Altered immune environment in peritoneal endometriotic lesions: relationship to lesion appearance

Reproductive Diseases

VOLUME 2, ISSUE 2, P207-218, MAY 01, 2021


Burcu Ersoy, M.Phil., Alison J. Hey-Cunningham, Ph.D., Laura Lindsay, Ph.D., Nesrin Varol, Ph.D., Robert Markham, Ph.D.



To study the localization of and quantify different immune cell populations in red, black, and white peritoneal endometriotic lesions and compare immune cell densities between lesions and the surrounding tissue.


Cross-sectional study.


Teaching hospital, university research laboratory.


Participants undergoing laparoscopic excision of endometriosis were recruited from gynecological operating theaters at Royal Prince Alfred Hospital, Sydney (n = 28).


Immunohistochemical staining for and quantification of dendritic cells (mature and immature), T cells (effector, cytotoxic, and regulatory), B cells, and macrophages in endometriotic peritoneal lesions and the surrounding tissue.

Main Outcome Measure(s)

Immune cell densities and aggregates were quantified.


Red and black lesions are significantly more likely to be surrounded by immune cell aggregates than white lesions (P=.036). In the tissue surrounding the peritoneal endometriotic lesions, there was a consistent pattern of greater and more variable density of immune cell populations for red lesions than black or white lesions and a range of significant positive correlations between densities of different immune populations (all P≤.004; not observed within the lesion stroma).


There is a greater presence of immune cells in the tissue surrounding earlier/red and black lesions than older scarred white lesions, particularly in the form of immune cell aggregates, indicating an immunologic response in close proximity to the adjacent lesion. The relationship between densities of immune populations in the tissue surrounding the lesions suggests complementary recruitment and local interactions between cells. Categorizing immune cell populations in proximity to peritoneal endometriotic lesions may improve the understanding of lesion persistence and transition to older white appearances. Early (red) peritoneal endometriotic lesions are surrounded by a greater density of immune cells, including immune aggregates, than later (black or white) lesions. These immune cells may support lesion persistence.

Please sign in or register for FREE

Your Fertility and Sterility Dialog login information is not the same as your ASRM or EES credentials. Users must create a separate account to comment or interact on the Dialog.