Pag. 17

J Reprod Med.2012 Mar-Apr;57(3-4):178-80.

Thoracic endometriosis: a case report.

Chamsy DJ, Qasim S, Kho KA.

Source

Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9032, USA.

Abstract

BACKGROUND:

Endometriosis is a benign gynecologic disorder that affects women of reproductive age. It can be asymptomatic or can cause pelvic pain or subfertility. On rare occasions it may manifest outside of the pelvis, leading to a multitude of symptoms that can be life-threatening if proper diagnosis is delayed.

CASE:

A 35-year-old, nulliparous female presented with dyspnea and pleuritic chest pain. She was diagnosed with a rare case of thoracic endometriosis. Her symptoms improved with combined surgical and medical management.

CONCLUSION:

The diagnosis of this rare entity often goes unrecognized unless physicians have a high clinical suspicion and make a temporal association between patients’ pulmonary symptoms and menstruation. Diagnosis can be confirmed only by pathological examination and immunohistochemical staining. Management should be guided by symptom severity and the patient’s desire to conserve future fertility.

J Reprod Med.2012 Mar-Apr;57(3-4):175-7.

Vulvar endometriosis presenting with dyspareunia: a case report.

Brug P, Gueye NA, Bachmann G.

Source

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901, USA. brugpa@umdnj.edu

Abstract

BACKGROUND:

Superficial dyspareunia can be caused by a multitude of medical and psychological conditions, including pathologic conditions of the vulva. Although infectious and inflammatory causes are more common, vulvar endometriosis is a rare and often overlooked etiology of dyspareunia.

CASE:

A 33-year-old woman, gravida 1, para 1, presented for a gynecologic consultation with a 2-year history of increasing dyspareunia and cyclical vulvar pain associated with a vulvar mass. Previous treatment with analgesics and sitz baths did not alleviate the symptoms. Pelvic examination revealed a right Bartholin’s gland mass that was tender to palpation. The working diagnosis was a Bartholin’s cyst as the cause of the dyspareunia, and the patient was scheduled for marsupialization and/or resection. Examination under anesthesia revealed an irregular, 5 cm, solid mass that extended into the labia majora, which was excised. Pathologic examination of the mass revealed endometriosis. The postoperative course was unremarkable and the patient reported complete resolution of symptoms.

CONCLUSION:

This case illustrates that superficial dyspareunia associated with cyclical vulvar pain can be caused by endometriosis involving the labia majora.

J Sex Med.2012 Mar;9(3):770-8. doi: 10.1111/j.1743-6109.2011.02593.x. Epub 2012 Feb 9.

What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis?

Mabrouk M, Montanari G, Di Donato N, Del Forno S, Frascà C, Geraci E, Ferrini G, Vicenzi C, Raimondo D, Villa G, Zukerman Z, Alvisi S, Seracchioli R.

Source

Minimally Invasive Gynecological Surgery Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy.

Abstract

INTRODUCTION:

Deep infiltrating endometriosis (DIE) is a form of endometriosis in which the lesion penetrates for more than 5 mm under the peritoneal surface. It is a chronic disease which can impair women’s sexual function. There is a growing body of evidence supporting combined surgical/medical treatment in the management of DIE.

AIMS:

The aims of this article are to evaluate the impact of the laparoscopic full excision of endometriosis and postoperative combined oral contraceptives (COC) administration on sexual function in patients with DIE and to compare sexual function outcomes of women submitted to intestinal resection and nodule excision.

METHODS:

It is a prospective cohort study in a tertiary care university hospital on 106 sexually active women, with histologically confirmed DIE, managed by laparoscopy and subsequent COC therapy for 6 months. Patients filled preoperatively and 6-month postoperatively a quality of sexual life questionnaire, the Sexual Health Outcomes in Women Questionnaire (SHOW-Q) and they ranked their symptom intensity using a 10-point visual analogue scale (VAS).

MAIN OUTCOME MEASURES:

Sexual function was measured through the SHOW-Q scores and pain symptoms through VAS scores. Intraoperative details, type of intervention and perioperative complications were noted.

RESULTS:

Six months after surgery and postoperative COC treatment, a significant improvement was observed in the SHOW-Q domains of pelvic problem interference, sexual satisfaction and desire (P<0.05). Laparoscopic management of DIE did not change significantly the orgasm area of the sexual functioning (P=0.7). No significant difference was found in SHOW-Q scores between patients submitted to intestinal resection and patients submitted to intestinal nodule excision (P>0.05).

CONCLUSIONS:

Sexual desire, satisfaction with sex and pelvic problem interference with intercourse are significantly improved after 6 months from laparoscopic excision of DIE combined with postoperative COC therapy. No difference in sexual outcomes was detected between patients submitted to intestinal resection and nodule excision.

J Vasc Interv Radiol.2012 Mar;23(3):430-2; author reply 433.

Uterine artery embolization for the treatment of adenomyosis: questions for long-term efficacy.

Yu L, Wu T, Spain J, Li X, Wang W.

Comment on

Microvasc Res.2012 Mar;83(2):237-42. Epub 2012 Jan 2.

Expression of vascular endothelial growth factor (VEGF) and its soluble receptor-1 in endometriosis.

Cho S, Choi YS, Jeon YE, Im KJ, Choi YM, Yim SY, Kim H, Seo SK, Lee BS.

