A study of endometriosis, endosalpingiosis, endocervicosis, and peritoneo-ovarian sclerosis : a clinical and pathologic study / by James Robert Goodall.

  • Goodall, James Robert, 1877-1947.
Date:
1943
Catalogue details

Licence: In copyright

Credit: A study of endometriosis, endosalpingiosis, endocervicosis, and peritoneo-ovarian sclerosis : a clinical and pathologic study / by James Robert Goodall. Source: Wellcome Collection.

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    and into the ovary are becoming increasingly numerous. And cases of ovarian stromatous endometriosis are now unquestionable facts. From the frequency of incidence and the destructiveness of ovarian endometriosis, one is led to believe that the ovary offers a very favorable soil for the implants and transplants of endometrial tissue, whatever their origin. As stated above, most of the ovarian invasions are of “spill” origin and therefore most ovarian growths suffer the destructive influence of menstrual blood. So that the two destructive factors are at work simul¬ taneously. In major involvements the affected ovary enlarges, due to many factors: (1) chiefly owing to blood cysts and (2) the new invasion by the endometrial growth; but also (3) by hypertrophy of its own specific cellular elements. This last, it is now thought, is a response or a factor in the production of hyperestrinism, similar to the hypertrophy of the uterine elements in cases of parietal endometriosis. Not only does the normal function of ripening of follicles go on in the immediate neighborhood of the endometriosis, but, from a careful study of active cases of ovarian endometriosis, there seems a decided increase in ovarian function. Whether many of the ripening ova reach maturity is questionable, but some do. This fact is of importance when we come to the question of sterility, which is almost an invariable ac¬ companiment of endometriosis. When the ovary becomes contaminated by “spill,” the endometrial cells may come to rest in its creases and clefts. Here they take root and invade the ovarian capsule. The contamination contains both stroma and glandu¬ lar cells, and each tries in its new location to assume its normal relation to the other. Consequently glandular cells grow into acini and become clothed with stroma cells. At the next menstrual epoch these cells in loco novo go through all the changes of: (1) growth in response to the fol¬ licular hormone, (2) succulence in response to the luteal hormone, and (3) blood extravasations both into the newly formed acinus and into its surrounding stroma cells as a sequence to the withdrawal of both hormones. In this manner blood is set free and the first ectopic cyst is formed. During one of the subsequent menstrual extravasations the cyst or cysts now rupture and recontaminate the surface of the ovary, and if the surface of the ovary at this spot has not been fused by the burrow¬ ing endometrial cells, the cyst contents, composed of living endometrial desquamated cells and blood detritus, brings about the fusion. From that time on the ovary and its fused neighbor operate as a conjoined soil for the uninvited guest of ectopic endometrial cells, which set up their own menage to the seemingly great discomfort of the hosts. As stated above, the surface cysts rupture and agglutinate that con¬ taminated organ with that of a contiguous organ, causing a welding of these two surfaces. This goes on repeatedly so that large surfaces may be-