Hum Reprod. 2015 Apr;30(4):812-32.

Platelets are an unindicted culprit in the development of endometriosis: clinical and experimental evidence.

Ding D1Liu X2Duan J1Guo SW3.

 

Abstract

STUDY QUESTION:

Do platelets play any role in the development of endometriosis?

SUMMARY ANSWER:

Activated platelets aggregate in endometriotic lesions and play important roles in the development of endometriosis.

WHAT IS KNOWN ALREADY:

Platelets play important roles in cancer development and metastasis but there is no published study on their role in the development of endometriosis, even though endometriotic lesions undergo repeated cycles of tissue injury and repair, which characteristically involve platelets.

STUDY DESIGN, SIZE, DURATION:

Cross-sectional clinical studies of women with and without endometriosis, in vitro experimentation, and animal studies using platelet and/or macrophage depletion.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Immunohistochemistry analysis of ectopic/eutopic endometrial tissues from 58 women with and 47 without endometriosis. Proliferation assay, cell cycle analysis by flow cytometry, gene expression and protein analysis for COX-2, VEGF, MMP-9, and Bcl-2 using primary cell culture, and evaluation of the rate of platelet activation induced by peritoneal fluid from women with and without endometriosis. Two mouse experiments, one that evaluated the effect of platelet depletion on lesion development and its associated phenotypic changes, and the other, the effect of platelet and/or macrophage depletion.

MAIN RESULTS AND THE ROLE OF CHANCE:

We found that platelets aggregated in endometriotic lesions, concomitant with elevated VEGF expression and microvessel density. Co-culture of endometriotic stromal cells with platelets enhanced cellular proliferation, and increased the expression of COX-2, MMP-9, VEGF, and Bcl-2. IL-1β-induced COX-2 up-regulation and increased production of the coagulant TXA(2) in endometriotic stromal cells. Tissue factor (TF) expression was elevated in endometriosis and TF concentrations were significantly elevated both in the supernatant of cultured primary endometriotic stromal cells and in peritoneal fluid from women with endometriosis. Platelet depletion resulted in significantly reduced lesion size and improved hyperalgesia in mice with induced endometriosis.

LIMITATIONS, REASONS FOR CAUTION:

This study is limited by its cross-sectional design and by its focus on ovarian endometriomas.

WIDER IMPLICATIONS OF THE FINDINGS:

The demonstration that platelets are involved in the development of endometriosis provides a rationale for the use of anti-coagulants to treat endometriosis, and opens prospects for developing novel biomarkers for diagnostic or prognostic purposes.

STUDY FUNDING/COMPETING INTERESTS:

Financial support for this study was provided by grants from the National Science Foundation of China, a grant from the Shanghai Science and Technology Commission, support from the Key Specialty Project of the Ministry of Health, People’s Republic of China. None of the authors has any conflict of interest to disclose.

 

 

Hum Reprod. 2015 Apr;30(4):840-7.

Surgical diminished ovarian reserve after endometrioma cystectomy versus idiopathic DOR: comparison of in vitro fertilization outcome.

Roustan A1Perrin J2Debals-Gonthier M3Paulmyer-Lacroix O4Agostini A5Courbiere B6.

 

Abstract

STUDY QUESTION:

Does the live birth rate after IVF depend on the etiology of diminished ovarian reserve (DOR)?

SUMMARY ANSWER:

IVF outcome and live birth rate are significantly impaired in women with DOR caused by a previous cystectomy for endometrioma compared with women with idiopathic DOR.

WHAT IS KNOWN ALREADY:

The safety of the surgical treatment of endometriomas is being discussed in terms of damage to ovarian reserve. Several studies have reported a poor response to controlled ovarian stimulation and a significantly impaired IVF outcome in women with DOR consecutive to an endometrioma cystectomy compared with women with tubal factor infertility.

STUDY DESIGN, SIZE, DURATION:

Retrospective case-control study conducted in women aged under 40 treated in our Reproductive Medicine Center between January 2010 and January 2014 for a DOR defined by anti-Müllerian hormone level <2 ng/ml. Two groups of patients were selected: group A included patients with a DOR diagnosed after cystectomy(s) for endometrioma(s), group B included patients with an idiopathic DOR. In each group, subgroups of patients ‘poor ovarian responders’, based on the ESHRE criteria (‘Bologna criteria’), have been established.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

A total of 51 patients in group A were matched to 116 patients in group B, representing respectively 125 and 243 IVF cycles. Among them, 39 patients in group A and 78 patients in group B validated strictly by the Bologna criteria, representing 99 and 189 IVF cycles, respectively. Each patient underwent a controlled ovarian hyperstimulation and IVF with fresh embryo transfer. Primary end-point was the live birth rate. Secondary end-points were the number of retrieved oocytes, fertilization rate, implantation rate, clinical pregnancy rate, spontaneous abortion rate and cycle cancelation rate.

MAIN RESULTS AND THE ROLE OF CHANCE:

Significantly lower pregnancy (11.2% in group A versus 20.6% in group B, P = 0.02) and live birth (7.2 versus 16.9% respectively, P = 0.01) rates per cycle were assessed in women in group A compared with women in group B. The same results were obtained in the Bologna criteria subgroup analysis with a significantly lower pregnancy (9.1 versus 20.1%, P = 0.016) and live birth (5.1 versus 15.3%, P = 0.001) rates per cycle in women in subgroup A compared with women in subgroup B. Patients in group A required significantly higher gonadotrophins doses (2881 IU ± 1111 versus 2526 IU ± 795, P = 0.005), longer ovarian stimulation (10.6 Days ± 2.8 versus 9.9 Days ± 2.4, P = 0.019) and higher cancelation rate for poor response (12 versus 6.2%, P = 0.05). Despite a mean number of retrieved oocytes similar with the group B (5.4 ± 3.1 and 5.1 ± 3.2, NS), and a significantly higher fertilization rate (65.7 versus 47.2%, P < 0.001), women in group A showed a significantly lower implantation rate (7.2 versus 13.5%, P = 0.03). Abortion rate, ectopic pregnancy rate and multiple pregnancy rate were similar in both groups.

LIMITATIONS, REASONS FOR CAUTION:

Data were collected retrospectively using the database of our Department. Sample size is relatively small but our study provides statistically significant evidence that the chances of IVF success are decreased in women with DOR after cystectomy for endometrioma. Further larger series are needed to confirm these findings.

WIDER IMPLICATIONS OF THE FINDINGS:

To our knowledge, this is the first study evaluating IVF outcome in patients with DOR after cystectomy(s) for endometrioma(s) versus in patients with an idiopathic DOR. In addition to the risk of damaging ovarian reserve, we hypothesize that endometrioma surgery would not have qualitative benefits on results in IVF in patients with DOR.

STUDY FUNDING/COMPETING INTERESTS:

The authors have no competing interests to declare.

 

 

 

 

 

Radiol Bras. 2014 Sep-Oct;47(5):323-5.

Atypical retroperitoneal endometriosis and use of tamoxifen.

Naufel DZ1Penachim TJ2de Freitas LL3Cardia PP2Prando A4.

 

Abstract

in EnglishPortuguese

The involvement of the retroperitoneum by endometriosis occurs only sporadically. In the present report, emphasis will be given to the magnetic resonance imaging findings which raised the diagnostic suspicion of periureteral lesion in a patient undergoing tamoxifen therapy, presenting with left upper quadrant pain and hydronephrosis. Histopathological findings obtained by means of computed tomography-guided percutaneous biopsy revealed the diagnosis of periureteral endometriosis.

 

 

Ann Thorac Surg. 2015 Mar;99(3):1075-8.

Catamenial pneumothorax with bullae.

Kawaguchi Y1Fujita T2Hanaoka J3.

 

Abstract

The physiologic mechanisms and diagnostic approach of catamenial pneumothorax remain controversial. We report 3 patients with catamenial pneumothorax with bullae. Endometrial cells in these patients were located around the bullae, suggesting a possible new mechanism for catamenial pneumothorax in which cyclic endometrial shedding in the lung causes destruction of the lining of alveolar epithelial cells and forms bullae. Because intrathoracic endometriosis is considered an underrecognized cause of secondary spontaneous pneumothorax, we performed careful histologic examination for definitive diagnosis of thoracic endometriosis.

 

 

Hum Reprod. 2015 May;30(5):1059-68.

Increased levels of dioxin-like substances in adipose tissue in patients with deep infiltrating endometriosis.

Martínez-Zamora MAMattioli LParera JAbad EColoma JLvan Babel BGalceran MTBalasch JCarmona F

 

Abstract

STUDY QUESTION:

Are the levels of biologically active and the most toxic dioxin-like substances in adipose tissue of patients with deep infiltrating endometriosis (DIE) higher than in a control group without endometriosis?

SUMMARY ANSWER:

DIE patients have higher levels of dioxins and polychlorinated biphenyls (PCBs) in adipose tissue compared with controls without endometriosis.

WHAT IS KNOWN ALREADY:

Some studies have investigated the levels of dioxin-like substances, in serum samples, in patients with endometriosis, with inconsistent results.

STUDY DESIGN, SIZE, DURATION:

Case-control study including two groups of patients. The study group (DIE group) consisted of 30 patients undergoing laparoscopic surgery because of DIE. In all patients, an extensive preoperative work-up was performed including clinical exploration, magnetic resonance imaging (MRI) and transvaginal sonography. All patients with DIE underwent a confirmatory histological study for DIE after surgery. The non-endometriosis control group (control group), included the next consecutive patient undergoing laparoscopic surgery in our center due to adnexal benign gynecological disease (ovarian or tubal procedures other than endometriosis) after each DIE patient, and who did not present any type of endometriosis.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

During the surgical procedure 1-2 g of adipose tissue from the omentum were obtained. Dioxin-like substances were analyzed in adipose tissue in DIE patients and controls without endometriosis.

MAIN RESULTS AND THE ROLE OF CHANCE:

The total toxic equivalence and concentrations of both dioxins and PCBs were significantly higher in patients with DIE in comparison with the control group (P < 0.05), mainly due to the significantly higher values of the two most toxic dioxins (2,3,7,8-tetrachlorodibenzo-p-dioxin [2,3,7,8-TCDD] and 1,2,3,7,8-pentachlorodibenzo-p-dioxin [1,2,3,7,8-PeCDD]) (P < 0.01 for each compound). The levels of furan 2,3,4,7,8-PeCDF were statistically higher in the DIE group compared with controls. Only four congeners of PCBs had toxic equivalence values and concentrations that were statistically higher in patients with DIE, but these included the most toxic and carcinogenic PCB-126 (PCB-114 P < 0.05; PCB-156 P < 0.05; PCB-189 P = 0.04; PCB-126 P < 0.01).

