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O DF, Roskams T, Van den Eynde K, Vanhie A, Peterse DP, Meuleman C, Tomassetti C, Peeraer K, D'Hooghe TM, Fassbender A. The Presence of Endometrial Cells in Peritoneal Fluid of Women With and Without Endometriosis. Reprod Sci 2016; 24:242-251. [PMID: 27324432 DOI: 10.1177/1933719116653677] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To reinforce Sampson's theory of retrograde menstruation in the pathogenesis of endometriosis, proof should be provided that during menstruation endometrial cells are present in peritoneal fluid (PF). We hypothesize that the prevalence of PF samples containing endometrial cells is higher in patients with endometriosis than in controls without endometriosis during menstruation. We selected from our biobank PF samples of 17 reproductive-age women with (n = 9) or without (n = 8) endometriosis who had received a diagnostic laparoscopy for investigation of pain/infertility. Peritoneal fluid had been collected during laparoscopy in the menstrual phase of the cycle, centrifuged, and the resulting pellet was stored at -80°C. About 5-μm sections of frozen PF pellets were stained using the Dako Envision Flex system with primary antibodies against epithelial cell adhesion molecule (Ep-CAM; endometrial epithelial cells), CD10 (endometrial stromal cells), prekeratin (epithelial/mesothelial cells), vimentin (endometrial/mesothelial/immune cells), calretinin (mesothelial cells), and CD68 (macrophages). The PF cells positive for Ep-CAM were detected in 5 of 9 patients with endometriosis and 6 of 8 controls ( P = .62). CD10 stained positively in 6 of the 9 patients with endometriosis and 3 of the 8 controls ( P = .35). Calretinin and prekeratin staining showed the presence of mesothelial cells in all pellets. Vimentin stained approximately 100% of the PF cells. CD68+ macrophages represented >50% of cells in all pellets. The prevalence of PF samples containing endometrial epithelial and stromal cells was not higher in patients with endometriosis than in controls without endometriosis during menstruation. Our findings question the relevance of endometrial cells in PF for the pathogenesis of endometriosis and support the importance of other mechanisms such as immune dysfunction and/or endometrial stem cells.
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Affiliation(s)
- Dorien F O
- 1 Department of Development and Regeneration, Organ systems, KU Leuven, Leuven, Belgium.,2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Tania Roskams
- 3 Department of Imaging and Pathology, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Kathleen Van den Eynde
- 3 Department of Imaging and Pathology, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Arne Vanhie
- 1 Department of Development and Regeneration, Organ systems, KU Leuven, Leuven, Belgium.,2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Daniëlle P Peterse
- 1 Department of Development and Regeneration, Organ systems, KU Leuven, Leuven, Belgium.,2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Christel Meuleman
- 2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Carla Tomassetti
- 2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Karen Peeraer
- 2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Thomas M D'Hooghe
- 1 Department of Development and Regeneration, Organ systems, KU Leuven, Leuven, Belgium
| | - Amelie Fassbender
- 1 Department of Development and Regeneration, Organ systems, KU Leuven, Leuven, Belgium.,2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
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2
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Atkins HM, Lombardini ED, Caudell DL, Appt SE, Dubois A, Cline JM. Decidualization of Endometriosis in Macaques. Vet Pathol 2016; 53:1252-1258. [PMID: 27281017 DOI: 10.1177/0300985816646433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The decidua is the superficial portion of endometrium that transforms, or decidualizes, under the influence of progesterone to nourish the early embryo during pregnancy. Deciduae outside the uterus are found in nearly 100% of human pregnancies. This condition, known as deciduosis, may mimic malignancy, resulting in additional diagnostic procedures that place the mother, baby, or both at risk. Deciduosis has been described in both Old World and New World nonhuman primates in conjunction with pregnancy and after treatment with exogenous progestins. Here the authors present 6 cases of deciduosis associated with endometriotic lesions in female rhesus and cynomolgus macaques (Macaca mulatta and Macaca fascicularis). Full diagnostic necropsies with histologic analyses were performed on all animals. Deciduae were stained with hematoxylin and eosin and by immunohistochemistry for vimentin, CD10, progesterone receptor, estrogen receptor, desmin, cytokeratin, kermix P8, chorionic gonadotropin, human placental lactogen, and calretinin. The most common clinical signs were abdominal pain (4 of 6) and anorexia (2 of 6). At necropsy, macaque uteri were often enlarged or disfigured (4 of 6) with abundant fibrous adhesions (5 of 6). Affected tissue consisted of epithelial-lined cysts and decidualized stroma with scattered gamma/delta T cells. Decidualized stromal cells were large and polyhedral with abundant cytoplasm and round vesicular nuclei. They stained positive for vimentin, CD10, progesterone, and estrogen. In summary, these cases illustrate deciduosis in 6 nonhuman primates with endometriosis. Understanding decidualization in nonhuman primates will aid in elucidating the pathophysiology of deciduosis during pregnancy or endometriosis and potentially lead to new interventions.
