Abstract：
OBJECTIVE: Do different subtypes of superficial peritoneal endometriotic lesions exist, based on the presence and morphology of smooth muscle, collagen fibres and immune cell populations?
METHODS: A retrospective cohort study of 24 patients, from across the menstrual cycle, with surgically and histologically confirmed endometriosis. Immunofluorescence was used to delineate the CD10 stromal area of lesions (n = 271 lesions from 67 endometriotic biopsies), and then smooth muscle actin (SMA) positive tissue and immune cell populations (CD45+ and CD68+) were quantified within and adjacent to these lesions. Second harmonic generation microscopy was used to evaluate the presence and morphology of type-1 collagen fibres within and surrounding lesions.
RESULTS: Overall, immune cell numbers and the area of SMA and collagen within endometriotic lesions tended to be low, but a spectrum of presentations significantly varied, particularly in the adjacent tissue microenvironment, based on lesion locations, the morphology of endometriotic gland profiles, or both. Lesions in which collagen fibres formed well aligned capsules around the CD10+ stromal border were identified compared with lesions in which collagen fibre distribution was random. Considerable inter- and intra-patient variability in the morphology of SMA and collagen was observed within and surrounding lesions.
CONCLUSIONS: These data demonstrate considerable diversity in the presence of immune cells and morphology of SMA and collagen within, but even more so, surrounding endometriotic lesions, even within individual patients. This heterogeneity, especially within individual patients, presents a challenge to incorporating these cell and tissue types into any new endometriosis classification systems or prognostic approaches.
METHODS: A retrospective cohort study of 24 patients, from across the menstrual cycle, with surgically and histologically confirmed endometriosis. Immunofluorescence was used to delineate the CD10 stromal area of lesions (n = 271 lesions from 67 endometriotic biopsies), and then smooth muscle actin (SMA) positive tissue and immune cell populations (CD45+ and CD68+) were quantified within and adjacent to these lesions. Second harmonic generation microscopy was used to evaluate the presence and morphology of type-1 collagen fibres within and surrounding lesions.
RESULTS: Overall, immune cell numbers and the area of SMA and collagen within endometriotic lesions tended to be low, but a spectrum of presentations significantly varied, particularly in the adjacent tissue microenvironment, based on lesion locations, the morphology of endometriotic gland profiles, or both. Lesions in which collagen fibres formed well aligned capsules around the CD10+ stromal border were identified compared with lesions in which collagen fibre distribution was random. Considerable inter- and intra-patient variability in the morphology of SMA and collagen was observed within and surrounding lesions.
CONCLUSIONS: These data demonstrate considerable diversity in the presence of immune cells and morphology of SMA and collagen within, but even more so, surrounding endometriotic lesions, even within individual patients. This heterogeneity, especially within individual patients, presents a challenge to incorporating these cell and tissue types into any new endometriosis classification systems or prognostic approaches.
摘要：
目的：腹膜浅表子宫内膜异位病变是否存在不同亚型，基于平滑肌的存在和形态，胶原纤维和免疫细胞群？
方法：对24例患者进行回顾性队列研究，从整个月经周期来看，经手术和组织学证实的子宫内膜异位症。免疫荧光用于描绘病变的CD10基质面积（来自67个子宫内膜异位活检的n=271个病变），然后将平滑肌肌动蛋白(SMA)阳性组织和免疫细胞群体(CD45+和CD68+)定量在这些病变内和邻近。二次谐波发生显微镜用于评估病变内和周围1型胶原纤维的存在和形态。
结果：总体而言，子宫内膜异位病灶内的免疫细胞数量和SMA和胶原蛋白面积趋于低，但是一系列的演讲差异很大，特别是在邻近的组织微环境中，根据病变位置,子宫内膜异位症的腺体形态，或者两者兼而有之。与胶原纤维分布随机的病变相比，确定了胶原纤维在CD10基质边界周围形成排列良好的胶囊的病变。在病变内部和周围观察到SMA和胶原蛋白形态的患者间和患者内相当大的差异。
结论：这些数据表明，免疫细胞的存在以及SMA和胶原蛋白的形态存在相当大的差异，但更重要的是，周围子宫内膜异位病变，甚至在个别患者中。这种异质性，尤其是在个体患者中，提出了将这些细胞和组织类型纳入任何新的子宫内膜异位症分类系统或预后方法的挑战。
方法：对24例患者进行回顾性队列研究，从整个月经周期来看，经手术和组织学证实的子宫内膜异位症。免疫荧光用于描绘病变的CD10基质面积（来自67个子宫内膜异位活检的n=271个病变），然后将平滑肌肌动蛋白(SMA)阳性组织和免疫细胞群体(CD45+和CD68+)定量在这些病变内和邻近。二次谐波发生显微镜用于评估病变内和周围1型胶原纤维的存在和形态。
结果：总体而言，子宫内膜异位病灶内的免疫细胞数量和SMA和胶原蛋白面积趋于低，但是一系列的演讲差异很大，特别是在邻近的组织微环境中，根据病变位置,子宫内膜异位症的腺体形态，或者两者兼而有之。与胶原纤维分布随机的病变相比，确定了胶原纤维在CD10基质边界周围形成排列良好的胶囊的病变。在病变内部和周围观察到SMA和胶原蛋白形态的患者间和患者内相当大的差异。
结论：这些数据表明，免疫细胞的存在以及SMA和胶原蛋白的形态存在相当大的差异，但更重要的是，周围子宫内膜异位病变，甚至在个别患者中。这种异质性，尤其是在个体患者中，提出了将这些细胞和组织类型纳入任何新的子宫内膜异位症分类系统或预后方法的挑战。
