Time to redefine endometriosis including its profibrotic nature
P. Vigano, M. Candiani, A. Monno, E. Giacomini, P. Vercellini, E. Somigliana
Human Reproduction, Vol.33, No.3 pp. 347–352, 2018
ABSTRACT: Endometriosis is currently deﬁned as presence of endometrial epithelial and stromal cells at ectopic sites. This simple and straightforward deﬁnition has served us well since its original introduction. However, with advances in disease knowledge, endometrial stro-mal and glands have been shown to represent only a minor component of endometriotic lesions and they are often absent in some disease forms. In rectovaginal nodules, the glandular epithelium is often not surrounded by stroma and frequently no epithelium can be identiﬁed in the wall of ovarian endometriomas. On the other hand, a smooth muscle component and ﬁbrosis represent consistent features of all disease forms. Based on these observations, we believe that the deﬁnition of endometriosis should be reconsidered and reworded as ‘A ﬁbrotic con-dition in which endometrial stroma and epithelium can be identiﬁed’. The main reasons for this change are: (1) to foster the evaluation of ﬁbrosis in studies on endometriosis pathogenesis using animal models; (2) to limit potential false negative diagnoses if pathologists stick strin-gently to the current deﬁnition of endometriosis requiring the demonstration of endometrial stromal and glands; (3) to consider ﬁbrosis as a potential target for treatment in endometriosis. This opinion article is aimed at boosting the attention paid to a largely neglected aspect of the disease. We hope that targeting the ﬁbrotic process might increase success in developing new therapeutic approaches.
Key words: endometriosis / ﬁbrosis / myoﬁbroblast / smooth muscle / Tranforming Growth Factor β1 / epithelial to mesenchymal transition
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