Fertility and Sterility Hepatocyte growth factor may be involved in cellular changes to the peritoneal mesothelium adjacent to pelvic endometriosis  Tadayuki Ishimaru, M.D., Khaleque Newaz Khan, M.D., Ph.D., Akira Fujishita, M.D., Michio Kitajima, M.D., Hideaki Masuzaki, M.D.  Fertility and Sterility  Volume 81, Pages 810-818 (March 2004) DOI: 10.1016/j.fertnstert.2003.09.037

FIGURE 1 (A) Sites of biopsy during laparoscopy adjacent to blood-filled red lesion as indicated by asterisks, and corresponding hematoxylin and eosin (H&E) staining. (B) Normal mesothelium. (C) Transformation of mesothelium to cuboidal or columnar cells. (D) Gland-like invagination of peritoneal mesothelium. Ishimaru. Change of peritoneal mesothelium by HGF.Fertil Steril 2004. Fertility and Sterility 2004 81, 810-818DOI: (10.1016/j.fertnstert.2003.09.037)

FIGURE 2 Immunostaining of HGF in the different endometriotic lesions and adjacent peritoneal mesothelium. The immunostaining of HGF appeared to be stronger in the red lesion: (A) red lesion and adjacent mesothelial cells; (C) cuboidal or columnar cells; (E) flat mesothelium. In comparison, the staining was less strong in the black lesion: (B) black lesion and adjacent mesothelium cells; (D) cuboidal or columnar cells; (F) flat mesothelium. Ishimaru. Change of peritoneal mesothelium by HGF.Fertil Steril 2004. Fertility and Sterility 2004 81, 810-818DOI: (10.1016/j.fertnstert.2003.09.037)

FIGURE 3 Quantitative-histogram (Q-H) score of hepatocyte growth factor (HGF) in the red lesion, black lesion, and adjacent peritoneal mesothelium. The Q-H scores of HGF in red lesions and adjacent cuboidal or columnar cells of peritoneal mesothelium were significantly higher than found with black lesions (P<.0001) and their corresponding adjacent mesothelial cells (P<.01). Although normal flat mesothelial cells were less immunoreactive, their Q-H scores adjacent to red lesions were also significantly higher than near black lesions (P<.05). The results are expressed as mean ± SEM. Ishimaru. Change of peritoneal mesothelium by HGF.Fertil Steril 2004. Fertility and Sterility 2004 81, 810-818DOI: (10.1016/j.fertnstert.2003.09.037)

FIGURE 4 CD68-positive macrophage infiltration in normal flat mesothelium and the cuboidal or columnar changed cells of peritoneum adjacent to either red lesions or black lesions of pelvic endometriosis. The macrophage infiltration was expressed as the mean macrophage number of five different fields of one specimen. The macrophage infiltration around the mesothelial cells adjacent to red lesions (both cuboidal or columnar cells and flat mesothelium) was found to be significantly higher than around the corresponding cells adjacent to black lesions (*<0.05 for both). The results are expressed as mean ± SEM. Ishimaru. Change of peritoneal mesothelium by HGF.Fertil Steril 2004. Fertility and Sterility 2004 81, 810-818DOI: (10.1016/j.fertnstert.2003.09.037)

FIGURE 5 Correlation of macrophage infiltration in different mesothelial cells of pelvic peritoneum with immunoreaction to HGF as measured by Q-H scores. The cuboidal or columnar changed cells of pelvic mesothelium adjacent to red endometriotic lesions displayed a statistically significant correlation between macrophage infiltration and the HGF Q-H score (r = 0.370, P=.018). Flat mesothelial cells or cuboidal or columnar changed cells adjacent to black lesions or other pelvic endometriosis did not show any correlation between these two markers. Ishimaru. Change of peritoneal mesothelium by HGF.Fertil Steril 2004. Fertility and Sterility 2004 81, 810-818DOI: (10.1016/j.fertnstert.2003.09.037)