LIMITATIONS, REASONS FOR CAUTION:

Since few patients were recruited, the study is only exploratory. Our results need to be confirmed in larger and more heterogeneous population studies since environmental and even genetic factors involved in determining dioxins and PCBs widely vary in different countries. Furthermore, the strict eligibility criteria used may preclude generalization of the results to other populations and the surgery-based sampling frame may induce a selection bias. Finally, adipose tissue was obtained only from the omentum, and not from other adipose tissue of the body.

WIDER IMPLICATIONS OF THE FINDINGS:

Our results suggest a potential role of dioxin-like substances in the pathogenesis of DIE. Further studies are warranted to confirm our findings.

 

 

Arch Gynecol Obstet. 2015 Sep;292(3):523-9.

Dienogest in the treatment of endometriosis: systematic review.

Andres Mde P1Lopes LABaracat ECPodgaec S.

 

Abstract

PURPOSE:

Endometriosis is a prevalent disease that affects 5-15 % of women of reproductive age. The aim of this study is to assess the effect of dienogest in the treatment of endometriosis.

METHODS:

The search was applied to electronic databases PubMed, Cochrane, EMBASE and Lilacs until September 2014, in a public tertiary hospital. We performed a systematic literature search of randomized trials comparing dienogest to other medical therapies in the treatment of endometriosis, as well as their references list, using the keywords “dienogest” and “endometriosis” by two independent authors. The data extraction were performed by two authors using predefined data fields. Nine randomized trials were included. Dienogest 2 mg/day was superior to placebo in reducing pelvic pain (27.4 versus 15.1 mm, P < 0.0001), with similar results to buserelin, leuprorelin, leuprolide acetate and triptorelin, in controlling symptoms associated with endometriosis. Dienogest 2 mg/day was effective in reducing endometriotic lesions (11.4 ± 1.71-3.6 ± 0.95, P < 0.001). The extended therapy with dienogest 2 mg/day also showed an improvement in pelvic pain after 24-52 weeks (-22.5 ± 32.1 and -28.4 ± 29.9 mm, respectively) with tolerable side effects.

CONCLUSION:

Dienogest should be considered as an alternative for controlling symptoms related to endometriosis. Nevertheless, in this systematic review, no studies were found comparing dienogest with first-line therapy, such as progestins and estrogen-progestogen combinations, which are proved to be effective in the treatment of endometriosis, are less expensive, and also can be used for contraception.

 

 

Actas Urol Esp. 2015 Sep;39(7):451-5.

Umbilical laparoendoscopic partial cystectomy.

Redondo C1Pérez S1Gimbernat H1Meilán E1García-Tello A1Angulo JC2.

 

Abstract

OBJECTIVE:

To present our center’s experience in single-port umbilical laparoendoscopic partial cystectomies, in both benign and malignant pathologies. Patient characteristics, perioperative aspects and the surgical techniques used are reviewed.

MATERIAL AND METHOD:

Since May 2012, five patients have undergone a transumbilical single-port laparoendoscopic partial cystectomy with curved equipment through a reusable multichannel system and a 3.5mm accessory trocar. Patients were three males and two females aged between 28 and 78 (median: 44±42.5) years. The etiologies were endometriosis (in 2 cases), a tumor in the diverticulum, a congenital bladder diverticulum and ureterocele (1 case of each).

RESULTS:

Median surgery time was 273±163.4minutes, and intraoperative bleeding 250±175ml. None of the patients required transfusion. The postoperative period was uneventful, with good results and no complications. The hospital stay was 3±1 days. With monitoring of 20±17.5 months, morphological and functional recovery in the bladder and ureter was confirmed in all cases and the patient with neoplastic disease was disease-free more than 2 years after the surgery.

CONCLUSIONS:

An umbilical laparoendoscopic partial cystectomy represents a viable surgical option and ensures that excellent surgical and cosmetic results are achieved.

 

 

Reprod Sci. 2015 Sep;22(9):1115-21.

Lack of Evidence That Male Fetal Microchimerism is Present in Endometriosis.

Fassbender A1Debiec-Rychter M2Van Bree R3Vermeesch JR2Meuleman C4Tomassetti C4Peeraer K4D’Hooghe T5Lebovic DI6.

 

Abstract

INTRODUCTION:

Fetal microchimerism has been implicated in the etiology of autoimmune diseases. This study was done to test the hypothesis that male fetal microchimerism is present in eutopic and ectopic endometrium (EM) obtained from women with endometriosis but not in eutopic EM from women without endometriosis.

METHODS:

A total of 31 patients were selected, including women with endometriosis (paired eutopic and ectopic EM; n = 19) and women without endometriosis (eutopic EM; n = 12). Tricolor interphase fluorescence in situ hybridization analysis was performed by cohybridization of CEP Y SpectrumAqua and CEP X SpectrumGreen (SG)/CEP Y SpectrumOrange probes.

RESULTS:

Ectopic EM from women with endometriosis had 75% XX chromosomes (double SG signals) and 25% X chromosomes (single SG signal). Y chromosomes were not observed in any of the eutopic/ectopic endometrial tissues from cases or controls.

CONCLUSIONS:

We were unable to confirm our hypothesis that male fetal microchimerism is present in eutopic and/or ectopic EM obtained from women with endometriosis.

 

 

Hum Reprod. 2015 May;30(5):1069-78

Aberrant activation of signal transducer and activator of transcription-3 (STAT3) signaling in endometriosis.

Kim BG1Yoo JY1Kim TH1Shin JH2Langenheim JF3Ferguson SD1Fazleabas AT4Young SL5Lessey BA6Jeong JW7.

 

Abstract

STUDY QUESTION:

Are STAT3 signaling molecules differentially expressed in endometriosis?

SUMMARY ANSWER:

Levels of phospho-STAT3 and HIF1A, its downstream signaling molecule, are significantly higher in eutopic endometrium from women with endometriosis when compared with women without the disease.

WHAT IS KNOWN ALREADY:

Endometriosis is an estrogen-dependent inflammatory condition. Interleukin 6 (IL-6) is an inflammatory survival cytokine known to induce prolonged activation of STAT3 via association with the IL-6 receptor.

STUDY DESIGN, SIZE, DURATION:

Cross-sectional measurements of STAT3 and HIF1A protein levels in eutopic endometrium from women with endometriosis versus those without.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Levels of phospho-STAT3 (pSTAT3) and HIF1A were examined in the endometrium of patients with and without endometriosis as well as in a non-human primate animal model using western blot and immunohistochemical analysis.

MAIN RESULTS AND THE ROLE OF CHANCE:

Levels of pSTAT3 were significantly higher in the eutopic endometrium from women with endometriosis when compared with women without the disease in both the proliferative and secretory phases. HIF1A is known to be stabilized by STAT3 and IL-6. Our immunohistochemistry results show abundant HIF1A expression within the eutopic endometrial epithelial cells of women with endometriosis. Furthermore, pSTAT3 and HIF1A proteins are co-localized in endometriosis. This aberrant activation of pSTAT3 and HIF1A is confirmed by sequential analysis of eutopic endometrium using a baboon animal model of induced endometriosis. Lastly, we confirmed this IL-6 induction of both STAT3 phosphorylation and HIF1A mRNA expression in Ishikawa human endometrial adenocarcinoma cell line.

LIMITATIONS, REASONS FOR CAUTION:

Ishikawa cancer cell line was used to study a benign disease. The peritoneal fluid contains various inflammatory cytokines in addition to IL-6 and so it is possible that other cytokines may affect the activity and expression of STAT3 signaling molecules.

WIDER IMPLICATIONS OF THE FINDINGS:

Our results imply that aberrant activation of STAT3 signaling plays an important role in the pathogenesis of endometriosis. Our findings could progress in our understanding of the etiology and pathophysiology of endometriosis and potential therapeutic interventions by targeted pharmacological.

STUDY FUNDING/COMPETING INTERESTS:

This work was supported by NIH R01 HD067721 (to S.L.Y and B.A.L) and NIH R01 HD057873 and American Cancer Society Research Grant RSG-12-084-01-TBG (to J.-W.J.). There are no conflicts of interest.

 

 

Hum Reprod. 2015 May;30(5):1156-68

Induction of post-menstrual regeneration by ovarian steroid withdrawal in the functionalis of xenografted human endometrium.

Coudyzer P1Lemoine P1Po C2Jordan BF2Van Der Smissen P1Courtoy PJ1Henriet P1Marbaix E3.

 

Abstract

STUDY QUESTION:

Does the endometrial functionalis have the potential to undergo self-renewal after menstruation and how is this process controlled by ovarian steroids?

SUMMARY ANSWER:

Endometrial xenografts subjected to withdrawal of estradiol and progesterone shrink but also show signs of proliferation and tissue repair; new estradiol supply prevents atrophy but is not sufficient to increase graft volume.

WHAT IS KNOWN ALREADY:

Menstruation, i.e. cyclic proteolysis of the extracellular matrix of endometrial functionalis, is induced by a fall in estrogen and progesterone concentration and is followed by tissue regeneration. However, there is debate about whether regenerating cells must originate from the basalis or from stem cells and whether new estrogen supply is required for the early repair concomitant with menstruation.

STUDY DESIGN, SIZE, DURATION:

Fragments from human endometrial functionalis (from 24 hysterectomy specimens) were xenografted in ovariectomized SCID mice and submitted to a 4-day estradiol and progesterone withdrawal (to mimic menstruation) followed by re-exposure to estradiol (to mimic the proliferative phase). We measured signs of proliferation and changes in graft volume.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Endometrium was collected from spontaneously cycling women. Cell proliferation was examined by immunolabeling Ki-67, cyclin D1 and phosphorylated-histone H3. Xenograft volume was measured by magnetic resonance imaging. Xenograft histomorphometry was performed to determine how the different tissue compartments contributed to volume change.