Source

Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea.

Abstract

The aim of this study is to evaluate the expression of vascular endothelial growth factor (VEGF) and its soluble receptor (sFlt-1) in peritoneal fluid (PF), peritoneal endometriotic lesions and eutopic endometrial tissues of patients with endometriosis. Peritoneal fluid, peritoneal endometriotic lesions and eutopic endometrial samples from patients with endometriosis, and peritoneal fluid, peritoneal tissue and endometrial samples from patients without endometriosis were obtained during an operative laparoscopy. The mean PF concentrations of VEGF and sFlt-1 were significantly higher in patients with endometriosis than in the controls. In the peritoneal tissue, the expressions of VEGF and sFlt-1 were significantly higher, where the expression of sFlt-1 in endometrium was significantly lower in patients with endometriosis. These findings indicate that not only abnormal expressions of angiogenic factors, but also aberrant expressions of antiangiogenic factors in the peritoneal and endometrial environment seem to be involved in the pathogenesis of endometriosis.

Minerva Endocrinol.2012 Mar;37(1):75-92.

Anomalies in the inflammatory response in endometriosis and possible consequences: a review.

Khoufache K, Michaud N, Harir N, Kibangou Bondza P, Akoum A.

Source

Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC, Canada.

Abstract

Defined by the presence of endometrial-like cells outside the uterus, endometriosis is one of the most diagnosed gynecological disorders, affecting 5 to 10 % of reproductive age women, but the true incidence is unknown. Endometriosis is a major cause of pelvic pain, dysmenorrhea, dyspareunia, infertility and menstrual irregularities, but there is no clear correlation between the symptoms and the extent of the disease. Despite decades of intensive investigations, little is known about the pathogenesis of endometriosis. The disease is often associated with chronic pelvic inflammation. Abnormal levels of immune cells such macrophages, dendritic and natural killer cells were found in the peritoneal cavity of patients. However these cells seem to be unable to detect and eliminate ectopic endometrial cells. Several studies showed that peritoneal immune cells are dysfunctional and may rather contribute to endometriosis development. A review of relevant clinical and scientific studies was carried out. This review sheds light on cellular and immunological pro-inflammatory changes which were observed in patients with endometriosis, their impact on angiogenesis, apoptosis, extracellular matrix remodeling and hormonal production and consequences on fertility.

Mol Hum Reprod.2012 Mar;18(3):136-45. Epub 2011 Oct 11.

MiR-199a attenuates endometrial stromal cell invasiveness through suppression of the IKKβ/NF-κB pathway and reduced interleukin-8 expression.

Dai L, Gu L, Di W.

Source

Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, People’s Republic of China.

Abstract

MicroRNAs have recently been identified as regulators that modulate target gene expression and are suggested to be involved in the development and progression of endometriosis. This study was undertaken to analyze the expression level of microRNA-199a (miR-199a) in paired ovarian endometrioma and eutopic endometrium from women with endometriosis, and to investigate the contribution of miR-199a to the invasive capability of endometrial stromal cells (ESCs). Cell adhesion, migration and Matrigel invasion assays were carried out to measure the invasiveness of ESCs. Bioinformatics prediction, reporter gene assay, PCR, western blotting and ELISA were performed to identify miR-199a targets and related signaling pathways. The results showed that the expression level of miR-199a was lower in the eutopic endometrium from women with endometriosis, and even lower in the paired ovarian endometrioma, compared with the expression in normal controls. Moreover, ectopic expression of miR-199a attenuated ESC adhesion, migration and invasiveness. MiR-199a targeted and inhibited IkappaB kinase beta (IKKβ) in ESCs. Accompanied by IKKβ reduction, miR-199a suppressed nuclear factor-kappa B (NF-κB) pathway activation and interleukin-8 (IL-8) production in ESCs. All these findings suggest that miR-199a, down-regulated in endometriosis, attenuates the invasive capability of ESCs in vitro partly through IKK/NF-κB pathway suppression and reduced IL-8 expression. In conclusion, miR-199a could be involved in the pathogenesis of endometriosis.

Niger Postgrad Med J.2012 Mar;19(1):46-9.

Widespread endometriosis mimicking ovarian malignancy: A case report.

Akinola RA, Akinola OI, Alakija A, Wright KO.

Abstract

A 26 year old Nigerian nulliparous woman who presented in the medical emergency unit of a teaching hospital was referred after two weeks of management to the gynecology casualty with a diagnosis of malignant left ovarian cyst, because of the ascites, massive haemorrhagic pleural effusion, a left ovarian mass and an elevated C-125 marker. However, exploratory laparotomy, cytologic and histological examination of the pleural fluid and biopsied specimens revealed endometriosis. We present a case of intra and extra-pelvic endometriosis which simulated a malignant ovarian lesion and was histologically confirmed by cytology of the haemorrhagic pleural effusion and biopsy of the ovarian mass and peritoneal deposits obtained at laparotomy. This is to draw the attention of clinicians to endometriosis as a cause of pleural effusion, ascites and groin swelling which can simulate ovarian cancer.

Obstet Gynecol.2012 Mar;119(3):519-26.

Postoperative levonorgestrel-releasing intrauterine system for pelvic endometriosis-related pain: a randomized controlled trial.

