Histopathological characteristics of endometrosis in thoroughbred mares in Japan: results from 50 necropsy cases.

Uteri from 50 necropsied nonpregnant Japanese Thoroughbred brood mares (1–30 years of age) were investigated to clarify the histopathological characteristics of endometrosis in Japanese Thoroughbred mares and the distribution pattern of endometrosis lesions in the uterus as a whole. Endometrosis was observed in all animals over 6 years of age and in all of the 21 mares aged over 12 years of age. The affected mares showed elastofibrosis of arteries, veins and lymphatic vessels in the uterine wall, atrophy of the uterine smooth muscle layers and hyperplasia of collagen fibers among the smooth muscle fascicles of the myometrium, in addition to pathomorphologic features of endometrosis such as stromal endometrial fibrosis accompanied by endometrial atrophy, periglandular fibrosis and reduction of uterine glands. The severity of the histopathological changes increased with advancing age. Lymphatic vessels with elastofibrosis showed marked lymph congestion, leading to lymphatic edema. With increasing age, the extent of the distribution of these lesions tended to expand from focal to diffuse involvement of the entire uterus. Based on these findings, we speculate that aging plays a role in the pathogenesis of endometrosis; circulatory disturbances due to intrauterine angiosis or angiopathy, particularly reduction of the arterial blood supply and disturbance of venous drainage, resulting in a reduction of lymphatic drainage (lymphatic edema), are closely related to the onset and progression of endometrial fibrosis and myometrial atrophy with fibroplasia may result in myometrial hypofunction during the peri-implantation or puerperal period.