BACKGROUND Clinical data suggest that the presence of an ovarian endometrioma may cause per se damage to the surrounding otherwise healthy ovarian tissue. However, the basic research has so far done a limited job in trying to understand the potential detrimental effect of an endometrioma presence in the context of the ovarian physiology. We have reviewed the literature with the aim of characterizing the pathophysiology of the endometrioma focusing mostly on factors and mechanisms potentially affecting the surrounding, otherwise normal, ovarian tissue. METHODS Comprehensive searches of PUBMED were conducted to identify human studies published from 1991 to 2013 in the English language on the cellular and molecular characterization of the various endometrioma components. RESULTS An endometrioma contains free iron, reactive oxygen species (ROS), proteolytic enzymes and inflammatory molecules in concentrations from tens to hundreds of times higher than those present in peripheral blood or in other types of benign cysts. The cyst fluid causes substantial changes in the endometriotic cells that it baths from gene expression modifications to genetic mutations The physical barrier between the cyst contents and the normal ovarian tissue is a thin wall composed of the ovarian cortex itself or fibroreactive tissue. ROS potentially permeating the surrounding tissues and proteolytic substances degrading the adjacent areas are likely to cause the substitution of normal ovarian cortical tissue with fibrous tissue in which the cortex-specific stroma is reduced. The fibrosis is associated with smooth muscle metaplasia and followed by follicular loss and intraovarian vascular injury. Follicular density in tissue surrounding the endometriotic cyst was consistently shown to be significantly lower than in healthy ovaries but this pathological change does not appear to be caused by the stretching of surrounding tissues owing to the presence of a cyst. CONCLUSIONS There is sufficient molecular, histological and morphological evidence, in part deriving from knowledge of the pathophysiology, to support a deleterious effect of the endometrioma on the adjacent ovarian cortical tissue, independent of the mere mechanical stretching owing to its size.

中文翻译：

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子宫内膜异位卵巢囊肿的区别性细胞和分子特征：从病理生理学到子宫内膜瘤介导的对卵巢的潜在损害。

背景技术临床数据表明，卵巢子宫内膜瘤的存在本身可能对周围健康的卵巢组织造成损害。但是，到目前为止，基础研究在试图了解卵巢内膜异位症在卵巢生理学方面的潜在有害作用方面所做的工作非常有限。我们综述了旨在表征子宫内膜瘤的病理生理特征的文献，主要侧重于可能影响周围的正常卵巢组织的因素和机制。方法对PUBMED进行全面搜索，以鉴定从1991年至2013年以英语发表的关于子宫内膜瘤各个成分的细胞和分子表征的人体研究。结果子宫内膜瘤含有游离铁，活性氧（ROS），蛋白水解酶和炎症分子的浓度比外周血或其他类型的良性囊肿中的浓度高几十至数百倍。囊肿液会导致子宫内膜异位细胞发生实质性变化，从基因表达修饰到遗传突变。囊肿内容物与正常卵巢组织之间的物理屏障是由卵巢皮质本身或纤维反应性组织组成的薄壁。潜在地渗透到周围组织中的ROS和降解邻近区域的蛋白水解物质可能会导致正常卵巢皮质组织被皮质特异基质减少的纤维组织所替代。纤维化与平滑肌化生有关，随后是滤泡丢失和卵巢内血管损伤。子宫内膜异位囊肿周围组织的卵泡密度始终被证明显着低于健康卵巢，但这种病理变化似乎不是由于囊肿的存在而引起的周围组织的拉伸引起的。结论有足够的分子，组织学和形态学证据，部分源于病理生理学知识，可支持子宫内膜瘤对邻近卵巢皮质组织的有害作用，而不受其大小的单纯机械拉伸的影响。