Pag. 2

 

 

Reprod Sci. 2011 Oct;18(10):1014-24. Epub 2011 Jun 21.

Cofilin and slingshot localization in the epithelium of uterine endometrium changes during the menstrual cycle and in endometriosis.

Morris K, Ihnatovych I, Ionetz E, Reed J, Braundmeier A, Strakova Z.

Source

1Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA.

Abstract

Regulation of the actin cytoskeleton is essential for epithelial cell polarity and protein trafficking within human uterine epithelium. The actin-binding protein cofilin is involved in regulation of actin dynamics by promoting actin branching and cytoskeleton reorganization. Dual immunohistochemical staining of cofilin and G-actin (represented by DNAse I staining) revealed cofilin-G-actin colocalization in the apical side of luminal epithelial cells of human uterine endometrium during the proliferative phase of the menstrual cycle. Interestingly, during the secretory phase of the menstrual cycle, cofilin was only present on the basolateral side. To determine whether the disease endometriosis causes a different pattern of actin remodeling, we investigated an established baboon model of induced endometriosis. The cofilin pattern in the secretory phase of baboons with endometriosis was similar to the proliferative phase in normal animals; cofilin was observed in the apical parts of luminal and glandular epithelium. A phosphatase regulating the activity of cofilin, slingshot (SSH1), revealed a similar staining pattern within these tissues. These patterns were confirmed through quantitative image analysis. Quantification of messenger RNA (mRNA) detected upregulated SSH1 and suggested a progesterone resistance-related pattern of nuclear steroid hormone receptors, but no change in membrane progesterone receptors (mPR alpha or mPR beta) was observed in endometriosis. Our data indicate that the severe dyssynchrony during menstrual cycle phases in endometriosis is connected with improper cytoskeleton rearrangements. We suggest that cofilin-mediated actin reorganization in uterine epithelial cells might be important in preparation for blastocyst implantation; dysregulation of this reorganization may lead to decreased fertility in endometriosis.

J Med Primatol. 2011 Oct;40(5):317-26. doi: 10.1111/j.1600-0684.2011.00496.x.

Behavioral tests as indicator for pain and distress in a primate endometriosis model.

Arnold C, Lamp J, Lamp O, Einspanier A.

Source

Institute of Physiological Chemistry, Veterinary Faculty, University of Leipzig, Leipzig, Germany.

Abstract

 Background As common marmosets (Callithrix jacchus) are frequently used experimental animals, sensitive test systems are needed to evaluate  A impairment and pain caused by procedures and diseases. Methods diurnal profile of healthy animals was obtained by videotaping. Differences in social behavior and cognitive skills between marmosets with established endometriosis and healthy monkeys were investigated using the videotaping, the  The Wisconsin General Test Apparatus (WGTA), and a food tree. Results marmosets showed a mostly trimodal course of activity. Social grooming and activity were significantly decreased in animals with endometriosis; furthermore, the diseased monkeys habituated significantly worse to the cognitive test settings. The food tree experiments offered no  The differences between diseased and control animals. Conclusion videotaping and the WGTA are suitable methods to detect disease-related impairments in common marmosets, which is essential for the refinement of experiments.

Invest Clin. 2011 Sep;52(3):274-90.

Relevance of apoptosis in the female reproductive system.

[Article in Spanish]

Meresman G.

Source

Instituto de Biología y Medicina Experimental, IBYME-CONICET, Ciudad Autónoma de Buenos Aires, Argentina. g.meresman@ibyme.conicet.gov.ar

Abstract

Apoptosis is a genetically controlled form of cell suicide. Due to the cyclic nature of the female reproductive system, the ovary, the endometrium and the mammary gland sustain continuous cycles of cell growth and apoptosis in response to hormonal changes. Apoptotic cell death plays multiple roles during embryonic and organ development. It is involved in sculpturing tissues and serves to delete structures that are no longer required. It is clear that apoptosis plays an active and important role in ovarian physiological functions. Apoptosis plays a major role during folliculogenesis and dominant follicle selection and also plays part in corpus luteum regression. In addition, it has been shown that programmed cell death plays important roles in the mammary gland development and ductal morphogenesis. During puberty, lumen formation is associated with the selective apoptosis of centrally located cells. In turn, postlactational involution of the mammary gland is characterized by the secretory epithelial cells undergoing programmed cell death. Apoptosis has also been associated with physiological, as well as pathological, endometrial processes such as cancer and endometriosis. The delicate balance between apoptosis and cell proliferation is essential in controlling the cyclical growth of the reproductive tissues and plays an important role in the prevention of neoplastic transformation.

PLoS One. 2011;6(9):e25011. Epub 2011 Sep 15.

Puerarin suppresses invasion and vascularization of endometriosis tissue stimulated by 17β-estradiol.

