51: Arch Pathol Lab Med. 2004 May;128(5):561-4.
Multifocal polypoid endometriosis presenting as huge pelvic masses causing deep vein thrombosis.
Laird LA, Hoffman JS, Omrani A.
Department of Pathology, New Britain General Hospital, New Britain, Conn 06050, USA.
We describe a case of multifocal polypoid endometriosis presenting with advanced bulky disease at a variety of pelvic sites. The extent of tumor and clinical features such as vaginal bleeding and pulmonary embolus were suggestive of a malignant process. Histopathology demonstrated glands that were neither crowded nor complex, with intervening fibromatous stroma that contained occasional endometrial stromal cells. These features were consistent with the newly described condition of polypoid endometriosis. Despite the endometrioid appearance of this tumor, there was florid ciliary cell change. An association has been suggested between polypoid endometriosis and prior tamoxifen use, although this patient had no history of prior hormone use.
PMID: 15086302 [PubMed]
52: Semin Reprod Med. 2004 Feb;22(1):45-50.
Aromatase and endometriosis.
Bulun SE, Fang Z, Imir G, Gurates B, Tamura M, Yilmaz B, Langoi D, Amin S, Yang S, Deb S.
Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois 60611, USA.
Aromatase p450 (p450arom) is the key enzyme for biosynthesis of estrogen, which is an essential hormone for the establishment and growth of endometriosis. There is no detectable aromatase enzyme activity in normal endometrium; therefore, estrogen is not locally produced in endometrium. Endometriosis tissue, however, contains very high levels of aromatase enzyme, which leads to production of significant quantities of estrogen. Moreover, one of the best-known mediators of inflammation and pain, prostaglandin E (2), strikingly induces aromatase enzyme activity and formation of local estrogen in this tissue. Additionally, estrogen itself stimulates cyclo-oxygenase-2 and therefore increases the formation of prostaglandin E (2) in endometriosis. We were able to target this positive feedback cycle in endometriosis using aromatase inhibitors. In fact, pilot trials showed that aromatase inhibitors could decrease pelvic pain associated with endometriosis.
PMID: 15083380 [PubMed]
53: Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004 Mar;24(3):258-9.
[Clinical observation on treatment of endometriosis with principle of activating blood circulation to remove stasis] [Article in Chinese] Wang RY, Zhou L.
PMID: 15074102 [PubMed]
54: Cancer. 2004 Apr 15;100(8):1650-6.
Laparoscopic fluorescence detection of ovarian carcinoma metastases using 5-aminolevulinic acid-induced protoporphyrin IX.
Loning M, Diddens H, Kupker W, Diedrich K, Huttmann G.
Department of Obstetrics and Gynecology, University of Lubeck, Lubeck, Germany. loening@gmx.de
BACKGROUND: The aim of the current clinical study was to evaluate the in vivo fluorescence detection of ovarian carcinoma metastases in a second-look laparoscopic procedure after intraperitoneally applied 5-aminolevulinic acid (ALA). METHODS: Five hours before laparoscopic surgery, ALA was applied intraperitoneally via short infusion in a concentration of 30 mg/kg bodyweight in a sterile, 1% solution. Application of ALA resulted in the endogenous production of the fluorescent photosensitizer, protoporphyrin IX (PP IX). The Combilight PDD 5133 system served as a light source, permitting the switch from white light mode to blue light mode to excite the PP IX accumulated in the ovarian tissue specimens. By means of blue light illumination, intraperitoneally located red fluorescent lesions, which were suspected to be metastases, underwent a biopsy. In addition, several biopsy specimens were taken from nonfluorescent areas of the peritoneal cavity. RESULTS: In 13 of 29 patients, ovarian carcinoma was confirmed histologically or cytologically. In 12 of these patients, metastases were visible by red fluorescence. In total, 123 biopsies were performed. Comparison of histologic assessment of the biopsy specimens with the fluorescence detection showed that strong red fluorescence had a sensitivity of 92% for detecting tumor tissue on specimens. In only 2% of all biopsy specimens was endometriosis observed in benign tissue specimens using fluorescence. In four of 13 patients with ovarian carcinoma, lesions were detected under fluorescence, which were not observed under white light illumination. CONCLUSIONS: Laparoscopic fluorescence detection of endogenous PP IX after intraperitoneal application of ALA may provide a higher sensitivity of finding peritoneal metastases of epithelian ovarian carcinoma compared with conventional laparoscopy. Direct visualization of in vivo fluorescence after ALA application may improve the early detection of intraperitoneal ovarian carcinoma micrometastases. The high tissue selectivity of PP IX accumulation in tumor tissue specimens also offers the opportunity for therapeutic approaches using photodynamic therapy in the future. Copyright 2004 American Cancer Society.
Publication Types: · Clinical Trial
PMID: 15073853 [PubMed]
55: Pharmacoepidemiol Drug Saf. 1996 Sep;5(5):315-9.
Package inserts of oral contraceptives in Italy.
Fioretti F, La Vecchia C, Tavani A, Parazzini F.
Istituto di Richerche Farmacologiche ‘Mario Negri’, 20157 Milan Italy.
To evaluate the understandability and the validity of information included in package inserts of the 20 main oral contraceptive (OC) preparations sold in Italy, we systematically tabulated the indications, contraindications and side-effects listed in their patient information leaflets. OC information leaflets included, in their vast majority, only contraception as indication, with no mention of endometriosis, dysmenorrhea, or other menstrual cycle disorders, which are potential indications for OC use. In contrast, information leaflets included an extremely detailed, but largely acritical, list of contraindications and side-effects, in the absence of any quantitative indication on their frequency and importance. These include, among others, depressive symptoms, visual impairments, or endometrial hyperplasia, which is indeed an indication for combined OC use. Such acritical and poorly explained information on potential, but often unproven, side-effects may cause confusion and lead to withdrawal from OC use for some women, in the absence of any real contraindication. In contrast, some real contraindications or serious side-effects, including cervical neoplasia, hepatomas, liver cancer or myocardial infarction, were not reported in OC leaflets. The incomplete data, and particularly the absence of quantitative information on OC leaflets, may cause negative attitudes of women towards their use, decreased compliance, and, however indirectly, be a determinant of the low prevalence of OC use among Italian women.
PMID: 15073817 [PubMed]
56: Hum Reprod Update. 2004 Mar-Apr;10(2):163-75.
Autoimmunity and antigenic targets in ovarian pathology.
Forges T, Monnier-Barbarino P, Faure GC, Bene MC.
Department of Reproductive Medicine, Maternite Universitaire A.Pinard, 10, rue du Dr Heydenreich, 54042 Nancy Cedex, France. t.forges@maternite.chu-nancy.fr
The involvement of autoimmune mechanisms in premature ovarian failure has been put forward by numerous investigators. In various other ovarian pathologies, such as idiopathic infertility, polycystic ovary syndrome, or endometriosis, similar mechanisms have been suggested. However, the exact role of autoimmunity in the pathophysiology of these diseases still remains controversial. The diagnosis of autoimmune ovarian disease relies on several clinical, biological and histological findings, but special interest has been focused on antiovarian autoantibodies. The search for these antibodies has been undertaken by several authors and yielded somewhat conflicting results which might be conditioned by methodological differences and by the multiplicity of potential immune targets. These targets, which comprise various steroidogenic enzymes, gonadotrophins and their receptors, the corpus luteum, zona pellucida and oocyte, are reviewed. Further investigation of these targets is required to improve the diagnostic tools that will lead to a precocious and reliable diagnosis of autoimmune ovarian disease, an appropriate clinical surveillance as well as the selection of patients who may benefit from immune-modulating therapy and possibly recover ovarian function and fertility.
