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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

 

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

Symptoms Progression Protean Appearance Microscopic Endo Adhesions Ovarian Endo Leiomyomatosis Deep Endo Other Problems Activity Surgical Recognition Conclusion

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.

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Bibliography

bulletCullen, T. S. (1896). Adeno-myoma uteri diffusum benignum. Johns Hopkins Hosp Rep, 6, 133-157.
bulletCullen, T. S. (1919). The distribution of adenomyomata containing uterine mucosa. Am J Obstet Gynecol, 80, 130-138.
bulletFallon, 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.
bulletKarnaky, 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.
bulletLockyer, C. (1913). Adenomyoma in the recto-uterine and recto-vaginal septa. Proc Royal Soc Med (Obstet), 6, 112-120.
bulletMartin, D. C., Hubert, G. D., Vander Zwaag, R., & El-Zeky, F. A. (1989). Laparoscopic appearances of peritoneal endometriosis. Fertil Steril, 51, 63-67.
bulletRussell, W. W. (1899). Aberrant portions of the Mullerian duct found in an ovary. Johns Hopkins Hosp Bul, 94-96(January, February, March), 8-10.
bulletSampson, 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.
bulletSampson, 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.
bulletSampson, 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.
bulletSampson, 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.
bulletSampson, J. A. (1927b). Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol, 14, 422-469.
bulletSampson, J. A. (1940). The development of the implantation theory for the origin of peritoneal endometriosis. Am J Obstet Gynecol, 40, 549-557.
bulletSemm, 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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