Wang D, Liu Y, Han J, Zai D, Ji M, Cheng W, Xu L, Yang L, He M, Ni J, Cai Z, Yu C.

Source

Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai, China.

Abstract

BACKGROUND:

Puerarin, a phytoestrogen with a weak estrogenic effect, binds to estrogen receptors, thereby competing with 17β-estradiol (E2) and producing an anti-estrogenic effect. This study was to investigate whether puerarin could suppress the invasion and vascularization of E2-stimulated endometriotic tissue.

METHODOLOGY/PRINCIPAL FINDINGS:

The endometriotic stromal cells (ESCs) were successfully established and their invasive ability under different treatments was assessed through a Transwell Assay. Simultaneously, matrix metallopeptidase 9 (MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1) were detected by western blotting. Vascularization of endometriotic tissues was observed by chicken chorioallantoic membrane (CAM) assay. The staining of MMP-9, intercellular adhesion molecule 1 (ICAM-1), TIMP-1, and vascular endothelial growth factor (VEGF) in grafted endometriotic tissues was examined using immunohistochemistry analysis. The purity of ESCs in isolated cells was >95%, as determined by the fluoroimmunoassay of vimentin. E2 (10(-8) mol/L) promoted the invasiveness of ESCs by increasing MMP-9 accumulation and decreasing TIMP-1 accumulation. Interestingly, puerarin (10(-9) mol/L) significantly reversed these effects (P<0.01). The CAM assay indicated that puerarin (10(-9) mol/L) also inhibited the angiopoiesis of endometriotic tissue stimulated by the E2 (10(-8) mol/L) treatment (P<0.05). Accordingly, immunohistochemistry showed that the accumulation of MMP-9, ICAM-1, and VEGF was reduced whereas that of TIMP-1 increased in the combination treatment group compared with the E2 treatment group.

CONCLUSIONS/SIGNIFICANCE:

This study demonstrated that puerarin could suppress the tissue invasion by ESCs and the vascularization of ectopic endometrial tissues stimulated by E2, suggesting that puerarin may be a potential drug for the treatment of endometriosis.

Tunis Med. 2011 Sep;89(9):686-92.

Confrontation ultrasonography-ca125-histology in the managment of ovarian cysts: A prospective study about 77 cases.

Mathlouthi N, Ben Ayed B, Dhouib M, Chaabene K, Trabelsi K, Amouri H, Guermazi M.

Abstract

Aim: To study the correlation between ultrasound, Doppler,measurement of CA 125 and histology in the preoperative diagnosis of ovarian cysts. Methods: Prospective and analytical study about 77 patients in whom we analyzed the contribution of ultrasound, the assay of CA125, the couple CA125 ultrasonography and laparoscopy in the diagnosis and management of cysts the ovary. The value of CA125 was considered pathological like the one adopted by our biochemistry laboratory of the CHU Habib Bourguiba, Sfax (> 35 UI / ml). Results: The mean age was 35.6 years. On the whole, ultrasound has a sensitivity of 71.41% and a specificity of 80%. The positive predictive value was 35.71% and negative predictive value was 96.55%. The sensitivity of CA125 to detect malignant lesions among ovarian cysts was 85.71% and a specificity of 85.93%. The PPV was low (42.85%). The combination Ultrasound-CA125 had a sensitivity of 85.7%, a specificity of 82.8%, a PPV and NPV respectively 35.3% and 98.1%. The concordance between the macroscopic perlaparoscopic and histological diagnosis of different tumors was 83.3% for functional cysts, 77.7% for serous cysts, and 100% for dermoid cysts, endometriosis and bleeding. Conclusion: The contribution of Doppler ultrasound and tumor markers is essential in the diagnosis of ovarian cysts.

J Spinal Disord Tech. 2011 Oct;24(7):474-8.

Cyclic sciatica in a patient with deep monolateral endometriosis infiltrating the right sciatic nerve.

Ceccaroni M, Clarizia R, Cosma S, Pesci A, Pontrelli G, Minelli L.

Source

*Gynecologic Oncology Division, International School of Surgical Anatomy †Department of Obstetrics and Gynecology, European Gynaecology Endoscopy School, Negrar, Verona ‡Department of Obstetrics and Gynecological Sciences, University of Naples “Federico II”, Naples §Department of Obstetrics and Gynecology, University of Turin, Turin ∥Department of Human Pathology, Sacred Heart Hospital, Negrar, Verona, Italy.

Abstract

STUDY DESIGN:

Case report.

OBJECTIVE:

To show by case presentation, the potential for endometriosis to infiltrate the somatic nerves causing lower extremity neuropathic pain and to discuss possible surgical remedy and the effectiveness of laparoscopic neurolysis.