PMID: 15073145 [PubMed]
57: Hum Reprod Update. 2004 Mar-Apr;10(2):119-33.
Macrophage contributions to ovarian function.
Wu R, Van der Hoek KH, Ryan NK, Norman RJ, Robker RL.
Department of Obstetrics and Gynaecology, The University of Adelaide, The Queen Elizabeth Hospital, Woodville Road, Woodville, South Australia 5011.
Macrophages are multifunctional cells that play key roles in the immune response and are abundant throughout female reproductive tissues. Macrophages are identified in tissues by their expression of cell surface receptors and can execute diverse functional activities, including phagocytosis and degradation of foreign antigens, matrix dissolution and tissue remodelling, and production and secretion of cytokines, chemokines and growth factors. Their specific localization and variations in distribution in the ovary during different stages of the cycle, as well as their presence in peri-ovulatory human follicular fluid, suggest that macrophages play diverse roles in intra-ovarian events including folliculogenesis, tissue restructuring at ovulation and corpus luteum formation and regression. This review presents the existing evidence for the regulation of ovarian function by macrophages and macrophage-derived products, highlighting the implications of these cells in ovarian diseases, particularly polycystic ovary syndrome, endometriosis and premature ovarian failure.
PMID: 15073142 [PubMed]
58: Cancer Detect Prev. 2004;28(2):94-8.
The relationship between endometrial carcinoma and coexistent adenomyosis uteri, endometriosis externa and myoma uteri.
Koshiyama M, Okamoto T, Ueta M.
Department of Obstetrics and Gynecology, Himeji National Hospital, 68, Honmachi, Himeji City, Hyogo 670-8520, Japan.
The relationship between endometrial carcinoma and coexistent adenomyosis uteri, endometriosis externa and myoma uteri has been reported in only a few studies. We studied the characteristics of the endometrial carcinomas accompanied by these benign diseases. The total number of endometrial carcinoma cases was 179, consisting of 29 (16%) endometrial carcinomas with adenomyosis uteri, 12 (7%) with endometriosis externa, 51 (28%) with myoma uteri, and 87 controls (49%) without these benign diseases. Seventy-nine, 75, and 65% of the endometrial carcinomas with adenomyosis uteri, endometriosis externa and myoma uteri, respectively, showed a low histologic grade (G1). In particular, the patients with adenomyosis uteri and endometriosis externa were relatively younger than the control patients (54.2, 54.1 years old versus 57.7 years old). Furthermore, these patients were all treated at stage 1 and had a good prognosis. In brief, there are some clinicopathologic differences between the endometrial carcinoma cases with benign hormone-dependent disease and the cases without these disease.
PMID: 15068832 [PubMed]
59: Fertil Steril. 2004 Apr;81(4):1142-4.
A rare case of extrauterine adenosarcoma arising in endometriosis of the rectovaginal septum.
Raffaelli R, Piazzola E, Zanconato G, Fedele L.
University of Verona, Verona, Italy. ricciarda.raffaelli@univr.it
OBJECTIVE: To present a rare case of endometrial stromal sarcoma arising in endometriosis of the rectovaginal septum. DESIGN: Case report. SETTING: Academic tertiary referral center for endometriosis treatment. PATIENT(S): A 50-year-old woman with a history of endometriosis presented with catamenial rectal pain and deep dyspareunia. Imaging findings suggested new endometriotic lesions in the rectovaginal space. INTERVENTION(S): Total hysterectomy, salpingo-oophorectomy, and excision of the lesion in the rectovaginal septum were performed. Although extemporary pathology confirmed endometriosis, the final histologic diagnosis was extrauterine adenosarcoma in the rectovaginal septum. Two years later, recurrence of the malignancy occurred and was treated by resecting the new perirectal mass. Subsequent radiotherapy and chemotherapy were administered. MAIN OUTCOME MEASURE(S): Imaging findings at follow-up evaluation. RESULT(S): The patient was in good health for 2 years after the initial surgery, when she developed a new lesion at the site of the previous resection. The histologic appearance of the lesion was consistent with recurrence of the tumor. After postoperative therapy, the patient is now without evidence of disease. CONCLUSION(S): Malignant transformation of endometriosis should be considered in the differential diagnosis of a new pelvic lesion in a patient with a history of endometriosis.
PMID: 15066480 [PubMed]
60: Zhonghua Fu Chan Ke Za Zhi. 2004 Feb;39(2):101-4.
[Relationship between endometriosis and glutathione S-transferase M1, T1 genes of the Uygurs and Hans in Xinjiang] [Article in Chinese] Ding Y, Chen ZF, Lin RY, Wang XF, Ding JB, Ai XZ, Wen H.
Department of Obstetrics and Gynecology, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China.
OBJECTIVE: To examine the association between glutathione S-transferase (GST)M1, T1 null genotypes and endometriosis of the Uygurs and Hans in Xinjiang. METHODS: The polymerase chain reaction method was used to detect the presence or absence of the GSTM1 and GSTT1 genes in genomic DNA from the Uygurs (107 controls and 41 cases) and the Hans (105 controls and 80 cases) in Xinjiang. RESULTS: The frequencies of the GSTM1-null genotype, GSTT1-null genotype, combined GSTM1-null and GSTT1-null genotype in endometriosis of the Uygurs (51.2%, 36.6%, 24.4%) were not significantly different from those in controls (53.2%, 29.9%, 13.1%). Similarly, no statistically significant difference was observed in the frequency of GSTM1-null genotype in cases of endometriosis of the Hans (56.8%) compared with the controls (51.8%), but the frequencies of GSTT1-null genotype, combined GSTM1-null and GSTT1-null genotype in endometriosis of the Hans (73.7%, 42.5%) were significantly different from those in controls (44.3%, 22.8%). When comparing the Uygurs with the Hans, we found no significant difference in the frequencies of GSTM1-null genotype, GSTT1-null genotype, combined GSTM1-null and GSTT1-null genotype between the two control populations, neither in the frequencies of the GSTM1-null genotype, combined GSTM1-null and GSTT1-null genotype between the two endometriosis populations. However, the frequency of GSTT1-null genotype in cases of the Hans (73.7%) was significantly higher than that in cases of the Uygurs (36.6%). CONCLUSIONS: No evidence was found to suggest an association between GSTM1-null genotype and endometriosis in the Hans and Uygurs. An association was found between GSTT1-null genotype and endometriosis in the Hans, but not in the Uygurs. The two nationalities have different genetic predisposing factors to the development of endometriosis.
PMID: 15059587 [PubMed]
61: Zhonghua Fu Chan Ke Za Zhi. 2004 Feb;39(2):97-100.
[Clinical characteristics of abdominal wall endometrioma and its recurrence-related factors] [Article in Chinese] Zhao XY, Lang JH, Leng JH, Liu ZF, Li HJ, Sun DW, Zhu L.
