Reprod Sci. 2011 Feb 14. [Epub ahead of print]

Evaluation of 18FDG PET-CT in the Diagnosis of Endometriosis: A prospective Study.

Fastrez M, Nogarède C, Tondeur M, Sirtaine N, Rozenberg S.

Source

Department of Obstetrics and Gynaecology, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium.

Abstract

Background: Noninvasive techniques have poor sensitivity and specificity in diagnosing endometriosis, which is often associated with an inflammatory process. In several benign diseases, measurement of hypermetabolism using fluorodeoxyglucose ((18)F (18)FDG) reflects the degree of inflammation and aggressiveness of the disease. This prospective study evaluated the value of (18)FDG positron emission tomography (PET)-computed tomography (CT) in assessing the presence of endometriosis. Methods: Ten consecutive patients suspected with endometriosis were prospectively included in this study. A preoperative (18)FDG PET-CT was performed in all the patients during the follicular phase of their cycle, which preceded laparoscopic surgery. Surgical endometriosis staging and histopathological analysis of removed tissue were confronted with the results from (18)FDG PET-CT. Results: Of the 10 patients, 9 had endometriosis confirmed by laparoscopy; 6 had advanced stage of the disease and 5 had histologically proven lesions. Nevertheless, none of the patients had (18)FDG-demonstrated hypermetabolism at PET-CT. Conclusions: In this preliminary series, we did not observe hypermetabolic activity in relation to endometriosis using (18)FDG PET-CT. This study’s most important limitation is the use of (18)FDG as an isotopic tracer, which is not specific to endometrial tissue.

ILAR J. 2011 Feb 8;52(1):66-77.

Calorie restriction and aging in nonhuman primates.

Kemnitz JW.

Source

Wisconsin National Primate Research Center, 1220 Capitol Court, Madison, WI 53715-1299. kemnitz@primate.wisc.edu.

Abstract

In the 75 years since the seminal observation of Clive McCay that restriction of calorie intake extends the lifespan of rats, a great deal has been learned about the effects of calorie restriction (CR; reduced intake of a nutritious diet) on aging in various short-lived animal models. Studies have demonstrated many beneficial effects of CR on health, the rate of aging, and longevity. Two prospective investigations of the effects of CR on long-lived nonhuman primate (NHP) species began nearly 25 years ago and are still under way. This review presents the design, methods, and main findings of these and other important contributing studies, which have generally revealed beneficial effects of CR on physiological function and the retardation of disease consistent with studies in other species. Specifically, prolonged CR appears to extend the lifespan of rhesus monkeys, which exhibited lower body fat; slower rate of muscle loss with age; lower incidence of neoplasia, cardiovascular disease, type 2 diabetes mellitus, and endometriosis; improved insulin sensitivity and glucose tolerance; and no apparent adverse effect on bone health, as well as a reduction in total energy expenditure. In addition, there are no reports of deleterious effects of CR on reproductive endpoints, and brain morphology is preserved by CR. Adrenal and thyroid hormone profiles are inconsistently affected. More research is needed to delineate the mechanisms of the desirable outcomes of CR and to develop interventions that can produce similar beneficial outcomes for humans. This research offers tremendous potential for producing novel insights into aging and risk of disease.

Int J Clin Oncol. 2011 Feb 8. [Epub ahead of print]

Primary squamous cell carcinoma associated with ovarian endometriosis: a case report and literature review.

Yamakawa Y, Ushijima M, Kato K.

Source

Department of Obstetrics and Gynecology, Takaoka City Hospital, 4-1 Takara-machi, Takaoka, Toyama, 933-8550, Japan, yoshihiro_yamakawa@municipal-hp-takaoka.jp.

Abstract

Primary squamous cell carcinoma (SCC) associated with ovarian endometriosis is extremely rare and has a poor prognosis due to insufficient information on the optimal postoperative treatment. Here, we describe the response of this tumor to the administration of paclitaxel-carboplatin. A 45-year-old woman diagnosed with stage IIIc primary SCC of the ovary associated with endometriosis underwent optimal surgery followed by six courses of chemotherapy at 3-week intervals with paclitaxel and carboplatin. She tolerated the chemotherapy well and remained without evidence of disease during first-line chemotherapy. Two months later, she was readmitted with recurrence of a pelvic tumor. Although she was treated with chemotherapy (weekly paclitaxel and chemotherapeutic regimen of irinotecan + mitomycin C), the tumor was resistant to second-line and third-line chemotherapy and she died 15 months after surgery. Paclitaxel-carboplatin administration may be an effective treatment for primary SCC of the ovary but further studies are required to investigate it true efficacy in the treatment of this disease.