SUMMARY OF BACKGROUND DATA:

Pelvic endometriosis may infiltrate the pelvic wall and somatic nerves causing severe neuropathic symptoms.

METHODS:

We report a case of a 41-year-old woman with a history of severe dysmenorrhea, dyspareunia, and chronic pelvic pain with concomitant monolateral right sciatica because of deep infiltrating pelvic endometriosis involving the sciatic nerve and pelvic wall.

RESULTS:

The patient was treated by laparoscopic neurolysis of the involved somatic nerves according to the Possover operation.

CONCLUSIONS:

Endometriosis is a chronic inflammatory disease, potentially infiltrating the somatic nerves. Laparoscopic neurolysis is a therapeutic aetiological therapy, which can relieve neurological symptoms deriving from nerve infiltration/compression.

Int J Gynaecol Obstet. 2011 Sep 22. [Epub ahead of print]

Correlation between laparoscopic and histopathologic diagnosis of endometriosis.

Wanyonyi SZ, Sequeira E, Mukono SG.

Source

Department of Obstetrics and Gynecology, Aga Khan University Hospital, Nairobi, Kenya.

Abstract

OBJECTIVE:

To review the histopathologic diagnosis of biopsies taken following visualization of endometriosis at laparoscopy and to correlate visual with microscopic diagnoses.

METHODS:

A retrospective review was undertaken of medical charts with a diagnosis of endometriosis at Aga Khan University Hospital, Nairobi, Kenya, between January 2001 and October 2010. Eligibility included visual diagnosis of endometriosis at laparoscopy, with a clear record of site, size, morphology, and number of lesions. The histopathologic diagnosis of the biopsies sampled was sought. Correlation was undertaken using κ statistics for diagnostic variability.

RESULTS:

Of the 204 relevant records, 152 (74.5%) met the eligibility criteria; from these cases, 239 specimens were submitted for histology. The most common symptom was chronic pelvic pain (108 [71.1%]). Most biopsies were obtained from the ovary and posterior cul-de-sac. Histopathologic diagnosis was confirmed in (152 [63.8%]) specimens and correlated with Asian race, multiparity, and chronic pelvic pain. Neither the site of the lesion nor the stage of disease influenced the histopathologic diagnosis.

CONCLUSION:

Laparoscopic visualization of endometriosis does not always correlate with histopathologic diagnosis; several other lesions may mimic endometriosis on histopathologic examination.

Fertil Steril. 2011 Sep 22. [Epub ahead of print]

Selective progesterone receptor modulators in reproductive medicine: pharmacology, clinical efficacy and safety.

Bouchard P, Chabbert-Buffet N, Fauser BC.

Source

Endocrinology Unit, AP-HP Hospital Saint-Antoine, Paris, France; University Pierre and Marie Curie, Paris, France.

Abstract

OBJECTIVE:

To discuss the mechanism of action of selective progesterone receptor modulators (SPRMs) and summarize the preclinical and clinical efficacy and safety data supporting the potential use of these compounds for gynecologic indications.

DESIGN:

Relevant publications from 2005 onward were identified using a PubMed search. Additional relevant articles were identified from citations within these publications.

SETTING:

None.

PATIENT(S):

None.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

None.

RESULT(S):

Mifepristone was first developed as a progesterone receptor antagonist and licensed for pregnancy termination because of the unique property of this compound to terminate pregnancy when associated with prostaglandins. Then SPRMs were developed, and among those ulipristal acetate, an efficient emergency contraceptive. Because SPRMs effectively inhibit endometrial proliferation and reduce endometriotic lesions in animal models, this suggests a possible role in the treatment of endometriosis in humans. Finally, a number of double-blind, randomized, placebo-controlled trials have demonstrated the efficacy of asoprisnil, mifepristone, telapristone acetate, and ulipristal acetate in reducing leiomyoma and uterine volume, and suppressing bleeding in women with uterine fibroids.

CONCLUSION(S):

Mifepristone in combination with prostaglandins has been licensed for pregnancy termination because of its unique ability is this area. Ulipristal acetate is available for emergency contraception. Several SPRMs hold further promise as an effective medical therapy for patients suffering from endometriosis and leiomyoma.

Hum Pathol. 2011 Sep 21. [Epub ahead of print]

CDC42-positive macrophages may prevent malignant transformation of ovarian endometriosis.

Canet B, Pons C, Espinosa I, Prat J.

