Fertil Steril. 2011 Mar 1;95(3):1113-4. Epub 2011 Jan 12.

Increased diagnostic accuracy of laparoscopy in endometriosis using indigo carmine: a new technique.

Rauh-Hain JA, Laufer MR.

Source

Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Abstract

OBJECTIVE:

To report the technique and outcome of laparoscopy in endometriosis using indigo carmine.

DESIGN:

Case report.

SETTING:

Tertiary care center.

PATIENT(S):

Twenty-nine-year-old nulligravid woman with a history of endometriosis and left unicornuate uterus with an absent right horn with a present right ovary and distal fallopian tube with recurrence of disease.

INTERVENTION(S):

Operative laparoscopy for destruction of endometriosis and chromopertubation, given the patient’s history of infertility.

MAIN OUTCOME MEASURE(S):

Identification of endometriosis.

RESULT(S):

Lesions of endometriosis were stained with indigo carmine and were easily identified.

CONCLUSION(S):

Tissue staining demonstrated lesions of endometriosis that were more easily identified; therefore, this technique could provide a special and unique approach to a more accurate diagnosis of endometriosis.

Fertil Steril. 2011 Mar 1;95(3):895-9. Epub 2010 Dec 10.

Migraine in women with chronic pelvic pain with and without endometriosis.

Karp BI, Sinaii N, Nieman LK, Silberstein SD, Stratton P.

Source

National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1109, USA.

Abstract

OBJECTIVE:

To examine the prevalence of migraine in women with chronic pelvic pain with and without endometriosis.

DESIGN:

Prospective study of headache, pelvic pain, and quality of life before laparoscopic surgery for pelvic pain. Endometriosis was diagnosed pathologically. Headaches were classified as migraine or non-migraine using International Headache Society criteria.

SETTING:

Clinical research hospital.

PATIENT(S):

108 women in a clinical trial for chronic pelvic pain (NCT00001848).

INTERVENTION(S):

Laparoscopy to diagnose endometriosis, assessment by neurologist to assess headaches.

MAIN OUTCOME MEASURE(S):

Prevalence of migraine and other headaches in women with chronic pelvic pain with or without endometriosis. Headache frequency, severity and relationship to pelvic pain and endometriosis.

RESULT(S):

Lifetime prevalence of definite or possible migraine was 67% of women with chronic pelvic pain. An additional 8% met criteria for possible migraine. Migraine was no more likely in women with endometriosis than those without. Women with the most severe headaches had a lower quality of life compared with those with pelvic pain alone.

CONCLUSION(S):

Migraine headache is common in women with chronic pelvic pain, regardless of endometriosis, and contributes to disability in those with both conditions. The strong association suggests a common pathophysiology.

Fertil Steril. 2011 Mar 1;95(3):1171-3.

Expression of oct-4 and c-kit antigens in endometriosis.

Pacchiarotti A, Caserta D, Sbracia M, Moscarini M.

Source

University of Rome Sapienza, Rome, Italy. arypac@alice.it

Abstract

The objective of this study was to test the expression of the oct-4 and c-kit, both markers of stem cells, in the ectopic endometrial tissue of endometriotic lesions of women with severe endometriosis. Our findings show that ectopic epithelial cells express oct-4 and c-kit and this suggests that the ectopic endometrium in endometriosis has a stem cell origin and could explain the possible progression to ovarian cancer.

Fertil Steril. 2011 Mar 1;95(3):877-81. Epub 2010 Nov 11.

Questioning patients about their adolescent history can identify markers associated with deep infiltrating endometriosis.

Chapron C, Lafay-Pillet MC, Monceau E, Borghese B, Ngô C, Souza C, de Ziegler D.

Source

Faculté de Médecine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Ouest, Centre Hospitalier, Paris, France. charles.chapron@cch.aphp.fr

Abstract

OBJECTIVE:

To investigate whether the clinical history, particularly of the adolescence period, contains markers of deeply infiltrating endometriosis (DIE).

DESIGN:

Cross-sectional study.

SETTING:

Universitary tertiary referral center.

PATIENT(S):

Two hundred twenty-nine patients operated on for endometriosis. Endometriotic lesions were histologically confirmed as non-DIE (superficial peritoneal endometriosis and/or ovarian endometriomas) (n = 131) or DIE (n = 98).

INTERVENTION(S):

Surgical excision of endometriotic lesions with pathological analysis of each specimens.

MAIN OUTCOME MEASURE(S):

Epidemiological data, pelvic pain scores, family history of endometriosis, absenteeism from school during menstruation, oral contraceptive (OC) pill use.

RESULT(S):

Patients with DIE had significantly more positive family history of endometriosis (odds ratio [OR] = 3.2; 95% confidence interval [CI]: 1.2-8.8) and more absenteeism from school during menstruation (OR = 1.7; 95% CI: 1-3). The OC pill use for treating severe primary dysmenorrhea was more frequent in patients with DIE (OR = 4.5; 95% CI: 1.9-10.4). Duration of OC pill use for severe primary dysmenorrhea was longer in patients with DIE (8.4 ± 4.7 years vs. 5.1 ± 3.8 years). There was a higher incidence of OC pill use for severe primary dysmenorrhea before 18 years of age in patients with DIE (OR = 4.2; 95% CI: 1.8-10.0).

CONCLUSION(S):

The knowledge of adolescent period history can identify markers that are associated with DIE in patients undergoing surgery for endometriosis.

Fertil Steril. 2011 Mar 1;95(3):900-5. Epub 2010 Nov 10.

Ultrasound-guided high-intensity focused ultrasound ablation for adenomyosis: the clinical experience of a single center.

Zhou M, Chen JY, Tang LD, Chen WZ, Wang ZB.

Source

Department of Obstetrics and Gynecology, First Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China.