MAIN RESULTS AND THE ROLE OF CHANCE:

Hormone withdrawal induced a rapid decrease in graft volume mainly attributable to stroma condensation and breakdown, concomitant with an increase of proliferation markers. Reinsertion of estradiol pellets after induced menstruation blocked volume decrease and stimulated epithelial and stromal growth, but, surprisingly, did not induce graft enlargement. Reinsertion of both estradiol and progesterone pellets blocked apoptosis.

LIMITATIONS, REASONS FOR CAUTION:

Mechanisms of endometrial remodeling are different in women and mice and the contribution of circulating inflammatory cells in both species remains to be clarified. Moreover, during human menstruation, endometrial fragments resulting from tissue proteolysis can be expelled by the menstrual flow, unlike in this model.

WIDER IMPLICATIONS OF THE FINDINGS:

Menstruation is a multifocal event within the functionalis. This is the first evidence that endometrial fragments that are not shed after menstrual tissue breakdown can support endometrial regeneration. Endometriosis is commonly thought to result from the retrograde migration of menstrual fragments of the degraded functionalis into the peritoneal cavity. Our study supports their potential to regenerate as ectopic endometrium.

STUDY FUNDING/COMPETING INTERESTS:

This work was supported by the Fonds de la Recherche Scientifique Médicale, Concerted Research Actions, Communauté Française de Belgique, Région wallonne, Région bruxelloise and Loterie nationale. P.H. and B.F.J. are research associates of the Belgian Fonds de la Recherche Scientifique (F.R.S.-F.N.R.S.). E.M. is Associate Editor at Human Reproduction. There is no conflict of interest to declare.

 

 

Hum Reprod Update. 2015 Jul-Aug;21(4):486-99.

Risks of conservative management in women with ovarian endometriomas undergoing IVF.

Somigliana E1Benaglia L2Paffoni A2Busnelli A3Vigano P4Vercellini P3.

 

Abstract

BACKGROUND:

Classical surgical management of endometriotic ovarian cysts using the laparoscopic stripping technique has been recently questioned because of the surgical-related injury to the ovarian reserve. Accordingly, available guidelines suggest that endometriomas with a mean diameter below 4 cm should not be systematically removed before IVF procedures. However, conservative management may have some potential drawbacks and risks. The presence of the endometrioma may theoretically interfere with ovarian responsiveness to hyperstimulation and oocyte competence, the retrieval of the oocytes may be more difficult and risky, the disease may progress during the procedure, pregnancy outcome may be affected and there is the risk of missing occult malignancies with cancer development later in life. In the present review, we aimed at assessing whether these risks do exist and, if so, at estimating their clinical relevance.

METHODS:

We searched PubMed for articles published in the English language between January 1990 and August 2014 that reported on endometriomas and assisted reproductive techniques. Special care was given to studies reporting data purporting to distinguish the effects of ovarian endometriomas per sé from those consequent to surgery for endometriosis or from endometriosis in general.

RESULTS:

Based on the evidence reviewed in the present study, it can be concluded that conservative management may actually expose women to four of the following theoretical risks, i.e. infection of the endometriomas, follicular fluid contamination with the endometrioma content, higher risk of pregnancy complications and cancer development later in life. The first three conditions do not justify surgery because these events are uncommon and the number of women needed to be treated would be exceedingly high and would not justify the costs and risks of the intervention. Albeit also very rare, the possibility of developing ovarian cancer later in life is more troublesome because it is a life-threatening condition. However, this alarmism is supported by only one cohort study and this risk can be effectively prevented by postponing surgery until after the IVF programme is concluded or when women have definitely satisfied their reproductive wishes.

CONCLUSION:

The available evidence on the risks of conservative management does not support systematic surgery before IVF in women with small ovarian endometriomas.

 

 

Int J Gynaecol Obstet. 2015 Jun;129(3):260-3.

Clinical features of fallopian tube accessory ostium and outcomes after laparoscopic treatment.

Zheng X1Han H1Guan J2.

 

Abstract

OBJECTIVE:

To investigate the clinical features of fallopian tube accessory ostium and treatment outcomes after laparoscopic treatment.

METHODS:

A retrospective analysis was conducted of patients who underwent laparoscopy for infertility at Peking University People’s Hospital, Beijing, China, between June 1, 2009, and January 31, 2012. Fallopian tube accessory ostium was treated surgically when identified. Other procedures were conducted simultaneously, if indicated. Patients were interviewed by telephone every 6 months after treatment.

RESULTS:

Among 1113 patients who underwent laparoscopy for infertility, 21 (1.9%) were diagnosed with fallopian tube accessory ostium. Furthermore, 19 (90.5%) of these 21 women were diagnosed with pelvic endometriosis. Accessory ostium was identified in 19 (4.7%) of 403 women with endometriosis versus 2 (0.3%) of 710 women without endometriosis (P=0.001). Among 18 patients with accessory ostium who completed follow-up and wished to conceive, 12 (66.7%) conceived after surgery, one of whom experienced a spontaneous abortion. No ectopic pregnancies occurred.

CONCLUSION:

Accessory ostium was confirmed by a thorough examination of the entire fallopian tube, especially the distal portion, during laparoscopy. Patients experienced satisfactory outcomes after surgical intervention.

 

 

 

Reprod Biomed Online. 2015 May;30(5):553-6.

miR-142-3p is a novel regulator of cell viability and proinflammatory signalling in endometrial stroma cells.

Kästingschäfer CS1Schäfer SD1Kiesel L1Götte M2.

 

Abstract

Endometriosis is associated with severe pelvic pain and reduced fertility. Recently, it has been linked to a dysregulation of microRNAs (miRNAs), which are post-transcriptional regulators of gene expression. The functional effect of dysregulated miR-142-3p expression in endometrial stroma cells was investigated. An increased expression of miR-142-3p resulted in a significantly reduced expression of steroid sulfatase and interleukin-6-coreceptor gp130 as well as reduced interleukin-6-mediated activation of the STAT3-pathway, suggesting an effect of miR-142-3p both on steroid hormone- and cytokine-mediated signalling events. At the functional level, miR-142-3p overexpression significantly reduced cell viability (P ≤ 0.01). miR-142-3p regulation emerges as a future therapeutic strategy for endometriosis.

 

 

Int J Clin Exp Pathol. 2015 Jan 1;8(1):1025-30.

Decidualization of intranodal endometriosis in a postmenopausal woman.

Kim HS1Yoon G2Kim BG2Song SY1.

 

Abstract

Here we describe an unusual case of decidualized endometriosis detected in pelvic lymph nodes. The presence of intranodal ectopic decidua in pregnant women has been described. A few cases of decidualization of endometriotic foci in the pelvic or para-aortic lymph nodes have also been associated with pregnancy. However, decidualized intranodal endometriosis occurring in a postmenopausal woman has not been described. A 52-year-old woman presented with a very large adnexal mass. Menopause occurred at the age of 47, and she had been treated with hormone replacement therapy. She received a total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic and para-aortic lymphadenectomy for clear cell carcinoma of the right ovary. Histological examination revealed the presence of ectopic decidua in several pelvic lymph nodes. The deciduas consisted of sheets of loosely cohesive, large, uniform, round cells with abundant eosinophilic cytoplasm. Typical of decidualization of intranodal endometriosis, a few irregularly shaped, inactive endometrial glands lined by single layers of columnar to cuboidal epithelium were present within the decidua. An immunohistochemical study revealed that the decidual cells were positive for CD10, vimentin, estrogen receptor and progesterone receptor, which indicated that progestin-induced decidualization had occurred in the intranodal endometriotic stroma. To the best of our knowledge, this case represents the first report of decidualized intranodal endometriosis occurring in association with hormone replacement therapy in a postmenopausal woman. Misdiagnosis of this condition as a metastatic tumor can be avoided by an awareness of these benign inclusions, supported by immunohistochemical staining results.

 

 

FP Essent. 2015 Mar;430:23-8.

Urogynecologic conditions: pelvic organ prolapse.

Noor NGarely AD.

 

Abstract

Chronic pelvic pain is a commonly encountered condition that often is multifactorial. Etiologies include gynecologic, urologic, gastrointestinal, and neurologic conditions. Laboratory tests, imaging, and surgical intervention are not always helpful in identifying the etiology of pelvic pain. For appropriate management of this complex disease process, a detailed history and physical examination, and a multidisciplinary approach are needed. Pelvic pain may be caused by endometriosis, pelvic inflammatory disease, adenomyosis, interstitial cystitis/painful bladder syndrome, or other factors. Evaluation may include keeping a pain diary; laboratory tests, such as a pregnancy test, urinalysis, or tests for sexually transmitted infections; ultrasonography of abnormalities detected on physical examination; and laparoscopy. Specific first-line treatments include nonsteroidal anti-inflammatory drugs and oral contraceptives for endometriosis; progestins, gonadotropin-releasing hormone analogs, aromatase inhibitors, or hysterectomy for adenomyosis; and education, food avoidance, and behavioral modifications for interstitial cystitis/painful bladder syndrome. Surgical options include nerve transection procedures, laparoscopic uterosacral nerve ablation, and presacral neurectomy, although data on effectiveness are limited.

 

 

J Minim Invasive Gynecol. 2015 Jul-Aug;22(5):719-26.

Circulating Micro-RNAs as Diagnostic Biomarkers for Endometriosis: Privation and Promise.

Nothnick WB1Al-Hendy A2Lue JR2.

 

Abstract

Endometriosis represents a major medical concern in women of reproductive age. One of the remaining major hurdles for successful treatment of endometriosis is the limitation of the process of timely disease diagnosis. A simple blood test for endometriosis-specific biomarkers would offer a more timely accurate diagnosis for the disease, thus allowing for earlier treatment intervention. Although there have been considerable efforts to identify such biomarkers, no clear choice for such noninvasive diagnostic tools has been identified. Micro-RNAs are small noncoding RNAs that have been evaluated intensively as biomarkers for several diseases, and they may hold promise for a diagnosis of endometriosis. In this review, we highlight the need for noninvasive testing for endometriosis, discuss the potential use of micro-RNAs as diagnostic tools for this disease, and consider potential limitations in the use of these small RNA molecules as diagnostic markers for endometriosis.

 

 

J Minim Invasive Gynecol. 2015 Jul-Aug;22(5):776-84.

Contribution of Computed Tomography Enema and Magnetic Resonance Imaging to Diagnose Multifocal and Multicentric Bowel Lesions in Patients With Colorectal Endometriosis.