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
OBJECTIVE: To analyze the clinical characteristics, and treatment, recurrence-related factors of abdominal wall endometriomas (AWE). METHODS: Fifty-seven cases of AWE treated at Peking Union Medical College Hospital from 1983 to 2002 were reviewed. RESULTS: The incidence of AWE was 1.04% (57/5478) in patients with endometriosis after surgical treatment. It was 0.046% in patients undergoing cesarean section in the same period. Of 57 cases with AWE, 56 had low-abdominal operation previously and one was primary umbilicus endometrioma. Fifty-five cases of AWE were secondary to cesarean section. The latent period of AWE was positively correlated to patient’s age at onset (P < 0.001). Fifty-five cases received surgical treatment while 2 were given medical treatment. Follow-up duration was 1.1 – 235 months. Five cases recurred and one was transformed to malignancy. The recurrence was correlated to the size and depth of the lesions. CONCLUSIONS: AWE could be diagnosed prior to operation according to its typical clinical manifestations. Ultrasonic examination may be valuable for the diagnosis of atypical cases. Surgical treatment is effective. A complete excision with clear margin is very important to prevent recurrence.
PMID: 15059586 [PubMed]
62: J Thorac Cardiovasc Surg. 2004 Apr;127(4):1219-21.
Endometriosis-related pneumothorax: clinicopathologic observations from a newly diagnosed case.
Alifano M, Cancellieri A, Fornelli A, Trisolini R, Boaron M.
U. O. di Chirurgia Toracica, Ospedale Bellaria-Maggiore, Bologna, Italy. marcoalifano@yahoo.com
PMID: 15052232 [PubMed]
63: J Gynecol Obstet Biol Reprod (Paris). 2004 Apr;33(2):140-4.
[Endometrioid adenocarcinoma arising from adenomyosis: a case report and literature review] [Article in French] Rubod C, Narducci F, Delattre C, Decocq J, Verbert A, Delahousse G.
Clinique de Gynecologie Obstetrique et Neonatologie, Pavillon Paul Gelle, Centre Hospitalier de Roubaix, 91, avenue Julien-Lagache, 59100 Roubaix.
In spite of many references to carcinoma arising from endometriosis, there are few documented cases in the literature of endometrioid adenocarcinoma developed in association with adenomyosis. We report a case of endometrioid adenocarcinoma arising from adenomyosis. Carcinogenic and prognostic factors as well as the therapeutic consequences of this unusual situation are discussed. The use of hormonal replacement therapy by patients with a prior history of adenomyosis is also examined.
PMID: 15052180 [PubMed]
64: J Soc Gynecol Investig. 2004 Apr;11(3):175-81.
Concentrations of alpha-fetoprotein, insulin-like growth factor binding protein-3, c-erbB-2, and epidermal growth factor in serum of patients with endometriosis.
Philippoussis F, Gagne D, Hugo P, Gosselin D.
MetrioGene BioSciences (a subsidiary of PROCREA BioSciences), Montreal, Quebec, Canada.
OBJECTIVE: Endometriosis, although it is a benign disorder, shares many similarities with cancer. There is increasing levels of evidence suggesting that some circulating factors involved in gynecologic cancers, such as alpha-fetoprotein (AFP), insulin-like growth factor binding protein-3 (IGFBP-3), c-erbB-2 (HER-2/neu), and epidermal growth factor (EGF), could also play a role in endometriosis. Hence, the present study was aimed at evaluating whether the levels of these molecules are modulated in the serum of patients with endometriosis. METHODS: Levels of AFP, IGFBP-3, c-erbB-2, and EGF were determined by enzyme-linked immunosorbent assay in serum from 36 subjects with surgically confirmed endometriosis and 36 controls with no surgical evidence of the disease. In addition, information such as demographic characteristics, personal habits, menstrual characteristics, and clinical profile was collected from each participating subject. RESULTS: No significant difference was found between serum levels of AFP, IGFBP-3, c-erbB-2, and EGF in patients with endometriosis and controls, even when we adjusted for potential confounders and took into account the menstrual cycle. Moreover, no correlation was observed between the serum concentrations of these molecules and the stage of the disease. However, a correlation was detected between soluble levels of IGFBP-3 and presence of uterine leiomyoma. CONCLUSION: Although AFP, IGFBP-3, c-erbB-2, and EGF are not altered in the circulation of patients with endometriosis, their involvement in the development of endometriotic lesions cannot be excluded.
PMID: 15051037 [PubMed]
65: Wiad Lek. 2003;56(9-10):430-3.
[In Process Citation] [Article in Polish] Rzymski P, Wozniak J, Opala T.
Katedry i Kliniki Zdrowia Matki i Dziecka Akademii Medycznej w Poznaniu. parzymsk@gpsk.am.poznan.pl
Soluble ICAM-1 could play different roles in pathological mechanisms of human endometrium found in such diseases as endometriosis, spontaneous abortion and infertility. The aim of our study was to evaluate in vitro sICAM-1 secretion to medium dependent on menstrual cycle and estradiol (E2) stimulation. MATERIAL AND METHOD: Hysteroscopic biopsies in 19 infertile women. We established 16 cell cultures. Tissue was collected on DMEM, 5% FCS, 5% BSA with Penicillin, Streoptomycin, Gentamycin (2.5 mg/ml). Isolation was performed during 4 hours. Tissue was washed twice, treated with collagenase 1A (1 mg/ml, 37 degrees C 2 hours), centrifuged 10 min by 1200 rpm. Cells were cultured in DMEM/5% FCS/5% BSA with Penicillin/Streptomycin. After 2 days of endometrial and stromal cells coculture D-Valine was used to stop fibroblasts’ growth. Number of cells was calculated according to Buerker method. After 2 days estradiol in concentration of 10(-10 M) was added to some cultures. Soluble ICAM-1 concentrations in supernatants were evaluated using standard ELISA kit. T-Student test was used for statistical analysis, p value < 0.05 was considered significant. RESULTS: Median culture time was 14.9 (+/- 3.3) days. Longer cultures were obtained from women in follicular phase. The addition of estradiol prolonged culture by 3.8 days. The level of soluble ICAM-1 in supernatants in follicular phase was 17.6 ng/ml, in luteal 8.8 ng/ml. E2 influenced sICAM-1 production in culture (15.8 vs. 10.6 ng/ml). CONCLUSIONS: Endometrial cells produce sICAM-1 constitutively. Soluble ICAM-1 concentrations are higher in follicular phase. Estradiol increases the excretion of sICAM-1.
PMID: 15049207 [PubMed]
66: Res Vet Sci. 2004 Jun;76(3):249-55.
Physiological and pathological expression of intermediate filaments in the equine endometrium.
Aupperle H, Schoon D, Schoon HA.
Institute of Veterinary-Pathology, University of Leipzig, An den TierKliniken 33, 04103 Leipzig, Germany. aupperle@rz.uni-leipzig.de
The aim of this study was to investigate the expression of the intermediate filaments cytokeratin, vimentin and desmin in the equine endometrium by immunohistological techniques. For this purpose, endometrial biopsies of 151 mares were examined to determine physiological cycle patterns and changes resulting from endometriosis. During the physiological cycle epithelial cells and mesenchymal cells express cytokeratin and vimentin, respectively, whilst desmin and vimentin were coexpressed by the smooth muscle cells. Epithelial coexpression of cytokeratin and vimentin was seen in numerous fibrotic glands and in the uterine glands of three mares with pathologically inactive endometria. Three different staining patterns (basal, perinuclear, diffuse) of vimentin were associated with typical morphological alterations of the affected epithelia. In addition, in 14 cases a stromal coexpression of vimentin and desmin was found, indicating an atypical stromal differentiation in inactive endometria of older mares, barren for several years.
