March is
officially endometriosis awareness month and that means it’s time for me to get
writing. Endometriosis awareness has come on in leaps and bounds since I
started this blog way back in the dim and distant past of 2009 and even more so
from the time before that. This has led to some noticeable real world
differences. For me, I’ve noticed that when I talk about my research interests
there are a lot more people who know about endo, or have at least heard of it;
I certainly don’t get as many blank stares as I used to. However, endometriosis
still doesn’t receive the attention that it deserves from governments and
policy makers, so I salute those brave souls battling to raise awareness of
this disease.
Endometriosis
is far from rare, however there are rare ways in which endometriosis can
present itself. This week’s post is dedicated to those rare forms of endo,
found in unexpected places, to create an ‘endometriosis atlas’ of sorts.
Anyone who
is familiar with endometriosis will know that it is usually found on or around
the pelvic reproductive organs, such as the uterus, ovaries, fallopian tubes
and the surrounding ligaments and structures. What is less well known is that
endometriosis has been found in almost every part of the human body, although
finding endo outside the ‘normal’ locations is rare to extremely rare depending
on the location. I’ve scoured through the literature and come up with the
diagram below showing all the places endo has been found in the body.
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| (Click on image for larger version) Original image from clipartqueen.com |
As I
mentioned before, many of these incidences of endo are rare, some of the cases
(like endo in the heart/brain/nose) have only ever been reported once or twice,
so whilst they are not impossible, they are very unlikely. In a lot of these
cases patients report cyclical symptoms, like pain or bleeding around the time
of menses, which is really the only clue physicians have that endo may be the
culprit.
Equally, or
perhaps more unusual than the odd locations of endometriosis in women, is the
occurrence of endometriosis and endomyometriosis (a uterus like mass containing
uterine muscle and endometrium) in men. There have only ever been around a
dozen cases of male endometriosis reported, so it is an extremely rare
phenomenon. Below is a diagram, similar to the one above showing, the locations
of male endometriosis and endomyometriosis.
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| (Click on image for larger version) |
Interestingly,
the majority of these cases have been in men undergoing hormone therapy for
prostate cancer, or men with a condition or medication that would alter their
normal hormonal balance. One of the more plausible explanations for male
endometriosis is that, during the very early stages of development, small
pieces of embryonic female reproductive system precursors remain and can become
‘activated’ when exposed to external hormonal influences (I’ve given a better
explanation of this previously).
Maybe this could give us some insight into how endometriosis in women develops?
Here are the
sources for each of the case reports where endo was found. It is probably isn’t
a comprehensive list as there are multiple reports for each incidence, but I’ve
only chosen one as a representative example.
Tear ducts: http://www.ncbi.nlm.nih.gov/pubmed/16974134
Heart, lungs
and diaphragm http://www.ncbi.nlm.nih.gov/pubmed/23256014
Diaphragm: http://www.ncbi.nlm.nih.gov/pubmed/20601386
Intestine: http://www.ncbi.nlm.nih.gov/pubmed/19886549
Mons Pubis http://www.ncbi.nlm.nih.gov/pubmed/23444127
Leg Muscle: http://www.ncbi.nlm.nih.gov/pubmed/19152878
Male cases: http://ijs.sagepub.com/content/22/5/421.long
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