Abstract

It is currently thought that most clear cell and endometrioid carcinomas arise from ovarian endometriosis. We recently suggested that, besides their origin in the ovary, reduction of CDC42 messenger RNA (a member of the RHO GTPase family) may contribute to explain why clear cell carcinomas are not uncommonly found limited to the ovary (stage I). On the other hand, little is known about the expression of CDC42 in ovarian endometriosis with and without carcinoma. Twenty-two endometriotic cysts not associated with carcinoma, 19 endometriotic cysts associated with carcinoma (contiguous endometriosis), as well as the 19 corresponding tumors (11 clear cell, 4 endometrioid, and 4 mixed-clear cell and endometrioid-carcinomas) were investigated. We analyzed CDC42 expression both by real-time polymerase chain reaction and immunohistochemistry. Endometriotic cysts not associated with carcinoma showed higher expression of CDC42 messenger RNA than cysts associated with carcinoma (P = .002). Immunohistochemically, CDC42 was exclusively expressed by macrophages. CDC42-positive macrophages were present in most of the endometriotic cysts not associated with carcinoma (11/19, or 58%). In contrast, only 5 endometriotic cysts containing carcinoma (contiguous endometriosis) (5/18, or 28%) and 1 ovarian carcinoma arising from endometriosis (1/18, or 5%) had CDC42-positive macrophages (58% versus 28%, P = .065; 28% versus 5%, P = .046). Our results raise the possibility that CDC42-positive macrophages may prevent the development of endometrioid and clear cell carcinomas.

Rev Mal Respir. 2011 Sep;28(7):908-12. Epub 2011 Jul 7.

Thoracic endometriosis: A difficult diagnosis.

[Article in French]

Hagneré P, Deswarte S, Leleu O.

Source

Service de gynécologie-obstétrique, centre hospitalier, 43, rue de l’Isle, 80100 Abbeville, France.

Abstract

Thoracic endometriosis is a rare disease, which presents in women at a mean age of 35 years, later than for pelvic endometriosis. There are no known predisposing factors for the condition and its pathogenesis is not yet clearly established. The symptoms always appear in connection with the periods of the person affected by the condition, occurring within 24-48h after the start of menstruation. Catamenial pneumothorax is the most common clinical entity. It is associated with pelvic endometriosis in 30-50% of cases. Thoracoscopy, preferably performed during menstruation, allows full inspection of the diaphragm and the pleural cavity for defects in the diaphragm, endometrial nodules and bullae. The level of CA 125 is often elevated but this is not a reliable or specific marker. Medical treatment is aimed at blocking the action of estrogen on the endometrium and ectopic endometrial implants. GnRH analogues or danazol are the preferred treatments. Surgery to repair and strengthen the diaphragm and/or resect nodules or bullae also has a role, supplemented by pleurodesis to prevent further pneumothorax or effusions. The main risk is recurrence, and thus the current usual practice is to combine surgery, immediately followed by hormone therapy focusing on GnRH analogues.

Rev Mal Respir. 2011 Sep;28(7):852-3. Epub 2011 Apr 1.

Thoracic endometriosis and catamenial pneumothorax.

[Article in French]

 

Oncol Rep. 2011 Dec;26(6):1347-56. doi: 10.3892/or.2011.1456. Epub 2011 Sep 12.

Molecular genetics and epidemiology of epithelial ovarian cancer (Review).

Haruta S, Furukawa N, Yoshizawa Y, Tsunemi T, Nagai A, Kawaguchi R, Tanase Y, Yoshida S, Kobayashi H.

Source

Department of Obstetrics and Gynecology, Nara Medical University, Nara 634-8522, Japan.

Abstract

This review summarizes data from recent molecular genetic and epidemiology studies of the generic term ‘female pelvic cancer’. The English-language literature was reviewed for genetic, epigenetic, epidemiologic and environmental risk factors. There are well-documented disparities among racial and ethnic groups with respect to epithelial ovarian cancer (EOC) prevalence. In the case of the serous histological subtype, primary EOC, fallopian tube cancer and peritoneal cancer could be regarded as a single disease entity. However, EOC is not a single disease. Comparing the profile of EOC between Japanese and Caucasians, clear cell carcinomas (27.6%) are more common in Japan, possibly with fewer serous adenocarcinomas (40.7%). This may reflect a proportional increase. The Japanese may exhibit a higher proportion of malignant transformation of endometriosis compared to the United States population. Although some part of the molecular genetic pathogenesis has been unveiled, the complete events of molecular genetic epidemiological changes associated with EOC remain to be identified. This review focuses on current knowledge of the genetic and environmental factors affecting the development of EOC, and outlines future challenges in its pathogenesis research.

Int J Gynecol Cancer. 2011 Oct;21(7):1200-7.

Redox-active iron-induced oxidative stress in the pathogenesis of clear cell carcinoma of the ovary.

Yamada Y, Shigetomi H, Onogi A, Haruta S, Kawaguchi R, Yoshida S, Furukawa N, Nagai A, Tanase Y, Tsunemi T, Oi H, Kobayashi H.

Source

Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan.