PMID: 15046960 [PubMed]
67: Proc Natl Acad Sci U S A. 2004 Apr 6;101(14):4996-5001. Epub 2004 Mar 24.
Effect of long-term treatment with low doses of the LHRH antagonist Cetrorelix on pituitary receptors for LHRH and gonadal axis in male and female rats.
Horvath JE, Toller GL, Schally AV, Bajo AM, Groot K.
Endocrine, Polypeptide, and Cancer Institute, Veterans Affairs Medical Center, New Orleans, LA 70112, USA.
Our previous studies showed that treatment of female rats with large doses of Cetrorelix, an antagonist of luteinizing hormone-releasing hormone (LHRH), reduces levels of serum LH, estradiol, progesterone, and the concentration of pituitary LHRH receptors (LHRH-Rs) and their mRNA expression. Serum LH and testosterone levels and pituitary LHRH-R in male rats are also decreased by high doses of Cetrorelix. This approach can be used for therapy of sex hormone-dependent cancers. However, in conditions where an incomplete hormone deprivation is indicated, lower doses of Cetrorelix may suffice. Thus, we investigated the effect of a 30-day treatment with a low-dose depot formulation of Cetrorelix (20-24 microg per kg per day) on the pituitary-gonadal axis of male and female rats. In both sexes, lower serum LH levels were observed on day 4 after administration. In males, LH returned to control levels by day 10, whereas in females, a rebound LH elevation occurred. Testosterone levels in male rats were decreased up to day 20, but on day 30, the values were similar to controls. In females, serum estradiol was reduced on day 4; however, by day 10 it returned to normal. Progesterone levels were diminished through the entire period. Female rats showed diestrous smears during the first week of treatment and prolonged estrous periods thereafter. The weights of testes and ovaries were significantly lower, but not the weights of prostate, seminal vesicles, and uterus. Pituitary LHRH-R mRNA and LHRH-R protein levels were not significantly different from the controls. Thus, the treatment with low doses of Cetrorelix did not seriously impair gonadal functions. The results suggest that Cetrorelix in low doses induces only a partial pituitary-gonadal inhibition and might be indicated for treatment of endometriosis, leiomyomas, and benign prostatic hyperplasia.
PMID: 15044692 [PubMed]
68: Mol Hum Reprod. 2004 Jun;10(6):399-407. Epub 2004 Mar 25.
Cyr61, a deregulated gene in endometriosis.
Absenger Y, Hess-Stumpp H, Kreft B, Kratzschmar J, Haendler B, Schutze N, Regidor PA, Winterhager E.
Institute of Anatomy, University Hospital, 45122 Essen.
Gene expression profiling was performed to identify genes involved in the development of endometriosis. In the secretory phase of the menstrual cycle, several estrogen-regulated genes were up-regulated in endometria of women with endometriosis. The most consistent regulation with one of the highest factors was observed for the Cyr61 gene, which codes for a secreted, cysteine-rich, heparin-binding protein that promotes cell adhesion, migration, and neovascularization. Estrogen responsiveness of endometrial Cyr61 expression was suggested by the higher expression during the proliferative phase and the reduction observed in human endometrial fragments grafted into nude mice subsequently treated with an anti-estrogen. The expression level of Cyr61 was found to be further increased in ectopic endometriotic lesions, as compared to eutopic endometria. In these lesions, an imbalance in expression of the estrogen-converting enzymes 17beta-hydroxysteroid dehydrogenase type 1 and 2 was found, which might explain the elevated Cyr61 level. However, Cyr61 expression was not altered in endometriotic lesions of women treated with a GnRH agonist. These results suggest that Cyr61 may represent a gene characteristic for endometriosis and also play an important role in the development and persistence of endometriotic lesions.
PMID: 15044605 [PubMed]
69: Environ Monit Assess. 2004 Mar;92(1-3):211-28.
Assessment of human health risk of dioxin in Korea.
Lim Y, Yang J, Kim Y, Chang Y, Shin D.
Dept. of Environmental Health, Seonam University, 720 Gwangchi-dong, Namwon, Jeonbuk, Korea.
This study assessed the daily exposure to dioxin using comparable approach methods in order to predict the human health risks of dioxin on the general adult population and incinerator workers in Korea. The health risk assessment of dioxin involved four scenarios (General-Direct, General-Breast Milk, General-Blood, and Worker-Blood). The risks were described in terms of the excess cancer risk and the MOEs (Margin-Of-Exposure) for cancer, reproductive dysfunctions, endometriosis, and neurobehavioral effects. The adult daily intake (General-Direct) of dioxin was estimated to be 0.50 pg-TEQ/kg-day based on the dioxin concentrations in the environmental media and foods in Korea. The average dioxin concentrations in General-Breast Milk, General-Blood, and Worker-Blood were 15.13 pg-TEQ/g fat, 14.57 pg-TEQ/g lipid, and 22.90 pg-TEQ/g lipid, respectively. The lifetime average daily doses (LADDs) of dioxin for General-Breast Milk, General-Blood, and Worker-Blood were estimated to be 1.35 pg-TEQ/kg day, 0.99 pg-TEQ/kg day, and 1.15 pg-TEQ/kg day, respectively. Although the estimated risks of cancer and reproductive dysfunctions were not unusually high in any of the four scenarios, the MOE values for the neurobehavioral effects on infants were not sufficiently high to guarantee the safety against this endpoint.
PMID: 15038545 [PubMed]
70: Fertil Steril. 2004 Mar;81(3):652-61.
Differential macrophage infiltration in early and advanced endometriosis and adjacent peritoneum.
Khan KN, Masuzaki H, Fujishita A, Kitajima M, Sekine I, Ishimaru T.
Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, Nagasaki, Japan. nemokhan@net.nagasaki-u.ac.jp
OBJECTIVE: To investigate the distribution of macrophage (Mphi) infiltration in eutopic and ectopic endometrium throughout the menstrual cycle. DESIGN: Controlled clinical study using intact tissue. SETTING: Nagasaki University School of Medicine, Nagasaki, Japan. PATIENT(S): Twenty infertile women with pelvic endometriosis and 20 women without endometriosis. INTERVENTION(S): Biopsy specimens from peritoneal lesions and corresponding eutopic endometrium were collected from women with or without endometriosis. Adjacent peritoneal biopsies were also obtained from a fraction of these women. The activated Mphi marker CD68, mitogenic marker hepatocyte growth factor (HGF), and endothelial cell surface marker von Willebrand factor were immunolocalized and quantitated by light microscopy and Q-H score. MAIN OUTCOME MEASURE(S): Tissue infiltration of Mphi in eutopic endometrium, ectopic endometrium, and adjacent peritoneum was examined, and its relationship with the immunoreaction of HGF and microvessel number was analyzed. The possible production of HGF by the isolated basal Mphi was also examined. RESULT(S): Tissue infiltration of Mphi in the eutopic and ectopic endometrium of women with stage I-II endometriosis was significantly higher than with stage III-IV endometriosis or in control women. Red peritoneal lesions and their adjacent peritoneum had the greatest Mphi concentration, compared with black or white lesions. These inflammatory cells showed a higher distribution in the secretory phase of the menstrual cycle. The Mphi density in the eutopic endometrium and corresponding red lesions showed a significant correlation with both Q-H score of HGF and microvessel density. A substantial amount of HGF was also produced by the isolated basal Mphi from women with endometriosis. CONCLUSION(S): These results suggest that the peritoneal lesions of early and active endometriosis and their adjacent peritoneum harbor abundant Mphi that could be involved in the growth of endometriosis.
