The Hidden Disease
Some physicians have likened the hunt for endometriosis during surgery to searching for Waldo in the famous book series. The difference is that instead of looking for a guy in a turtleneck top decorated with red and white stripes, you're looking for reddened inflamed tissue and whitening ridges of scar tissue. It's still much like finding something very small in a very large and colorful zoo or circus.
Endometriosis is like finding Waldo for a variety of reasons. For one thing, endometriosis comes with a plethora of symptoms. One woman may talk about painful defecation during her periods while another will say that menstrual cramps are driving her out of her mind. A third endometriosis patient will say she has almost no pain whatsoever. Confounding the picture further, studies have shown that the intensity of the pain suffered seems to bear no correlation to the surgical endometriosis findings. That may mean that hunting for endometrial tissue is useless from the start.
But also, endometriosis tends to vary its hiding places. You can't depend on finding the tissue in the fallopian tubes or adhering to the ovaries, just as you never know where Waldo will pop up—he's not always just behind the lion, or standing by the ticket booth. If you're still following this analogy, you might begin to see why physicians sometimes decide to go looking for endometriosis in some pretty far-fetched places, for instance inside the lungs.
If you've read up on endometriosis, you know it tends to migrate within the abdominal cavity. But by no means is this always the case. Doctors have found endometriosis in the diaphragm, vagina, thigh, arm, pleura, trachea, and even in surgical scars such as those resulting from C-section surgeries.
No one knows why pieces of the endometrium end up in such wild and sometimes even life-threatening places. On the other hand, when the tissue finds its way to a home, it tends to stay there for the duration. That means that once the tissue is found in the tubes or on the ovaries, it will always grow in this area.
Some experts blame the migrating tissue on retrograde menstruation in which the uterine lining moves back into the tubes, wending its way toward the ovaries instead of exiting via the vagina as a menstrual period. Other experts believe the problem stems from immune system issues that cause wrong-headed tissue deposits, while still others say the tissue spreads through the blood stream or the lymph system. Then there are the experts who believe the extra-uterine tissue is only a genetic tendency and others who think the tissue is transferred during surgery.
The final theory, however, may explain the rare episodes in which endometrial tissue is found in scar tissue. This type of endometrial tissue is called surgical scar endometrioma. These endometriomas are thought to develop when abnormal tissue from the uterus makes direct contact with normal tissues undergoing the healing process. The abnormal tissues then implant onto the healing tissues, and voila: endometrioma.