Belghiti J1Thomassin-Naggara I2Zacharopoulou C1Zilberman S1Jarboui L3Bazot M2Ballester M4Daraï E5.

 

Abstract

STUDY OBJECTIVE:

To evaluate the diagnostic contribution of the computed tomography (CT) enema and magnetic resonance imaging (MRI) for multifocal (multiple lesions affecting the same segment) and multicentric (multiple lesions affecting several digestive segments) bowel endometriosis.

DESIGN:

Prospective cohort study (Canadian Task Force classification II-2).

PATIENTS:

Eighty-five patients.

SETTING:

Tenon University Hospital, Paris, France.

INTERVENTION:

All patients received a preoperative CT enema and underwent MRI interpreted by 2 radiologists.

MEASUREMENTS AND MAIN RESULTS:

Patients underwent colorectal resection for colorectal endometriosisfrom February 2009 to November 2012. Nineteen patients (22%) had multifocal lesions, and 11 patients (13%) had multicentric lesions. Six patients (7%) had both multifocal and multicentric lesions. The sensitivity, specificity, and positive and negative likelihood ratios (LRs) of MRI for the diagnosis of multifocal lesions were 0.58, 0.84, 3.55, and 0.5, respectively. The sensitivity, specificity, and positive and negative LRs of the CT enema for the diagnosis of multifocal lesions were 0.64, 0.86, 4.56, and 0.4, respectively. The sensitivity, specificity, and positive LR of MRI for the diagnosis of multicentric lesions were 1, 0.88, and 8.4, respectively. The sensitivity, specificity, and positive and negative LRs of MRI for the diagnosis of multicentric lesions were 0.46, 0.92, 5.6, and 0.59, respectively. No difference was observed between MRI and the CT enema for the diagnosis of multifocal and multicentric colorectal endometriosis. The interobserver agreement was good for MRI and the CT enema (κ = 0.45 and 0.45) for multifocality, and it was poor for both MRI and the CT enema (κ = 0.32 and 0.34) for multicentricity.

CONCLUSIONS:

Both MRI and the CT enema were able to diagnose multifocal and multicentric bowel endometriosis with similar accuracy.

 

 

J Assist Reprod Genet. 2015 May;32(5):685-9.

Laparoscopic excision of ovarian endometrioma does not exert a qualitative effect on ovarian function: insights from in vitro fertilization and single embryo transfer cycles.

Harada M1Takahashi NHirata TKoga KFujii TOsuga Y.

 

Abstract

PURPOSE:

To evaluate whether laparoscopic excision of endometrioma exerts a qualitative effect on ovarian function.

METHODS:

A retrospective analysis of oocytes retrieved in 25 cycles of 21 patients undergoing IVF treatment with controlled ovarian stimulation. The number of oocytes recovered from ovaries with a history of excision of endometrioma (E-Ov) were compared to those from contra-lateral healthy ovaries (H-Ov) as for the analysis of a quantitative effect of surgery. As for the analysis of a qualitative effect, 55 oocytes from E-Ov were compared to 128 oocytes from H-Ov in terms of normal fertilization rate and the rate of top-quality embryos per normally fertilized eggs. Furthermore, 10 embryos derived from oocytes recovered from E-Ov were compared to 24 embryos derived from oocytes from H-Ov in terms of clinical and on-going pregnancy rates per embryos in 34 single embryo transfer cycles.

RESULTS:

Mean number of oocytes recovered from E-Ov was significantly smaller than that from H-Ov (2.2 ± 2.0 vs. 5.1 ± 3.3, P = 0.009). There was no difference between oocytes from E-Ov and H-Ov as for normal fertilization rate (63.6% vs. 69.5%, P = 0.43) and the rate of top-quality embryos (40.0% vs. 49.0%, P = 0.34). Clinical and on-going pregnancy rates per embryos were also similar in embryos derived from oocytes recovered from E-Ov and H-Ov (40.0% vs. 25.0%, P = 0.39 and 20.0% vs. 20.8%, P = 0.96).

CONCLUSIONS:

The quality of oocytes recovered from the ovary with a history of laparoscopic excision of endometrioma is not inferior to the quality of oocytes from contra-lateral healthy ovary.

 

 

Reprod Sci. 2015 Sep;22(9):1098-106.

Periostin Enhances Migration, Invasion, and Adhesion of Human Endometrial Stromal Cells Through Integrin-Linked Kinase 1/Akt Signaling Pathway.

Xu X1Zheng Q1Zhang Z2Zhang X1Liu R1Liu P3.

 

Abstract

Although our previous study confirmed that periostin (PN) was overexpressed in the eutopic and ectopic endometrial stroma of women with endometriosis by immunohistochemitry, the role of PN in the pathophysiology of endometriosis remains unknown. Thus, we aimed to investigate the effects of PN on endometrial stromal cells (ESCs) migration, invasion, adhesion, and proliferation and to further study the mechanism under this process. Eutopic (EuSCs), ectopic (EcSCs), and normal ESCs (NSCs) were isolated and cultured. We evaluated the above-mentioned biology behaviors and the expression of PN, integrin-linked kinase 1 (ILK1), and phospho-Akt (p-Akt) in NSCs, EuSCs as well as EcSCs before and after receiving PN small-interfering RNA (siRNA). The protein and messenger RNA (mRNA) levels of PN were upregulated in EuSCs (P < .05; P = .2261 in proliferative phase and P = .3385 in secretory phase) and EcSCs (P < .001; P < .001 in proliferative phase and P < .05 in secretory phase) compared with NSCs, although there was no significant difference in PN mRNA between EuSCs and NSCs. In EcSCs, abilities of migration, invasion, and adhesion and the expressions of ILK1 and p-Akt were enhanced; and all of those were downregulated after PN siRNA interference. Thus, PN enhanced ESCs migration, invasion, and adhesion due to the ILK1/Akt signal pathway. As an agonist in the development and progression of endometriosis, PN may be a new clinical treatment target of endometriosis.

 

 

Rev Bras Ginecol Obstet. 2015 Feb;37(2):77-81.

Predictive factors for recurrence of ovarian endometrioma after laparoscopic excision.

Carvalho Mde S1Pereira AM1Martins JA1Lopes RC1.

 

Abstract

PURPOSE:

To analyze the factors that might influence the recurrence of ovarian endometriomas after laparoscopic excision.

METHODS:

A retrospective cohort study. We evaluated 129 patients who underwent laparoscopic excision of ovarian endometriomas from 2003 to 2012 and who were followed up for at least two years after surgery. Vaginal ultrasound was repeated to exclude persistent lesion and to identify recurrence. The Student’s t-test was used to compare continuous variables and the χ2 or Fischer exact test (for values of less than five) was used to test homogeneity between proportions. A logistic regression model for multivariate proportional hazards was used to analyze predictors of long-term outcome. The level of significance was set at 5% in all analyses.

RESULTS:

The overall rate of ovarian endometrioma recurrence was 18.6%. Endometrioma diameter, surgical procedure techniques and demographic data such as age, presenting symptoms, body mass index, smoking and physical exercise habits were not associated with recurrence, whereas interruption of postoperative medical treatment was significantly correlated with a higher recurrence rate (OR 23.7; 95%CI 5.26-107.05; p=0.001).

CONCLUSION:

Current oral contraceptive use appears to be associated with a dramatic reduction in the risk of recurrence of ovarian endometriotic cysts. Treatment interruption was associated with a higher recurrence rate of ovarian endometrioma after laparoscopic treatment.

 

 

Rev Bras Ginecol Obstet. 2015 Feb;37(2):87-93

Histological classification and quality of life in women with endometriosis.

Porto BT1Ribeiro HS1Galvão MA2Sekula VG3Aldrigui JM1Ribeiro PA1.

 

Abstract

PURPOSE:

To assess the relationship between the histological classification and the quality of life of patients operated for endometriosis.

METHODS:

A cross-sectional observational study, with assessment of 32 biopsies of the intestine, peritoneum and uterosacral ligament from 40 women with deep endometriosis. The quality of life (QOL) was determined by applying the SF-36 questionnaire pre-operatively and at 6 and 12 months postoperatively. Biopsies were histologically classified into pure stromal (EP), glandular differentiated (GD), glandular undifferentiated (GI) and mixed (GM), remaining in the sample only GI and GM, which are related to eight domains of the SF-36.

RESULTS:

According to the histologic type, the following distribution was observed: peritoneum 63% GI and 35% GM; intestine 19% GI and 24% GM; uterosacral ligament with 41% GI and 35% GM. Regarding the QOL and the histological classification, in the intestine only GM was associated with improvement of social and emotional aspects from 0 to 6 months; the domains general health status (p=0.01) and social aspect (p=0.04) were significantly related to improvement of the QOL from 0 to 6 months, and the general health status tended to improve from 0 to 12 months. Regarding pain (p=0.06) and the emotional aspect (p=0.05), the QOL tended to improve from 0 to 6 months and the vital capacity (p=0.1) improved from 0 to 6 months and from 0 to 12 months. Regarding the emotional aspect, evolution of the two histological types was not favorable for improvement in MG from 0 to 6 months. No significant relationships between histologic type and QOL were evident in the uterosacral ligament samples.

CONCLUSION:

Improvement in the QOL of women undergoing laparoscopic surgery for deep endometriosis is associated with the histologic grade. The peritoneal biopsy of GI revealed improved QOL after surgery.

 

 

Int J Gynecol Pathol. 2015 May;34(3):245-52.

Pathology of endometrial ablation failures: a clinicopathologic study of 164 cases.

Simon RA1Quddus MRLawrence WDSung CJ.

 

Abstract

Endometrial ablation is a minimally invasive alternative to hysterectomy for abnormal uterine bleeding. Although the failure rate is low, continued bleeding or development of pelvic pain after ablation does occur. We analyzed the clinicopathologic features of 164 hysterectomy specimens after endometrial ablation, 19 of which were performed for indications other than failed ablation (control cases). Pathologic findings included: dense fibrosis and hyalinization of the endometrial surface ablative necrosis within the uterine cavity and adherent to the endometrial surface, persistent months after ablation; uterine cavity lined by superficial, large, congested, patent blood vessels with atherosis; ablation changes present only in the lower uterine segment; and residual endometrium present in the cornual regions. Patients with ablative necrosis underwent subsequent hysterectomy sooner than those without such debris (median of 5 vs. 23 mo, respectively). Patients with superficial abnormal vessels were also more likely to have a shorter ablation-hysterectomy interval than those without (median of 2 vs. 18 mo, respectively). Patients with associated adenomyosis or prior tubal ligation were significantly more likely to have continued bleeding. Possible sources of continued abnormal bleeding or pelvic pain include: the presence of ablative necrosis or superficial abnormal blood vessels, although the association did not reach statistical significance in this study; incomplete ablation, affecting only the lower uterine segment or sparing the cornual region; tubal endometriosis after ligation; and endometrial regeneration via adenomyosis.