PMID: 15037416 [PubMed]
71: Fertil Steril. 2004 Mar;81(3):487-92.
Hormonal suppressive therapy for endometriosis may not improve patient health.
Blumenfeld Z.
Department of Obstetrics and Gynecology, Rambam Medical Center, and the B Rappaport Faculty of Medicine, Technion, Isreal Institute of Technology, Haifa, Israel. bzeev@techunix.technion.ac.il
OBJECTIVE: To critically examine the possible association between hormonal treatment of endometriosis and ovarian cancer. RESULT(S): The malignant potential of endometriosis has been suggested by several clinical studies. Although controversial, ovarian carcinoma of the endometrioid and clear cell subtypes has been associated with endometriosis, particularly among subjects with a longstanding disease. Furthermore, a significantly higher frequency of endometriosis has been found in patients undergoing surgery for endometrioid, clear cell, and mixed subtypes of ovarian carcinoma, as compared with the other subtypes. Changes in the genomic material in endometriotic implants were observed by many investigators in chromosomes 1, 5, 6, 7, 16, and 22 by several methods (fluorescent in situ hybridization, comparative genomic hybridization, and others). Because hormonal ablative treatments may suppress the normal, eukaryotic cells more than the aneuploid cells bearing chromosomal aberrations, it may increase the rate of dyskaryotic cells in the endometriotic implants, possibly augmenting the risk of malignant transformation. A recent published association between Danazol and ovarian cancer suggests that such a theoretical risk may occur. CONCLUSION(S): The hormonal ablative treatment of endometriosis may increase the risk of malignant transformation in the endometriotic implants by causing a negative selection and increasing the rate of dyskaryosis and loss of heterozygosity.
Publication Types: · Review · Review, Tutorial
PMID: 15037387 [PubMed]
72: Eur J Obstet Gynecol Reprod Biol. 2004 Mar 15;113(1):87-93.
Increased prevalence of p53 overexpression from typical endometriosis to atypical endometriosis and ovarian cancer associated with endometriosis.
Sainz de la Cuesta R, Izquierdo M, Canamero M, Granizo JJ, Manzarbeitia F.
Departments de Obstetricia y Ginecologia, Anatomia Patologica y Epidemiologia, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Avenida de los Reyes Catolicos, 2, 28040 Madrid, Spain.
OBJECTIVE: To evaluate the expression of p53, c-erb-B-2, MIB1 and Bcl-2 in normal endometrium, endometriosis, atypical endometriosis and ovarian cancer associated with endometriosis, looking for immunohistochemical markers that may help determine endometriosis with premalignant potential. STUDY DESIGN: Between 1948 and 1999, 410 epithelial ovarian cancers and 521 cases of endometriosis were surgically treated at Fundacion Jimenez Diaz. Pathology reports and slides were reviewed. Four groups were defined: (1) endometriosis/cancer (n=17); (2) atypical endometriosis (n=6); (3) endometriosis (n=17); (4) endometrium (n=7). Tumors and controls were immunostained and evaluated for expression of p53, c-erb-B-2, MIB1 and Bcl-2. Statistical analysis was performed using Chi-square for linear trends, Fisher exact and Kruskal-Wallis tests. RESULTS: Of the 410 cancers, 17 (4.1%) had associated endometriosis and of the 521 endometriosis, 6 (1.2 %) had atypical changes. Fourteen of 17 (82.4%) cancers associated with endometriosis and all atypical endometriosis had p53 overexpression. Only 2 of 17 (11.8%) endometriosis and none of the endometriums had mutant p53 (P<0.01). We found a trend towards increased expression of MIB1 (0.073) in the cancer and atypical endometriosis groups, and no differences in expression of Bcl-2 or c-erb-B-2. The sensitivity and specificity of p53 as a marker for the diagnosis of atypical endometriosis and cancer associated with endometriosis were 87%; CI 95% (73.2-100%) and 92% (80.6-100%), respectively. When comparing all groups, the mean positive p53 and MIB1 cell count was statistically significant (P=0.01). CONCLUSIONS: Overexpression of p53 in atypical endometriosis and cancer associated with endometriosis is a common finding and may be used to identify endometriosis with premalignant potential.
PMID: 15036718 [PubMed]
73: Hum Reprod. 2004 Apr;19(4):760-8. Epub 2004 Jan 29.
Is insulin resistance an essential component of PCOS?: The endometriosis syndromes: a clinical classification in the presence of aetiological confusion and therapeutic anarchy.
Garry R.
School of Women’s and Infants’ Health, University of Western Australia, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Western Australia 6008. rgarry@obsgyn.uwa.edu.au
Clinical confusion and inappropriate management continues to surround endometriosis. It is poorly recognized that the disorder can exist in two different morphological forms that have different symptoms, signs and prognosis. Earlier classification systems have been useful for research but are of limited value in aiding day-to-day management. In the clinic, two discrete phenotypes can be defined by the presence or absence of palpable nodules in the deep pelvis. Patients with such nodules with or without associated ovarian endometrioma usually have severe symptoms with significant risks of bowel and urinary tract involvement. The predominant histological feature of these lesions is extensive fibromuscular hyperplasia (adenomyoma). These patients will often need extensive surgical intervention. Patients without such palpable lesions usually have the classic superficial subperitoneal lesions with endometrial-like glands and stroma on histological examination. This group often has less severe symptoms and has little risk of developing serious associated problems. These lesions may be helped by medications and/or simple ablative surgery. It is suggested that these collections of symptoms and signs or syndromes be named after the pioneers who first described the lesions. Cullen’s syndrome can be used to describe those patients with severe symptoms of endometriosis associated with palpable pelvic nodules. Sampson’s syndrome can describe those with similar symptoms associated with a structurally normal pelvis.
PMID: 15033944 [PubMed]
74: Eur J Gynaecol Oncol. 2004;25(2):255-6.
Endometrioid adenocarcinoma arising in endometriosis foci six years after estrogen replacement therapy: a case report.
Areia A, Sousa V, Frutuoso C, Dias I, Martins MI, de Oliveira CF.
Department of Gynecology, Coimbra University Hospital, Portugal.
We present a case of a 53-year-old woman who developed an endometrioid adenocarcinoma six years after total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO), who was on estrogenic-only hormone replacement therapy (HRT).
PMID: 15032298 [PubMed]
75: Ginekol Pol. 2003 Dec;74(12):1549-56.
[The use of magnetic resonance imaging for the evaluation of treatment outcome in uterine artery embolisation for fibroids] [Article in Polish] Pietura R, Janczarek M, Bednarek W, Kotarski J, Szczerbo-Trojanowska M.
Zakladu Radiologii Zabiegowej i Neuroradiologii AM w Lublinie.
THE AIM: Of the study was to evaluate utility of magnetic resonance (MR) in the assessment of the women who fulfilled inclusion criteria for uterine artery embolisation as a symptomatic leiomyoma treatment and outcome of procedures. MATERIALS AND METHODS: MR examination was performed in 220 patients. Uterine artery embolizations were performed in 170 patients. RESULTS: The reasons for disqualification were: no correlation between symptoms and size an position of leiomyoma–61%, adenomyosis–20%. In MR imaging dominant leiomyoma volumes were diminished by 59.6% (p < 0.05) over a period of 3 months. CONCLUSIONS: MR is the method of choice in the assessment of women referred to uterine artery embolisation as a symptomatic leiomyoma treatment. MR imaging is effective and objective method of evaluation outcomes of uterine embolisation.
