Endometriosis, A Modern Syndrome (Report‪)‬

When was endometriosis first identified? Over the last decade, great interest has been shown for the reconstruction of the path that led to the identification of the two conditions we call adenomyosis and endometriosis. Recently, the debate has focused on Carl Rokitansky, indicated as the "discoverer" of endometriosis (1,2). We have argued against this attribution as, in our view, there are three conditions that must be met before credit can be given for having identified the two pathologies: (i) to have found the presence of epithelial structures outside the uterine cavity; (ii) to have identified these as endometrial glands and stroma; and (iii) to have clearly understood that this invasion was "benign" (and therefore, "non neoplastic") in nature (3). Using these criteria, there is no doubt that it was the surgeon Thomas Cullen who described for the first time the full morphological and clinical picture of endometriosis and adenomyosis (4). In 1920, he drew a scheme with the classic sites of adenomyotic lesions in the pelvis (5). He correctly mentioned that the condition, called in these days adenomyoma, involved the presence of ectopic endometrial-like tissue in the myometrial wall, rectovaginal septum, hilus of the ovary, uterine ligaments, rectal wall and umbilicus. Cullen considered uterine adenomyoma, ovarian endometriosis and deep endometriosis as one disease characterized by the presence of adeno-myomatous tissue outside the uterine cavity and today there is increasing evidence that he may have been right.