The Importance of Stromal Endometriosis in Thoracic Endometriosis.

Ezekiel Mecha,Jane B Maoga,Agnes N Mwaura,Roselydiah Makunja,Muhammad A Riaz,Charles O A Omwandho,Ivo Meinhold-Heerlein,Lutz Konrad

doi:10.3390/cells10010180

Ezekiel Mecha, Jane B Maoga + Show 6 more

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https://doi.org/10.3390/cells10010180

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Abstract

Thoracic endometriosis (TE) is a rare type of endometriosis, where endometrial tissue is found in or around the lungs and is frequent among extra-pelvic endometriosis patients. Catamenial pneumothorax (CP) is the most common form of TE and is characterized by recurrent lung collapses around menstruation. In addition to histology, immunohistochemical evaluation of endometrial implants is used more frequently. In this review, we compared immunohistochemical (CPE) with histological (CPH) characterizations of TE/CP and reevaluated arguments in favor of the implantation theory of Sampson. A summary since the first immunohistochemical description in 1998 until 2019 is provided. The emphasis was on classification of endometrial implants into glands, stroma, and both together. The most remarkable finding is the very high percentage of stromal endometriosis of 52.7% (CPE) compared to 10.2% (CPH). Chest pain, dyspnea, right-sided preference, and diaphragmatic endometrial implants showed the highest percentages in both groups. No significant association was found between the recurrence rate and the various appearances of endometriosis. Sometimes in CPE (6.8%) and CPH (30.6%) no endometrial implants were identified underlining the importance of sensitive detection of endometriosis during and after surgery. We suggest that immunohistochemical evaluation should become mandatory and will improve diagnosis and classification of the disease.

Highlights

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These data clearly indicate that the endometrium is the main source for ectopic endometrial cells, this does not exclude other hypotheses regarding the pathogenesis of endometriosis
We looked for the keywords: thoracic endometriosis syndrome, lung endometriosis, pleural endometriosis, diaphragmatic endometriosis, pneumothorax, catamenial pneumothorax, and all together with endometriosis

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The greatest enigma in pathogenesis of endometriosis is still the unanswered question of why, despite a high rate of retrograde menstruation, only approximately 1–10% of women in their reproductive age acquire endometriosis [10] This clearly indicates the importance of additional causative factors like inflammation, oxidative stress [11], disturbance of the peritoneal barrier [12], and genetic/epigenetic changes [5], which affect migration, adhesion, and invasion of endometrial cells at ectopic sites. The overall recurrence rates were lowest for patients who underwent hysterectomy together with laparoscopy compared to laparoscopy alone [13] These data clearly indicate that the endometrium is the main source for ectopic endometrial cells, this does not exclude other hypotheses regarding the pathogenesis of endometriosis

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