 

 

Int J Gynecol Pathol. 2015 May;34(3):275-80.

Pseudoxanthomatous salpingitis as an ex vivo model of fallopian tube serous carcinogenesis: a clinicopathologic study of 49 cases.

Seidman JD1Woodburn R.

 

Abstract

Iron is a well-documented carcinogen based on both animal models and observational studies in humans. There are limited published data on pseudoxanthomatous salpingitis, an uncommon condition characterized by the accumulation of histiocytes containing iron and iron-related compounds-lipofuscin and hemosiderin-in the lamina propria of the fallopian tube. The clinical and pathologic features of 49 consecutive cases were evaluated. The mean patient age was 53. A history of endometriosis was found in 20%, infertility in 17%, and tubal ligation in 7%. Thirteen (27%) had endometrial cancer and 2 patients had prior radiation therapy for cervical carcinoma. Histologic evidence of endometriosis other than tubal pigment deposition was identified in 65%, and in the fallopian tubes in 35%. Pigment deposition was unilateral in 65% and multifocal or diffuse in 80%. Plasma cells, eosinophils, and neutrophils were present in the tubal lamina propria in 57%, 18%, and 24%, respectively. Hydrosalpinx was present in 51%. An iron stain was positive in pseudoxanthoma cells lacking hemosiderin in 14 of 18 cases (78%). By immunohistochemistry, 2 of 22 cases displayed p53 signatures. The Ki67 proliferation index was elevated (>10%) in 11 of 22 cases, with a mean index of 32% in those cases. An elevated proliferation index did not correlate with inflammation. In summary, these findings characterize the clinical and pathologic features of pseudoxanthomatous salpingitis and confirm its close association with endometriosis, occasional association with radiation therapy, and the presence of iron in the histiocytes. In view of the evolving paradigm shift implicating the fallopian tubal epithelium as the site of origin of high-grade extrauterine serous carcinoma, the presence of iron and iron-related compounds in the fallopian tube provides an opportunity to study the early events in high-grade serous carcinogenesis in a setting characterized by a well-documented carcinogen in close anatomic proximity to the putative epithelium of origin.

 

 

Cancer Res Treat. 2016 Jan;48(1):250-8.

Systemic Inflammatory Response Markers and CA-125 Levels in Ovarian Clear Cell Carcinoma: A Two Center Cohort Study.

Kim HS1Choi HY2Lee M2Suh DH3Kim K3No JH3Chung HH2Kim YB3Song YS4.

 

Abstract

PURPOSE:

We compared the predictive and prognostic values of leukocyte differential counts, systemic inflammatory (SIR) markers and cancer antigen 125 (CA-125) levels, and identified the most useful marker in patients with ovarian clear cell carcinoma (OCCC).

MATERIALS AND METHODS:

The study included 109 patients with OCCC who did not have any inflammatory conditions except endometriosis, and underwent primary debulking surgery between 1997 and 2012. Leukocyte differential counts (neutrophil, lymphocyte, monocyte, eosinophil, basophil, and platelet), SIR markers including neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelet to lymphocyte ratio (PLR), and CA-125 levels were estimated to select potential markers for clinical outcomes.

RESULTS:

Among potential markers (neutrophil, monocyte, platelet, NLR, MLR, PLR, and CA-125 levels) selected by stepwise comparison, CA-125 levels were best at predicting advanced stage disease, suboptimal debulking and platinum-resistance (cut-off values, ≥ 46.5, ≥ 11.45, and ≥ 66.4 U/mL; accuracies, 69.4%, 78.7%, and 68.5%) while PLR ≥ 205.4 predicted non-complete response (CR; accuracy, 71.6%) most accurately. Moreover, PLR < 205.4 was an independent factor for the reduced risk of non-CR (adjusted odds ratio, 0.17; 95% confidence interval [CI], 0.04 to 0.69), and NLR < 2.8 was a favorable factor for improved progression-free survival (PFS; adjusted hazard ratio, 0.49; 95% CI, 0.25 to 0.99) despite lack of a marker for overall survival among the potential markers.

CONCLUSION:

CA-125 levels may be the most useful marker for predicting advanced-stage disease. Suboptimal debulking and platinum-resistance, and PLR and NLR may be most effective to predict non-CR and PFS in patients with OCCC.

 

 

 

 

 

Acta Obstet Gynecol Scand. 2015 Jun;94(6):637-45.

Gonadotrophin-releasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis: a multi-center randomized trial.

Granese R1Perino A2Calagna G2Saitta S3De Franciscis P4Colacurci N4Triolo O1Cucinella G2.

 

Abstract

OBJECTIVES:

To evaluate the efficacy of dienogest + estradiol valerate (E2V) and gonadotrophin-releasing hormone analogue (GnRH-a) in reducing recurrence of pain in patients with chronic pelvic pain due to laparoscopically diagnosed and treated endometriosis.

DESIGN:

Multi-center, prospective, randomized study.

SETTING:

Three university departments of obstetrics and gynecology in Italy.

POPULATION:

Seventy-eight women who underwent laparoscopic surgery for endometriosis combined with chronic pelvic pain.

METHODS:

Post-operative administration of dienogest + E2V for 9 months (group 1) or GnRH-a monthly for 6 months (group 2).

MAIN OUTCOME MEASURES:

A visual analogue scale was used to test intensity of pain before laparoscopic surgery at 3, 6 and 9 months of follow up. A questionnaire to investigate quality of life was administered before surgery and at 9 months of follow up.

RESULTS:

The visual analogue scale score did not show any significant differences between the two groups (p = 0.417). The questionnaire showed an increase of scores for all women compared with pre-surgery values, demonstrating a marked improvement in quality of life and health-related satisfaction with both treatments. No significant differences were found between the groups. The rate of apparent endometriosis recurrence was 10.8% in group 1 and 13.7% in group 2 (p = 0.962).

CONCLUSION:

Both therapies seemed equally efficacious in preventing endometriosis-related chronic pelvic pain recurrence in the first 9 months of follow-up.

 

 

BMJ Open. 2015 Mar 11;5(3)

Disease history and risk of comorbidity in women’s life course: a comprehensive analysis of the Japan Nurses’ Health Study baseline survey.

Nagai K1Hayashi K1Yasui T2Katanoda K3Iso H4Kiyohara Y5Wakatsuki A6Kubota T7Mizunuma H8.

 

Abstract

OBJECTIVE:

To classify diseases based on age at peak incidence to identify risk factors for later disease in women’s life course.

DESIGN:

A cross-sectional baseline survey of participants in the Japan Nurses’ Health Study.

SETTING:

A nationwide prospective cohort study on the health of Japanese nurses. The baseline survey was conducted between 2001 and 2007 (n=49,927).

MAIN OUTCOME MEASURES:

Age at peak incidence for 20 diseases from a survey of Japanese women was estimated using the Kaplan-Meier method with the Kernel smoothing technique. The incidence rate and peak incidence for diseases whose peak incidence occurred before the age of 45 years or before the perimenopausal period were selected as early-onset diseases. The OR and 95% CI were estimated to examine the risk of comorbidity between early-onset and other diseases.

RESULTS:

Four early-onset diseases (endometriosis, anaemia, migraine headache and uterine myoma) were significantly correlated with one another. Late-onset diseases significantly associated (OR>2) with early-onset diseases included comorbid endometriosis with ovarian cancer (3.65 (2.16 to 6.19)), endometrial cancer (2.40 (1.14 to 5.04)) and cerebral infarction (2.10 (1.15 to 3.85)); comorbid anaemia with gastric cancer (3.69 (2.68 to 5.08)); comorbid migraine with transient ischaemic attack (3.06 (2.29 to 4.09)), osteoporosis (2.11 (1.71 to 2.62)), cerebral infarction (2.04 (1.26 to 3.30)) and angina pectoris (2.00 (1.49 to 2.67)); and comorbid uterine myoma with colorectal cancer (2.31 (1.48 to 3.61)).

CONCLUSIONS:

While there were significant associations between four early-onset diseases, women with a history of one or more of the early-onset diseases had a higher risk of other diseases later in their life course. Understanding the history of early-onset diseases in women may help reduce the subsequent risk of chronic diseases in later life.

 

 

BMJ Case Rep. 2015 Mar 11;2015

A case of endometriosis presenting as an inguinal hernia.

Husain F1Siddiqui ZA2Siddiqui M3.

 

Abstract

Endometriosis is a common clinical presentation for gynaecologists. Occasionally it can present to general surgeons as a swelling in the groin or abdominal wall. This condition should be included in the differential diagnosis in female patients. A 32-year-old woman with a 2-year history of a painful persistent lump in her right groin was referred to the general surgeons by her general practitioner. She was referred with a diagnosis of a suspected inguinal hernia. MRI excluded a hernia and exploration of the groin and subsequent histology confirmed the lesion to be an endometrial deposit.

 

 

Diagn Ther Endosc. 2015;2015

Laparoscopic treatment of 1522 adnexal masses: an 8-year experience.

Grammatikakis I1Trompoukis P1Zervoudis S2Mavrelos C2Economides P2Tziortzioti V1Evangelinakis N1Kassanos D1.

