Lymphangiogenesis in deep infiltrating endometriosis

• Published in: Human reproduction (Oxford) Vol. 26; no. 10; pp. 2713 - 2720
• Main Authors: Keichel, S., Barcena de Arellano, M.-L., Reichelt, U., Riedlinger, W.F.J., Schneider, A., Köhler, C., Mechsner, S.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-10-2011
• Subjects: Adult; Biological and medical sciences; Endometriosis - physiopathology; Female; Gene Expression Regulation; Gynecology. Andrology. Obstetrics; Homeodomain Proteins - biosynthesis; Humans; Immunohistochemistry - methods; Lymph Nodes - pathology; Lymphangiogenesis; Lymphatic Metastasis; Medical sciences; Premenopause; Sentinel Lymph Node Biopsy - methods; Stromal Cells - cytology; Tumor Suppressor Proteins - biosynthesis; Vascular Endothelial Growth Factor C - biosynthesis; Vascular Endothelial Growth Factor D - biosynthesis; Vesicular Transport Proteins - biosynthesis; lymphangiogenesis; endometriosis; lymphatic spread; deep infiltrating endometriosis; lymph node; Vertebrata; Mammalia; Lymph node; Uterine diseases; Endometriosis; Lymphatic; Female genital diseases
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/der230

BACKGROUND
In patients diagnosed with deep infiltrating endometriosis (DIE), foci of endometriosis are detected in mesorectal lymph nodes (LNs) after segmental bowel resection and in pelvic sentinel LNs. Lymph vessels (LVs) seem to be the possible routes for the dissemination of endometriotic cells from DIE-lesions to LN. Therefore, we conducted a study to investigate the occurrence and density of LV and lymphangiogenic growth factors in DIE.
METHODS
Included in this study were 38 premenopausal women who underwent surgery due to symptomatic rectovaginal DIE. In order to identify LV, immunohistochemical analysis with anti-Podoplanin (D2-40), LYVE-1 and Prox-1 was performed. Furthermore, the expression of VEGF-C and VEGF-D in endometriotic tissue was investigated.
RESULTS
LV density (LVD) of DIE lesions was significantly higher compared with healthy corresponding tissue. All LV makers could be detected, and the density of LYVE-1- or Prox-1-positive LV was significantly higher than that of D2-40-positive LV. Endometriotic epithelial cells and stromal cells showed a moderate to strong VEGF-C and VEDF-D expression.
CONCLUSIONS
DIE lesions have lymphangiogenic properties, probably leading to endometriosis-like cells in lymphatic vessels and LNs featuring a loco-regional disease.