Tanmahasamut P, Rattanachaiyanont M, Angsuwathana S, Techatraisak K, Indhavivadhana S, Leerasiri P.

Source

Gynecologic Endocrinology Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. sipta@mahidol.ac.th

Abstract

OBJECTIVES:

To estimate the effectiveness of a postoperative levonorgestrel-releasing intrauterine system for relieving pelvic pain in patients with endometriosis.

METHODS:

A double-blind randomized controlled trial was conducted in 55 patients with endometriosis and moderate-to-severe dysmenorrhea (visual analog scale, greater than 50 mm) undergoing laparoscopic conservative surgery. After surgery, patients were randomized to a levonorgestrel-releasing intrauterine system (n=28) or expectant management (n=27) group. Primary outcome was the change of dysmenorrhea visual analog scale. Secondary outcomes included changes of pelvic pain and dyspareunia visual analog scale, Short Form-36 score, and adverse effects.

RESULTS:

The two groups were comparable in age, body mass index, parity, and baseline pain scores. At 12 months, the levonorgestrel-releasing intrauterine system group had a significantly lower median value of dysmenorrhea and noncyclic pelvic pain score. Compared with the control group, the levonorgestrel-releasing intrauterine system group had greater reduction in dysmenorrhea visual analog scale (-81.0 compared with -50.0 mm, P=.006) and pelvic pain visual analog scale (-48.5 compared with -22.0 mm, P=.038) but a comparable reduction in dyspareunia visual analog scale (-15.0 compared with -19.0 mm, P=.831). Two patients in levonorgestrel-releasing intrauterine system group (7.4%) and nine in the expectant management group (39.1%) had recurrent dysmenorrhea within 1 year postoperatively (P=.014). Number-needed-to-treat to prevent one case with recurrent dysmenorrhea within the first year was three cases. The Short Form-36 scores improved in the levonorgestrel-releasing intrauterine system group but did not change in the expectant management group. There was no serious adverse event during the study period.

CONCLUSION:

The levonorgestrel-releasing intrauterine system is effective and well accepted for long-term therapy after conservative surgery for patients with moderate to severe pain related to endometriosis. It can improve the patient’s quality of life, including physical and mental health.

Pol Merkur Lekarski.2012 Mar;32(189):151-3.

Single nucleotide polymorphisms of VEGF gene in endometriosis.

[Article in Polish]

Góralczyk B, Smolarz B, Romanowicz H, Szyłło K.

Abstract

Endometriosis is a common gynaecological disease of unknown etiology. Angiogenesis appears to be one of the processes involved in its pathogenesis. Angiogenic factors VEGF level is increased in patients with endometriosis. Studies have shown that endometriosis maybe associated with VEGF single nucleotide polymorphism (SNP) polymorphisms. Results from studies that assayed VEGF polymorphism in endometriosis are reviewed. Data in the literature suggest that VEGF SNPs such as: -460C/T +405G/C and 936C/T seem to be a risk factor for endometriosis.

Reprod Fertil Dev.2012 Mar;24(3):482-9.

Epidermal growth factor upregulates endometrial CYR61 expression via activation of the JAK2/STAT3 pathway.

Klein R, Stiller S, Gashaw I.

Source

University of Duisburg-Essen, Institute of Anatomy II, Hufelandstraße 55, 45122 Essen, Germany.

Abstract

Endometrial cysteine-rich protein 61 (CYR61, CCN1) is a growth factor-inducible gene whose expression is elevated during the proliferative phase of the menstrual cycle and which has been implicated in the pathogenesis of endometriosis. This study aimed to define the mediators of epidermal growth factor (EGF) signalling on CYR61 expression in spontaneously immortalised human endometrial epithelial cells (HES) as a model system. After 30 min of EGF treatment, the receptor was phosphorylated and internalised as well as mRNA CYR61 increased in HES cells. However, neither inhibition of C-terminal EGF receptor (EGFR)-phosphorylation nor blockage of the mitogen-activated proteinkinase/extracellular signal-regulated kinase (MAPK/ERK) pathway was able to reduce CYR61 levels. Surprisingly, the HES cells showed upregulation of CYR61 mRNA expression after inhibition of the MAPK/ERK pathway when treated with EGF. Specific inhibitor studies identified the contribution of Janus kinase 2 (JAK2) and the signal transducer and activator of transcription protein STAT3 to the regulation of CYR61 expression. The JAK2/STAT3 interaction contributed to the basal expression of CYR61 and mediated EGF-driven regulation of CYR61 after 30 and 120 min of treatment. In summary, EGF-mediated CYR61 upregulation in HES cells involves STAT3 and is counter-regulated by the EGFR/MAPK/ERK pathway.

Srp Arh Celok Lek.2012 Mar-Apr;140(3-4):225-8.

Distal ileal endometriosis as a cause of ileus: a case report.

Gregorić P, Doklestić K, Pandurović M, Radenković D, Karadzić B, Raspopović M, Micev M, Ivancević N, Sijacki A, Bajec D.

Source

Clinic for Emergency Surgery, Clinical Centre of Serbia, Belgrade, Serbia. pajag@eunet.rs

Abstract

INTRODUCTION:

Endometriosis is a benign condition affecting females of reproductive age. Although intestinal endometriosis is common, it is rarely manifested as an acute bowel obstruction secondary to ileal endometriosis. Enteric endometriosis should be considered as a differential diagnosis when assessing females of reproductive age with acute small bowel obstruction.