N Engl J Med. 2011 Feb 3;364(5):482-3; author reply 484-5.

Endometriosis-associated ovarian carcinomas.

Nissenblatt M.

Comment on

N Engl J Med. 2011 Feb 3;364(5):483-4; author reply 484-5.

Endometriosis-associated ovarian carcinomas.

Birnbaum DJ, Birnbaum D, Bertucci F.

Comment on

Appl Immunohistochem Mol Morphol. 2011 Feb 2. [Epub ahead of print]

Primary Peritoneal Clear Cell Adenocarcinoma Associated With Endometriosis.

Muezzinoglu B, Corak S, Yucesoy I.

Source

Departments of *Pathology †Obstetrics and Gynecology Kocaeli University Medical School Kocaeli, Turkey.

Acta Obstet Gynecol Scand. 2011 Feb;90(2):136-9. doi: 10.1111/j.1600-0412.2010.01008.x. Epub 2010 Dec 2.

Distribution of endometriotic lesions in endometriosis stage IV supports the menstrual reflux theory and requires specific preoperative assessment and therapy.

Scioscia M, Bruni F, Ceccaroni M, Steinkasserer M, Stepniewska A, Minelli L.

Source

Department of Obstetrics and Gynecology, Sacro Cuore Don Calabria General Hospital, Negrar, Verona Department of Perinatal Medicine, Tor Vergata University, Rome Gynecologic Oncology Division, Sacro Cuore Don Calabria General Hospital, Negrar, Verona, Italy.

Abstract

A detailed picture of the prevalence and distribution of abdomino-pelvic endometriosis in more that 1,500 cases of endometriosis stage IV is presented. A great prevalence of endometriotic localizations in the posterior pelvic compartment compared to the other quadrants with more frequently observed lesions on the left part of the pelvis supports the menstrual reflux theory. The extent of anatomical sites suggests the opportunity to plan a proper preoperative instrumental study for patients with clinical suspect of severe endometriosis possibly to set a multidisciplinary clinical or surgical management.

© 2010 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2010 Nordic Federation of Societies of Obstetrics and Gynecology.

 

Ann Diagn Pathol. 2011 Feb;15(1):12-8. Epub 2010 Oct 20.

Carcinoma of müllerian origin presenting as colorectal cancer: a clinicopathologic study of 13 Cases.

Yang Q, Wang H, Cho HY, Jung SJ, Kim KR, Ro JY, Shen SS.

Source

Department of Pathology, Three Gorges University, Hubei, People’s Republic of China.

Abstract

Carcinomas of müllerian origin involving colorectum in women with no concurrent or history of gynecologic malignancies are diagnostically challenging, and its histogenetic origin is uncertain. We reviewed 13 cases of carcinoma of müllerian origin with clinical presentation mimicking primary colorectal carcinoma. The patients’ average age was 63.9 years. All except 2 patients presented with mass lesions in rectosigmoid colon or rectovaginal septum. The major presenting symptoms were rectal bleeding (4/13), rectosigmoid mass (6/13), vaginal mass (1/13), and abdominal pain or constipation (2/13). The average size of tumor was 4.2 cm (range, 2.4-15.0 cm). Among the 10 patients who underwent preoperative biopsy, 5 were diagnosed to have moderately and poorly differentiated colorectal carcinoma. All tumors were surgically resected with final diagnoses of moderately differentiated endometrioid carcinoma in 6 cases, mixed serous and endometrioid carcinoma in 4 cases, malignant mixed müllerian tumor in 2 cases, and undifferentiated carcinoma in 1 case. In 9 of 13 cases, foci of endometriosis were identified adjacent to or within the tumor. One case had endosalpingiosis. Immunohistochemical stains showed, after positive results, the following: cytokeratin 7 (CK7; 13/13), estrogen receptor (13/13), progesterone receptor (10/13), cytokeratin 20 (CK20; 0/13), and CDX-2 (0/13). In conclusion, carcinoma of müllerian origin often presents as bulky mass in rectosigmoid or rectovaginal septum clinically mimicking primary colorectal cancer. Endometriosis might be an important etiologic factor. Familiarities of this unusual clinicopathologic entity, careful morphologic evaluation, and immunohistochemical stain with a panel of markers (CK7, CK20, estrogen receptor, progesterone receptor, CDX-2) will be helpful for the correct diagnosis.

