Histological and Immunohistochemical Characterization of the Similarity and Difference Between Ovarian Endometriomas and Deep Infiltrating Endometriosis
Abstract
Ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE) have long been recognized to have different histology and, as such, postulated to be 2 separate disease entities. Few studies, however, have attempted to elucidate the causes for their differences. Making use of ectopic endometrial tissue samples from 25 and 20 women with OMA and DIE, respectively, and control endometrial tissue samples from 25 women without endometriosis, we conducted an immunohistochemical analysis to evaluate the expression of a group of carefully chosen markers for epithelial-mesenchymal transition (EMT), fibroblast-to-myofibroblast transdifferentiation (FMT), smooth muscle metaplasia (SMM), fibrosis, vascularity, hormonal receptors, and proteins involved in epigenetic modifications. We found that both OMA and DIE lesions exhibited the same cellular changes consistent with EMT, FMT, SMM, and fibrosis as already shown in animal models. Compared to OMA, DIE lesions underwent more thorough and extensive EMT, FMT, and SMM and, consequently, displayed significantly higher fibrotic content but less vascularity. The 2 conditions also showed different expression levels of hormonal receptors. Both OMA and DIE lesions, especially the latter, showed significantly higher staining of enhancer of zeste homolog 2, H3K9me3, and H3K27me3 than that of control endometrium, suggesting progressive epigenetic changes concomitant with cellular ones. Finally, proteins that are known to be involved in fibrogenesis, such as thymocyte differentiation antigen 1 and peroxisome proliferator-activated receptor γ , were also aberrantly expressed under both conditions. The many similarities shared by both OMA and DIE indicate that the 2 conditions may actually share the same pathogenesis/pathophysiology. Their differences, however, suggest that the source of these differences may result from the different lesional microenvironments.
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The vast heterogeneity of endometriosis appears to be determined mostly by the lesional microenvironments.
“As we showed previously, however, the vast heterogeneity of endometriosis appears to be determined mostly by the lesional microenvironments80.”
From Platelets induce increased estrogen production through NF-κB and TGF-β1 signaling pathways in endometriotic stromal cells (2020) · cites this paper as [80]
Compared with OE, DE lesions appeared to have gone through EMT, FMT, and SMM more thoroughly and extensively, and exhibited significantly more fibromuscular tissues yet reduced cellularity and vascularity.
“we recently found that, compared with OE, DE lesions appeared to have gone through EMT, FMT, and SMM more thoroughly and more extensively, and, accordingly, exhibited significantly more fibromuscular tissues yet reduced cellularity and vascularity28.”
From Neuropeptides Substance P and Calcitonin Gene Related Peptide Accelerate the Development and Fibrogenesis of Endometriosis (2019) · cites this paper as [28]
Proteins known to be involved in fibrogenesis, such as THY-1 and PPAR-g, were aberrantly expressed in these conditions.
“Proteins that are known to be involved in fibrogenesis, such as THY-1 and PPAR-g, were also aberrantly expressed in these conditions.”
From Pathogenesis of deep endometriosis (2017) · cites this paper as [49]
These conditions may share the same pathogenesis/pathophysiology.
“They showed that these conditions may share the same pathogenesis/pathophysiology.”
From Pathogenesis of deep endometriosis (2017) · cites this paper as [49]
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Nie, J., Yi, Y., Liu, X., & Guo, S.-W. (2025) · Human Reproduction Open · doi:10.1093/hropen/hoaf028 · Cited by 11 · see citing works
Self-citation
- Authors
- Liu, X., Zhang, Q., & Guo, S.-W.
- Affiliations
- Fudan University (CN)
- Corresponding author
- Liu, Xishi
- Venue
- Reproductive Sciences
- Published
- 2018-03
- Volume
- 25
- Issue
- 3
- Pages
- 329-340
- ISSN
- 1933-7191 (ISSN-L)
- 1933-7205
- OpenAlex
- W2738561245
- Semantic Scholar
- 84379f483075ecabc3afc7111d7829ffdc5bc53d
- Cited by
- 110
- References
- 85
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 16 · 2023: 10 · 2022: 13 · 2021: 6 · 2020: 16 · 2019: 8 · 2018: 11 · 2017: 3
- FWCI
- 12.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Reproductive Sciences (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81370695, 81471434, 81530040, 81671436)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- endometrioma, deep infiltrating endometriosis, ectopic endometrium, epithelial-mesenchymal transition, fibroblast-to-myofibroblast transdifferentiation, fibrosis, vascularity, hormone receptors, epigenetic modifications, H3K9me3, H3K27me3, TGF-β1, PPARγ, endometriosis pathogenesis
- MeSH terms
- Adult, Endometriosis, Endometrium, Female, Humans, Middle Aged, Ovarian Diseases, Peritoneal Diseases, Biomarkers, Cell Transdifferentiation, Young Adult, Myofibroblasts, Epithelial-Mesenchymal Transition
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