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Causes of Endometriosis: Coelomic Metaplasia Theory
If we explain the pathogenesis of endometriosis according to the theory of endometrial implantation, then where does the focus of endometriosis, such as lung and kidney, come from?
In the early 20th century, Meyer put forward the theory of coelomic metaplasia, that is, coelomatous epithelium covering the ovary and pelvic peritoneum. It has tissue homology with endometrium and can be transformed into endometrium under certain stimulation.
How it differentiates into olfactory tissue or other special cells in the uterus has not been elucidated, which may be caused by the repeated action of some hormones or the stimulation of menstrual blood and chronic inflammation. Endometriosis occurs in men with prostate cancer treated with estrogen, which strongly supports this theory.
Through animal experiments, it has been confirmed that endometrium can be transferred through blood and lymph channels and implanted in some parts far away from the pelvis, such as the nasal cavity, lungs, kidneys, lymph nodes, etc.


The germinal epithelium, pelvic peritoneum and pleura of the ovary all originate from the lymphatic and venous dissemination of the coelomic epithelium. They can be transformed into endometrioid tissue and form endometriosis by repeated stimulation of menstrual blood, hormone, or chronic inflammation.
Because the ovary and Mullerian tubes are both derived from the coelomic epithelium, the coelomic metaplasia theory can explain the endometriosis of ovary. Metaplasia can also explain the pathological changes in the distant parts such as chest, limbs, and umbilicus, and serous cells that can also be found.
This theory can even be extended to the peritoneum to explain peritoneal endometriosis. They believe that part of the peritoneum is a differentiated tissue, and can produce tissue similar to normal endometrium. Peritoneal mesothelium also has the ability of proliferation and differentiation.
However, no endometriosis was found in other tissues differentiated from coelomic epithelium except ovary, Mullerian tube, and peritoneum, which challenged the theory of coelomic metaplasia. So far, there are not enough clinical or experimental data for this theory.
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