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Explain the theories of endometriosis in brief 2nd mbbs pathology ROBBINS AND COTRANS PATHOGENESIS OF DISEAS 2ND YEAR

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Theories of pathogenesis of endometriosis

Endometriosis is the presence of functional endometrial glands and stroma outside the uterus. Its exact pathogenesis is uncertain. Robbins groups the proposed origins into two broad categories: spread from uterine endometrium, and formation from cells outside the uterus that can differentiate into endometrial tissue.
  1. Regurgitation or retrograde menstruation theory (Sampson theory)
    • Menstrual endometrial tissue flows backward through the fallopian tubes into the peritoneal cavity.
    • Viable endometrial fragments implant on pelvic peritoneum, ovaries, pouch of Douglas, uterosacral ligaments, etc.
    • This is the leading explanation for common pelvic lesions.
  2. Benign metastasis theory
    • Endometrial tissue spreads from the uterus through lymphatic channels or blood vessels.
    • Explains endometriosis at distant sites, such as the lung, bone, and brain.
  3. Metaplastic theory
    • Coelomic epithelium (peritoneal mesothelium) undergoes metaplasia and transforms into endometrial-type glands and stroma.
    • It is embryologically plausible because coelomic epithelium gives rise to the Müllerian ducts, from which the endometrium develops.
    • Mesonephric remnants may also differentiate into endometrial tissue.
  4. Extrauterine stem/progenitor-cell theory
    • Bone marrow-derived stem or progenitor cells migrate to ectopic sites and differentiate into endometrial tissue.
    • This may contribute to lesions where direct implantation of menstrual endometrium is difficult to explain.

Important contributing factors

Regardless of how lesions originate, their establishment and persistence are promoted by:
  • Estrogen dependence
  • Inflammation, with increased prostaglandin E2
  • Angiogenesis, especially increased VEGF, allowing the implants to obtain blood supply
  • Altered immune clearance of ectopic endometrial tissue
Exam line: No single theory explains every form or site of endometriosis; it is probably a multifactorial disease.
Source: Robbins & Kumar Basic Pathology, Endometriosis section, lines 557-568.
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