CASE OUTLINE:

A 41-year-old woman presented with symptoms and signs of an acute small bowel obstruction requiring emergency surgery. A small bowel resection was performed with end-to-end anastomosis. Histological examination demonstrated endometriosis with fibrosis and stricture of the ileal segment. This case is important to report as it highlights the diagnostic difficulty this particular condition pre sents to an emergency surgeon.

CONCLUSION:

In the differential diagnosis, endometriosis should be taken into consideration when assessing females of reproductive age who present with abdominal pain and small bowel obstruction.

Taiwan J Obstet Gynecol.2012 Mar;51(1):66-70.

Simultaneous laparoscopy for endometriotic women undergoing in vitro fertilization.

Chen ML, Lee KC, Yang CT, Hung KH, Wu MH.

Source

Department of Obstetrics and Gynecology, Lucina Women & Children Hospital, Kaohsiung, Taiwan.

Abstract

OBJECTIVE:

The aim of this study was to investigate simultaneous laparoscopy in endometriotic women with infertility undergoing in vitro fertilization (IVF).

MATERIALS AND METHODS:

Forty-seven infertile patients with endometriosis were enrolled in this retrospective study and underwent IVF cycles in a university affiliated hospital.

RESULTS:

The chemical pregnancy, clinical pregnancy and live birth rates were statistically significantly different between patients with minimal or mild stage endometriosis and patients with moderate or severe stage endometriosis, who received simultaneous laparoscopy and modified IVF with a GnRH antagonist protocol. A higher live birth rate was achieved in IVF patients with minimal or mild stage endometriosis combined with laparoscopic treatment, than in patients who received traditional IVF with prior laparoscopic surgery for endometrioma.

CONCLUSION:

Simultaneous laparoscopy combined with a modified IVF (GnRH antagonist) protocol may benefit patients with minimal and mild endometriosis. Traditional GnRH agonist IVF cycles may improve the fecundity rates in women with moderate and severe endometriosis after laparoscopic treatment.

Taiwan J Obstet Gynecol.2012 Mar;51(1):50-4.

Estrogen receptor expression affected by hypoxia inducible factor-1α in stromal cells from patients with endometriosis.

Wu MH, Lu CW, Chang FM, Tsai SJ.

Source

Department of Obstetrics and Gynecology, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan.

Abstract

OBJECTIVE:

Endometriosis is an estrogen-dependent disease. The aim of this study was to evaluate the different expression of estrogen receptors (ER) and its relation to hypoxia inducible factor-1α (HIF-1α) in stromal cells from women with endometriosis.

MATERIALS AND METHODS:

Paired eutopic endometrial and ectopic endometriotic stromal cells were isolated from women with endometriosis while they underwent laparoscopy. The expression of ERα and ERβ was measured by reverse transcription-polymerase chain reaction and Western blot. Regulation of ER expression was evaluated by HIF-1α knockdown via short interference RNA.

RESULTS:

The expression of ERβ was significantly increased in ectopic stromal cells. Treatment of endometrial stromal cells with hypoxia induced ERβ expression. Knockdown of HIF-1α abolished hypoxia-induced ERβ expression and increased ERα expression.

CONCLUSION:

The expression of ERβ is regulated by hypoxia. Results of this study will provide important information in the involvement of hypoxia factors in mediating estrogen action via different ER expression in endometriosis.

Taiwan J Obstet Gynecol.2012 Mar;51(1):18-25.

Robotic surgery in complicated gynecologic diseases: experience of Tri-Service General Hospital in Taiwan.

Tan SJ, Lin CK, Fu PT, Liu YL, Sun CC, Chang CC, Yu MH, Lai HC.

Source

Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

Abstract

OBJECTIVE:

Minimally invasive surgery has been the trend in various specialties and continues to evolve as new technology develops. The development of robotic surgery in gynecology remains in its infancy. The present study reports the first descriptive series of robotic surgery in complicated gynecologic diseases in Taiwan.

MATERIALS AND METHODS:

From March 2009 to February 2011, the records of patients undergoing robotic surgery using the da Vinci Surgical System were reviewed for patient demographics, indications, operative time, hospital stay, conversion to laparotomy, and complications.

RESULTS:

Sixty cases were reviewed in the present study. Forty-nine patients had benign gynecologic diseases, and 11 patients had malignancies. These robot-assisted laparoscopic procedures include nine hysterectomy, 15 subtotal hysterectomy, 13 myomectomy, eight staging operation, two radical hysterectomy, five ovarian cystectomy, one bilateral salpingo-oophorectomy and myomectomy, two resections of deep pelvic endometriosis, one pelvic adhesiolysis, three sacrocolpopexy and one tuboplasty. Thirty-three patients had prior pelvic surgery, and one had a history of pelvic radiotherapy. Adhesiolysis was necessary in 38 patients to complete the whole operation. Robotic myomectomy was easily accomplished in patients with huge uterus or multiple myomas. The suturing of myometrium or cervical stump after ligation of the uterine arteries minimized the blood loss. In addition, it was much easier to dissect severe pelvic adhesions. The dissection of para-aortic lymph nodes can be easily accomplished. All these surgeries were performed smoothly without ureteral, bladder or bowel injury.

