Aberrant endometrium

Abstract

1. 1. From the records of Touro Infirmary 135 patients with some form of aberrant endometrium were found in a series of 1200 patients who were operated upon for some pelvic pathology between January, 1927 and January, 1931. 2. 2. Of these 135 cases 15 per cent were adenomyomata of the uterus and 85 per cent were peritoneal endometriomata. The aberrant endometrium in the pelvis was considered to be extensive enough to produce some of the symptoms in 26 per cent of the patients of the entire series. 3. 3. During the time that this series was taken, there were 497 patients with uterine fibroids operated upon; 280 with chronic salpingitis; 202 with uterine displacements; and 40 with cystadenomata of the ovary. 4. 4. The belief that the condition was not being recognized by the general surgeon was justified. The correct diagnosis was made at the time of operation in 58 per cent of patients on the gynecological services and in only 2 per cent on the general surgical services. 5. 5. It was estimated that in 19 per cent the lesions were so small that they could only be recognized by the microscope. 6. 6. Fibroids were associated with the aberrant endometrial tissue in 46 per cent of the patients. Displacements of the uterus were mentioned in 8 per cent of the cases. Pelvic inflammatory disease was present in 37 per cent. 7. 7.The youngest patient in the series was sixteen years old, the oldest sixty-one. The majority of patients were between twenty and forty-five years of age. 8. 8. Thirty per cent of the patients were sterile. One patient was the mother of twelve children. Twenty per cent of the patients with marked endometriosis were unmarried. 9. 9. Menorrhagia was a symptom in 22 per cent, metrorrhagia in 11 per cent, dysmenorrhea 26 per cent and no menstrual disturbance in 51 per cent. Three per cent were past the menopause. In the group with extensive endometriosis, menorrhagia was a symptom in 31 per cent, metrorrhagia in 8 per cent, dysmenorrhea in 31 per cent and no menstrual disturbance in 48 per cent. The aberrant endometrium was believed to have caused little if any of the menstrual disorders. The symptoms were believed to have been caused principally by the associated pathology. 10. 10. Dyspareunia was present in several. 11. 11. In one instance aberrant endometrium was found in a normal pregnant woman; in one instance it was found in a patient with an extra-uterine pregnancy. In neither of these patients was there a decidual reaction in the aberrant endometrium. 12. 12. Three patients were operated upon and ruptured chocolate cysts found. In none of the three was this suspected before operation. 13. 13. There are no constant characteristic signs or symptoms of aberrant endometrium. In most instances the associated pathology can account for the symptoms and signs. The most important individual symptom is pain and tenderness over the site of the growths during the menstrual period. This, however, is the exception and not the rule. 14. 14. Aberrant endometrium probably has its origin both from the implantation of uterine mucosa regurgitated through the tube and from a metaplasia of the germinal epithelium or pelvic peritoneum.