Abstract

OBJECTIVE:

: Epithelial ovarian cancer (EOC) is the most lethal pelvic gynecologic cancer. Clear cell carcinoma (CCC) and endometrioid adenocarcinoma (EAC) of the ovary have been associated with endometriosis, thus indicating that endometriosis has been believed to increase the risk of developing EOC. The aim of our review was to identify and synthesize the most current information on CCC with regard to molecular and pathophysiological distinctions.

METHOD:

: This article reviews the English-language literature for molecular, pathogenetic, and pathophysiological studies on endometriosis and endometriosis-associated ovarian cancer (EAOC). In this review, we focus on the functions and roles of redox-active iron in CCC carcinogenesis.

RESULTS:

: The iron-induced reactive oxygen species signals can contribute to carcinogenesis via 3 major processes: step 1, by increasing oxidative stress, which promotes DNA mutagenesis, histone modification, chromatin remodeling, and gene products activation/inactivation thus contributing to EAOC initiation; step 2, by activating detoxification and antiapoptotic pathways via the transcription factor hepatocyte nuclear factor 1β overexpression, thereby contributing to CCC promotion; and step 3, by creating an environment that supports sustained growth, angiogenesis, migration, and invasion of cancer cells via estrogen-dependent (EAC) or estrogen-independent (CCC) mechanisms, thus supporting tumor progression and metastasis.

CONCLUSIONS:

: These aspects of reactive oxygen species biology will be discussed in the context of its relationship to EAOC carcinogenesis.

Physiol Behav. 2011 Oct 24;104(5):722-7. Epub 2011 Jul 27.

The display of paced mating behavior in a rat model of endometriosis.

Clark AS, Robinson S, Boisvert E, Quill KA.

Abstract

Endometriosis is a disorder associated with chronic pelvic pain and ill effects on women’s sexual health. The present study examined the effects of pelvic endometriotic implants on the display of paced mating behavior in female rats. Approximately 2months after the surgical induction of endometriosis, rats were tested for paced mating behavior during proestrus (Experiment 1) or after bilateral ovariectomy and hormone replacement (Experiment 2). Although endometriotic implants were confirmed at autopsy, rats with surgical endometriosis in both experiments exhibited normal patterns of paced mating behavior. The positive relationship between implant material and contact-return latency following ejaculation in Experiment 2 suggests that the sensitivity to vigorous mating stimulation may be influenced by endometriosis.

Curr Probl Diagn Radiol. 2011 Nov-Dec;40(6):219-32.

Beyond the boundaries-endometriosis: typical and atypical locations.

Sonavane SK, Kantawala KP, Menias CO.

Source

Department of Abdomen Radiology, Mallinckrodt, Institute of Radiology, Barnes Jewish Hospital, Washington University, St. Louis, MO.

Abstract

Endometriosis is characterized by the presence of endometrial glands and stroma in an ectopic location outside the endometrial cavity. This condition affects women during their reproductive years. Ovaries are by far the commonest location of endometriosis and have peculiar imaging features. However, the imaging diagnosis of extraovarian endometriosis is difficult to make both clinically and radiologically. The purpose of this article is to review the imaging features of endometriosis at typical and atypical sites on different modalities and to describe the commonly encountered complications. Atypical sites for endometriosis include the gastrointestinal tract, urinary tract, soft tissues, and chest. Depending on the site, they can present with varied symptoms, including bowel obstruction, melena, hematuria, dysuria, dyspnea, and swelling in the soft tissues, respectively. The endometriotic implant in the extraovarian location is a challenging diagnosis. It is important to be aware of the sites, radiologic appearances, and complications of ovarian and extraovarian endometriosis while evaluating a woman in the reproductive age group with appropriate symptomatology. Endometriosis at extraovarian locations is a challenging diagnosis clinically and radiologically. Clinical symptomatology with characteristic imaging features in the appropriate patient population is helpful in reaching the diagnosis. Precise diagnosis regarding presence, location, and extent of endometriosis is useful for preoperative evaluation and surgical planning of endometriosis.

Heavy Menstrual Bleeding.

Editors

National Collaborating Centre for Women’s and Children’s Health (UK).

Source

London: RCOG Press; 2007 Jan.

National Institute for Health and Clinical Excellence: Guidance .