Appl Radiat Isot. 2011 Feb;69(2):381-8. Epub 2010 Nov 20.

Gamma-ray energy absorption and exposure buildup factor studies in some human tissues with endometriosis.

Kurudirek M, Doğan B, İngeç M, Ekinci N, Özdemir Y.

Source

Faculty of Science, Department of Physics, Ataturk University, 25240 Erzurum, Turkey. mkurudirek@gmail.com

Abstract

Human tissues with endometriosis have been analyzed in terms of energy absorption (EABF) and exposure (EBF) buildup factors using the five-parameter geometric progression (G-P) fitting formula in the energy region 0.015-15 MeV up to a penetration depth of 40 mfp (mean free path). Chemical compositions of the tissue samples were determined using a wavelength dispersive X-ray fluorescence spectrometer (WDXRFS). Possible conclusions were drawn due to significant variations in EABF and EBF for the selected tissues when photon energy, penetration depth and chemical composition changed. Buildup factors so obtained may be of use when the method of choice for treatment of endometriosis is radiotherapy.

 

SETTING:

Academic research hospital.

PATIENT(S):

A 35-year-old woman with a noncyclic, painful abdominal nodule near a caesarean delivery scar.

INTERVENTION(S):

3D ultrasonography and wide surgical resection with healthy margins.

MAIN OUTCOME MEASURE(S):

3D ultrasonographic assessment of the endometriotic nodule.

RESULT(S):

We found that 3D ultrasonography offered a more specific description of parietal endometriosis with irregular and spiculated margins and depth infiltration as well as provided preoperative evaluation of volume measurements.

CONCLUSION(S):

Three-dimensional ultrasonography is a useful, noninvasive tool in extrapelvic endometriosis.

Fertil Steril. 2011 Jan;95(1):291.e15-8. Epub 2010 Jun 25.

Aromatase inhibitors in recurrent ovarian endometriomas: report of five cases with literature review.

Lall Seal S, Kamilya G, Mukherji J, De A, Ghosh D, Majhi AK.

Source

Department of Obstetrics and Gynecology, Bankura Sammilani Medical College, Gobindanagar, West Bengal, India. sealsubrata@gmail.com

Abstract

OBJECTIVE:

To determine the role of the aromatase inhibitor letrozole in the treatment of recurrent ovarian endometrioma cases.

DESIGN:

Nonrandomized proof of concept study.

SETTINGS:

Outpatient tertiary-care center.

PATIENT(S):

Five premenopausal patients with documented ovarian endometriomas and chronic pelvic pain, all of whom were previously treated with surgery and medicine with unsatisfactory results.

INTERVENTION(S):

Ovarian endometriomas were diagnosed by biopsy after laparoscopic ovarian cystectomy and subsequently treated with hormones. After a 6-month washout of endometriosis hormone therapies, women took letrozole (2.5 mg), one tablet of 0.15 mg of desogestrel, and 0.03 mg of ethinyl estradiol, calcium (1,200 mg), and vitamin D3 (800 IU) daily for 6 months.

MAIN OUTCOME MEASURE(S):

Size of endometriomas (monitored by ultrasound), assessment of pelvic pain (by visual analog scale), and bone density (DEXA scan).

RESULT(S):

Disappearance of ovarian endometrioma and reduction in pelvic pain in all cases at the end of 6 months. The size of ovarian endometriomas was reduced after 3 months. Pain scores decreased only after 1 month of treatment and continued decreasing in each treatment month. Overall, no significant change in bone density was detected.

CONCLUSION(S):

Letrozole given with combined pills achieved complete regression of recurrent endometriotic cysts and pain relief in all cases.

Front Biosci (Elite Ed). 2011 Jan 1;3:648-62.

Apoptosis and endometriosis.

Taniguchi F, Kaponis A, Izawa M, Kiyama T, Deura I, Ito M, Iwabe T, Adonakis G, Terakawa N, Harada T.