CONCLUSION:

The present analyses include various complicated gynecologic conditions, which make the estimation of the effectiveness of robotic surgery in each situation individually not appropriate. However, our experiences do show that robotic surgery is feasible and safe for patients with complicated gynecologic diseases.

Transpl Int.2012 Mar;25(3):357-65. doi: 10.1111/j.1432-2277.2011.01427.x. Epub 2012 Jan 13.

Danazol induces prolonged survival of fully allogeneic cardiac grafts and maintains the generation of regulatory CD4(+) cells in mice.

Uchiyama M, Jin X, Zhang Q, Hirai T, Bashuda H, Watanabe T, Amano A, Niimi M.

Source

Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan.

Abstract

Danazol, a derivative of testosterone, is useful for treatment of endometriosis as well as pretreatment for in vitro fertilization and embryo transfer, although its mechanisms of action are unclear. The aim of this study was to investigate the effect of danazol on alloimmune responses in murine heart transplantation. CBA male mice (H2(k) ) underwent transplantation of C57BL/6 male (H2(b) ) hearts and received a single dose of danazol (0.4, 1.2 or 4mg/kg/day) by intraperitoneal injection on the day of transplantation and for 6days thereafter. An adoptive transfer study was performed to determine whether regulatory cells were generated. The median survival time (MST) of allografts in danazol-treated (1.2 and 4mg/kg/day) mice was 28 and 63days, respectively, compared with 7days in untreated mice. Moreover, secondary CBA recipients given whole splenocytes or CD4(+) cells from primary danazol-treated (4mg/kg/day) CBA recipients 30days after transplantation had prolonged allograft survival (MSTs, 29 and 60days, respectively). Cell proliferation, interleukin (IL)-2 and interferon-γ were suppressed in danazol-treated mice, whereas IL-4 and IL-10 were up-regulated. Moreover, danazol directly suppressed allo-proliferation in a mixed leukocyte culture. Flow cytometry showed an increased CD4(+) CD25(+) Foxp3(+) cell population in splenocytes from danazol-treated mice. Danazol prolongs cardiac allograft survival and generates regulatory CD4(+) cells.

Ultrasound Obstet Gynecol.2012 Mar;39(3):336-40. doi: 10.1002/uog.10052.

Endometriosis of the abdominal wall: ultrasonographic and Doppler characteristics.

Savelli L, Manuzzi L, Di Donato N, Salfi N, Trivella G, Ceccaroni M, Seracchioli R.

Source

Gynecology and Reproductive Medicine Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. luca.savelli@aosp.bo.it

Abstract

OBJECTIVES:

To describe the sonographic and clinical features of abdominal wall endometriosis (AWE), a frequently misdiagnosed condition.

METHODS:

This was a retrospective study of 21 consecutive women with pathologically proven endometriosis of the abdominal wall. Ultrasonographic and Doppler examinations were performed, before surgery, with a high-frequency linear transducer. The clinical data and the results of the sonographic examinations were reviewed and described.

RESULTS:

At ultrasound, all the nodules appeared as discrete solid masses that were less echogenic than the surrounding hyperechoic fat. The nodules had a median diameter of 20 (range, 5-50) mm and in 18/21 (86%) cases the nodules had a round/oval shape. In eight of 21 (38%) women the AWE was located at the umbilicus, in six of 21 (29%) it was between the transverse suprapubic line and the umbilicus, in five of 21 (24%) it was found along the scar of a previous Cesarean section and in two of 21 (9%) it was in the right inguinal canal. The content was homogeneously hypoechoic in 12/21 (57%) women and inhomogeneous in the other nine (43%). The outer borders were invariably ill defined. Scarce blood vessels were found by power Doppler. Cyclic or continuous spontaneous pain at the level of the AWE was present in 19/21 (91%) cases, and two (9%) patients were asymptomatic.

CONCLUSIONS:

Hypoechoic round/oval nodules with ill-defined borders and a hyperechoic rim should raise the suspicion of abdominal wall endometriosis, even in patients with no history of endometriosis or previous laparotomic surgery. Pressing the ultrasound probe against the nodule should reinforce a suspected diagnosis because of the pain it induces.

Biol Reprod.2012 Feb 29;86(2):47. Print 2012 Feb.

TIMP1 contributes to ovarian anomalies in both an MMP-dependent and -independent manner in a rat model.

Stilley JA, Sharpe-Timms KL.