Excerpt

Heavy menstrual bleeding (HMB) has an adverse effect on the quality of life of many women. It is not a problem associated with significant mortality. Many women seek help from their general practitioners and it is a common reason for referral into secondary care. In order for women to be treated successfully, it is essential that the underlying problem is understood by both the patient and the healthcare professional. This guideline provides background information as well as covering epidemiology, physiology, investigation and, ultimately, treatment. The aim is to consider the evidence and review it, taking into account both the woman’s and the healthcare professional’s viewpoints and interests. This is not always easy but it is anticipated that the information contained in the guideline will help women reach an informed and beneficial decision with their doctors. Once they have read the guideline, they will know what questions to ask and what the options available to them are. Constructive dialogue should allow patients to be able to trust the advice given by their practitioner as they will be confident that they have the latest information and will be able to use it to inform this decision-making process. Clinical guidelines have been defined as systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions. This guideline has been developed with the aim of providing guidance on HMB. The effectiveness of the various treatments as well as their risks and benefits are discussed in relation to their use in the treatment of HMB but the discussion cannot be extrapolated to the use of particular treatments to relieve other symptoms, such as hysterectomy for cancer or endometriosis. The implications of each treatment in relation to fertility are also clearly stated so that no woman will undergo treatment that renders her infertile unless this is her specific wish.

Int J Gynaecol Obstet. 2011 Sep 19. [Epub ahead of print]

Vaginal danazol for the treatment of endometriosis-related pelvic pain.

Bhattacharya SM, Tolasaria A, Khan B.

Source

SC Das Memorial Medical and Research Center, Kolkata, India; Department of Obstetrics and Gynecology, KPC Medical College, Kolkata, India.

 

Arch Gynecol Obstet. 2011 Sep 20. [Epub ahead of print]

Endometriosis: the consequence of uterine denervation-reinnervation.

Quinn MJ.

Source

Womens Hospital, University of Zhejiang, Hangzhou, China, mjquinn001@btinternet.com.

Abstract

Difficult intrapartum episodes and persistent straining during defecation cause injuries to uterine nerves and uterosacral ligaments. Injuries to uterine nerves (denervation) result in loss of fundocervical polarity, uterotubal dysmotility and retrograde menstruation. Ectopic endometrium, delivered by retrograde menstruation, adheres to injuries to uterosacral ligaments and peritoneal surfaces. Difficult vaginal deliveries result in laparoscopic appearances of asymmetry of uterosacral ligaments with, or without, ectopic endometrium. Straining during defaecation causes the “classic” appearances of nulliparous endometriosis including hypertrophy of the uterosacral ligaments often with large volumes of ectopic endometrium. Laparoscopic appearances depend on the site, nature, extent, and timing of tissue injury, as well as the presence of available endometrium. Tissue repair, including reinnervation in the uterine isthmus, cervix, vagina and uterosacral ligaments, contributes to chronic pelvic pain, dysmenorrhea, dyspareunia and subfertility some time after the primary injuries.

Arch Gynecol Obstet. 2011 Sep 20. [Epub ahead of print]

Co-expression of bone morphogenetic protein 6 with estrogen receptor a in endometriosis.

Athanasios F, Afrodite N, Effstratios P, Demetrios K.

Source

First Department of Obstetrics and Gynecology, “Helena Venizelou” Hospital, Agias Barbaras 32, Palaio Faliro, 17563, Athens, Greece, farfaras@gmail.com.

Abstract

BACKGROUND:

Bone morphogenetic protein 6 (BMP-6) has decisive role in controlling multiple organogenetic processes, as well as modulating cell differentiation and proliferation. Considering those pleiotropic effects, we focused on determining expression of that multifunctional growth factor in ectopic endometriotic tissues.

MATERIALS AND METHODS:

In this prospective study, 85 consecutive women with endometriosis were included. All patients underwent gynecological operations due to endometriosis associated problems and tissue specimens were collected from ectopic endometriotic lesions. Immunohistochemical staining of paraffin sections for both BMP-6 and estrogen receptors a (ERa) was performed in all 85 cases using an avidin-biotin-peroxidase procedure.

RESULTS:

Ectopic endometrium showed intense cytoplastic immunoreactivity to BMP-6 in both epithelium and stroma. In addition, we have demonstrated that BMP-6 expression is highly associated with strong expression of ERa.

DISCUSSION:

The availability of BMP-6 in the ectopic endometrium may be at least partly involved in the mechanisms of attachment, survival and expansion of endometriosis. Moreover, the statistically significant correlation in expression of BMP-6 and ERa demonstrated in this study may be associated with the development of rich in estrogen microenvironment, but requires further investigation. In conclusion, this is the first study in our knowledge demonstrating strong expression of BMP-6 in endometriosis.

J Minim Invasive Gynecol. 2011 Sep 17. [Epub ahead of print]

Quality of Life after Segmental Resection of the Rectosigmoid by Laparoscopy in Patients with Deep Infiltrating Endometriosis with Bowel Involvement.

Bassi MA, Podgaec S, Dias JA Jr, D’Amico Filho N, Petta CA, Abrao MS.

Source

Department of Obstetrics and Gynecology, University of São Paulo Medical School, São Paulo, Brazil; Samaritano Hospital, São Paulo, Brazil.

