The Human Endometrium

The structural, biochemical and clinical events related to menstruation, implantation, parturition, endometriosis, abnormal uterine bleeding and endometrial cancer are discussed in this comprehensive volume on the biological functions of the endometrium. New topics, such as the biochemical and molecular mechanisms regulating maternal embryonic interaction, are explored, and gynecologic endoscopy and therapeutic tools are discussed. The proceedings of the first conference is also available from the Academy, as volume 622 of The Annals of The New York Academy of Science.

The Endometrium is devoted to a comprehensive multi-disciplinary account of the uterine endometrium. This book is the first to define the regulatory biological interrelationships between epithelial and stromal cell phenotypes, endothelial cells, extracellular matrix and immunobiological elements. It highlights their relevance to clinical conditions

Although the physiology of the menstrual cycle appears clear and easily explained by a balance in the concentration of various sex steroid hormones, numerous details of its mechanism are still poorly understood and little is known about the relationship among clinical events, plasma hormone concentrations, molecular impacts on target tissues and their regulation. In the following chapters, the authors have attempted to establish a correlation between endometrial histology and well-understood physiologic events of the menstrual cycle. They have provided up-to-date information on the effects of various hormones and combinations of hormones on the endometrium. The interdependence of endometrial morphology, molecular biology, endocrinology and physiology, provides grounds for a better understanding of the complex mechanism of the menstrual cycle, and sheds some light on its pathophysiology. Such an approach adds ariother dimension to interpretation of many menstrual abnormalities and numerous aspects of infertility in women with normal physiognomies and apparently regular menstrual cycles. The pathologist must be aware of these new concepts since a knowledge of functional changes reflected in hormone serum levels and sex steroid receptor concentrations allows a mare detailed analysis and a better interpretation of the structural features of the endometrium. This information placed in the proper clinical context can help the gynecologist provide optimal therapy. The reader will find a valuable reference for a synthesis of clinical, morphological, and biochemical data related to the menstrual cycle and its aberrations.

Reevaluation of tumor classification, differential diagnosis and differential therapy based on modern knowledge. Revision of all chapters to incorporate new facts based on recent discoveries.

Practical, evidence-based review of all factors that can affect the endometrium and influence implantation success rates.

1. 1 Historical Perspective In the nineteenth century, knowledge of the events leading to ovulation, fertilization, and implantation was very limited, so much so that Seiler (1832), in his book The Uterus and the Human Egg, wrote: ". . . in the left ovary the first signs of fertilization, namely a Graaf vesicle could be seen. The right ovary shows proof of a second successful copulation: a fresh scar from the ovulated egg and the beginning of a corpus luteum. " In fact all nineteenth century authors strictly divide the female cycle into two phases: the menstrual period and the intermenstruum (ct. Hitschmann and Adler 1908). The generally accepted histology of the endometrium in those days was that of the late proliferative phase. Deviations from this were considered to be pathological (Von Ebner 1902). As Gebhard (1899) expressly put it: "As a rule, it can be said that in the mature woman the endometrial glands run straight; an irregular course of the glands is to be regarded as pathological. " The same author describes the changes occurring during the secretory phase of the cycle as "endometritis glandularis" which he believed to arise from a local nutritional disturbance. The uterine stroma was believed to be lymphoid (Toldt 1877), and the uterine glands were compared to the crypts of Lieberkiihn (Von Ebner 1902).