Source

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

Abstract

Ovulatory dysfunction occurs in women with endometriosis, yet the mechanisms are unknown. We have shown that endometriotic lesions synthesize and secrete tissue inhibitor of metalloproteinase (TIMP) 1 into the peritoneal cavity in humans and a rat model of endometriosis, where excess TIMP1 localizes in the ovarian theca in endometriosis and modulating peritoneal TIMP1 alters ovarian dynamics. Here, we evaluated whether mechanisms whereby excessive peritoneal fluid TIMP1 negatively impacts ovarian function are matrix metalloproteinase (MMP)-dependent and/or MMP-independent actions. Rats were treated with a mutated TIMP1 without MMP inhibitory function (Ala-TIMP1), wild-type TIMP1 (rTIMP1), or PBS. Rats treated with Ala-TIMP1 or rTIMP1 had fewer antral follicles, fewer new corpora lutea, and the presence of luteinized unruptured follicle syndrome compared with PBS rats. Ala-TIMP1 and rTIMP1 differentially caused downstream changes in gene expression and protein localization related to ovulation, as measured by whole-genome microarray with quantitative real-time PCR validation and immunohistochemistry. More vascular endothelial growth factor and FN were expressed and localized in ovaries of Ala-TIMP1-treated rats compared to rTIMP1- and PBS-treated rats inferring MMP-independent functions. Less caspase 3 localized in ovaries of rTIMP1 compared with the other two groups, and was thus dependent on MMP action. Furthermore, after coimmunoprecipitation, more CD63 was bound to TIMP1 in ovaries of rats treated with Ala-TIMP1 than in rTIMP1-treated rats, providing evidence for another MMP-independent mechanism of ovulatory dysfunction. We predict that MMP-dependent and MMP-independent events are involved in improper fortification of the follicular wall through multiple mechanisms, such as apoptosis inhibition, extracellular matrix components and angiogenesis. Collectively, excessive peritoneal TIMP1 causes changes in ovarian dynamics, both dependently and independently of MMP inhibition.

Reprod Sci.2012 Feb 28. [Epub ahead of print]

G Protein-Coupled Estrogen Receptor (GPER) Expression in Normal and Abnormal Endometrium.

Plante BJ, Lessey BA, Taylor RN, Wang W, Bagchi MK, Yuan L, Scotchie J, Fritz MA, Young SL.

Abstract

Rapid estrogen effects are mediated by membrane receptors, and evidence suggests a role for both a membrane-associated form of estrogen receptor alpha (ESR1; ERα) and G-protein coupled receptor 30 (GPER; GPR30). Considering estrogen’s importance in endometrial physiology and endometriosis pathophysiology, we hypothesized that GPER could be involved in both cyclic changes in endometrial estrogen action and that aberrant expression might be seen in the eutopic endometrium of women with endometriosis. Using real-time reverse transcriptase-polymerase chain reaction (RT-PCR) and immunohistochemical analysis of normal endometrium, endometrial samples demonstrated cycle-regulated expression of GPER, with maximal expression in the proliferative phase. Eutopic and ectopic endometrium from women with endometriosis overexpressed GPER as compared to eutopic endometrium of normal participants. Ishikawa cells, an adenocarcinoma cell line, expressed GPER, with increased expression upon treatment with estrogen or an ESR1 agonist, but not with a GPER-specific agonist. Decreased expression was seen in Ishikawa cells stably transfected with progesterone receptor A. Together, these data suggest that normal endometrial GPER expression is cyclic and regulated by nuclear estrogen and progesterone receptors, while expression is dysregulated in endometriosis.

BMJ.2012 Feb 24;344:e1363. doi: 10.1136/bmj.e1363.

Endometriosis is associated with an increased risk of ovarian cancer, study shows.

Sundaralingam A.

Jpn J Radiol.2012 Feb 21. [Epub ahead of print]

Perineural spread of endometriosis along the obturator nerve into the adductor thigh compartment.

Waer P, Samson I, Sinnaeve F, Sciot R, Pans S.

Source

Department of Radiology, University Hospitals of Leuven, Herestraat 49, 3000, Leuven, Belgium, pieter.waer@uzleuven.be.

Abstract

We report the case of a young woman with recurrent unilateral hip pain. A polylobular cystic mass was found in the right adductor space. Magnetic resonance imaging (MRI) revealed a polynodular mass migrating from the intrapelvic region along the obturator nerve. Because of a history of cyclic pain and the characteristics on MRI (hypointense rim and spots of spontaneous hyperintense signal on T1-weighted images), an endometrioma was suspected. The diagnosis of endometriosis was later confirmed through ultrasound-guided biopsy.

Acta Histochem.2012 Feb 20. [Epub ahead of print]

Expression of Th1 and Th2 cytokine-associated transcription factors, T-bet and GATA-3, in the eutopic endometrium of women with endometriosis.

Chen P, Zhang Z, Chen Q, Ren F, Li T, Zhang C, Wang D.

Source

Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang 110004, People’s Republic of China.

Abstract

The objective of the present study was to evaluate the expression of T-box expressed in T cells (T-bet) and GATA binding protein 3 (GATA-3) in the eutopic endometrium from women with endometriosis. Endometrial tissues were collected from 20 women with laparoscopically confirmed endometriosis and 20 women without endometriosis. T-bet and GATA-3 expression was measured by quantitative real-time PCR (qPCR), immunohistochemistry and Western blot analysis. Eutopic endometrial tissues from patients with endometriosis expressed lower levels of T-bet mRNA and high levels of GATA-3 mRNA, leading to a significant lower T-bet/GATA-3 mRNA ratio (P<0.05). Western blot analysis showed that the T-bet/GATA-3 protein ratio in endometriosis group was also statistically lower than that in the control group (P<0.05). These results suggested that T-bet and GATA-3 may act as cytokine regulatory genes, and the Th2-specific transcription factor, GATA-3, probably plays an essential role in the immune response and the development of endometriosis.