Source

Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan. tani4327@med.tottori-u.ac.jp

Abstract

Apoptosis is a distinctive form of programmed cell death resulting in the efficient elimination of cells without eliciting an inflammatory response. Endometriosis is characterized by the presence of endometrial cells with capacity to avoid apoptosis outside the uterus. Apoptosis plays a fundamental role for the pathogenesis of endometriosis. Eutopic endometrium from women with endometriosis has increased expression of anti-apoptotic factor and decreased expression of pro-apoptotic factors compared with endometrium from healthy women. These differences could contribute to the survival of regurgitating endometrial cells into the peritoneal cavity and development of endometriosis. Increased apoptosis of Fas-bearing immune cells in the peritoneal cavity may leads to their decreased scavenger activity that eventually results in prolonged survival of ectopic endometrial cells in women with endometriosis. This study is a current review of the literatures focused on the physiological role of apoptosis in normal endometrium and alterations in regulation of apoptosis in eutopic and ectopic endometrium from women with endometriosis. The role of apoptosis in the treatment of endometriosis is also reviewed.

Front Biosci (Elite Ed). 2011 Jan 1;3:591-603.

The role of nuclear factor-kappa-B p50 subunit in the development of endometriosis.

Lu Y, Sun Q, Zheng Y, Liu X, Geng JG, Guo SW.

Source

Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.

Abstract

p50 is a member of the NF-kappaB family known to be involved in endometriosis. To gain insight into the roles of p50 in the development of endometriosis, we cross-transplanted endometrial fragments from p50 knockout mice to wild-type mice and vice versa, and also autotransplanted the fragments within the knockout and wild-type mice, inducing endometriosis. We then evaluated the size of the endometrial implants, and immunoreactivity to phosphorylated p65 (p-p65), PKCepsilon and TRPV1 in ectopic and eutopic endometrium as well as in vagina. We found that p50 deletion significantly reduces the size of endometrial implants. The immunoreactivity to p-p65 and PKCepsilon, but not TRPV1, was reduced in endometrial implants in p50 knockout mice. Deletion of p50 significantly reduced p-p65 and PKCepsilon, but not TRPV1, expression in eutopic endometrium and vagina. It also disrupts NF-kappaB activation and PKCepsilon expression in eutopic and vagina, suggesting the role of NF-kappaB in regulating PKCepsilon, which plays an important role in nociception. These data show that p50 is involved in the development of endometriosis and may be a promising therapeutic target.

Front Biosci (Elite Ed). 2011 Jan 1;3:529-39.

Risk of carcinoma in women with ovarian endometrioma.

Kobayashi H, Kajihara H, Yamada Y, Tanase Y, Kanayama S, Furukawa N, Noguchi T, Haruta S, Yoshida S, Naruse K, Sado T, Oi H.

Source

Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan. hirokoba@naramed-u.ac.jp

Abstract

Endometriosis affects an estimated 10% of women in the reproductive-age group. Here, we review current knowledge on molecular genesis of endometriosis-associated epithelial ovarian carcinoma (EOC). This article reviews the English language literature for biology, pathogenesis, and pathophysiological studies on endometriosis-associated EOC. Although endometriosis generally remains a benign condition, it demonstrates somatically acquired genetic alterations. Clear cell carcinoma (CCC) and endometrioid adenocarcinoma (EAC) are the most frequent types of EOC associated with endometriosis. Retrograde menstruation or ovarian hemorrhage carries highly pro-oxidant factors, such as iron, into the peritoneal cavity or ovarian endometrioma. CCC and EAC should be considered separately in studies of endometriosis-associated EOC. The repeated events of hemorrhage in endometriosis can contribute to carcinogenesis and progression via 3 major processes: 1) increasing oxidative stress promotes DNA methylation; 2) activating anti-apoptotic pathways supports tumor promotion; and 3) aberrant expression of stress signaling pathways contributes to tumor progression. This review summarizes recent advances in the understanding of epidemiology, carcinogenesis, pathogenesis, and pathophysiology of endometriosis-associated EOC; and a possible novel model is proposed.

Ginekol Pol. 2011 Jan;82(1):71-3.

A case of bifocal endometriosis involving a pfannenstiel incision.

Evsen MS, Sak ME, Yalinkaya A, Firat U, Caca FN.

Source

Dicle University, School of Medicine, Department of Obstetrics and Gynecology, Diyarbakir, Turkey. mevs26@yahoo.com

Abstract

A 25-year-old woman was referred to our clinic for atypical cyclic pain and masses at both ends of a Pfannenstiel incision scar. Ultrasound of the anterior abdominal wall showed two masses. Both masses were hypoechoic, heterogeneous lesions located at opposite ends of the scar. The lesions were surgically excised with. Microscopic examination revealed endometrial gland structures with endometrial stroma in fibroadipose tissue in sections of both specimens indicative of endometriosis. Incisional endometriosis (IE) is a form of extrapelvic endometriosis especially in scars of obstetric or gynecologic surgery IE may be multifocal at surgical scars. We report the a case of bifocal incisional endometriosis in Pfannesteil scar. Whole scar evaluation should be done for incisional endometriosis and surgical excision should be performed for treatment.

