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- Sites of endometriosis:
- Pathogenesis:
- Pathology:
- Under the action of ovarian hormones, changes in
endometrium (glands & stroma) in ectopic sites take place
i.e proliferative changes / growth but no secretory
changes due to deficiency of steroid receptors
- periodical or cyclical growth & shedding until menopause
- periodically shed blood:
a) spill----blood---irritant---surrounding dense t/s rxn---
adhesion & fibrosis---puckering of peritoneum; dense
adhesions amongst pelvic strts but fallopian tubes
remain patent
b) encysted-----cyst has 2 fates
i) cyst----tenseruptures
ii) cyst----enlarges----shrinks in betn periods as
serum is absorbed-----cyst content is chocolate
colored----chocolate cyst----common site:
ovary------endometrial cyst/endometrioma also
called chocolate cyst due to hemmorhagic
follicular / corpus luteum cyst or due to bleeding
into cystadenoma
- Diagnosis:
- Clinical diagnosis
Benefits
Confirmation of lesion with site, size & extent: classic lesion
of pelvic endometriosis (powder burn or match stick spots on
peritoneum of PODfindings may be recorded on video/DVD
(ROG-2006))
Biopsy can be taken at the same time (microscopically:
endometrial glands, stroma, hemosiderin-laden
macrophages or pseudoxanthoma cells)
Staging can be done
Extent of adhesions could be recorded
Opportunity to do laparoscopic surgery if needed
- Biopsy confirmation of the excised lesion: ideal; but ve
histology does not exclude it
- Staging or classification of endometriosis based on
i) appearance, size & depth of peritoneal implants
ii) appearance, size & depth of ovarian implants
iii) degree of cul-de-sac obliteration
iv) presence, extent & type of adnexal adhesion
- Staging of diagnosed endometriosis based on laparoscopic
findings:
i) to predict prognosis
ii) to choose therapy
iii) to evaluate T/t protocol
- Stage determined by adding specific points given to each
- American Fertility Society (AFS) scoring
- Limitations :