Gynecol Endocrinol.2012 Feb 17. [Epub ahead of print]

Nexplanon: the new implant for long-term contraception. A comprehensive descriptive review.

Palomba S, Falbo A, Di Cello A, Materazzo C, Zullo F.

Source

Department of Obstetrics & Gynaecology, University “Magna Graecia” of Catanzaro, Viale Europa, Catanzaro , Italy.

Abstract

Nexplanon(®) is a new long-term reversible contraception method. The current review is aimed to analyze the published data concerning the contraceptive effectiveness of Nexplanon(®) and its effects on reproductive function. Pharmacological properties and technical procedures of insertion and removal, as well as the efficacy and safety data available, were discussed. Possible strategies for treating Nexplanon(®)-related bleeding were also described. With regard to the future research and the future scientific developments of contraceptive implants, the possible use of Nexplanon(®) wide-ranging for the symptomatic treatment of endometriosis and premenstrual syndrome (PMS) were considered. Finally, it was defined in which women the use of Nexplanon(®) is indicated and in which it is contra-indicated.

Mol Aspects Med.2012 Feb 15. [Epub ahead of print]

Functions of water channels in male and female reproductive systems.

Zhang D, Tan YJ, Qu F, Sheng JZ, Huang HF.

Source

Department of Reproductive Endocrinology, Zhejiang Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; The Key Laboratory of Reproductive Genetics, Ministry of Education, China.

Abstract

Twelve water channels (aquaporins) are expressed in mammalian reproductive systems, and play very important roles in maintaining water homeostasis in reproductive cells. Impairment of their functions can result in attenuated male and female fertility. Alteration of AQPs expression is also found in reproductive tissues of the patients with polycystic ovarian syndrome, endometriosis or endometrium carcinoma. A lot of data have increased understanding of the functions and mechanisms of regulation of aquaporins at both the molecular and the clinical level. Researches have also focused on aquaporins as therapeutic targets. This review discusses recent advances in uncovering the physiological and pathophysiological roles of aquaporins in the reproductive systems.

Psychol Health Med.2012 Feb 13. [Epub ahead of print]

Co-morbid pain conditions and feelings of invalidation and isolation among women with vulvodynia.

Nguyen RH, Ecklund AM, Maclehose RF, Veasley C, Harlow BL.

Source

a Division of Epidemiology & Community Health , University of Minnesota , Minneapolis , Minnesota , USA.

Abstract

Many women with vulvodynia also suffer from other chronic co-morbid pain conditions. Alone, these pain conditions are associated with feeling invalidated by others and feeling socially isolated. It is unclear, however, how the presence of additional pain co-morbidities are associated with the psychosocial wellbeing of women with vulvodynia. We used data from a survey administered by the National Vulvodynia Association. Women reported clinician-diagnosed vulvodynia, presence of co-morbid pain, and how often they felt that they felt no one believed their pain existed (invalidated) and isolated. Analyses determined prevalence of feeling invalidated or isolated, and the difference in prevalence when co-morbidities existed. Forty-five percent of these 1847 women with vulvodynia reported having at least one of the following five chronic pain conditions, chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis, or irritable bowel syndrome. Adjusted baseline prevalence among all women of feeling invalidated was 9% and of feeling isolated was 14%. Having a co-morbid condition with vulvodynia, as well as having an increasing number of co-morbid conditions with vulvodynia, was significantly associated with the presence of feeling both invalidated and isolated. Chronic fatigue syndrome was the co-morbidity most strongly associated with feelings invalidation and isolation. One or more co-morbid pain conditions in addition to vulvodynia were significantly associated with psychosocial wellbeing. However, the temporality of the association could not be elucidated and therefore we cannot conclude that these pain conditions cause poor psychosocial wellbeing. Despite this, future studies should explore the utility of promoting validation of women’s pain conditions and reducing social isolation for women with chronic pain.

Gynecol Endocrinol.2012 Feb 6. [Epub ahead of print]

Molecular links between endometriosis and cancer.

Pollacco J, Sacco K, Portelli M, Schembri-Wismayer P, Calleja-Agius J.

Source

Department of Anatomy, Faculty of Medicine and Surgery, University of Malta , Tal-Qroqq, Msida, MSD 2080 , Malta.

Abstract

Endometriosis is the leading cause of morbidity among premenopausal women affecting about 1 in 10 females. The features shared by endometriosis and cancer include the ability to evade apoptosis, the stem cell-like ability and angiogenic potential. As such characteristics are encoded by the cell’s genetic constitution, acquired mutations are responsible for the malignant transformation of endometriosis. Indeed, a number of tumour-suppressor genes and proto-oncogenes, such as protein 53 (P53) and B-cell lymphoma 2 (BCL-2) respectively, are mutated and as a result differentially expressed between endometriotic and malignant tissue associated with endometriosis. Moreover, cytokines and macrophages, both of which are inflammatory mediators have been implicated in the transformation process. The angiogenic properties possessed by cancer arising from endometriosis signifies a bad prognosis, while the stem cell-like activity possessed by both endometriosis and cancer has been attributed to the effect of oestrogen. A number of differences between endometriosis and cancer are found at the molecular level. Considering the link between these two pathologies, the three components which fuel the malignant transformation of endometriosis can be embodied in the endometriosis-induced carcinoma (EIC) triangle which shows the intricate relationship between endocrinologic, immunologic and genetic components.