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Affiliation(s)
- H M Atkins
- Department of Pathology, Section on Comparative Medicine, School of Medicine, Wake Forest University, Medical Center Boulevard, Winston-Salem, NC, USA
| | - E D Lombardini
- Division of Comparative Pathology, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - D L Caudell
- Department of Pathology, Section on Comparative Medicine, School of Medicine, Wake Forest University, Medical Center Boulevard, Winston-Salem, NC, USA
| | - S E Appt
- Department of Pathology, Section on Comparative Medicine, School of Medicine, Wake Forest University, Medical Center Boulevard, Winston-Salem, NC, USA
| | - A Dubois
- Department of Medicine, F. Edward Hébert School of Medicine, Laboratory of Gastrointestinal and Liver Studies, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - J M Cline
- Department of Pathology, Section on Comparative Medicine, School of Medicine, Wake Forest University, Medical Center Boulevard, Winston-Salem, NC, USA
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Stewart CJR, Bharat C, Leake R. Asynchronous glands in secretory pattern endometrium: clinical associations and immunohistological changes. Histopathology 2015; 67:39-47. [DOI: 10.1111/his.12620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/15/2014] [Indexed: 01/27/2023]
Affiliation(s)
- Colin J R Stewart
- Department of Histopathology; King Edward Memorial Hospital; Perth WA Australia
- School for Women's and Infants’ Health; University of Western Australia; Perth WA Australia
| | - Chrianna Bharat
- Centre for Applied Statistics; University of Western Australia; Perth WA Australia
- Department of Research; Sir Charles Gairdner Hospital; Perth WA Australia
| | - Robyn Leake
- Hollywood Hospital; Nedlands Perth WA Australia
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Abstract
Of 969 non-consecutive endometrial biopsies performed for investigation of recurrent reproductive failure, 20 cases (2.1%) showed the striking presence of retarded or asynchronous endometrial glands in otherwise unremarkable mid or late secretory endometrium. These glands were characterised by tall columnar cells with crowded nuclei showing increased reactivity for the proliferative marker MIB-1, occasional mitoses, greatly reduced or absent secretion, and persistent expression of oestrogen receptors and usually progesterone receptors and their isoforms typical of late proliferative phase endometrium. The nearby endometrial stromal cells exhibited no discernibly reduced reactivity for calretinin. These changes were seen in single glands (even portions of glands), or clusters of glands, adjacent to normal late secretory type endometrial glands and set in pseudodecidualised stroma characteristic of late luteal phase. Some examples also displayed adjacent glands with intermediate features and it is speculated that firstly, this is a relatively common phenomenon in women with recurrent miscarriage or implantation failure and with an unknown potential to affect implantation. Secondly, it is an intrinsic defect of the endometrium and can occur in sequential endometrial biopsies in the same patient. Thirdly, it differs from previously described patterns of so-called luteal phase defect or deficient secretory phase in that it occurs in the demonstrated presence of adequate progesterone effect on the endometrium and is associated with persistence rather than exaggerated down-regulation of receptors. Nevertheless, supplementary progesterone therapy (vaginal pessaries) for the first trimester appeared to have a beneficial therapeutic effect on reproductive outcome in these patients.
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Chambers JK, Uchida K, Ise K, Nakayama H. Cystic rete ovarii and uterine tube adenoma in a rabbit. J Vet Med Sci 2014; 76:909-12. [PMID: 24572633 PMCID: PMC4108778 DOI: 10.1292/jvms.14-0053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 6-year-old female rabbit
was presented to a veterinary clinic, and the result of ultrasound examination suggested a
tumor in the uterine tube. Subsequently, both ovaries and uterus were surgically removed.
In gross, a single large cyst in the right ovary and enlargement of the left uterine tube
were observed. Histological examination revealed that the cyst had developed in the hilus
of the ovary and was lined by single-layered cuboidal cells. In the left uterine tube, a
tumor composed of epithelial cells arranged in tubular structures and pleomorphic cells
between the tubular structures was observed. Immunohistochemically, the epithelial cells
of the cyst were positive for pan-cytokeratin, cytokeratin 18, CD10, E-cadherin,
calretinin and estrogen receptor; the tumor cells of the left uterine tube were positive
for pan-cytokeratin, cytokeratin 18, E-cadherin, vimentin, calretinin and estrogen
receptor. From these results, the cyst was diagnosed as cystic rete ovarii, and the tumor
was diagnosed as adenoma of the uterine tube. This case is the first to demonstrate cystic
rete ovarii and uterine tube adenoma in rabbits.