Abstract

STUDY OBJECTIVE:

To estimate the quality of life of patients undergoing laparoscopic resection of a segment of the rectosigmoid for the treatment of deep infiltrating endometriosis with bowel involvement.

DESIGN:

Prospective application of the SF-36 Health Status Questionnaire to 151 women before and 1 year after surgical intervention (Canadian Task Force Design Classification II).

SETTING:

Department of Obstetrics and Gynecology, University of São Paulo Medical School, and Samaritano Hospital, São Paulo, Brazil.

PATIENTS:

A total of 151 women (mean age 34.05 ± 5.65 years) with deep infiltrating endometriosis underwent resection of a segment of the rectosigmoid by laparoscopy between 2002 to 2009.

INTERVENTIONS:

All the patients had historical data collected and underwent clinical examination and transvaginal ultrasonography with prior bowel preparation for resection of a segment of the rectosigmoid by laparoscopy indicated for patients with symptoms (pelvic pain) with 1 or more lesions of more than 3 cm in length or multifocal lesions.

MEASUREMENTS AND MAIN RESULTS:

Wilcoxon signed rank test verified differences between the degrees of the symptoms and the SF-36 scores before and 1 year after laparoscopic treatment. There was a significant improvement (p < .001) in all pain-related symptoms, as well as a significant increase (p < .001) in scores in all the SF-36 domains and in the sum of the components comprising both physical and mental health.

CONCLUSION:

Laparoscopic segmental resection of the rectosigmoid fulfills its essential objective of treating endometriosis with bowel involvement and improving patients’ QoL to a significant extent.

Reprod Sci. 2011 Sep 16. [Epub ahead of print]

Hypermethylation of the CpG Island Spanning From Exon II to Intron III is Associated With Steroidogenic Factor 1 Expression in Stromal Cells of Endometriosis.

Xue Q, Zhou YF, Zhu SN, Bulun SE.

Abstract

Endometriosis is an estrogen-dependent disease. Steroidogenic factor 1 (SF-1), a transcription factor, is essential for the activation of multiple steroidogenic genes for estrogen biosynthesis in endometriosis-derived stromal cells. Objective: Unravel the mechanism for differential SF-1 expression in endometrial and endometriotic stromal cells. DESIGN: We identified a novel CpG island in the SF-1 gene, which spans from exon II to intron III. We evaluated the methylation status of this CpG island. PATIENTS: Eutopic endometrium from disease-free participants (n = 8) and the walls of cystic endometriosis lesions of the ovaries (n = 8). None of the patients had received any preoperative hormonal therapy. Stromal cells were isolated from these 2 types of tissues. Results: SF-1 messenger RNA (mRNA) levels in endometriotic stromal cells were significantly higher than those in endometrial stromal cells. Bisulfite sequencing showed strikingly increased methylation in endometriotic cells compared with endometrial cells (P < .001). A strong correlation between mRNA levels and percentage methylation of the exon II/intron III are observed. Specifically, the Pearson correlation coefficient was .98 (P < .001) for this association. Conclusions: We demonstrated that methylation of a coding exon/intron sequence in the SF-1 gene positively regulated its expression in endometriosis, whereas its hypomethylation in normal endometrium was associated with drastically lower SF-1 levels.

Gynecol Oncol. 2011 Sep 16. [Epub ahead of print]

Gynecological conditions and the risk of endometrial cancer.

Rowlands IJ, Nagle CM, Spurdle AB, Webb PM; Australian National Endometrial Cancer Study Group; Australian Ovarian Cancer Study Group.

Abstract

OBJECTIVE:

To examine the association between gynecological conditions (including uterine fibroids, endometriosis, pelvic inflammatory disease and infections of the tubes/womb), and risk of endometrial cancer overall and by histological subtype.

METHODS:

Data came from a population-based, case-control study, which included 1399 women with endometrial cancer diagnosed between 2005 and 2007 and 1539 controls. Women provided detailed risk factor information via interview or self-completed questionnaire. Logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between gynecological conditions and cancer.

RESULTS:

A self-reported history of uterine fibroids was associated with an increased risk of endometrial cancer (OR=1.39; 95% CI: 1.10-1.74). This association was reduced for women with body-mass index≥35kg/m(2) (OR=0.71; 95% CI: 0.37-1.37), and increased in groups normally thought to be at low risk including women with normal BMI (OR=1.66; 95% CI: 1.14-2.41) and premenopausal women (OR=1.82; 95% CI: 0.99-3.32). After excluding conditions diagnosed in the previous year, we found no association between endometrial cancer and endometriosis, pelvic inflammatory disease, infections of the tubes/womb. There was no evidence that risk varied by tumor subtype.