PMID: 15029748 [PubMed]
76: Ginekol Pol. 2003 Nov;74(11):1456-64.
[In Process Citation] [Article in Polish] Madej P, Madej JA, Kaminski K, Milnerowicz H, Lagan J, Nowak M, Dzimira S.
Zakladu Higieny Ciazy, Porodu i Pologu, Katedry Zdrowia Kobiety, SAM w Katowicach.
OBJECTIVES: Endometriosis is an illness accompanied by invasion features, but malignant changes appear extremely seldom. Metallothionein (MT) is a protein and takes part in the detoxicating processes of the organism. MT is located, among others, in benign and malignant neoplasms in animals as well as humans, mainly in the S phase of cellular cycle, and that is why MT is considered to be both an index of cell proliferation and tumor progress. MATERIALS AND METHODS: 34 specimens from 21 women with ovary endometriosis (III degree according to AFS) have been examined. The specimens were obtained during surgery and they were histopathologically verified. The material was coloured by H + E and by van Gieson method, and MT was determined immunohistochemically. The measurement of the cells number containing MT was performed with measurement system Multi-Scan Base V8.08, with the microscope Axiophot, Zeiss Jena in so-called measurements areas, with the surface 18802 microns 2. RESULTS: High MT capacity was found in the epithelial cells in the endometriosis focus. This high MT capacity may imply that there exists the proliferation process in the focuses of external endometriosis. Simultaneously, the lowest MT capacity was discovered in glandular ducts. CONCLUSIONS: Proliferating epithelial cells contain the highest capacity of MT, which indicates increase of number of dividing cells particularly in the S phase of cellular cycle and that is why MT can be considered one of the markers of ovary endometriosis.
PMID: 15029735 [PubMed]
77: Arq Gastroenterol. 2003 Jul-Sep;40(3):192-7. Epub 2004 Mar 15.
[Rectovaginal septum endometriosis: a disease with specific diagnosis and treatment] [Article in Portuguese] Abrao MS, Neme RM, Averbach M.
Departamento de Obstetricia e Ginecologia, Faculdade de Medicina, Universidade de Sao Paulo, Brazil. msabrao@attglobal.net
BACKGROUND: The involvement of the rectovaginal septum, of rectum and sigmoid by endometriosis leads to intense symptoms as dysmenorrhea, pelvic pain, deep dyspareunia, tenesmus and hematochezia in young and middle aged women during periods. The diagnosis can be made by tipycal history and vaginal examination, rectal examination, barium enema, proctoscopy and so on. The indications of operation include severe clinic symptoms and failed conservative therapy. The treatment of choice for this type of endometriosis is the surgical resection of affected tissue, in order to relieve patient symptoms, and avoid disease progression. The correct assessment as to the presence and extension of the endometriosis-affected sites such as the rectum, uterosacral ligaments and rectovaginal septum is extremely important to provide better results with the surgical treatment of endometriosis. AIM: To describe the main aspects related to rectovaginal septum endometriosis and offer the general surgeon some information about this enigmatic disease. CONCLUSION: Rectovaginal septum endometriosis is a frequent disease, with specific diagnosis and treatment.
PMID: 15029397 [PubMed]
78: Indian J Pathol Microbiol. 2003 Jan;46(1):20-3.
Incidence of pelvic and extrapelvic endometriosis in Eastern region of Nepal.
Sinha AK, Agarwal A, Lakhey M, Mishra A, Sah SP.
Department of Pathology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. anshu3@hotmail.com
Endometriosis is described as the presence of endometrial glands or stroma in abnormal locations outside the uterus. It afflicts 10% women of childbearing age. A 5-year retrospective analysis of histopathologically proven cases of endometriosis was done. Haematoxylin and Eosin stained slides were reviewed for type of lining epithelium, endometrial glands, stroma, fresh and old hemorrhage & inflammatory cells. Clinical details were analyzed. Age of the patient ranged from 22 – 48 years. The most common site of endometriosis was ovaries (69.23%) followed by scars (11.43%), cervix (7.69%), fallopian tube (3.84%), vagina (3.84%) and appendix (3.84%) in descending order of frequency. Most common symptom was pain. On ultrasound and X-ray diagnosis could not be made in any case. Clinically endometriosis was diagnosed in 9 (34.62%) cases. On histopathological examination majority of the cases (42.3%) had endometrial glands, stroma and hemosiderin laden macrophages. 3 cases (11.43%) had endometrial lining epithelium and stroma only, which on laproscopy also were diagnosed to have endometriosis. It was concluded that high rate of surgical excision of organs were done because of misdiagnosis.
PMID: 15027712 [PubMed]
79: Obstet Gynecol. 2004 Mar;103(3):583; author reply 583-4.
Comment on: · Obstet Gynecol. 2003 Nov;102(5 Pt 2):1125-7.
Iatrogenic endometriosis caused by uterine morcellation during a supracervical hysterectomy.
Decenzo JA.
Publication Types: · Comment · Letter
PMID: 15024758 [PubMed]
80: Fertil Steril. 2004 Mar;81 Suppl 1:904-11. Related Articles, Links
Regulation of endometrial stromal cell matrix metalloproteinase activity and invasiveness by interleukin-8.
Mulayim N, Savlu A, Guzeloglu-Kayisli O, Kayisli UA, Arici A.
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8063, USA.
OBJECTIVE: To evaluate the effect of interleukin-8 (IL-8) on endometrial stromal cell metalloproteinase (MMP) activity and invasiveness. DESIGN: Experimental laboratory study. SETTING: University medical center. PATIENT(S): Reproductive age women without endometriosis. INTERVENTION(S): Endometrial stromal cells were grown in culture and treated with recombinant IL-8 (0.0001-10 ng/mL) for 24 to 48 hours. Supernatants were collected for soluble assay of collagenase activity and gelatin zymography. Endometrial stromal cells were plated on 8-microm pore membranes coated with Matrigel or human simple matrix and treated with IL-8 for 48 hours. MAIN OUTCOME MEASURE(S): Collagenase activity and MMP2 and 9 activity of control vs. IL-8 treated endometrial cells, and number of endometrial cells that invade through Matrigel or human simple matrix. RESULT(S): Collagenase activity in cells treated with IL-8 (1-10 ng/mL) was higher than in control cells. On gelatin zymograms, MMP2 and MMP9 activity of endometrial stromal cells was stimulated by IL-8 treatment (1-10 ng/mL). The number of cells that invaded the Matrigel or human simple matrix was 1.7-fold higher in the group treated with 10 ng/mL of IL-8 compared with the control group. CONCLUSION(S): IL-8 increases MMP activity and invasive capability of endometrial stromal cells in culture; IL-8 may be involved in the pathogenesis of endometriosis and menstrual physiology.
PMID: 15019828 [PubMed]
81: Fertil Steril. 2004 Mar;81 Suppl 1:869-75. Related Articles, Links
Expression of angiopoietin 1 and 2 in ectopic endometrium on the chicken chorioallantoic membrane.
Drenkhahn M, Gescher DM, Wolber EM, Meyhoefer-Malik A, Malik E.
Institute of Physiology, Medical University of Luebeck, Luebeck, Germany.
