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Dr Martin
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Dan C. Martin, MD
UT Medical Group, Inc.

University of Tennessee Health Science Center (UTHSC)

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Daniel Clyde Martin, M.D.
UT Medical Group, Inc.
Infertility and Gynecology
Reproductive Surgery
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TN 38138-1733

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Glenn Ann Martin, Ph.D.
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Fluid and Cellular Activity
Associated with Endometriosis

Adapted from "Recognition of Endometriosis" in
Laparoscopic Appearance of Endometriosis, Lecture Supplement
Martin DC (ed), Resurge Press, Memphis, (c)1991

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Peritoneal fluid studies of macrophages, (Olive, Weinberg, & Haney, 1985) peritoneal fluid lysozyme activity, (Olive, Haney, & Weinberg, 1987) and endometrial epithelial cells (Kruitwagen, Poels, Willemsen, de Ronde, Jap, & Rolland, 1991) suggest that these are related to infertility. The appearance of polypoid red lesions shows that these tend to be within the peritoneal cavity and have an increased likelihood of either secreting or desquamating directly into the peritoneal cavity than scarred retroperitoneal lesions. In addition, these polypoid forms appear to be more active than the retroperitoneal forms in the production of the ability to synthesize prostaglandin F. (Vernon, Beard, Graves, & Wilson, 1986; Wild & Wilson, 1987) Publications demonstrating a decrease in polypoid red areas with age (Koninckx, Meuleman, Demeyere, Lesaffre, & Cornillie, 1991) and a decrease in cell counts with rAFS scoring (Haney, Jenkins, & Weinberg, 1991) open new areas for further study.

In that much of the published data is based on endometriosis being diagnosed from black or bluish "dark" lesions, (Buttram & Reiter, 1985; Dmowski, 1984; Haney, 1987; Hulka, 1985; Kirshon, Poindexter, & Fast, 1989) there may be significant bias in the results of these studies. Many of these "dark" lesions are retroperitoneal as opposed to clear vesicles and red polyps which are more frequently on the surface. (Cornillie, Brosens, Vasquez, & Riphagen, 1986; Vasquez, Cornillie, & Brosens, 1983) Lesions on the surface have a more direct anatomic route to the intraperitoneal environment than those which are retroperitoneal. Superficial pelvic endometriosis has been documented to secrete PP14 and CA-125 mainly in the peritoneal fluid, whereas deep endometriosis secretes mainly into the plasma. (Koninckx, Ruttinen, Seppala, & Cornillie, 1992) A lack of differentiation between these various types may be responsible for some of the dissatisfaction with the various staging systems and some of the variation in studies of the intraperitoneal environment. Until studies are done of the various lesion types, this area has many unanswered questions.

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bulletButtram, V. C., & Reiter, R. C. (1985). Endometriosis. In V. C. Buttram & R. C. Reiter (Eds.), Surgical Treatment of the Infertile Female (pp. 89-147). Baltimore: Williams & Wilkins.
bulletCornillie, F. J., Brosens, I. A., Vasquez, G., & Riphagen, I. (1986). Histologic and ultrastructural changes in human endometriotic implants treated with the antiprogesterone steroid ethylnorgestrienone (Gestrinone) during 2 months. Int J Gynecol Pathol, 5, 95-109.
bulletDmowski, W. P. (1984). Pitfalls in clinical, laparoscopic and histologic diagnosis of endometriosis. Acta Obstet Gynecol Scan (Suppl), 123, 61-66.
bulletHaney, A. F. (1987). Endometriosis: pathogenesis and pathophysiology. In E. A. Wilson (Eds.), Endometriosis (pp. 23-52). New York: Alan R Liss.
bulletHaney, A. F., Jenkins, S., & Weinberg, J. B. (1991). The stimulus responsible for the peritoneal fluid inflammation observed in infertile women with endometriosis. Fertil Steril, 56, 408-413.
bulletHulka, J. F. (1985). Special techniques. In J. F. Hulka (Eds.), Textbook of Laparoscopy (pp. 75-77). Orlando: Grune and Stratton.
bulletKirshon, B., Poindexter, A. N., & Fast, J. (1989). Endometriosis in multiparous women. J Reprod Med, 34, 215-217.
bulletKoninckx, P. R., Meuleman, C., Demeyere, S., Lesaffre, E., & Cornillie, F. J. (1991). Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril, 55, 759-765.
bulletKoninckx, P. R., Ruttinen, L., Seppala, M., & Cornillie, F. J. (1992). CA-125 and placental protein 14 concentrations in plasma and peritoneal fluid of women with deeply infiltrating pelvic endometriosis. Fertil Steril, 57, 523-530.
bulletKruitwagen, R. F. P. M., Poels, L. G., Willemsen, W. N. P., de Ronde, I. J. Y., Jap, P. H. K., & Rolland, R. (1991). Endometrial epithelial cells in peritoneal fluid during the early follicular phase. Fertil Steril, 55, 297-303.
bulletOlive, D. L., Haney, A. F., & Weinberg, J. B. (1987). The nature of the intraperitoneal exudate associated with infertility: peritoneal fluid and serum lysozyme activity. Fertil Steril, 48, 802-806.
bulletOlive, D. L., Weinberg, J. B., & Haney, A. F. (1985). Peritoneal macrophages and infertility: the association between cell number and pelvic pathology. Fertil Steril, 44, 772-777.
bulletVasquez, G., Cornillie, F., & Brosens, I. A. (1983). Peritoneal endometriosis: scanning electron microscopy and histology of minimal pelvic endometriotic lesions. Fertil Steril, 42, 696-703.
bulletVernon, M. W., Beard, J. S., Graves, K., & Wilson, E. A. (1986). Classification of endometriotic implants by morphologic appearance and capacity to synthesize protaglandin F. Fertil Steril, 46, 801-806.
bulletWild, R. A., & Wilson, E. A. (1987). Clinical presentation and diagnosis. In E. A. Wilson (Eds.), Endometriosis (pp. 53-77). New York: Alan R Liss, Inc.

Adapted from "Recognition of Endometriosis" in
Laparoscopic Appearance of Endometriosis, Lecture Supplement
Martin DC (ed), Resurge Press, Memphis, (c)1991

The color illustrations that accompanied this paper are in the Color Atlas.

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