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Reprod Sci. 2020 Feb 19. doi: 10.1007/s43032-020-00171-0. [Epub ahead of print]

The Lymphatic System in Endometriosis: a Pilot Study of Endometrial-Like Cells and Immune Cell Populations in Lymph Nodes Associated with Deep Infiltrating Bowel Lesions.

Author information

1
The University of Sydney Obstetrics, Gynaecology and Neonatology; Central Clinical School; Faculty of Medicine and Health, Medical Foundation Building K25, The University of Sydney, Sydney, NSW, 2006, Australia.
2
Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia.
3
The University of Sydney Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
4
The University of Sydney Obstetrics, Gynaecology and Neonatology; Central Clinical School; Faculty of Medicine and Health, Medical Foundation Building K25, The University of Sydney, Sydney, NSW, 2006, Australia. alison.hey-cunningham@sydney.edu.au.

Abstract

In endometriosis, the lymphatic and immune systems are implicated in disease establishment and progression. The objective of this pilot study was to examine endometrial-like, and for the first time, immune cell populations in lymph nodes associated with deep infiltrating endometriosis (DIE) bowel lesions. Premenopausal women undergoing excision of endometriosis and/or hysterectomy were included. DIE bowel lesion-associated (n = 10) and other pelvic (n = 15) lymph nodes were studied. Samples were immunohistochemically stained for endometrial-like cells (CD10), T cells (CD3, CD4, CD8, and FoxP3), dendritic cells (DC; DC-Lamp and DC-Sign), B cells (CD20, CD79 and plasma), macrophages (CD68), and natural killer cells (NK; CD57). Cell abundance (percentage positive area) and antigen expression (optical density; OD) were quantified. Endometrial-like cells and each immune cell population were present in all studied nodes. The DIE bowel lesion-associated nodes showed features of immune activation, with T cell proliferation (CD3+ area p = 0.007, CD4+ area p = 0.015 compared with other pelvic nodes); and a mixture of helper and regulatory T cells, B cells, DCs, macrophages, and plasma cells present in the paracortex. In DIE bowel lesion-associated compared with other pelvic nodes, CD10+ endometrial-like cells were reduced (percentage positive area p < 0.001, OD p = 0.004). This study provides new insight into lymphatic and immune system involvement in advanced endometriosis. In particular, we have shown evidence of immune activation in DIE lesion-associated nodes. This was despite lower endometrial-like cell numbers compared with other pelvic nodes. The observations contribute to a developing understanding of the local immune response to advanced disease.

KEYWORDS:

Deep infiltrating endometriosis; Endometriosis; Immune response; Lymph nodes; Lymphatic spread

PMID:
32077078
DOI:
10.1007/s43032-020-00171-0

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