OBJECTIVE: To investigate the role of angiopoietin 1 and 2 (ANGPT1/ANGPT2) in angiogenesis of the ectopic endometrium as a crucial step in the development of an endometriotic lesion, we analyzed their expression patterns in an experimental model of endometriosis. DESIGN: Experimental prospective study. SETTING: University hospital. PATIENT(S): Endometrium samples obtained from healthy, ovulating women undergoing hysterectomy for benign gynecologic conditions. INTERVENTION(S): Endometrial fragments were transplanted to the chicken chorioallantoic membrane (CAM) and cultivated for 0, 24, 48, and 72 hours. MAIN OUTCOME MEASURE(S): Expression of ANGPT1 and ANGPT2 mRNA was quantified by competitive reverse transcriptase polymerase chain reaction (RT-PCR) and normalized to expression of the housekeeping gene human glyceraldehyde 3-phosphate dehydrogenase (GAPDH) mRNA. The expression of ANGPT1 and ANGPT2 protein was analyzed by immunohistochemical staining. RESULT(S): All grafts expressed ANGPT1 and ANGPT2 mRNA. The mRNA concentration of both factors decreased after cultivation, but the ANGPT2/ANGPT1 ratio increased considerably during the first 24 hours of cultivation. The immunohistochemical investigation for ANGPT1 and ANGPT2 revealed presence of both proteins at all the times but no obvious correlation with the duration of cultivation. CONCLUSION(S): The ratio of ANGPT2/ANGPT1 mRNA in endometrial grafts increased after 24 hours of cultivation on the chicken chorioallantoic membrane and shows a shift toward a more dominant role of ANGPT2. This agrees with the current model of angiopoietin action in angiogenesis and might indicate angiogenic activity in the endometrial graft. The angiopoietins are likely to play an important role in the pathogenesis of endometriosis.
PMID: 15019822 [PubMed]
82: Fertil Steril. 2004 Mar;81 Suppl 1:857-62. Related Articles, Links
Immunolocalization of angiopoietin 1 in human peritoneal endometriotic lesions.
Gescher DM, Berndorff U, Meyhoefer-Malik A, Moubayed P, Malik E.
Department of Obstetrics and Gynecology, University Hospital of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany. dgescher@ukaachen.de
OBJECTIVE: To analyze the expression of angiopoietin 1 (ANGPT1) in pigmented and nonpigmented endometriosis implants and specify its role in the interaction of angiogenic factors. DESIGN: Experimental retrospective study. SETTING: University hospital. PATIENT(S): Eighty-two sections from 201 laparoscopic tissue samples of 43 female patients. INTERVENTION(S): Biopsies of peritoneal endometriotic lesions of macroscopically different forms. MAIN OUTCOME MEASURE(S): Angiopoietin 1 expression and location pattern in endothelial cells, periendothelial cells, glandular epithelium, and stromal structures. RESULT(S): Angiopoietin 1 is immunohistochemically detectable in endothelial cells, periendothelial cells, in the glandular epithelium, and in the stroma. Differences in the expression of pigmented and nonpigmented lesions are not statistically significant. CONCLUSION(S): Pigmented and nonpigmented endometriotic lesions differ according to their clinical activity and angiogenic potential. Angiopoietin 1 is an important representative of the angiogenic factors and is involved in the angiogenic processes of these lesions. There were no significant differences in the expression and location within different lesion types for ANGPT1. Thus, it is not a direct activity marker of a lesion.
PMID: 15019820 [PubMed]
83: Fertil Steril. 2004 Mar;81 Suppl 1:819-23. Related Articles, Links
Light and electron microscopic evaluation of antileukotriene therapy for experimental rat endometriosis.
Ihara T, Uchiide I, Sugamata M.
Department of Pathology, Tochigi Institute of Clinical Pathology, 2308-3 Minamiakatsuka, Nogi, Shimotsuga-gun, Tochigi 329-0112, Japan.
OBJECTIVE: To evaluate the effect of antileukotriene therapy, we examined the morphologic alteration in experimental rat endometriosis both with and without leukotriene receptor antagonist treatment. DESIGN: Light and electron microscopic analysis. SETTING: Tochigi Institute of Clinical Pathology, Japan. ANIMAL(S): Female Sprague-Dawley rats maintained on a schedule of 12 hours of light and 12 hours of dark for 2 weeks. INTERVENTION(S): Uterine transplants were attached to rat peritoneum via the surgical autotransplantation technique. After autotransplantation, the rats were given daily administration of leukotriene receptor antagonist, and the lesions were examined at 4 and 7 days after autotransplantation. MAIN OUTCOME MEASURE(S): The morphologic comparison of rat endometriosis with and without antileukotriene therapy. RESULT(S): In the rats treated with leukotriene receptor antagonist, a significant decrease in stromal proliferation was observed when compared with nontreated rats. The treated rats showed not only the suppression of infiltration and activation of mast cells but also widespread apoptosis of proliferative fibroblasts in the lesions. CONCLUSION(S): Our results reveal that a leukotriene receptor antagonist has significant therapeutic value for the treatment of rat endometriosis. It is likely that antileukotriene therapy would be efficacious in the treatment and prevention of human endometriosis.
PMID: 15019815 [PubMed]
84: Fertil Steril. 2004 Mar;81 Suppl 1:810-8. Related Articles, Links
Hepatocyte growth factor may be involved in cellular changes to the peritoneal mesothelium adjacent to pelvic endometriosis.
Ishimaru T, Khan KN, Fujishita A, Kitajima M, Masuzaki H.
Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. tadayuki@net.nagasaki-u.ne.jp
OBJECTIVE: To investigate the possible involvement of hepatocyte growth factor (HGF) in the cellular changes of pelvic mesothelium and the association of these changes with macrophage (Mphi) infiltration and the different stages of pelvic endometriosis. DESIGN: Controlled clinical study using intact tissue. SETTING: Nagasaki University School of Medicine, Nagasaki, Japan. PATIENT(S): Biopsy specimens from 25 red lesions, 20 black lesions of pelvic endometriosis and their adjacent peritoneum were excised either en bloc or separately during laparoscopy. INTERVENTION(S): Hepatocyte growth factor and activated macrophage-marker CD68 were immunolocalized using respective antibodies, and were quantitated by a computer analyzed quantitative-histogram (Q-H) score and light microscopy, respectively. MAIN OUTCOME MEASURE(S): The possible immunoreaction of HGF near the endometriotic lesions and their adjacent peritoneal mesothelium was examined. The association between immunostaining of HGF and macrophage infiltration around these cells was also investigated. RESULT(S): A fraction of biopsy specimens of pelvic peritoneum revealed histologically proven change from normal flat to cuboidal or columnar cell types. In cuboidal cells or flat cells of mesothelium adjacent to red lesions, the immunoreaction of HGF, as expressed by the Q-H scores, was found to be significantly higher than in corresponding cells adjacent to black lesions. The flat or cuboidal cells of pelvic mesothelium surrounding the red lesions also demonstrated greater macrophage infiltration than the cells surrounding black lesions. The Q-H scores of HGF in the cuboidal or columnar cells surrounding the red lesions showed a statistically significant correlation with the accumulation of macrophage in the cells; no similar correlation was demonstrated for black lesions. CONCLUSION(S): Adjacent peritoneum of pelvic endometriotic lesions may manifest an inflammatory response. Hepatocyte growth factor might be involved in the cellular changes found in the peritoneal mesothelium of women with pelvic endometriosis.
PMID: 15019814 [PubMed]
85: Fertil Steril. 2004 Mar;81 Suppl 1:775-9. Related Articles, Links
Efficacy of anti-tumor necrosis factor therapy in the treatment of spontaneous endometriosis in baboons.
