Adenomyoma
“The term ‘adenomyoma’ implies a new formation composed of gland-elements, hyperplastic cellular connective tissue [stroma], and smooth muscle.” 1
Adenomyoma
“An isolated area of endometrial glands and stroma in the uterine musculature that can be identified grossly.” 2
Adenomyosis
“The growth of endometrial glands and stroma into the uterine myometrium to a depth of at last 2.5 mm from the basalis layer of the endometrium.” 3
Adenomyosis
“Adenomyosis may be defined as the benign invasion of endometrium into the myometrium. This invasion produces a diffusely enlarged uterus which microscopically exhibits ectopic, nonneoplastic, endometrial glands and stroma surrounded by hypertrophic-hyperplastic musculature. Some of the historical synonyms for adenomyosis are: endometriosis interna, adenomyoma, adenomyomatosis, adenometritis, adenomyositis, and [briefly] von Recklinghausen’s disease.” 4
Bildung
“The nine-year-long Gymnasium with an emphasis on training in classical studies and then the university with its philosophical faculty, complemented by faculties for medicine, theology, and jurisprudence, became the places to devote oneself seriously to Bildung. Academic scholarship in all fields was expected to serve the higher moral aims laid out by idealism and neo-humanism. Professors therefore had to be more than simply purveyors of knowledge. They were seen as moral models and agents of creativity, restlessly aiming at expanding the limits of knowledge, disregarding any utilitarian purpose or social constraints, and guided only by their free will.” 5
Chocolate cyst
“A cystic area of endometriosis in the ovary.” 6
Choristoma
A choristoma is a mass of histologically normal tissue that is “not normally found in the organ or structure in which it is located.” Müllerian choristomas are a subset of non-müllerian choristomas found throughout the body.
Coelomic Metaplasia
“The potential ability of coelomic epithelium to develop into several different histologic cell types.” 7
Coelomic metaplasia
The abnormal transformation of adult, fully differentiated tissue lining the peritoneal cavity into a differentiated tissue of another kind, such as endometrial tissue.
Emergence
“Emergence…refers to the arising of novel and coherent structures, patterns, and properties during the process of self-organization in complex systems. Emergent phenomena are conceptualized as occurring on the macro level, in contrast to the micro-level components and processes out of which they arise. In a wide variety of scientific and mathematical fields, grouped together loosely under the title ‘complexity theory,’ a intense search is now under way for characteristics and laws associated with emergent phenomena observed across different types of complex systems.” 8
Endometrioma
“A small area of endometriosis that can be identified macroscopically.” 9
Endometriosis
“The presence and growth of glands and stroma identical to the lining of the uterus in an aberrant location.” 10
Endometriosis
Sampson’s definition of endometriosis – 1940: “The term endometriosis was introduced to indicate the presence of ectopic tissue which possess the histologic structure and function of the uterine mucosa. It also includes the abnormal conditions which may result not only from the invasion of organs and other structures by this disease, but also from its reaction to menstruation.” 11
Germinal epithelium
Germinal epithelium of the ovary consists of low flat mesothelial cells on the surface of the ovary, similar to those lining the peritoneal cavity. Mesothelial cells are derived from the mesoderm which gives rise to the gastrointestinal and reproductive organs.
Gymnasium
The Gymnasia “were meant to create environments where students would learn, through active participation to think for themselves and develop new ideas. The focus on the individual’s creative potential, and more so, on the importance of providing an educational environment aimed at stimulating this potential, is fully consistent with the humanistic conception of Bildung. ” 12
Heteroplasia
Heteroplasia, on the other hand, is the development of cytologic and histologic elements that are not normal for the organ or part in question, as the growth of bone in a site where there is normal fibrous connective tissue. 13Heterotopia means cells or tissue displaced to an abnormal location.
Metaplasia
Metaplasia is the abnormal transformation of an adult, fully differentiated tissue of one kind into a differentiated tissue of another kind; metaplasia is an acquired condition in contrast to heteroplasia. 14
Müllerian duct
Müllerian duct, also known as the paramesonephric duct, arises from the urogenital ridge in the fetus to form the fallopian tubes, uterus, cervix, and upper vagina.
Müllerian rest
The paired müllerian tubes – primitive vertebrate fallopian tubes, uterus, cervix, and upper vagina – comprise two elongated masses in the early vertebrae embryo. A müllerian rest represents a group of cells or a portion of the müllerian that has become displaced and lies embedded in tissue of another character that persists as an embryonic remnant in the adult.
Müllerianosis
Müllerianosis may be defined as an organoid structure of embryonic origin; a choristoma composed of müllerian rests – normal endometrium, normal endosalpinx, and normal endocervix – singly or in combination, incorporated within other normal organs during organogenesis. “A choristoma is a mass of histologically normal tissue that is not normally found in the organ or structure in which it is located.” 15 Müllerian choristomas are a subset of non-müllerian choristomas found throughout the body. 16 They represent les formes frustes of the cervix, uterus, and fallopian tubes.
