Rich innervation of deep infiltrating endometriosis

Abstract

The rich innervation of DIE may help to explain why patients with this type of lesion have severe pelvic pain.

Possible involvement of nerve growth factor in dysmenorrhea and dyspareunia associated with endometriosis

“…In addition, treatment with a blocking antibody to NGF has been reported to effectively reduce pain and improve the quality of life in patients with tumor-induced bone cancer pain [18]. We and other investigators have demonstrated the involvement of NGF in endometriosis and its associated pain [19,20,31]; therefore, it is rational to treat endometriosis-associated pelvic pain by targeting NGF and its signaling pathway. In particular, a close association between PF-NGF levels and severity of endometriosisrelated pain may substantiate a possible NGF-targeting therapy for patients with dysmenorrhea and/or dyspareunia together with elevated PF-NGF.…”

“…Thus, given the up-regulation of NGF in endometriotic lesions as presented here, it is highly likely that nerve fibers may proliferate in these lesions under the influence of NGF, ultimately leading to the development of pain. Recently, it has been reported that nerve fiber density and expression levels of NGF in deep infiltrating endometriosis are much higher than in superficial peritoneal endometriotic lesions [31]. Also, in rodent models of endometriosis, NGF expression is up-regulated with resulting development of numerous nerve fibers within the endometriotic lesions [22,23,32].…”

Th1 and Th2 immune responses related to pelvic endometriosis

“…Particularly, in more aggressive, infiltrating forms of the disease, there appears to be a predominant action of cell immunity, with cells, enzymes and cytokines provoking adhesion, infiltration and maintenance of the foci of ectopic endometrial tissue. Deeply infiltrating endometriosis is a major issue in several studies related to this disease, including etiopathogenesis, clinical data, imaging methods and an intense clinical and surgical treatment debate 16,17,18,19,20,21 . There are still some topics that have no consensus, such as the best imaging method for diagnosis of deep lesions (mainly bowel endometriosis) 18,19 and the best option for treatment of these lesions, due to the complication risk related to the more advanced surgical procedures 20,21 .…”

Inflammation and Chronic Pelvic Pain: A Biological Trigger for Depression in Women?

“…This MC augmentation is more evident in deep infiltrating lesions (typically associated with more severe pelvic pain) and in close proximity to nerve fibers. A concomitant alteration of somatosensory fibers, namely an augmentation of nerve fiber density, parallels MC alteration in the affected tissues [38]. BPS/IC has also been reported to show an accumulation and activation of MCs.…”