Gynecol Obstet Fertil. 2011 Jan;39(1):e20-2. Epub 2010 Dec 22.

Perimenopausal discovery of endometriomas on ovarian abscess.

[Article in French]

Faure AC, Faure C, Messica O, Margossian H, Ory JP.

Source

Centre hospitalier universitaire de Besançon, France. aclfaure@yahoo.fr

Abstract

Ovarian abscess is a rare gynaecological diagnosis. The case reported is the one of an unexplained fever with a strong physical alteration during more than 14 days occurring around the menopause, at the age of 54. It has been discovered an ovarian tumour which was, infact, an infected endometrioma. The patient never complained from endometriosis during her reproductive life. She had no other risk factor for ovarian abscess.

Gynecol Obstet Fertil. 2011 Jan;39(1):3-7. Epub 2010 Dec 22.

Endometriosis and fertility: Results after surgery and Assisted Reproductive Technology (ART).

[Article in French]

Dechanet C, Rihaoui S, Reyftmann L, Hedon B, Hamamah S, Dechaud H.

Source

Département de médecine et biologie de la reproduction, pôle naissances et pathologies de la femme, hôpital universitaire A.-de-Villeneuve, Montpellier, France. clodechanet@gmail.com

Abstract

OBJECTIVE:

To evaluate fertility outcomes after laparoscopic and ART management of endometriosis in an infertile population.

PATIENTS AND METHODS:

Retrospective analysis including 79 infertile patients treated by laparoscopic surgery. Fertility was studied in relation to pregnancy’s mode (spontaneous or ART) and to endometriosis stages (rAFS).

RESULTS:

After laparoscopy, 8.9% of patients had a spontaneous pregnancy. IIU led to a cumulative rate of pregnant women of 21.5%. Then after laparoscopy, IIU and IVF, 68.4% of patients were pregnant. The average delay was 460 days between laparoscopy and spontaneous pregnancy, 271 days between surgery and IIU pregnancy and 600 days between surgery and IVF pregnancy. Among women with stages I-II endometriosis (62 cases), 11.3% patients obtained a spontaneous pregnancy, the cumulative rate of pregnant women after laparoscopy and IIU was 25,8%. After laparoscopy, IIU and IVF, 66.1% of patients were pregnant. The average post-surgical time to spontaneous pregnancy was 460 days. The average delay between surgery and IIU pregnancy was 279 days and 589 days between surgery and IVF pregnancy. In case of stages III-IV (17 patients), 76.4% of pregnancies were obtained. No spontaneous pregnancy was observed. 94.1% of patients were treated with IVF, leading to a global rate of pregnancy of 70.5%. The average delay between surgery and IVF pregnancy was 563 days.

CONCLUSIONS:

With a combination of surgery and ART, two-third of patients were pregnant with an average time between surgery and pregnancy of less than two years. This combination (surgery and ART) increases the chances of becoming pregnant. At the moment, the delay between surgery and ART needs to be established.

Gynecol Obstet Invest. 2011;71(3):189-92. Epub 2010 Dec 14.

Appendectomy in the gynecological setting: intraoperative findings and corresponding histopathology.

Shavell VI, Mahdi HM, Awonuga AO, Edelman DA, Webber JD, Gidwani RM, Husain M, Berman JM.

Source

Department of Gynecology, Wayne State University School of Medicine and the Detroit Medical Center, Detroit, Mich., USA.

Abstract

Background/Aims: To evaluate the intraoperative findings and corresponding histopathology associated with appendectomies performed during benign gynecological surgery. Methods: Retrospective case series. Results: Twenty-two appendectomies were performed from 2002 through 2008 at Hutzel Women’s Hospital due to intraoperative findings of inflammation or erythema (n = 8), periappendiceal adhesions (n = 5), injury to the appendix or mesoappendix (n = 2), fecalith (n = 2), dilation of the appendix (n = 1), adnexal mass involving the appendix (n = 1), and suspected lipoma (n = 1). Final pathology was consistent with significant findings such as acute inflammation, periappendicitis, and adhesions or endometriosis involving the appendix in 68.2% of cases. Conclusion: In the benign gynecological setting, appendectomies were primarily performed due to inflammation or erythema. In the majority of cases, significant appendiceal pathology was confirmed.