 

Abstract

Objective. To reevaluate the long-term effectiveness and safety of laparoscopy in benign ovarian pathology. Materials and Methods. 1522 women with benign adnexal cysts, laparoscopically treated in the 3rd Department of Ob/Gyn, General University hospital “Attikon” and “Lito” Maternity Hospital between July 1998 and December 2006, were included. Results. The diagnosis in 1222 (80,6%) cases was endometriosis of the ovary, 60 (4%) hydrosalpinx, 51 (3,3%) serous cystadenomas, 44 (2,9%) dermoid ovarian cyst, 38 (2,5%) borderline tumors, 35 (2,3%) unruptured follicles, and 33 (2,2%) paraovarian cysts. In 174 cases (11,5%) laparoscopy was converted to laparotomy due to technical difficulties or suspicion of cancer. In particular, laparotomy was performed in 119 (8%) women due to severe adhesions and 18 (1,2%) women due to bleeding that could not be controlled safely by laparoscopy. In 36 (2,4%) women frozen section during operation revealed malignancy and laparoscopy was converted to laparotomy. A few operative complications were recorded like post-op fever, small hematomas at the trocar entries. Conclusions. Laparoscopic surgery seems to offer significant advantages such as reduced hospital stay, less adverse effects, better quality of life, and superior vision especially on surgical treatment of cases like endometriosis.

 

 

Iran Red Crescent Med J. 2014 Oct 5;16(11)

Functional rudimentary horn as a rare cause of pelvic pain: a case report.

Arab M1Mehdighalb S2Khosravi D2.

 

Abstract

INTRODUCTION:

Pelvic pain results from many causes such as primary dysmenorrhea, uterine anomalies, menstrual outflow obstruction, endometriosis, myoma and adenomyosis. This study reports on a rare case of non-communicating functional rudimentary horn.

CASE PRESENTATIONS:

A 15-year-old nulligravida young woman with a history of severe intermittent pelvic pain presented a 4-5 centimeter mass. A surgical procedure for appendicitis was previously performed on this patient. Per-operative diagnosis was myoma and suspicion of leismus sarcoma. Laparotomy revealed left rudimentary horn, non-communication was confirmed by postoperative hysterosalpingogram (HSG) and magnetic resonance imaging (MRI). Resection of mass and left fallopian tube was done during the second surgery.

CONCLUSIONS:

Rudimentary horn should be considered in differentiation of pelvic pain and mass in young females. Early diagnosis and horn resection prevents emergency surgery and reliefs pain.

 

 

Hum Reprod Update. 2015 Jul-Aug;21(4):500-16.

Endometriosis: a high-risk population for major chronic diseases?

Kvaskoff M1Mu F2Terry KL3Harris HR4Poole EM5Farland L2Missmer SA3.

 

Abstract

BACKGROUND:

Despite an estimated prevalence of 10% in women, the etiology of endometriosis remains poorly understood. Over recent decades, endometriosis has been associated with risk of several chronic diseases, such as cancer, autoimmune diseases, asthma/atopic diseases and cardiovascular diseases. A deeper understanding of these associations is needed as they may provide new leads into the causes or consequences of endometriosis. This review summarizes the available epidemiological findings on the associations between endometriosis and other chronic diseases and discusses hypotheses for underlying mechanisms, potential sources of bias and methodological complexities.

METHODS:

We performed a comprehensive search of the PubMed/Medline and ISI Web of Knowledge databases for all studies reporting on the associations between endometriosis and other diseases published in English through to May 2014, using numerous search terms. We additionally examined the reference lists of all identified papers to capture any additional articles that were not identified through computer searches.

RESULTS:

We identified 21 studies on the associations between endometriosis and ovarian cancer, 14 for breast cancer, 8 for endometrial cancer, 4 for cervical cancer, 12 for cutaneous melanoma and 3 for non-Hodgkin’s lymphoma, as well as 9 on the links between endometriosis and autoimmune diseases, 6 on the links with asthma and atopic diseases, and 4 on the links with cardiovascular diseases. Endometriosis patients were reported to be at higher risk of ovarian and breast cancers, cutaneous melanoma, asthma, and some autoimmune, cardiovascular and atopic diseases, and at decreased risk of cervical cancer.

CONCLUSIONS:

Increasing evidence suggests that endometriosis patients are at higher risk of several chronic diseases. Although the underlying mechanisms are not yet understood, the available data to date suggest that endometriosis is not harmless with respects to women’s long-term health. If these relationships are confirmed, these findings may have important implications in screening practices and in the management and care of endometriosis patients.

 

 

Mol Cell Endocrinol. 2015 May 15;407:9-17.

Di-(2-ethylhexyl)-phthalate induces oxidative stress in human endometrial stromal cells in vitro.

Cho YJ1Park SB1Han M2.

 

Abstract

Di-(2-ethylhexyl)-phthalate (DEHP) accumulates in the environment, and its exposure is possibly associated with endocrine-related disease in women of reproductive age. The effects of DEHP on human endometrial cells are unknown. We treated human endometrial stromal cells with 10, 100, and 1000 pmol of DEHP and measured reactive oxygen species (ROS) generation, expression levels of antioxidant enzymes, alteration of MAPK/NF-κB signaling and hormonal receptors. DEHP increased reactive oxygen species (ROS) generation and decreased expression of superoxide dismutase (SOD), glutathione peroxidase (GPX), heme oxygenase (HO), and catalase (CAT). By DEHP exposure, p-ERK/p-p38 and NF-κB mediated transcription was increased. Additionally, DEHP induced estrogen receptor-α (ER-α) expression in a dose-dependent manner. This study shows the need for future mechanistic studies of oxidative stress, MAPK/NF-κB signaling, and ER-α as molecular mediators of DEHP-associated endometrial stromal cell alterations, which may be associated with the development of endocrine-related disease such as endometriosis.

 

 

Gynecol Obstet Invest. 2015;80(3):187-92

Activated Platelets Induce Estrogen Receptor β Expression in Endometriotic Stromal Cells.

Zhang Q1Ding DLiu XGuo SW.

 

Abstract

BACKGROUND/AIMS:

Endometriosis is viewed first and foremost as an estrogen-dependent disease, featuring not only excessive estrogen production but also aberrant expression of estrogen receptors (ERs), particularly ERβ, that mediate the estrogen action. ERβ is the predominant ER in mediating estrogen action in endometriosis, and estrogen plays a vital role in the development of endometriosis; thus, ERβ is viewed as a strong candidate for therapeutic targeting. Given our recent finding that platelets aggregate in endometriotic lesions, we sought to investigate whether activated platelets can upregulate ERβ.

METHODS:

Using primary endometriotic stromal cells derived from patients with ovarian endometriomas and platelets harvested from healthy donors, we performed real-time RT-PCR analysis of mRNA abundance (n = 8) and Western blot analysis of protein expression (n = 8) of ERα and ERβ when co-cultured with phosphate-buffered saline, platelets, thrombin alone, and platelets plus thrombin for 48 h.

RESULTS:

Treatment of endometriotic stromal cells with activated platelets resulted in the upregulation of ERβ gene and protein expression.

CONCLUSION:

In the presence of aggregated and thus activated platelets in endometriotic lesions, ERβ, but not ERα, is upregulated in endometriotic stromal cells. Our result suggests that the use of antiplatelet therapy may have potential in the treatment of endometriosis.

 

Ultrasound Obstet Gynecol. 2015 Dec;46(6):737-40.

Interobserver agreement and accuracy of non-invasive diagnosis of endometriosis by transvaginal sonography.

Tammaa A1Fritzer N1Lozano P1Krell A1Salzer H1Salama M2Hudelist G1,3.

 

Abstract

OBJECTIVES:

To evaluate interobserver agreement and accuracy of transvaginal sonography (TVS) in diagnosing deep infiltrating endometriosis (DIE) and endometriomas.

METHODS:

A total of 67 consecutive patients referred to a pelvic pain clinic and scheduled for laparoscopy were enrolled in the study between January 2013 and January 2014. Patients were independently examined prospectively by two experienced sonographers (Observers A and B) who were blinded to the other’s results. For the two observers, Gwet’s first-order agreement coefficient (Gwet’s AC1) was used to calculate interobserver agreement and diagnostic accuracy, as well as sensitivity, specificity, positive (PPV) and negative (NPV) predictive values using TVS, as compared to laparoscopy, for diagnosing DIE and endometriomas.

RESULTS:

Among the 67 patients enrolled, 65 were analyzed. For the diagnosis of DIE and endometriomas by TVS, the level of agreement (Gwet’s AC1) between Observers A and B and sensitivity/specificity values for the respective Observers were, by site: vagina (Gwet’s AC1, 0.933; 62%/94% and 82%/94%), bladder (Gwet’s AC1, 1.00; 67%/97% and 67%/97%), uterosacral ligaments (Gwet’s AC1, 0.84; 73%/83% and 53%/90%), adnexa (Gwet’s AC1, 0.95; 71%/93% and 71%/93%), rectovaginal septum (Gwet’s AC1, 0.95; 40%/90% and 33%/87%) and rectosigmoid (Gwet’s AC1, 0.98; 93%/96% and 94%/98%) which reflected high interobserver agreement. With the exception of sensitivity of diagnosis of DIE affecting the RVS, similar results were observed when TVS was compared with laparoscopy.

CONCLUSIONS:

TVS is a highly accurate and reproducible method for non-invasive diagnosis of DIE by well-trained professionals.

 

 

J Endocrinol. 2015 May;225(2):69-76.

Dienogest reduces HSD17β1 expression and activity in endometriosis.

Mori T1Ito F2Matsushima H2Takaoka O2Koshiba A2Tanaka Y2Kusuki I2Kitawaki J2.

 

Abstract

Endometriosis is an estrogen-dependent disease. Abnormally biosynthesized estrogens in endometriotic tissues induce the growth of the lesion and worsen endometriosis-associated pelvic pain. Dienogest (DNG), a selective progesterone receptor agonist, is widely used to treat endometriosis and efficiently relieves the symptoms. However, its pharmacological action remains unknown. In this study, we elucidated the effect of DNG on enzymes involved in local estrogen metabolism in endometriosis. Surgically obtained specimens of 23 ovarian endometriomas (OE) and their homologous endometrium (EE), ten OE treated with DNG (OE w/D), and 19 normal endometria without endometriosis (NE) were analyzed. Spheroid cultures of stromal cells (SCs) were treated with DNG and progesterone. The expression of aromatase, 17β-hydroxysteroid dehydrogenase 1 (HSD17β1), HSD17β2, HSD17β7, HSD17β12, steroid sulfatase (STS), and estrogen sulfotransferase (EST) was evaluated by real-time quantitative PCR. The activity and protein level of HSD17β1 were measured with an enzyme assay using radiolabeled estrogens and immunohistochemistry respectively. OESCs showed increased expression of aromatase, HSD17β1, STS, and EST, along with decreased HSD17β2 expression, when compared with stromal cells from normal endometria without endometriosis (NESCs) (P<0.01) or stromal cells from homologous endometrium (EESCs) (P<0.01). In OESCs, DNG inhibited HSD17β1 expression and enzyme activity at 10(-7) M (P<0.01). Results of immunohistochemical analysis displayed reduced HSD17β1 staining intensity in OE w/D (P<0.05). In conclusion, DNG exerts comprehensive inhibition of abnormal estrogen production through inhibition of aromatase and HSD17β1, contributing to a therapeutic effect of DNG on endometriosis.

