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Department of Gynaecology, Obstetrics and Urology, Sapienza University, Rome, and b Department of
Experimental and Clinical Medicine, School of Sciences of Human Health, University of Florence, Florence, Italy;
c
Leuven Institute for Fertility and Embryology, Leuven, Belgium
Key Words
History Adenomyoma Adenomyosis Endometriosis
Abstract
A dispute has recently emerged whether early descriptions
exist of the condition we name endometriosis. A first question is: Who identified endometriosis? To respond, two noncomplementary methods have been employed: searching
for ancient descriptions of symptoms associated with endometriosis or, alternatively, identifying researchers who described pathological features we associate with the presence of endometriosis in its various forms. We opted for the
latter and found no evidence that in older times anyone delineated the macroscopic features of endometriosis; descriptions of menstrual or cyclic pain cannot be taken as proof of
knowledge of what caused it. During the mid-part of the
19th century, Rokitansky had a great intuition: endometrial
glands and stroma can be present in ovarian and uterine
neoplasias. However, using histological parameters of endometrial structure and activity, the first scientist to delineate
peritoneal endometriosis under the name adenomyoma
was Cullen. On the other hand, Rokitansky was the first to
describe a form of adenomyosis (an adenomatous polyp).
Early descriptions of ovarian endometrioma as haematomas
of the ovary or chocolate cysts date back to the end of the
19th century. The first mention of an ovary containing uterine mucosa was published in 1899 by Russel, but Sampson
was the first to demonstrate specific endometrial activities,
such as desquamation at the time of menstruation and decidualization in pregnancy; subsequently, he presented a
theory on its pathogenesis.
2014 S. Karger AG, Basel
Introduction
Over the past two decades there has been an increasing interest in the history of endometriosis, and recently
Nezhat et al. [1] detailed a large number of classic texts
from antiquity to the 19th century containing descriptions of symptoms that they considered evidence of the
existence of endometriosis. Clearly, whereas some of the
women mentioned probably had endometriosis, these
descriptions cannot be taken as evidence of an early identification of the condition, and, indeed, scholars disagree
on who was the first to become aware of its existence. This
is why we have argued that to resolve the dispute, it is necessary to outline a specific methodological approach [2],
beginning with its current definition, namely the presence of functional endometrial-like tissue outside the
uterus, but in the pelvic cavity, or even outside, with eviGiuseppe Benagiano
28, chemin des Massettes
CH1218 Grand Saconnex (Switzerland)
E-Mail pinoingeneva@bluewin.ch
This can indeed be first the description of a case of adenomyosis. Once again, however, early researchers of adenomyoma failed to mention Rokitanskys cases.
The name adenomyoma was coined around the end of
the 19th century. In 1896, both Cullen and Von Recklinghausen described the condition [59, 60], followed by Pick
[61] and Rolly [62, 63] in 1897.
The History of Endometriosis
There is no doubt that Cullen considered uterine adenomyoma, ovarian endometriosis and deep endometriosis as one disease characterized by the presence of endometrial tissue outside the uterine mucosa.
At this point, adenomyoma was subdivided into endometriosis and adenomyosis: two separate entities.
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