Gynecol Obstet Invest. 2011;71(3):170-6. Epub 2010 Dec 14.

Endometriosis Cost Assessment (the EndoCost Study): A Cost-of-Illness Study Protocol.

Simoens S, Hummelshoj L, Dunselman G, Brandes I, Dirksen C, D’Hooghe T.

Source

Research Centre for Pharmaceutical Care and Pharmaco-Economics, Katholieke Universiteit Leuven, Leuven, Belgium.

Abstract

Aims: The EndoCost study aims to calculate the costs of endometriosis from a societal perspective. Methods: This multicentre, prevalence-based cost-of-illness analysis aggregates data on endometriosis costs and quality of life from a prospective hospital questionnaire and from both retrospective and prospective patient questionnaires. The EndoCost study comprises 12 representative tertiary care centres involved in the care of women with endometriosis in 10 countries. The sample includes patients with a laparoscopic and/or histological diagnosis of endometriosis and with at least 1 patient contact related to endometriosis during 2008. The EndoCost study measures direct healthcare costs (e.g. costs of medication, physician visits), direct non-healthcare costs (e.g. transportation costs), and indirect costs of productivity loss. Cost questions are developed specifically for the purpose of the EndoCost study. Quality of life is measured using the EuroQol-5D and relevant parts of the Global Study of Women’s Health instruments. Both aggregate analyses and country-specific analyses are planned for total costs per patient. Costs are broken down into cost drivers and into the various payers that incur costs. Conclusions: The cost estimates provided by the EndoCost cost-of-illness analysis may be used to justify the prioritisation of future research in endometriosis.

Gynecol Obstet Invest. 2011;71(2):118-23. Epub 2010 Dec 9.

Matrix metalloproteinase-3 mRNA: a promising peripheral blood marker for diagnosis of endometriosis.

De Sanctis P, Elmakky A, Farina A, Caramelli E, Seracchioli R, Mabrouk M, Mignemi G, Venturoli S, Villa G, Guerrini M, Manuzzi L, Montanari G, Valvassori L, Zucchini C.

Source

Department of Histology, Embryology and Applied Biology, University of Bologna, Bologna, Italy.

Abstract

BACKGROUND/AIMS:

Endometriosis is an invasive disease. Its diagnosis depends on laparoscopy, which is traumatic and associated with potential complications. The aim of this study was to develop a rapid, reliable, and less invasive diagnostic test for endometriosis. We hypothesized that genes related to cell invasion would be transcriptionally upregulated in endometriosis, and tested whether blood levels of their transcripts might be used as biomarkers of endometriosis.

METHODS:

We used quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) to quantify the mRNA levels of vascular endothelial growth factor A (VEGFA), matrix metalloproteinase-3 (MMP-3), and MMP-9 in peripheral blood from 20 patients with mild/intermediate endometriosis, 20 patients with severe endometriosis and 20 endometriosis-free subjects.

RESULTS:

Our results indicate that circulating mRNA for MMP-3 is significantly higher in patients with endometriosis than in control patients, regardless of the degree of severity. Conversely, the level of circulating mRNA for VEGFA and MMP-9 did not distinguish patients from controls.

CONCLUSION:

MMP-3 mRNA is a promising peripheral blood marker that discriminates between patients with endometriosis and healthy subjects. Our results support the possibility of finding genes suitable for diagnostic qRT-PCR for endometriosis in peripheral blood and should be explored further.

Gynecol Obstet Invest. 2011;71(2):112-7. Epub 2010 Dec 9.

Increased nerve density in deep infiltrating endometriotic nodules.

Anaf V, El Nakadi I, De Moor V, Chapron C, Pistofidis G, Noel JC.

Source

Department of Gynecology, Academic Hospital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium. vincent.anaf@ulb.ac.be

Abstract

BACKGROUND/AIMS:

Deep infiltrating endometriosis is a very painful condition and the mechanism of pain is still poorly understood. Pain and hyperalgesia can partly be explained by an increased number of nerve structures in the painful lesion. In order to clarify this issue, we assessed the nerve density in deep infiltrating endometriotic nodules of the posterior vagina and in the adjacent healthy vaginal tissue of the same patient.

METHODS:

A prospective clinical and pathological study of 31 cases of deep infiltrating vaginal endometriotic nodules was conducted. Fifteen patients were in the proliferative phase and 16 in the secretory phase. The nerve density was studied by immunohistochemistry with the monoclonal antibody NF against neurofilaments in deep infiltrating endometriosis and in the adjacent unaffected vaginal tissue in the proliferative and in the secretory phases. Neurofilaments constitute the main structural elements of neuronal axons and dendrites.