CONCLUSION:

Overall these results suggest that women with uterine fibroids are at increased risk of endometrial cancer, and that greater monitoring of premenopausal and normal weight women with fibroids may be important for the early detection of endometrial cancer.

 

Am J Pathol. 2011 Sep 13. [Epub ahead of print]

Proangiogenic Tie2(+) Macrophages Infiltrate Human and Murine Endometriotic Lesions and Dictate Their Growth in a Mouse Model of the Disease.

Capobianco A, Monno A, Cottone L, Anna Venneri M, Biziato D, Di Puppo F, Ferrari S, De Palma M, Manfredi AA, Rovere-Querini P.

Source

Autoimmunity and Vascular Inflammation Unit, San Raffaele Scientific Institute, Milan, Italy.

Abstract

Endometriosis affects women of reproductive age, causing infertility and pain. Although immune cells are recruited in endometriotic lesions, their role is unclear. Tie2-expressing macrophages (TEMs) have nonredundant functions in promoting angiogenesis and growth of experimental tumors. Here we show that human TEMs infiltrate areas surrounding newly formed endometriotic blood vessels. We set up an ad hoc mouse model in which TEMs, and not Tie2-expressing endothelial cells, are targeted. We transplanted in wild-type recipients bone marrow cells expressing a suicide gene (Herpes simplex virus type 1 thymidine kinase) under the Tie2 promoter/enhancer. TEMs infiltrated endometriotic lesions. TEM depletion by ganciclovir administration arrested the growth of established lesions, without toxicity. Lesion architecture was disrupted, with: i) loss of glandular organization, ii) reduced neovascularization, and iii) activation of caspase 3 in CD31(+) endothelial cells. Thus, TEMs are important for maintaining the viability of newly formed vessels and represent a potential therapeutic target in endometriosis.

J Obstet Gynaecol Can. 2011 Sep;33(9):891.

Vulvar endometriosis.

Fei Ngu S, Cheung VY.

Source

Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR.

Clin Chem Lab Med. 2011 Sep 16. [Epub ahead of print]

The diagnostic accuracy of two human epididymis protein 4 (HE4) testing systems in combination with CA125 in the differential diagnosis of ovarian masses.

Lenhard M, Stieber P, Hertlein L, Kirschenhofer A, Fürst S, Mayr D, Nagel D, Hofmann K, Krocker K, Burges A.

Source

Department of Obstetrics and Gynecology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany.

Abstract

Abstract Background: Cancer antigen 125 (CA125) is the best known single tumor marker for ovarian cancer (OC). We investigated whether the additional information of the human epididymis protein 4 (HE4) improves diagnostic accuracy. Methods: We retrospectively analyzed preoperative sera of 109 healthy women, 285 patients with benign ovarian masses (cystadenoma: n=78, leimyoma: n=66, endometriosis: n=52, functional ovarian cysts: n=79, other: n=10), 16 low malignant potential (LMP) ovarian tumors and 125 OC (stage I: 22, II: 15, III: 78, IV: 10). CA125 was analyzed using the ARCHITECT system, HE4 using the ARCHITECT(a) system and EIA(e) technology additionally. Results: The lowest concentrations of CA125 and HE4 were observed in healthy individuals, followed by patients with benign adnexal masses and patients with LMP tumors and OC. The area under the curve (AUC) for the differential diagnosis of adnexal masses of CA125 alone was not significantly different to HE4 alone in premenopausal (CA125: 86.7, HE4(a): 82.6, HE4(e): 81.6% p>0.05) but significantly different in postmenopausal [CA125: 93.4 vs. HE4(a): 88.3 p=0.023 and vs. HE4(e): 87.8% p=0.012] patients. For stage I OC, HE4 as a single marker was superior to CA125, which was the best single marker in stage II-IV. The combination of CA125 and HE4 using risk of malignancy algorithm (ROMA) gained the highest sensitivity at 95% specificity for the differential diagnosis of adnexal masses [CA125: 70.9, HE4(a): 67.4, HE4(e): 66.0, ROMA(a): 76.6 and ROMA(e): 74.5%], especially in stage I OC [CA125: 27.3, HE4(a): 40.9, HE4(e): 40.9, ROMA(a): 45.5 and ROMA(e): 45.5%]. Conclusions: CA125 is still the best single marker in the diagnosis of OC. HE4 alone and even more the combined analysis of CA125 and HE4 using ROMA improve the diagnostic accuracy of adnexal masses, especially in early OC.

QJM. 2011 Sep 15. [Epub ahead of print]

Thoracic endometriosis as cause of recurrent pneumothorax.

Aguilar-Shea AL, Gallardo-Mayo C.

Source

From Family Practice, Consultorio Cerceda, Centro de Salud Manzanares El Real, Madrid, Spain and Department of Anesthesiology, Hospital Infanta Leonor, Madrid, Spain.

 

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