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Hum. Reprod. Advance Access originally published online on January 16, 2009
Human Reproduction 2009 24(4):827-834; doi:10.1093/humrep/den464
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Rich innervation of deep infiltrating endometriosis

Guoyun Wang1, Natsuko Tokushige2,3, Robert Markham2 and Ian S. Fraser2

1 Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, People's Republic of China 2 Department of Obstetrics and Gynecology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, Sydney, NSW 2006, Australia

3 Correspondence address. E-mail: ntokushige{at}med.usyd.edu.au

BACKGROUND: Deep infiltrating endometriosis (DIE) is a specific type of endometriosis, which can be associated with more severe pelvic pain than other forms of endometriotic lesions. However, the mechanisms by which pain is generated are not well understood.

METHODS: DIE (n = 31) and peritoneal endometriotic (n = 40) lesions were sectioned and stained immunohistochemically with antibodies against protein gene product 9.5, neurofilament, nerve growth factor (NGF), NGF receptors tyrosine kinase receptor-A (Trk-A) and p75, substance P, calcitonin gene-related peptide, vesicular acetylcholine transporter, neuropeptide Y, vasoactive intestinal peptide and tyrosine hydroxylase to demonstrate myelinated, unmyelinated, sensory and autonomic nerve fibres.

RESULTS: There were significantly more nerve fibres in DIE (67.6 ± 65.1/mm2) than in peritoneal endometriotic lesions (16.3 ± 10.0/mm2) (P < 0.01). DIE was innervated abundantly by sensory A{delta}, sensory C, cholinergic and adrenergic nerve fibres; NGF, Trk-A and p75 were strongly expressed in endometriotic glands and stroma of DIE.

CONCLUSIONS: The rich innervation of DIE may help to explain why patients with this type of lesion have severe pelvic pain.

Key words: deep infiltrating endometriosis/immunohistochemistry/nerve fibres/pain

Submitted on October 15, 2008; resubmitted on November 13, 2008; accepted on December 3, 2008.


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