RESULTS:

The nerve density was significantly different in the endometriotic nodule than in the adjacent unaffected vaginal tissue (p = 0.0013). The same significant difference was found between endometriotic nodules and the unaffected vagina in the proliferative phase (p = 0.009) and in the secretory phase (p = 0.04). This difference was not significant between the proliferative and the secretory phases in the endometriotic lesions and in the controls.

CONCLUSIONS:

We hypothesize that the significantly increased number of nerve structures in the endometriotic nodules may contribute to the occurrence of severe and neuropathic pain that characterizes these lesions.

Gynecol Obstet Invest. 2011;71(2):77-86. Epub 2010 Dec 9.

Altered gene expression profile in vaginal polypoid endometriosis resembles peritoneal endometriosis and is consistent with increased local estrogen production.

Syrcle SM, Pelch KE, Schroder AL, Nichols BM, Mills MP, Barrier BF, Havey AD, Nagel SC.

Source

Department of Obstetrics, Gynecology and Women’s Health, University of Missouri School of Medicine, Columbia, MO 65212, USA.

Abstract

BACKGROUND:

In a university hospital setting, a 25-year-old woman presented with large vaginal and cervical polyps. Past medical history was significant for stage IV endometriosis. Polypectomy was performed and the polyps were histologically consistent with endometriosis. Gene expression was compared with control vaginal tissue to assess if the altered gene expression profile was similar to peritoneal endometriosis.

METHODS AND RESULTS:

Using quantitative reverse transcription, real-time PCR, estrogen receptor-β expression was found to be upregulated 10-fold while estrogen receptor-α expression was downregulated 5-fold in the vaginal polyp relative to control vaginal tissue. The estrogen-synthesizing enzyme aromatase was upregulated 8-fold and 3β-hydroxysteroid dehydrogenase was upregulated 400-fold in the polyp. Immunohistochemical staining revealed altered cell type localization for progesterone receptor in the polyp and increased cell proliferation in polyp stromal cells relative to control.

CONCLUSIONS:

Increased proliferation in the vaginal polypoid endometriotic tissue may be due to increased local estrogen production. The altered gene expression profile was very similar to the altered gene expression profile seen in peritoneal endometriosis.

Gynecol Oncol. 2011 Jan;120(1):158-9. Epub 2010 Nov 5.

Multimodal therapy in the treatment of vaginal adenocarcinoma arising from endocervicosis.

Starbuck K, Garcia C, Wu Q, Runowicz CD.

Source

University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06032, USA.

Histochem Cell Biol. 2011 Jan;135(1):83-91. Epub 2010 Dec 18.

Increased c-Jun N-terminal kinase activation in human endometriotic endothelial cells.

Uz YH, Murk W, Bozkurt I, Kizilay G, Arici A, Kayisli UA.

Source

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, 06520-8063, USA.

Abstract

Endometriosis is a common inflammatory gynecological disease characterized by the presence of endometrial tissue outside of the uterine cavity. The c-Jun N-terminal kinase (JNK) is a subfamily of the mitogen-activated protein kinases (MAPKs) involved in cellular processes ranging from cytokine expression to apoptosis, and is activated in response to inflammation and cellular stress. We hypothesized that inflammatory cytokines in the peritoneal microenvironment increase JNK MAPK activity in endometriotic endothelial cells, and that human endometrial endothelial cells (HEECs) may be involved in inflammatory pathogenesis of endometriosis. Thus, we evaluated the expression of the total- and phosphorylated-(phospho)-JNK in endometrial and endometriotic endothelial cells in vivo, and in HEECs treated with normal peritoneal fluid (NPF), endometriotic peritoneal fluid (EPF), and the inflammatory cytokines interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) in vitro. Phospho-JNK immunoreactivity in HEECs in normal endometrium was significantly higher in the early proliferative and late secretory phases compared to other phases. Both eutopic and ectopic HEECs from the early secretory phase also revealed higher phospho-JNK immunoreactivity, compared to their respective cycle-matched normal HEECs. Moreover, HEECs treated with EPF showed significantly higher phospho-JNK levels compared to that in HEECs treated with NPF. In conclusion, our in vivo and in vitro findings suggest that increased phosphorylation of JNK in HEECs from women with endometriosis is likely due to high level of IL-1β and TNF-α in peritoneal fluid; this in turn may up-regulate inflammatory cytokine expression and thus play a role in the pathogenesis of endometriosis.

