MODERN VIEWS ON THE PATHOGENESIS OF EXTRAGENITAL ENDOMETRIOSIS (Literature review)
DOI:
https://doi.org/10.11603/1811-2471.2019.v.i3.10494Keywords:
extragenital endometriosis, pathogenesis theory, VEGF, MMP, Sampson's theory, angiogenesis, immune dysfunction, retrograde menstruationAbstract
SUMMARY. Endometriosis is a chronic benign hormone-dependent condition in which endometrium spreads and grows outside the uterine mucosa, with identical to eutopic endometrium morphological and functional properties. This review is dedicated to modern view on pathogenesis of extragenital endometriosis. The article presents both the theory of etiology and pathogenesis of this pathology and possible mechanisms that can potentially be considered as the key to pathogenetic therapy.
Endometriosis is detected in 50 % of women with dysmenorrhea, in 50–80 % of patients with chronic pelvic pain and in 25–40 % of women with infertility, and in the structure of gynecological disease, endometriosis ranks third after inflammatory processes and uterine fibroids. Сonsidering the not-too-high effectiveness of treatment, a significant percentage of recurrence of the disease, the issue of updating views on pathogenetic mechanisms in order to optimize the therapeutic endometriosis tactic still remains relevant.
The aim – to conduct the literature analysis in order to identify contemporary views on the pathogenesis of extragenital endometriosis and possible points of application in the development of targeted therapy.
Conclusions. The most widely accepted theory of pathogenesis of endometriosis is the theory of retrospective menstruation of Sampson. This theory suggests that viable fragments of the endometrial tissue disintegrate into the peritoneal cavity or into the pelvic organs. The most probable evolution of this theory should be the theory of angiogenesis on the background of immune dysfunction, which contributes to the primary implantation of endometrioid ectopic and their subsequent development.
Modern literature points to the role of angiogenesis in the formation and development of lesions, but at the same time, there is an immune dysfunction, which probably leads to the predominance of angiogenic factors locally.
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