 

 

J Ultrasound. 2014 Mar 13;18(1):71-2.

Premenstrual inguinal swelling and pain caused by endometriosis in the Bartholin gland: a case report.

Robotti G1Canepari E2Torresi M2.

 

Abstract

Endometriosis is a pathological condition characterized by the presence of endometrial tissue outside the endometrium. The authors describe a case of endometriosis in the Bartholin gland, which was initially diagnosed as a Bartholin gland cyst. The correct diagnosis was later made on the basis of the patient history and the results of the ultrasound examination. Endometriosis in the Bartholin gland should be considered in the presence of dyspareunia, cyclic swelling and pain at the vulvar level, and characteristic ultrasound findings.

 

 

 

Med Care. 2015 Apr;53(4 Suppl 1):S63-7.

Reproductive health diagnoses of women veterans using department of Veterans Affairs health care.

Katon JG1Hoggatt KJBalasubramanian VSaechao FSFrayne SMMattocks KMFeibus KBGalvan IVHickman RHayes PMHaskell SGYano EMPhibbs CSZephyrin LC.

 

Abstract

BACKGROUND:

Little is known regarding the reproductive health needs of women Veterans using Department of Veterans Affairs (VA) health care.

OBJECTIVE:

To describe the reproductive health diagnoses of women Veterans using VA health care, how these diagnoses differ across age groups, and variations in sociodemographic and clinical characteristics by presence of reproductive health diagnoses.

RESEARCH DESIGN:

This study is a cross-sectional analysis of VA administrative and clinical data.

SUBJECTS:

The study included women Veterans using VA health care in FY10.

MEASURES:

Reproductive health diagnoses were identified through presence of International Classification of Disease, 9th Revision (ICD-9) codes in VA clinical and administrative records. The prevalence of specific diagnosis categories were examined by age group (18-44, 45-64, ≥65 y) and the most frequent diagnoses for each age group were identified. Sociodemographic and clinical characteristics were compared by presence of at least 1 reproductive health diagnosis.

RESULTS:

The most frequent reproductive health diagnoses were menstrual disorders and endometriosis among those aged 18-44 years (n=16,658, 13%), menopausal disorders among those aged 45-64 years (n=20,707, 15%), and osteoporosis among those aged ≥65 years (n=8365, 22%). Compared with women without reproductive health diagnoses, those with such diagnoses were more likely to have concomitant mental health (46% vs. 37%, P<0.001) and medical conditions (75% vs. 63%, P<0.001).

CONCLUSIONS:

Women Veterans using VA health care have diverse reproductive health diagnoses. The high prevalence of comorbid medical and mental health conditions among women Veterans with reproductive health diagnoses highlights the importance of integrating reproductive health expertise into all areas of VA health care, including primary, mental health, and specialty care.

 

 

Obstet Gynecol Surv. 2015 Mar;70(3):183-95.

Current treatment of endometrioma.

Kaponis A1Taniguchi F2Azuma Y3Deura I4Vitsas C5Decavalas GO6Harada T7.

 

Abstract

IMPORTANCE:

Ovarian endometrioma is the most common form of endometriosis. Laparoscopy is frequently chosen for its treatment because medical treatment alone is inadequate. However, the role of laparoscopic treatment of ovarian endometriomas has been challenged by evidence questioning the benefits of surgery, especially in cases of young or infertile women. Other therapeutic modalities include expectant management, medical therapy, and, in cases of infertility, ovulation induction and assisted reproductive technology. None of these treatments offer cure of endometriosis.

OBJECTIVE:

The objective of this study was to present data concerning the current management of endometrioma. Benefits and complications after treatment and the impact on in vitro fertilization outcome are also highlighted.

EVIDENCE ACQUISITION:

An extensive literature search (PubMed) and Cochrane Library review up to December 2013 were performed using the following keywords: “endometrioma,” “cystectomy,” “infertility,” “IVF,” “malignant transformation,” “management,” and “recurrence.”

RESULTS:

There is a lack of data from randomized trials to inform the optimal management of endometriomas with respect to pain relief, recurrence, and fertility.

CONCLUSIONS AND RELEVANCE:

Further studies are needed to determine the optimal management of endometrioma. Currently, there is no evidence that surgical management improves the fertility of women with endometrioma.

 

 

J Health Psychol. 2016 Oct;21(10):2259-68.

Coping strategies employed by women with endometriosis in a public health-care setting.

Roomaney R1Kagee A2.

 

Abstract

This study explored how South African patients attending public health facilities reported coping with endometriosis. A total of 16 women with endometriosis were interviewed, and we explored how participants coped with endometriosis. All interviews were audio-recorded and transcribed. Thematic analysis was used to identify themes. Participants reported employing both problem-focused and emotion-focused strategies to cope with endometriosis. Problem-focused strategies included limiting physical activities, increasing knowledge about endometriosis, scheduling social and work activities around menstrual cycle, engaging in self-management and relying on social support. Emotion-focused coping strategies included accepting the disease, adopting a positive attitude, engaging in self talk and evoking spirituality.

 

 

J Surg Case Rep. 2015 Mar 13;2015(3).

An unusual case of asymptomatic spontaneous umbilical endometriosistreated with skin-sparing excision.

Arkoulis N1Chew BK2.

 

Abstract

Spontaneous umbilical endometriosis is a rare extrapelvic manifestation of endometriosis. Very few such cases have been previously reported, almost always associated with a variety of symptoms, usually during menstruation. We present a case of asymptomatic umbilical endometriosis treated with skin-sparing excision. Differential diagnoses relevant to the clinician, as well as treatment options, are also presented. Surgeons should always consider umbilical endometriosis in their diagnostic approac

 

 

Fertil Steril. 2015 May;103(5):1244-51.

Autophagy is upregulated in ovarian endometriosis: a possible interplay with p53 and heme oxygenase-1.

Allavena G1Carrarelli P2Del Bello B1Luisi S2Petraglia F2Maellaro E3.

 

Abstract

OBJECTIVE:

To evaluate the occurrence of the autophagic process in ovarian endometriomas compared with eutopic endometrium of affected women and with normal endometrium of healthy women.

DESIGN:

Biochemical and molecular study in tissue extracts.

SETTING:

University cellular pathology laboratory and university hospital.

PATIENT(S):

Patients with ovarian endometriosis (n = 13) and healthy women (n = 18).

INTERVENTION(S):

Specimens of endometrium were obtained by hysteroscopy from patients with endometriosisand from healthy control subjects; specimens of ovarian endometriomas were collected by laparoscopy. All patients underwent surgery after the end of menstrual bleeding, resulting in most of our patients (approximately 80% in each group) being in the proliferative phase.

MAIN OUTCOME MEASURE(S):

Autophagy was evaluated by Western blot analysis of biochemical markers (LC3-II, LC3-II/LC3-I ratio and p62) and by quantitative real-time polymerase chain reaction of autophagy-related genes (ATG14, BECN1, ATG7, and LC3B); apoptosis-related (p53 and Bcl-2) and oxidative stress-related (heme oxygenase-1) proteins were also evaluated by Western blot analysis.

RESULT(S):

All tested biochemical markers and messenger RNA levels of autophagy-related genes showed a significant up-regulation of autophagy in ovarian endometriomas compared with eutopic endometria of affected or healthy women. Moreover, a significant decrease of p53 protein and a significant increase of heme oxygenase-1 protein was also evident in endometriomas.

CONCLUSION(S):

The upregulated autophagic process observed in ovarian endometriomas can be regarded as an integral part of endometriosis pathogenesis, possibly contributing to survival of endometriotic cells in ectopic sites and to lesion maintenance. The decreased susceptibility to apoptosis and the persistent oxidative stress experienced by endometriotic cells could favor autophagy stimulation.

 

 

Fertil Steril. 2015 May;103(5):1252-60.

Circulating microRNAs as potential biomarkers for endometriosis.

Cho S1Mutlu L2Grechukhina O2Taylor HS3.

 

Abstract

OBJECTIVE:

To evaluate whether microRNAs (miRNAs) associated with endometriosis are detectable in the circulation and could serve as potential noninvasive biomarkers for endometriosis.

DESIGN:

Case-control study.

SETTING:

University hospital.

PATIENT(S):

Twenty-four women with endometriosis and 24 women without the disease (controls).

INTERVENTION(S):

Serum samples collected from women undergoing laparoscopy for endometriosis and other benign gynecologic disease.

MAIN OUTCOME MEASURE(S):

Total RNA extracted from serum and quantitative reverse-transcription polymerase chain reaction to determine levels of miRNA let-7a-f and miR-135a,b.

RESULT(S):

The levels of circulating let-7b and miR-135a were statistically significantly decreased in women with endometriosis compared with controls, and let-7d and 7f showed a trend toward down-regulation. Let-7b expression strongly correlated with serum CA-125 levels and showed the highest area under the curve of 0.691. When the patients were analyzed according to phase of the menstrual cycle, the expression of let-7b, 7c, 7d, and 7e was statistically significantly lower in the women with endometriosis during the proliferative phase. Using a logistic regression model, we evaluated the diagnostic power of differently expressed miRNAs; the combination of let-7b, let-7d, and let-7f during the proliferative phase yielded the highest area under the curve value of 0.929 in discriminating endometriosis from controls.

CONCLUSION(S):

Several circulating miRNAs are differentially expressed in the sera of women with endometriosis compared with controls. The combination of serum let-7b, 7d, and 7f levels during the proliferative phase may serve as a diagnostic marker for endometriosis.

 

 

Reprod Biomed Online. 2015 May;30(5):532-41.

Down-regulation of the CYP19A1 gene in cumulus cells of infertile women with endometriosis.

Barcelos ID1Donabella FC1Ribas CP1Meola J1Ferriani RA1de Paz CC2Navarro PA3.