Hum Reprod. 2011 Jan;26(1):112-6. Epub 2010 Nov 24.

Ureteral endometriosis: clinical and radiological follow-up after laparoscopic ureterocystoneostomy.

Stepniewska A, Grosso G, Molon A, Caleffi G, Perin E, Scioscia M, Mainardi P, Minelli L.

Source

Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Negrar (Verona), Italy. annastep@infinito.it

Abstract

BACKGROUND:

Ureteral endometriosis is a rare entity that may lead to progressive hydroureteronephrosis and renal loss. When the localization of ureteral stenosis is close to the ureterovesical junction, ureterocystoneostomy may be required. The aim of the present study was to evaluate post-operative complication rates and clinical outcomes at 1- and 6-month follow-up after laparoscopic ureterocystoneostomy.

METHOD:

Twenty patients who underwent ureterocystoneostomy for pelvic endometriosis in our tertiary referral centre for endoscopic surgery during 1 year were studied. A cystography was performed on Day 7 after surgery to verify the integrity of anastomosis and a satisfactory bladder capacity. Follow-up consisted of gynaecological examination and transvaginal ultrasound at 1 and 6 months after surgery. At 6 months, urography and cystography were also performed. Measurements included results of a pre-operative clinical and instrumental assessment, intra- and post-operative complications, post-operative bladder capacity at cystography and improvement of pain, using a visual analogue scale for the main symptoms related to endometriosis and uro-specific pain.

RESULTS:

Neither a case of ureteral fistula nor other complications requiring re-intervention were reported. Post-operative transient deficit of bladder voiding occurred in five cases (25%), urinary infection in one and post-operative pyrexia in four (20%) patients. The median time to resuming voiding function was 3 days (range 1-20 days). In six cases, a mild vesico-ureteral reflux at the operated side was observed at 7-day cystography. Post-operative symptomatology was improved significantly (P<0.05) for all symptoms. Urography and cystography performed at 6 months confirmed good post-operative reconstructions in all cases.

CONCLUSIONS:

The objective of surgical treatment of ureteral endometriosis is to remove the stenotic tract and to preserve renal function. In cases of intrinsic ureteral endometriosis, the procedure of laparoscopic ureterocystoneostomy is feasible and has good outcomes at short- and medium-term follow-up.

Hum Reprod. 2011 Jan;26(1):117-26. Epub 2010 Nov 24.

Dioxins in ascites and serum of women with endometriosis: a pilot study.

Cai LY, Izumi S, Suzuki T, Goya K, Nakamura E, Sugiyama T, Kobayashi H.

Source

Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.

Abstract

BACKGROUND:

Animal studies and laboratory experiments have demonstrated that exposure to dioxins may be involved in the pathophysiology of endometriosis. However, recent epidemiological investigations have shown conflicting results. Although peritoneal fluid is a specific microenvironment playing a pivotal role in the development of endometriosis, to our knowledge, there is no published study evaluating the concentrations of dioxins in serum and peritoneal fluid simultaneously. The present study explores the possible correlation between the local peritoneal fluid levels of dioxins and concurrent endometriosis.

METHODS:

There were 17 infertile women enrolled in the present study. After the diagnostic laparoscopic examination, the women were divided into two groups: endometriosis (n = 10) and controls (n = 7). We measured 29 dioxins simultaneously in serum and peritoneal fluid samples: 7 polychlorinated dibenzo-p-dioxins (PCDDs), 10 polychlorinated dibenzofurans (PCDFs), and 12 polychlorinated biphenyls (dioxin-like PCBs). A dioxin toxic equivalency (TEQ) system was utilized to calculate the dioxin concentration in each sample.

RESULTS:

Serum concentrations of itemized components of 29 dioxins were similar in the endometriosis patients compared with the controls. Higher concentrations of PCDFs and dioxin-like PCBs were observed in peritoneal fluid than in serum, whereas the reverse was shown for PCDDs. Statistical analysis showed that higher levels of dioxin TEQ (PCDDs and PCDFs) in peritoneal fluid were significantly associated with an increased risk of endometriosis (OR: 2.5; 95% CI: 1.17-5.34; P = 0.035).

CONCLUSIONS:

This is the first report suggesting that higher concentrations of dioxins (PCDDs and PCDFs) in peritoneal fluid are linked to endometriosis. More detail and epidemiological research is warranted to further explore this link.

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