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Dan C. Martin, MD
UT Medical Group,
Inc.
University of Tennessee Health Science Center (UTHSC)
UTHSC Academic Office
Daniel Clyde Martin, M.D.
UT Medical Group,
Inc.
Infertility and Gynecology
Reproductive Surgery
Germantown Office Building
7945 Wolf River Boulevard
Suite 320
Germantown, Tennessee
TN 38138-1733
(901) 347-8331
(901) 347-8188 fax
Directions to Office
Updated information is
at
UTMG 2006
Click for information
on:
Glenn Ann Martin, Ph.D.
Clinical
Psychologist
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Introduction to
Recognition of Endometriosis
Adapted from "Recognition of Endometriosis" in
Laparoscopic Appearance of Endometriosis, Lecture Supplement
Martin DC (ed), Resurge Press, Memphis, (c)1991
and the
Color
Atlas of Endometriosis
           
Adapted from "Recognition of Endometriosis" in
Laparoscopic Appearance of Endometriosis, Lecture Supplement
Martin DC (ed), Resurge Press, Memphis, (c)1991
Recognition of Endometriosis
was written for readers with a intermediate knowledge of endometriosis.
This accompanied the
Laparoscopic Appearance of Endometriosis, Color Atlas
in 1991.
Basic knowledge is better
covered in
The
Endometriosis Sourcebook by Mary Lou Ballweg and the
Endometriosis Association with foreword by Dan Martin, MD.
Recognition is but one of the many problems of
endometriosis. Without proper recognition, patients can have too much or
too little treatment. At one extreme is treating extensive
infiltration as if it were surface endometriosis. At the other end is
treating cancer or chlamydia as though they were endometriosis. Either of
this extremes can result in delayed adequate treatment.
Endometriosis has a long history. It was described as adenomyomata of the recto-vaginal septum in early
reports. (Cullen, 1919; Lockyer, 1913; Sampson, 1921) This was similar to uterine
adenomyomata of the uterus (Cullen, 1896) and was a mass of glands, stroma and fibromuscular tissue. Microscopic ovarian endometriosis was also another early description which resulted in early concepts of
metaplasia. (Russell, 1899)
Sampson (Color
Atlas)
published a extensive series of articles on endometriosis from 1921(Sampson, 1921) to
1940. (Sampson, 1940) He described chocolate cysts, blebs, adenomyomatous infiltration in the rectovaginal septum, adherent
surfaces, (Sampson, 1921) red raspberries, purple raspberries, blueberries, deep infiltration, cancer arising in endometriotic
implants (Sampson, 1924) and peritoneal pockets. (Sampson, 1927b) He changed his description of small from 2 to 4 cm in 1921(Sampson, 1921) to a few mm in
1924. (Sampson, 1924) Sampson originally quoted earlier theories on the metaplastic origin of
endometriosis. (Russell, 1899; Sampson, 1921) In subsequent papers, he postulated retrograde menstruation was the origin of
endometriosis. (Sampson, 1922; Sampson, 1927a)
Subtle appearing lesions may be more prevalent than
dark lesions. (Martin, Hubert, Vander Zwaag, & El-Zeky, 1989) These subtle lesions have many descriptions and appear to proceed darker lesions. Colorless, amenorrheic lesions were seen by
Fallon (Fallon, Brosnan, Manning, Moran, Meyers, & Fletcher, 1950) in 1950.
Karnaky (Karnaky, 1969) published an age dependent appearance of endometriosis starting with an initial water blister presentation in 1969. Semm noted subtle clear lesions detected using meticulous search with magnification and discussed invisible lesions noted only after coagulation. He called this color change with coagulation a thermocolor
test. (Semm & Friedrich, 1987)
The term "typical" and "atypical" are generally avoided in this paper for two reasons. First, the most common appearances in my studies have been
subtle. (Martin, et al., 1989) Second, the use of atypical is better reserved for histologic atypicality in premalignant and malignant processes.
Return to top of
page.
Bibliography
 | Cullen, T. S. (1896). Adeno-myoma uteri diffusum benignum. Johns Hopkins Hosp Rep, 6, 133-157. |
| Cullen, T. S. (1919). The distribution of adenomyomata containing uterine mucosa. Am J Obstet Gynecol, 80, 130-138. |
| Fallon, J., Brosnan, J. T., Manning, J. J., Moran, W. G., Meyers, J., & Fletcher, M. E. (1950). Endometriosis: a report of 400 cases. Rhode Island Med J, 33, 15-23. |
| Karnaky, K. J. (1969). Theories and known observations about hormonal treatment of endometriosis-in-situ, and endometriosis at the enzyme level. Arizona Medicine, January, 37-41. |
| Lockyer, C. (1913). Adenomyoma in the recto-uterine and recto-vaginal septa. Proc Royal Soc Med (Obstet), 6, 112-120. |
| Martin, D. C., Hubert, G. D., Vander Zwaag, R., & El-Zeky, F. A. (1989). Laparoscopic appearances of peritoneal endometriosis. Fertil Steril, 51, 63-67. |
| Russell, W. W. (1899). Aberrant portions of the Mullerian duct found in an ovary. Johns Hopkins Hosp Bul, 94-96(January, February, March), 8-10. |
| Sampson, J. A. (1921). Perforating hemorrhagic (chocolate) cysts of the ovary. Their importance and especially their relation to pelvic adenomas of the endometrial type ("adenomyoma" of the uterus, rectovaginal septum, sigmoid, etc.). Arch Surg, 3, 245-323. |
| Sampson, J. A. (1922). Ovarian hematomas of endometrial type (perforating hemorrhagic cysts of the ovary) and implantation adenomas of endometrial type. Boston Med Surg J, 186, 445. |
| Sampson, J. A. (1924). Benign and malignant endometrial implants in the peritoneal cavity, and their relation to certain ovarian tumors. Surg Gynecol Obstet, 38, 287-311. |
| Sampson, J. A. (1927a). Metastatic or embolic endometriosis, due to the menstrual dissemination of endometrial tissue into the venous circulation. Am J Pathol, 3, 93-109. |
| Sampson, J. A. (1927b). Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol, 14, 422-469. |
| Sampson, J. A. (1940). The development of the implantation theory for the origin of peritoneal endometriosis. Am J Obstet Gynecol, 40, 549-557. |
| Semm, K., & Friedrich, E. R. (1987). Operative Manual for Endoscopic Abdominal Surgery. Chicago: Yearbook Medical Publishers. |
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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