 

Abstract

Aromatase plays a fundamental role in the establishment of oocyte quality, which might be compromised in infertile women with endometriosis. The expression of the CYP19A1 gene (that encodes aromatase) was compared in cumulus cells and oestradiol concentrations in the follicular fluid of infertile women with and without endometriosis submitted to ovarian stimulation for intracytoplasmic sperm injection. Cumulus cells were isolated and the expression of the CYP19A1 was quantitated through real-time polymerase chain reaction. Oestradiol concentrations in follicular fluid were measured by chemiluminescence immunoassay. A lower expression of the CYP19A1 in the cumulus cells of infertile women with endometriosis was observed compared with controls (0.17 ± 0.13 and 0.56 ± 0.12, respectively), and no significant difference in the follicular fluid oestradiol concentrations was observed between groups. Our results show reduced expression of the CYP19A1 in cumulus cells of infertile women with endometriosis, which may play a role in the pathogenesis of endometriosis-related infertility.

 

 

Gynecol Surg. 2015;12(1):21-30.

Ovarian endometrioma in the adolescent: a plea for early-stage diagnosis and full surgical treatment.

Gordts S1Puttemans P1Gordts S1Brosens I1.

 

Abstract

The incidence and severity of endometriosis in adolescent are comparable with the incidence in adult women. The mean delay between the onset of symptoms and the final diagnosis varies between 6.4 and 11.7 years. The longer the diagnosis is delayed, the more the endometriosis can progress to a more severe stage certainly in the group of patients with pelvic pain. The evolution of endometriosis and its progressivity are not predictable, and the severity of the disease is not directly related to the degree of pain. Endometriotic cysts have a detrimental effect on the ovarian reserve by the evolution in time and the surgical excision technique. Already, in small endometriotic cysts (<4 cm), loss of follicular reserve is present together with the formation of fibrosis in the cortex of the ovary. Early diagnosis of endometriosis in the adolescent deserves our full attention. Non-invasive imaging techniques like 2-D and 3-D ultrasound are helpful in the early diagnosis. Early ablative surgery is recommendable. Although laparoscopy is traditionally recommended, transvaginal laparoscopy has been shown to be most effective in ablating endometriomas with a maximum diameter of 3 cm. Early detection and intervention will contribute to a better quality of life in these adolescents and also to a lower damage of the ovarian tissue by a less invasive ablative surgery.

 

 

 

 

PLoS One. 2015 Mar 16;10(3)

Soluble ligands for the NKG2D receptor are released during endometriosisand correlate with disease severity.

González-Foruria I1Santulli P2Chouzenoux S3Carmona F4Batteux F5Chapron C6.

 

Abstract

BACKGROUND:

Endometriosis is a benign gynaecological disease. Abundant bulk of evidence suggests that patients with endometriosis have an immunity dysfunction that enables ectopic endometrial cells to implant and proliferate. Previous studies show that natural killer cells have a pivotal role in the immune control of endometriosis.

METHODS AND FINDINGS:

This is a prospective laboratory study conducted in a tertiary-care university hospital between January 2011 and April 2013. We investigated non-pregnant, younger than 42-year-old patients (n= 202) during surgery for benign gynaecological conditions. After complete surgical exploration of the abdominopelvic cavity, 121 women with histologically proven endometriosis and 81 endometriosis-free controls women were enrolled. Patients with endometriosis were classified according to a surgical classification in three different types of endometriosis: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE). Peritoneal fluid samples were obtained from all study participants during the surgery in order to detect soluble NKG2D ligands (MICA, MICB and ULBP-2). When samples with undetectable peritoneal fluid levels of MICA, MICB and ULBP-2 were excluded, MICA ratio levels were significantly higher in endometriosispatients than in controls (median, 1.1 pg/mg; range, 0.1-143.5 versus median, 0.6 pg/mg; range, 0.1-3.5; p=0.003). In a similar manner peritoneal fluid MICB levels were also increased in endometriosis-affected patients compared with disease-free women (median, 4.6 pg/mg; range, 1.2-4702 versus median, 3.4 pg/mg; range, 0.7-20.1; p=0.001). According to the surgical classification, peritoneal fluid soluble MICA, MICB and ULBP-2 ratio levels were significantly increased in DIE as compared to controls (p=0.015, p=0.003 and p=0.045 respectively). MICA ratio levels also correlated with dysmenorrhea (r=0.232; p=0.029), total rAFS score (r=0.221; p=0.031) and adhesions rAFS score (r=0.221; p=0.031).

CONCLUSIONS:

We demonstrate a significant increase of peritoneal fluid NKG2D ligands in women with endometriosis especially in those cases presenting DIE. This study suggests that NKG2D ligands shedding is a novel pathway in endometriosis complex pathogenesis that impairs NK cell function.

 

Womens Health (Lond). 2015 Mar;11(2):127-35.

Exploring the relationship between endometriomas and infertility.

Berlanda N1Alberico DBarbara GFrattaruolo MPVercellini P.

 

Abstract

Several clinical and epidemiological studies demonstrated an association between endometriosis and infertility. A role in the genesis of infertility may be played by endometriomas, which may interfere with ovulation or damage ovarian tissue. Unlike peritoneal implants, the availability of an accurate noninvasive sonographic diagnosis facilitates the investigation of endometrioma associated infertility. The laparoscopic excision of an endometrioma relieves the ovary from the damage caused by the cyst itself, which may be progressive over time, but at the same time is associated with a detrimental effect on ovarian reserve and with high rates of postoperative endometrioma recurrence. Therefore, the management of endometrioma-related infertility should not be based upon surgery alone, but upon a combination of surgery, with a refinement of the operating technique, long-term oral contraceptive, in vitro fertilization and oocyte cryopreservation.

 

 

Gynecol Endocrinol. 2015 May;31(5):406-8.

Dienogest. A possible conservative approach in bladder endometriosis. Results of a pilot study.

Angioni S1Nappi LPontis ASedda FLuisi SMais VMelis GB.

 

Abstract

Deep endometriosis involvement of the bladder is uncommon but it is symptomatic in most of the cases. Although laparoscopic excision is very effective, some patients with no pregnancy desire require a medical approach. We performed a pilot study on the effect of a new progestin dienogest on bladder endometriosis. Six patients were treated for 12 months with dienogest 2 mg/daily. Pain, urinary symptoms, quality of life, nodule volume and side effects were recorded. During treatment, symptoms improved very quickly and the nodules exhibit a remarkable reduction in size. Dienogest may be an alternative approach to bladder endometriosis.

 

 

 

 

Bull Exp Biol Med. 2015 Mar;158(5):681-3.

Comparison of treatment options for experimental endometriosis in rats.

Aleksinskaya ES1Nazarov SBPosiseeva LVNazarova AOMalyshkina AI.

 

Abstract

The effectiveness of surgery, immunomodulator “Vilon” therapy, and their combination in the treatment of experimental endometriosis in rats was assessed by the parameters of reproductive function. The experiments demonstrated that surgery combined with intraperitoneal application of “Vilon” is a promising option in the treatment of endometriosis.

 

Int J Fertil Steril. 2015 Jan-Mar;8(4):429-36.

The expression of the autophagy gene beclin-1 mRNA and protein in ectopic and eutopic endometrium of patients with endometriosis.

Zhang L1Liu Y2Xu Y2Wu H2Wei Z2Cao Y2.

 

Abstract

BACKGROUND:

To investigate the expression of Beclin-1 mRNA and protein in eutopic and ectopic endometrium of women with and without endometriosis, and evaluate the association of Beclin-1 protein expression and serum CA125 levels in the endometriosis group due to CA125 being a well-known biomarker of endometriosis.

MATERIALS AND METHODS:

The expression levels (mean ± SD) of the mRNA and protein of Beclin-1 were examined in uterine endometria from 26 women without endometriosis and in eutopic and ectopic endometria from 26 endometriosis patients through experimental study, as reverse transcription PCR and Western-blotting assays. Serum CA125 levels in the endometriosis and control groups were compared and the correlation between Beclin-1 protein expression and serum CA125 was evaluated in the endometriosis group.

RESULTS:

Both eutopic (0.12 ± 0.04, 1.25 ± 0.42) and ectopic (0.12 ± 0.05, 1.09 ± 0.50) endometriotic tissue from 26 women with endometriosis expressed significantly lower levels of Beclin-1 mRNA and protein than endometrium from 26 normal women (0.15 ± 0.02, 1.67 ± 0.44) (p<0.05). Serum CA125 levels were found to be significantly higher in the endometriosis group (p<0.05). In addition, Beclin-1 protein expression of eutopic endometria in patients with endometriosis was negatively correlated with serum CA125 (r= -0.57, p<0.01).

CONCLUSION:

The present study strongly suggests that Beclin-1 may play a role in the formation and progression of endometriosis.

 

 

Int J Fertil Steril. 2015 Jan-Mar;8(4):437-44.

The 763C>G Polymorphism of The Secretory PLA2IIa Gene Is Associated with Endometriosis in Iranian Women.

Sahmani M1Darabi M2Darabi M1Dabaghi T3Alizadeh SA1Najafipour R1.

 

Abstract

BACKGROUND:

Endometriosis is a chronic gynecological disease resulting from complex interactions between genetic, hormonal, environmental and oxidative stress and intrinsic inflammatory components. The aim of this study was to investigate the potential association of the 763C>G polymorphism in the secretory phospholipase A2 group IIa gene (PLA2G2A) with the risk of endometriosis in Iranian women.

MATERIALS AND METHODS:

Ninety seven patients with endometriosis along with 107 women who were negative for endometriosis after laparoscopy and laparatomy, and served as the control group, were enrolled for this cross-sectional study. Samples were genotyped using the polymerase chain reaction-restriction fragment length polymorphism method.

RESULTS:

Multivariate analysis was used to examine the association between the risk of endometriosis and the 763C>G polymorphism of PLA2G2A. Genotype distributions of PLA2G2A were significantly different between patients and the controls (p<0.001, OR=0.22, 95% CI=0.21-0.39). Correlation analysis showed that there was a significant association between the normal homozygous genotype and susceptibility to endometriosis (p<0.001).

CONCLUSION:

The present study suggests that the 763C>G polymorphism of PLA2G2A plays an important role as an independent factor in the risk of endometriosis in Iranian women.

 

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