Barrier BF, Bates GW, Leland MM, Leach DA, Robinson RD, Propst AM.
Southwest Foundation for Biomedical Research, San Antonio, TX, USA. breton.barrier@lackland.af.mil
OBJECTIVE: To determine the efficacy of anti-tumor necrosis factor therapy (etanercept) for treating endometriosis in baboons. DESIGN: A randomized, placebo-controlled, blinded study using the baboon endometriosis model. SETTING: Southwest National Primate Research Center. ANIMAL(S): Twelve female baboons with spontaneous peritoneal endometriosis. INTERVENTION(S): Etanercept (n = 8) or sterile water (n = 4) was administered subcutaneously three times per week. MAIN OUTCOME MEASURE(S): After 8 weeks, the number, color, and surface area of peritoneal lesions was evaluated. Revised American Society for Reproductive Medicine staging was used. RESULT(S): A statistically significant decrease in red lesion surface area in the treatment group was observed. A trend toward a decrease in the absolute number of red lesions was noted in the treatment group. White and black lesion number and total surface area slightly increased in both groups but failed to achieve statistical significance. Endometriosis was diagnosed in 60% of captive-born baboons with primary infertility. CONCLUSION(S): These results indicate that etanercept effectively reduces the amount of spontaneously occurring active endometriosis in the baboon.
PMID: 15019808 [PubMed]
86: J Reprod Med. 2004 Feb;49(2):115-20. Related Articles, Links
Quality of life in Brazilian women with endometriosis assessed through a medical outcome questionnaire.
Marques A, Bahamondes L, Aldrighi JM, Petta CA.
Physical Therapy Section, Women’s Hospital, Sao Paulo, Brazil.
OBJECTIVE: To assess the quality of life in women with pelvic pain associated with endometriosis through the 36-item Short Form Health Survey (SF-36). STUDY DESIGN: The study was cross-sectional and conducted at a tertiary care center. Sixty women diagnosed surgically with endometriosis were interviewed during the first half of 2001. RESULTS: In general, a poor quality of life was observed among the women interviewed. No correlation was found between the quality of life and intensity of pain, use of medications and/or living with a partner. Women with moderate or severe endometriosis scored better on the emotional aspects of the questionnaire. Among those who exercised regularly, better scores on mental health were observed. CONCLUSION: According to the SF-36 questionnaire, this cohort study of Brazilian women with endometriosis showed a poor quality of life.
PMID: 15018440 [PubMed]
87: Reproduction. 2004 Mar;127(3):293-304. Related Articles, Links
Endometriosis and the neoplastic process.
Varma R, Rollason T, Gupta JK, Maher ER.
Section of Medical and Molecular Genetics, Birmingham Women’s Hospital, Birmingham, UK. r.varma@bham.ac.uk
Endometriosis is a frequent disorder that commonly presents with infertility and pelvic pain. Although the precise aetiology of endometriosis is unclear, it is generally considered to involve multiple genetic, environmental, immunological, angiogenic and endocrine processes. Genetic factors have been implicated in endometriosis but the susceptibility genes remain largely unknown. Although endometriosis is a benign disorder, recent studies of endometriosis suggest endometriosis could be viewed as a neoplastic process. Evidence to support this hypothesis includes the increased susceptibility to develop ovarian clear-cell and endometrioid cancers in the presence of endometriosis, and molecular similarities between endometriosis and cancer. In this article we discuss (i) the evidence suggesting that endometriosis might be viewed as a neoplastic process, and (ii) the implications of this hypothesis for elucidating the pathogenesis of endometriosis and developing novel methods of diagnostic classification and individualised treatments.
PMID: 15016949 [PubMed]
88: Hum Reprod. 2004 Apr;19(4):996-1002. Epub 2004 Mar 11. Related Articles, Links
Preferential infiltration of large bowel endometriosis along the nerves of the colon.
Anaf V, El Nakadi I, Simon P, Van de Stadt J, Fayt I, Simonart T, Noel JC.
Departments of Gyneacology, Academic Hospital Erasme, Free University of Brussels, Brussels, Belgium. vincent.anaf@ulb.ac.be
BACKGROUND: Little is known about the mode and the extent of infiltration of endometriotic lesions in the large bowel. METHODS: In 31 patients undergoing large bowel resection for severe deep-infiltrating endometriosis of the sigmoid and rectum with severe digestive symptoms, we performed a prospective morphological, histological and immunohistological study (using the monoclonal antibodies S100 for the detection of the nerves and CD10 for the detection of the endometriotic stromal cells) on the large bowel resection specimen. The evaluation of invasion of the large bowel by endometriosis was performed by studying the presence, localization and mean number of lesions in the different layers of the colon, the relationship between endometriosis and the nerves of the colon, the nerve density in the respective layers of the large bowel and the presence of endometriosis on the resection margins. RESULTS: The most richly innervated layers of the large bowel are the most intensely involved by endometriosis. We found that 53 +/- 15% of endometriotic lesions were in direct contact the nerves of the colon by means of perineurial or endoneurial invasion. The mean largest diameter of the lesion does not seem to be correlated with the depth of infiltration. The margins were positive in 9.7% of cases. In cases of positive margins, the endometriotic lesions were in close histological relationship with the nerves. CONCLUSIONS: There is a close histological relationship between endometriotic lesions of the large bowel and the nerves of the large bowel wall. Endometriotic lesions seem to infiltrate the large bowel wall preferentially along the nerves, even at distance from the palpated lesion, while the mucosa is rarely and only focally involved.
PMID: 15016784 [PubMed]
89: Anticancer Res. 2004 Jan-Feb;24(1):151-4. Related Articles, Links
Genomic imbalance and onco-protein expression of ovarian endometrioid adenocarcinoma arisen in an endometriotic cyst.
Noack F, Schmidt H, Buchweitz O, Malik E, Horny HP.
Department of Pathology, University Hospital Lubeck, Germany. noack@patho.mu-luebeck.de
BACKGROUND: Malignant transformation in endometriosis is a rare but well known complication. However, detailed mechanisms of malignant transition and tumourigenesis in endometriosis remain unknown. We here describe the case of an endometrioid carcinoma arisen in endometriotic ovarian cyst fulfilling Sampson’s criteria for malignant transformation of endometriosis. We compared genetic alterations and oncoprotein expression in the endometriotic ovarian cyst and the associated endometrioid adenocarcinoma. MATERIALS AND METHODS: Genomic instability was evaluated by comparative genomic hybridization (CGH). Onco-protein expression was analysed by immunohistochemistry with antibodies against bcl-2, c-MYC, cyclin D1, p53, HER-2 and KIT protein. RESULTS: CGH revealed a gain of 8q, including the locus of the oncogene c-MYC at 8q24. Immunohistochemistry disclosed a differing protein expression profile between the epithelia of the pre-existing cyst and adenocarcinoma. Apart from HER-2, all onco-proteins were more strongly expressed in epithelial cells of the adenocarcinoma than of the endometriotic cyst. CONCLUSION: The solitary genomic imbalance of chromosome 8 possibly reflects the importance for initiation and/or progression of endometrioid carcinoma. Overexpression of onco-proteins then may occur subsequently in the malignant transformation of ovarian endometriosis. However, the exact mechanisms of malignant transition in ovarian endometriosis remain to be elucidated in future studies with a higher number of cases.
PMID: 15015590 [PubMed]
90: Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004 Feb;24(2):182-5. Related Articles, Links
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