi:10.1016/j.tice.2025.102867 · Cited by 2 · see citing works
The quest for genetic sequence variants conferring risk of endometriosis
Guo, S. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816561-4.00006-5 · Cited by 2 · see citing works
Self-citationRole of molecular signaling pathways in the pathogenesis of adenomyosis
Shalina, M. A., Yarmolinskaya, M. I., Netreba, E. A., & Beganova, A. K. (2021) · Journal of obstetrics and women s diseases · doi:10.17816/jowd57192 · Cited by 1 · see citing works
Iron deposition in ovarian endometrioma evaluated by magnetic resonance imaging R2* non-invasively
Zhang, P., Song, Y., Su, M., Lin, Y., He, Y., Liu, X., Wu, N., Lin, Y., Wang, Z., Yuan, M., et al. (2025) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2025.105024 · Cited by 1 · see citing works
Self-citationDing, D., Chang, L., Wang, X., Xu, Y., Yang, B., Pylypenko, D., Xu, T., Wang, J., Yu, D., & Wang, F. (2025) · La radiologia medica · doi:10.1007/s11547-025-02152-2 · Cited by 1 · see citing works
Self-citationWang, X., He, J., Shen, S., Li, M., Yuan, S., Xu, W., Zhu, S., Ding, Y., & Wang, X. (2026) · Cellular Signalling · doi:10.1016/j.cellsig.2026.112362 · Cited by 1 · see citing works
Unexpected high levels of iron and rubidium in the peritoneal fluid of endometriosis patients
López-Botella, A., Romero, A., Sánchez, R., Torró, J. L. T., Velasco, I., Acién, M., & Gómez‐Torres, M. J. (2025) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2025.180270 · Cited by 1 · see citing works
Luo, M., Cai, X., Liu, X., Yan, D., & Guo, S. (2022) · Medical Research Archives · doi:10.18103/mra.v10i11.3341 · Cited by 1 · see citing works
Self-citationSaraswati, P. S. (2019) · INDONESIAN JOURNAL OF HEALTH SCIENCES RESEARCH AND DEVELOPMENT (IJHSRD) · doi:10.36566/ijhsrd/vol1.iss1/1
Liu, X., Benagiano, G., Ding, D., & Guo, S. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa542
Self-citationThe roles and functions of macrophages in endometriosis
Jiao, X., Ji, M., Guo, S., & Wang, G. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-820661-4.00007-8
Self-citationEndometriosis Research: From Bench to Bedside
Laganà, A. S., & La Rosa, V. L. (2022) · MDPI eBooks · doi:10.3390/books978-3-0365-2798-7
The Role of Platelets in the Pathogenesis of Endometriosis and New Therapeutic Ideas
许, 万. (2022) · Advances in Clinical Medicine · doi:10.12677/acm.2022.124367
Clinical diagnosis model Construction of endometriosis based on clinical data*Preprint
Zhang, W., Jia, Q., Tang, H., Chen, Y., Shan, W., Zhu, G., & Chen, J. (2024) · Research Square · doi:10.21203/rs.3.rs-3890783/v1
Xu, X., Chen, Y., Yu, Q. P., Wang, J., Xu, P., Zhu, L., Xu, Q., Zhang, J., Cui, S., Yu, K., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20408677
Decoding Endometriosis: A Comprehensive Guide to Understanding Symptoms and Impacts
Emami, A. (2025) · Obstetrics and gynecology. · doi:10.5772/intechopen.1008252
Xu, X., Cai, X., Liu, X., & 郭孙伟 (2021) · Figshare · doi:10.6084/m9.figshare.14059997
Self-citationXu, X., Chen, Y., Yu, Q., Wang, J., Xu, P., Zhu, L., Xu, Q., Zhang, J., Cui, S., Yu, K., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20408680
Xu, X., Chen, Y., Yu, Q., Wang, J., Xu, P., Zhu, L., Xu, Q., Zhang, J., Cui, S., Yu, K., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20408683
Is endometriosis a progressive disease?
Guo, S., Canis, M. J., & Vercellini, P. (2026) · Trends in Molecular Medicine · doi:10.1016/j.molmed.2026.02.011
Self-citationGoyal, R. (2026) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2026.05.27.728028
Paramshetti, S., Angolkar, M., Patil, D., Spandana, K. M. A., Osmani, R. A. M., Gangadharappa, H. V., Fatease, A. M. A., Alamri, A. H., Hani, U., & Trivedi, R. (2026) · Journal of Drug Delivery Science and Technology · doi:10.1016/j.jddst.2026.108752 · Cited by 1 · see citing works
- Authors
- Guo, S.-W., Ding, D., Shen, M., & Liu, X.
- Affiliations
- Fudan University (CN)
- Corresponding author
- Guo, Sun-Wei
- Venue
- Reproductive Sciences
- Published
- 2015-07
- Volume
- 22
- Issue
- 7
- Pages
- 873-883
- ISSN
- 1933-7191 (ISSN-L)
- 1933-7205
- PMC
- PMC4565481
- OpenAlex
- W2118681643
- Cited by
- 86
- References
- 67
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 7 · 2023: 7 · 2022: 8 · 2021: 8 · 2020: 12 · 2019: 4 · 2018: 7 · 2017: 5 · 2016: 9 · 2015: 4
- FWCI
- 9.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Reproductive Sciences (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81471434, 81070470, 81370695, 81270676)
- Science and Technology Commission of Shanghai Municipality
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Reproductive Medicine › Ovarian cancer diagnosis and treatment
- Keywords
- endometrioma, ferritin, free iron, bilirubin, adhesion, collagen content, fibrosis
- MeSH terms
- Adult, Endometriosis, Female, Humans, Ovarian Cysts, Cyst Fluid
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review