Nosography
Faber defines nosography as “the description of diseases.” 17
Nosology
Nosology, the classification of disease, is based on the “assumption that the way in which things [are] organized into groups [reflects] something about their actual relationships in nature.” 18
Ontological concept of disease
Ontology views “disease as an entity that invaded the healthy organism and followed its own peculiar course of development.” Ontological concept of disease was advocated by the Paris clinical school. 19Ontology also stands for “fixed categories of diseases.” 20
Physiological concept of disease
Physiological view of disease stresses “the uniqueness of each person’s illness, defining the illness as the consequence of an alteration of the normal organic functions. Symptoms were not the signs of an alien disease entity living out its own life cycle within the sick individual, but rather the result of a disturbance of the body’s normal physiological processes.” 21
Retrograde Menstruation
“The flow of menstrual blood, endometrial cells, and debris via the fallopian tubes into the peritoneal cavity.” 22
Sarcoma
At mid-nineteenth century, Rokitansky wrote that he had “selected the term sarcoma to designate the benign growths, not because of any especial analogy with muscle-flesh, but in order to fix and define a name familiarized by long usage, and also by no little abuse. The malignant we shall leave in possession of their ancient characteristic appellation cancer, – carcinoma. ” 23
Serosal metaplasia
Serosal metaplasia is a more restricted term that refers to the abnormal transformation of adult, fully differentiated tissue covering the surface of pelvic and abdominal organs – such as the uterus – into a differentiated tissue of another kind, such as endometrial tissue.
Wissenschaft
Daum equated the German term Wissenschaft with [self-directed] scholarship and research, which included “the sciences, social sciences, and humanities.” 24
Wissenschaft
“ Wissenschaft [is] a difficult term to define not least because its meaning underwent several changes through the years. Once identified closely with another nebulous term, Bildung , Wissenschaft originally signified the search for a holistic understanding of all knowledge aimed at cultivating the individual’s personality by developing one’s moral and intellectual sensitivities. In this earlier formulation, Wissenschaft had an inward focus, but as the century progressed, the focus turned outward and Wissenschaft came to refer to the production of new knowledge through in-depth scholarly work in a specialized area of research. Accompanying this transition was an increased appreciation of the importance of acquiring practical experience; by the late nineteenth century, at least in the sciences and medicine, the revered Wissenschaftler was one who could manipulate sophisticated instrumental apparatus and gain in this way control over laboratory conditions and, presumably, over nature.” 25
Wolffian or mesonephric rest
The mesonephros – the primitive vertebrate kidney – comprises two elongated masses in the early vertebrate embryo. A Wolffian rest represents a group of cells or a portion of the mesonephros (Wolffian body) that has become displaced and lies embedded in tissue of another character that persists as an embryonic remnant in the adult.
Between 1860 and 1946 and even to this day, ambiguity and confusion surrounded proper terminology for pelvic floor anatomy in the female.
Posterior fornix of the vagina
Posterior fornix of the vagina is that space bounded anteriorly by that portion of the uterine cervix that protrudes into the vagina and posteriorly by the rectovaginal pouch of Douglas. 26
Pseudo-retrocervical septum
A pseudo-retrocervical septum may be formed – above the anatomic (true) rectovaginal septum – by dense obliterative adhesions that cement together the anterior and posterior walls of the rectovaginal pouch of Douglas as well as cement together the posterior surface of the uterus to the anterior surface of the rectum to produce a frozen pelvis. 27
Retrocervical septum
I have coined a new term “ retrocervical septum ” by combining Adamyan’s anatomically correct term “retrocervix” with the time-worn but anatomically correct term “septum” that connotes a dividing wall or partition between the posterior vaginal fornix and the rectovaginal pouch of Douglas. If this new term is considered for academic use, then endometriosis of the “retrocervical septum” may replace the anatomically incorrect terminology: endometriosis of the “rectovaginal septum.” 28
Recto-genital space
(Lockyer) = rectovaginal pouch of Douglas (RVPD) = culdesac.
Rectovaginal septum
Rectovaginal septum is among the most misused terms found in the medical literature. With minor exceptions, the anatomically incorrect terminology endometriosis of the rectovaginal septum has been used throughout the late nineteenth and twentieth centuries, and on into the twenty-first century for endometriotic lesions of the “ retrocervical septum ” that separates the posterior vaginal fornix from the anterior rectovaginal pouch of Douglas. 29The incorrect terminology endometriosis or adenomyoma of the rectovaginal septum had become so entrenched that several authorities called attention to the error beginning in the latter third of the twentieth century. 30 Thomas Cullen, borrowing from Lockyer, introduced the anatomically incorrect terminology “endometriosis of the rectovaginal septum” into the North American medical literature. Cullen observed that the earliest lesions of extrauterine adenomyomas (endometriosis) in the lower pelvis originated on the anterior portion of the rectovaginal pouch of Douglas, the “ retrocervical septum ” that separated the rectovaginal pouch of Douglas from the posterior vaginal fornix. He erroneously termed this location the rectovaginal septum, apparently unaware of the location of the true rectovaginal septum demonstrated by Denonvilliers in 1836. 31 The true anatomic rectovaginal septum of Denonvilliers is a strong sheet of fibrous tissue that separates the vagina anteriorly from the rectum posteriorly. “It extends from [the floor of] the rectovaginal pouch of Douglas to the perineal body and forms the anterior surface of the rectovaginal space.” 32 The rectovaginal space permits the rectum and vagina to distend independently. The incorrect terminology, endometriosis of the rectovaginal septum, became so embedded in the medical literature that only in the late twentieth century have some authors begun to use Adamyan’s anatomically correct term “retrocervix,” or the cumbersome terminology, endometriosis of the retrocervical portion of the rectovaginal pouch of Douglas. 33