TAILIEUCHUNG - ENDOMETRIOSIS AND ADENOMYOSIS

Endometriosis is the extrauterine occurrence of endometrial glands and stroma, most often involving the ovaries or dependent visceral peritoneal surfaces. Although benign, endometriosis is progressive, tends to recur, may be locally invasive, may have widespread disseminated foci (rare), and may exist in pelvic lymph nodes (30%). The etiology is unknown, but several mechanisms may be important in pathogenesis. Endometriosis is a significant gynecological problem, occurring in 7%–10% of the general population and up to 50% of premenopausal women. Endometriosis is found in 20%–50% (mean 38%) of infertile women, and in 71%–87% of those with chronic pelvic pain. . | ENDOMETRIOSIS AND ADENOMYOSIS ENDOMETRIOSIS Endometriosis is the extrauterine occurrence of endometrial glands and stroma most often involving the ovaries or dependent visceral peritoneal surfaces. Although benign endometriosis is progressive tends to recur may be locally invasive may have widespread disseminated foci rare and may exist in pelvic lymph nodes 30 . The etiology is unknown but several mechanisms may be important in pathogenesis. Endometriosis is a significant gynecological problem occurring in 7 -10 of the general population and up to 50 of premenopausal women. Endometriosis is found in 20 -50 mean 38 of infertile women and in 71 -87 of those with chronic pelvic pain. Endometriosis is responsible for 20 of all gynecologic operations and is the single leading nonobstet-ric cause 5 of hospitalization for women age 15-44 years. PATHOLOGY Although some contend that it may be entirely a microscopic diagnosis with no grossly visible alterations most authorities maintain that grossly visible changes are necessary for a clinical diagnosis. Early lesions appear as red petechiae on the pelvic peritoneal surfaces. With accumulation of menstrual-like detritus these multifocal lesions develop into small 1-10 mm flat to cystic dark blue brown or black lesions with hemorrhage into adjacent tissues. Collectively these changes are often described as a powder-burn appearance. They also cause thickening and scarring of the contiguous peritoneal surfaces. As the disease progresses the size and number of these lesions increase and extensive adhesions form. The largest cysts occur in the ovary where they are termed endometriomas and are filled with thick chocolate-colored blood breakdown products. 755 Copyright 2001 The McGraw-Hill Companies. Click Here for Terms ofUse. BENSON PERNOLL S 756 HANDBOOK OF OBSTETRICS AND GYNECOLOGY Pelvic endometriosis is characteristically multifocal involving in order of decreasing frequency the ovary 50 cul-de-sac uterosacral ligaments .

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