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The History of the Discovery of Ectopic Epithelial Cells in Lower Peritoneal Organs: The So-Called Mucosal Invasion

1
Department of Health Sciences, University Hospitals of Leicester, University of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK
2
Department of Experimental and Clinical Medicine, School of Sciences of Human Health, University of Florence, 50134 Florence, Italy
3
Department of Maternal and Child Health, Gynaecology and Urology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00100 Rome, Italy
*
Author to whom correspondence should be addressed.
Academic Editor: Simone Ferrero
Reprod. Med. 2021, 2(2), 68-84; https://doi.org/10.3390/reprodmed2020008
Received: 8 March 2021 / Revised: 24 March 2021 / Accepted: 4 April 2021 / Published: 7 April 2021
Through microscopy, early researchers identified the epithelium on the inner surfaces of the uterus, cervix and Fallopian tubes. The identification of ectopic epithelium was gradual, starting from the gross pathology study of unusual cystic lesions. Towards the end of the nineteenth century, attention focused on the epithelium as a critical component. The term ‘adenomyoma’ was coined around eighteen eighty to designate the majority of mucosa-containing lesions. Several theories were advanced to explain its aetiology. In the main, lesions were considered to arise from invasion from uterine epithelium; implantation of endometrium through retrograde menstruation; hematogenous or lymphatic spread; or from embryonic remnants. Although initially widely rejected, around 1920, an almost unanimous consensus formed on the endometrial nature of epithelial invasions. During the following years, adenomyosis and endometriosis came to be used to distinguished lesions within or outside the uterus. Adenomyosis was attributed to direct infiltration of uterine mucosa into the myometrium, and endometriosis to the implantation of endometrial cells and stroma into the peritoneal cavity through retrograde menstruation. Around the same time, ovarian lesions, initially described as ovarian hematomas or chocolate cysts, were regarded as a form of endometriosis. Three variants of endometriosis were thus described: superficial peritoneal, deep nodular and ovarian endometriomas. Ectopic epithelium has long been recognised as having similarities to tubal, or cervical epithelium. Lesions containing mixed epithelium are often termed Müllerianosis. This article demonstrates the stepwise evolution of knowledge, the role of the pioneers and the difficulties that needed to be overcome. It also demonstrates the value of collaboration and the inter-connected nature of the scientific endeavour. View Full-Text
Keywords: adenomyoma; adenomyosis; chocolate cysts; endometriosis; mucosal invasion; Müllerianosis adenomyoma; adenomyosis; chocolate cysts; endometriosis; mucosal invasion; Müllerianosis
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MDPI and ACS Style

Habiba, M.; Lippi, D.; Benagiano, G. The History of the Discovery of Ectopic Epithelial Cells in Lower Peritoneal Organs: The So-Called Mucosal Invasion. Reprod. Med. 2021, 2, 68-84. https://doi.org/10.3390/reprodmed2020008

AMA Style

Habiba M, Lippi D, Benagiano G. The History of the Discovery of Ectopic Epithelial Cells in Lower Peritoneal Organs: The So-Called Mucosal Invasion. Reproductive Medicine. 2021; 2(2):68-84. https://doi.org/10.3390/reprodmed2020008

Chicago/Turabian Style

Habiba, Marwan, Donatella Lippi, and Giuseppe Benagiano. 2021. "The History of the Discovery of Ectopic Epithelial Cells in Lower Peritoneal Organs: The So-Called Mucosal Invasion" Reproductive Medicine 2, no. 2: 68-84. https://doi.org/10.3390/reprodmed2020008

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