Endometriosis and the Fallopian Tubes: Theories of Origin and Clinical Implications

Abstract

Endometriosis is a common, oestrogen driven chronic condition, where endometrium-like epithelial and stromal cells exist in ectopic sites. At present, no curative treatments are available and the existing evidence for disease progression is conflicting. The pathogenesis is still unknown and evidently complex, as mechanisms of initiation may depend on the anatomical distribution of endometriotic lesions. However, amongst the numerous theories and plethora of mechanisms, contributions of the fallopian tubes (FT) to endometriosis are rarely discussed. The FT are implicated in all endometriosis associated symptomatology and clinical consequences; they may contribute to the origin of endometriotic tissue, determine the sites for ectopic lesion establishment and act as conduits for the spread of proinflammatory media. Here, we examine the available evidence for the contribution of the human FT to the origin, pathogenesis and symptoms/clinical consequences of endometriosis. We also examine the broader topic linking endometriosis and the FT epithelium to the genesis of ovarian epithelial cancers. Further studies elucidating the distinct functional and phenotypical characteristics of FT mucosa may allow the development of novel treatment strategies for endometriosis that are potentially curative.

Post salpingectomy intraluminal endometriosis in a premenopausal lady - an incidental finding often paid less attention to

“…The pathogenesis and initiation of this lesion is complex. 4 Its clinical manifestation is poorly documented and diagnosis is frequently incidental after hysterectomies for other indications like fibroids, endometrial hyperplasia and adenomyosis. 5 The diagnosis in our case was also made incidentally while sampling the fallopian tubes sent in a hysterectomy done for a patient who was operated for multiple fibroids.…”

“…1 Endometriosis is an estrogen driven disease and progesterone resistance is considered to be a crucial requirement for the seeding and maintenance of endometriotic lesions. 4 However the tubal mucosa is known to be less hormonally responsive than the neighbouring endometrium and may not exhibit similar cyclical proliferative dynamics. 4 In our case too there were no concordance between the endometrial phase and the tubal endometriotic tissue.…”

“…4 However the tubal mucosa is known to be less hormonally responsive than the neighbouring endometrium and may not exhibit similar cyclical proliferative dynamics. 4 In our case too there were no concordance between the endometrial phase and the tubal endometriotic tissue.…”

Endometriosis of the Canal of Nuck: A Systematic Review of the Literature

“…A plethora of theories have been proposed to explain the presence of endometrial-like tissue outside the uterine cavity. One of them suggests that during retrograde menstruation, endometrial cells elude to the pelvic cavity via the fallopian tubes resulting in the formation of endometriotic implants throughout the pelvic structures [ 48 ]. This theory can also explain the local spread of endometrial tissue through the inguinal canal and the patent NC.…”

Endometriosis Is Associated with a Significant Increase in hTERC and Altered Telomere/Telomerase Associated Genes in the Eutopic Endometrium, an Ex-Vivo and In Silico Study

“…Endometriosis is a common gynaecological disease defined as the presence of endometrial glands and stroma-like lesions outside the uterus and it is an oestrogen-dependent disease, which can cause significant morbidity in a large number of women of reproductive age [ 9 , 10 ]. Unfortunately, there are no curative treatments and none of the available treatments is effective in managing the symptoms associated with this disease [ 11 ].…”