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Affiliation(s)
- James K Chambers
- Department of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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Stromal p16 expression differentiates endometrial polyp from endometrial hyperplasia. Virchows Arch 2012; 461:141-8. [DOI: 10.1007/s00428-012-1276-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 05/23/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
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Farooq U, Laureano AC, Miteva M, Elgart GW. Cutaneous endometriosis: diagnostic immunohistochemistry and clinicopathologic correlation. J Cutan Pathol 2011; 38:525-8. [PMID: 21352260 DOI: 10.1111/j.1600-0560.2011.01681.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endometriosis is a condition where endometrial glands and stroma are ectopically located in sites other than the uterine cavity. Cutaneous endometriosis is very rare, representing approximately 1.1% of cases of extrapelvic endometriosis. We report a case of a 44-year-old female with no prior surgical history who presented with multiple tan brown periumbilical nodules. Histopathological examination revealed multiple glandular structures in the dermis with surrounding stroma. Immunohistochemistry cinches the diagnosis, as CD10, estrogen receptor and progesterone receptor are strongly positive in our case. The mainstay of treatment of cutaneous endometriosis is surgical excision of the lesion.
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Affiliation(s)
- Uzma Farooq
- Kendall Medical Laboratory, Coral Gables, FL, USA.
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Mesothelial proteins are expressed in the human cornea. Exp Eye Res 2010; 91:623-9. [PMID: 20709057 DOI: 10.1016/j.exer.2010.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 07/28/2010] [Accepted: 08/01/2010] [Indexed: 11/24/2022]
Abstract
The goal of our study was to determine whether proteins typical of the human mesothelial cell phenotype, such as mesothelin, HBME-1 (Hector Battifora mesothelial cell-1) protein and calbindin 2, are expressed in the human cornea, especially in endothelial cells. Cryosections and endothelial and epithelial imprints of sixteen human cadaverous corneoscleral discs were used. The presence of proteins was examined using immunohistochemistry and Western blotting, while mRNA levels were determined by qRT-PCR. A strong signal for mesothelin was present in the corneal epithelium, while less intense staining was visible in the endothelium. Similarly, higher and lower mRNA levels were detected using qRT-PCR in the corneal epithelium and endothelium, respectively. HBME-1 antibody strongly stained the corneal endothelium and stromal keratocytes. Marked positivity was present in the corneal stromal extracellular matrix, while no staining was present in the sclera. Calbindin 2 was detected using immunohistochemistry and Western blotting in the corneal epithelium, endothelium and stroma. qRT-PCR confirmed its expression in epithelial and endothelial cells. Three proteins expressed constitutively in mesothelial cells were detected in the human cornea. The possible function of mesothelin in cell-cell contact on the ocular surface is discussed. The presence of HBME-1 protein in the endothelial layer may indicate a still unknown function that could be shared with mesothelial cells of the pleura and peritoneum. The much more pronounced occurrence of calbindin 2 in the corneal epithelium compared to fewer positive endothelial cells explains the higher turnover of epithelial cells compared to the proliferatively inactive endothelium.
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Mai KT, Teo I, Veinot JP, Senterman M, Nguyen B. Histopathogenesis of endometrium with asynchronous glands in dysfunctional uterine bleeding. Histopathology 2009; 55:126-30. [PMID: 19614778 DOI: 10.1111/j.1365-2559.2009.03321.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
The utility of calretinin was first described in the diagnosis of mesothelioma. In the female genital tract, calretinin was initially reported in Wolffian remnants and related lesions and later used in the diagnosis of sex cord stromal tumors of the ovary, endometrial stromal tumors with sex cord-like differentiation, and uterine tumors resembling sex cord tumors of the ovary. This review discusses calretinin expression in normal tissues of the female genital tract and highlights its potential utility in the diagnosis of these subsets of neoplasms with emphasis to tumors that may constitute a problem in their differential diagnosis. In particular, the limited utility of calretinin in the diagnosis of sex cord stromal tumors of the ovary, in the differential diagnosis between mesothelioma and serous tumors involving the ovary and/or peritoneum, and in the differential diagnosis between Wolffian lesions and endometrial carcinoma are addressed.
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