Junctional zone endometrium alterations in gynecological and obstetrical disorders and impact on diagnosis, prognosis and treatment

Vasilios Tanos, Safinez Balami, Lee Lingwood
Current opinion in obstetrics & gynecology · 2019 · vol. 31(6) , pp. 418–427 · doi:10.1097/gco.0000000000000572 · PMID:31573995 · W2978853005
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This review examines junctional zone endometrium alterations in gynecological and obstetrical disorders, finding it extended in endometriosis and a potential origin for leiomyoma and other uterine pathologies.

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Abstract

PURPOSE OF REVIEW: To investigate the JZE alterations in gynecological and obstetrical disorders and impact on diagnosis, prognosis and treatment. RECENT FINDINGS: JZE was found to be significantly extended in patients with endometriosis, leading to the conclusion that endometriosis is a primary disease of the uterus, much like adenomyosis. Statistical correlation was then demonstrated between the severity of endometriosis and the depth of the adenomyosis infiltrates, hence the thickening of the JZE. Stem cells, predominantly found in the JZE were also found in histological sections of leiomyoma, suggested to be the origin of leiomyoma. This reservoir of JZE stem cells is influenced by different stressors leading to their differentiation into leiomyoma, endometriosis, adenomyosis or endometrial cancer, according to the stressor. The variability in presentation was hypothesized to be connected to genetic and epigenetic factors. JZE was also suggested to act as a barrier, stopping endometrial carcinoma cells invasion and metastasis. In addition, JZE plays a major role in conception, pregnancy and postpartum. SUMMARY: JZE is an important anatomical landmark of the uterus contributing to normal uterine function under the influence of ovarian hormones. Alterations of the JZE thickness and contractility can be used as pathognomonic clinical markers in infertility and chronic pelvic pain, for subendometrial and myometrial disorders, for example, adenomyosis and fibroids. Prospective randomized control trials will clarify the diagnostic steps, imaging modalities to follow and probably triage the patients between medical and surgical treatments.

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Condition tags

mesh:D004715mesh:D017699endometriosisadenomyosischronic_pelvic_paininfertility

MeSH descriptors

Endometriosis Endometrium Uterine Diseases Adenomyosis Adenomyosis Cell Differentiation Endometrial Neoplasms Endometrial Neoplasms Endometriosis Endometrium Female Gynecology Humans Infertility, Female Infertility, Female Leiomyoma Leiomyoma Myometrium Pelvic Pain Pelvic Pain

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Cited by (9)

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