Endometriosis in MRKH cases as a proof for the coelomic metaplasia hypothesis?

Lutz Konrad, Raimund Dietze, Pradeep Kumar Kudipudi, Fabian Horné, Ivo Meinhold-Heerlein, Ivo Meinhold‐Heerlein
Reproduction (Cambridge, England) · 2019 · vol. 158(2) , pp. R41–R47 · doi:10.1530/rep-19-0106 · PMID:30978694 · W2937308305
review OA: bronze CC0 ⤵ 52 in-corpus citations
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This review suggests MRKH patients only develop endometriosis if a uterus or endometrium is present, supporting Sampson's implantation hypothesis rather than coelomic metaplasia.

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Abstract

A diagnosis of endometriosis is based upon the histological identification of endometrial tissue at ectopic sites which are commonly located on the pelvic organs, the peritoneum and ovary. In rare cases, ectopic lesions can be found in other organs, such as kidney, bladder, lung or brain. Diagnosis is achieved by laparoscopic intervention followed by histological confirmation of endometriotic tissue. Prevalence is estimated at approximately 10% in the general female population with many patients experiencing pain and/or infertility. Currently, the implantation hypothesis by Sampson is the most accepted hypothesis about the pathogenesis of endometriosis. However, the occurrence of endometriosis in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome who sometimes lack a uterus or endometrium seems to suggest metaplasia as a cause of endometriosis. A critical reevaluation of the literature about MRKH does not reveal conclusive evidence of an association of uterus/endometrium agenesis and endometriosis. Most often only MRI diagnoses of uterus/endometrium agenesis and only very rarely conclusive histological evidence of the endometriotic lesions are presented. In contrast, whenever biopsies were performed endometriosis always appeared together with uterus/endometrium remnants. Taken together, we suggest that MRKH patients only develop endometriosis if a uterus/endometrium is present which underscores and not contradicts the implantation hypothesis of Sampson.

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Condition tags

mesh:D004715endometriosisinfertility

MeSH descriptors

46, XX Disorders of Sex Development Endometriosis Mullerian Ducts 46, XX Disorders of Sex Development Congenital Abnormalities Endometriosis Female Humans Metaplasia Mullerian Ducts Uterus Uterus

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