The objective of this study was to determine the distribution of cyclooxygenase-2 (COX-2) in eutopic and ectopic endometria in endometriosis and adenomyosis. The subjects were 35 patients with endometriosis diagnosed by laparoscopy, 33 patients with histologically confirmed adenomyosis and 50 female controls with normal fecundity. Expression of COX-2 was immunohistochemically investigated in tissues from eutopic endometrium and myometrium and ectopic endometrium of the wall of ovarian chocolate cysts using polyclonal antibody. Surface epithelial cells, endometrial glandular epithelial cells or stromal cells were assessed. Cells were semi-quantitatively assessed on a scale of 1 to 5 using a nomogram created from positive cell count and the degree of staining. COX-2 expression in surface and glandular epithelia of the control group varied markedly during the menstrual cycle. It was lowest in the early proliferative phase and gradually increased thereafter. It remained high throughout the secretory phase. However, in patients with endometriosis, expression of COX-2 in glandular epithelium was higher than that in the control group, though it varied throughout the menstrual cycle. On the other hand, there was no variation in expression of COX-2 in the adenomyosis group during the menstrual cycle, and it was lower than that in the endometriosis group in all phases. Pronounced COX-2 expression was observed in glandular cells from ectopic endometrial tissue of ovarian chocolate cyst walls in all cases regardless of the menstrual phase. In summary, increased COX-2 expression in eutopic and ectopic endometria was believed to be strongly correlated with pathological abnormalities in these disorders.
Adenomyosis is characterized as ectopic endometrial tissues within the myometrium in the uterus. The only difference between adenomyosis and endometriosis is the site of endometriotic tissues: inside or outside of the uterus. It is well known that endometriosis is frequently associated with various autoimmune phenomena. This short review covers various aspects of the immune cascade found in adenomyosis. In adenomyosis, a series of immune responses is activated, including changes in both cellular and humoral immunity, i.e. a strong expression of cell surface antigens or adhesion molecules, an increased number of macrophages or immune cells, and deposition of immunoglobulins and complement components. Furthermore, the disease exhibited high frequency of autoantibodies in peripheral blood. Thus, an immunological 'vicious circle' is formed in the endometrium in adenomyosis. Endometrial cells seem to be under immunological stress, protecting themselves by exposing heat shock proteins. It is concluded that the endometrial environment in adenomyosis differs widely from that in normal fertile women. These abnormal immune responses might be involved in poor reproductive performance in adenomyosis.
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