Autoimmun Rev.2012 Feb 4. [Epub ahead of print]

Is there an association between autoimmunity and endometriosis?

Eisenberg VH, Zolti M, Soriano D.

Abstract

Endometriosis is a benign gynecologic disorder that affects 5-10% of women of reproductive age worldwide. It is characterized by the presence of ectopic endometrial cells and stroma in various locations outside the endometrium. In some of these women there are also a chronic local inflammatory process and presence of autoantibodies. It is not known whether this process is part of the etiology or is a secondary response to the ectopic cells. Furthermore, endometriosis shares similarities with several autoimmune diseases, which include elevated levels of cytokines, decreased apoptosis, and cell-mediated abnormalities. Our aim in this paper was to review the association between autoimmunity and endometriosis. For this purpose we conducted a thorough literature review in the MEDLINE/PubMed database using the keyword endometriosis crossed with: autoimmune disease, autoimmune diseases, autoimmunity, autoantibodies, immunity, immune-modulation, endometrial antibodies, etc.

Cell Tissue Res.2012 Feb 3. [Epub ahead of print]

Cellular and molecular basis for endometriosis-associated infertility.

Stilley JA, Birt JA, Sharpe-Timms KL.

Source

Division of Reproductive and Perinatal Research, Department of Obstetrics, Gynecology and Women’s Health, The University of Missouri School of Medicine, 1 Hospital Drive, N 625 HSC, DC051.00, Columbia, MO 65212, USA.

Abstract

Endometriosis is a gynecological disease characterized by the presence of endometrial glandular epithelial and stromal cells growing in the extra-uterine environment. The disease afflicts 10%-15% of menstruating women causing debilitating pain and infertility. Endometriosis appears to affect every part of a woman’s reproductive system including ovarian function, oocyte quality, embryo development and implantation, uterine function and the endocrine system choreographing the reproductive process and results in infertility or spontaneous pregnancy loss. Current treatments are laden with menopausal-like side effects and many cause cessation or chemical alteration of the reproductive cycle, neither of which is conducive to achieving a pregnancy. However, despite the prevalence, physical and psychological tolls and health care costs, a cure for endometriosis has not yet been found. We hypothesize that endometriosis causes infertility via multifaceted mechanisms that are intricately interwoven thereby contributing to our lack of understanding of this disease process. Identifying and understanding the cellular and molecular mechanisms responsible for endometriosis-associated infertility might help unravel the confounding multiplicities of infertility and provide insights into novel therapeutic approaches and potentially curative treatments for endometriosis.

Acta Obstet Gynecol Scand.2012 Feb;91(2):264-8. doi: 10.1111/j.1600-0412.2011.01308.x. Epub 2011 Dec 20.

Transvaginal ultrasonography of rectosigmoid endometriosis: interobserver variation of lesion size.

Egekvist AG, Forman A, Seyer-Hansen M.

Source

Department of Obstetrics and Gynecology, Aarhus University Hospital Skejby, Denmark. egekvist@dadlnet.dk

Abstract

This study evaluates the interobserver variation of transvaginal ultrasonographic measurements of the size of deep infiltrating endometriosis lesions in the rectosigmoid wall performed by an experienced and a less experienced sonographer. Fifteen outpatient women were seen for a gynecologic examination and 24 women were seen with rectosigmoid endometriosis. Transvaginal ultrasonography was performed independently by two observers with a focus on the presence and size of rectosigmoid endometriosis. The senior observer had several years of experience, whereas the junior observer was a medical student with no prior experience in transvaginal ultrasonography. The findings of the two observers were identical concerning the identification of rectosigmoid endometriosis. The probability of differences in size within 30% of the mean was 0.81, 0.63 and 0.61 for length, width and depth, respectively. Our data suggest that fair skills in this technique can be acquired by inexperienced examiners within a short period of time.

AJR Am J Roentgenol.2012 Feb;198(2):W146-51.

Subcutaneous abdominal wall masses: radiological reasoning.

Stein L, Elsayes KM, Wagner-Bartak N.

Source

Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA.

Abstract

OBJECTIVE: A 36-year-old woman presented to her primary care physician with right lower abdominal pain. Her physician subsequently requested a CT to rule out appendicitis. Contrast-enhanced CT was performed and revealed no evidence of appendicitis but showed two subcutaneous ovoid soft-tissue masses anterior to the rectus sheath in the upper pelvis. Pelvic MRI confirmed the two masses, which showed mild enhancement. The objective of this article is to discuss a diagnostic approach to subcutaneous soft-tissue masses in the abdominal wall. Diagnosis was endometriosis of the abdominal wall. CONCLUSION: Integrating salient imaging findings with clinical history is crucial when approaching the diagnosis of subcutaneous soft-tissue masses. The diagnosis of endometriosis should be entertained when soft-tissue masses are seen in the distribution of a cesarean section scar in a woman of reproductive age. Pain, particularly with a cyclic pattern, is highly suggestive of endometriosis. If endometriosis is suspected on CT or ultrasound, MRI can be performed for further evaluation. Definitive diagnosis is made with biopsy. Because subcutaneous nodules are so amenable percutaneous biopsy, imaging features, although of interest, are somewhat ancillary to the diagnostic workup.

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