Abstract

OBJECTIVE:

To assess the midterm outcomes after ultrasound-guided high-intensity focused ultrasound (HIFU) ablation in treatment of patients with symptomatic adenomyosis.

DESIGN:

A prospective clinical trial.

SETTING:

University teaching hospital.

PATIENT(S):

Seventy-eight patients with symptomatic adenomyosis.

INTERVENTION(S):

A single treatment session of ultrasound-guided HIFU ablation for adenomyosis.

MAIN OUTCOME MEASURE(S):

Dysmenorrhea and menorrhagia scores and the incidence of complications.

RESULT(S):

In all 78 patients, 84.6% tolerated the treatment procedure well with pain scores between 0 and 4. Treatment was terminated in only one patient because of increased blood pressure persistently. Sixty-nine patients have finished at least an 18-month follow-up; the mean follow-up time was 24.2 months. Nonperfused regions in lesions were observed in 60 (87.0%) patients on the enhanced magnetic resonance imaging scans. Scores for menorrhea and dysmenorrhea decreased. Clinical effectiveness of the treatment was observed in 62 women (89.9%) with varying degrees of symptomatic relief of dysmenorrhea. Eight patients had relapses. Twenty-two patients (28.6%) had 27 complications. Of these, four had two or more complications. Twenty-three events (85.1%) did not need medical intervention (Society of Interventional Radiology class A). No serious complications including death or major permanent injuries were observed.

CONCLUSION(S):

Ultrasound-guided HIFU ablation may be a safe and effective noninvasive alternative in the treatment of symptomatic adenomyosis.

Fertil Steril. 2011 Mar 1;95(3):1133-6. Epub 2010 Nov 10.

HOXA10 expression is decreased in endometrium of women with adenomyosis.

Fischer CP, Kayisili U, Taylor HS.

Source

Division of Reproductive Endocrinology and Infertility, Yale University, New Haven, Connecticut, USA.

Abstract

HOXA10 gene expression is decreased in the secretory phase endometrium of women with adenomyosis. Diminished expression of HOXA10 is a potential mechanism explaining decreased implantation observed in women with adenomyosis.

Fertil Steril. 2011 Mar 1;95(3):882-8.e1. Epub 2010 Nov 5.

Effects of hyperprolactinemia treatment with the dopamine agonist quinagolide on endometriotic lesions in patients with endometriosis-associated hyperprolactinemia.

Gómez R, Abad A, Delgado F, Tamarit S, Simón C, Pellicer A.

Source

Instituto Universitario Instituto Valenciano de Infertilidad, Valencia University School of Medicine and Fundación Investigación Clínico Valencia, Valencia, Spain.

Abstract

OBJECTIVE:

To assess whether dopamine receptor 2 agonists reduced the size of peritoneal lesions in women with endometriosis and elucidate whether affectation of vascular endothelial growth factor (VEGF)/VEGF receptor 2 (VEGFR2)-dependent angiogenesis was mediating the observed effects.

DESIGN:

Proof-of-concept study.

SETTING:

University hospital and a university-affiliated private IVF research center.

PATIENT(S):

Hyperprolactinemic patients (n = 9) with endometriosis requiring a first surgical intervention (L1) and benefiting from a second-look laparoscopy (L2) were evaluated.

INTERVENTION(S):

During L1, four to six peritoneal red lesions were identified. One-half of the lesions were removed and the remaining one-half were labeled with silk knot sutures. After L1, quinagolide was administered in a titrated manner (25-75 μg/d) for 18-20 weeks. During L2, the remaining lesions were surgically excised.

MAIN OUTCOME MEASURE(S):

Both L1 and L2 were video recorded to compare the effects of quinagolide treatment on lesion size. Lesions removed at L1 and L2 were compared by means of: 1) histologic analysis; 2) immunohistochemical quantitative analysis of angiogenesis; and 3) quantitative fluorescence polymerase chain reaction array analysis of 84 chemokines and pro-/antiangiogenic molecules.

RESULT(S):

Quinagolide induced a 69.5% reduction in the size of the lesions, with 35% vanishing completely. Histologic analysis showed tissue degeneration, which was supported by down-regulation of VEGF/VEGFR2, three proangiogenic cytokines (CCL2, RUNX1, and AGGF1) and plasminogen activator inhibitor (PAI) 1, a potent inhibitor of fibrinolysis in the L2 lesions.

CONCLUSION(S):

By interfering with angiogenesis, enhancing fibrinolysis, and reducing inflammation, quinagolide reduces or eliminates peritoneal endometriotic lesions in women with endometriosis.

Fertil Steril. 2011 Mar 1;95(3):1123-6. Epub 2010 Nov 3.

Overexpression of nerve growth factor in peritoneal fluid from women with endometriosis may promote neurite outgrowth in endometriotic lesions.

Barcena de Arellano ML, Arnold J, Vercellino F, Chiantera V, Schneider A, Mechsner S.

Source

Endometriosis Research Center Charité, Department of Gynaecology, Charité Campus Benjamin Franklin, Berlin, Germany. sylvia.mechsner@charite.de

Abstract

To investigate the role of the nerve growth factor (NGF) in the endometriosis-associated innervation in the development of endometriosis-associated symptoms, 41 peritoneal fluid samples (PF) from patients with surgically and histologically proven endometriosis and 20 PF from patients with other gynecologic conditions were analyzed with Western blot and a novel in vitro model using dorsal root ganglia (DRG) to show neuronal outgrowth; endometrial cells also were analyzed. The results suggest that the PF of endometriosis patients and endometriotic lesions have neurotropic properties, because the Western blot analysis and the cell culture stainings showed NGF expression, and the neurite outgrowth of DRG treated with PF of patients with endometriosis was significantly higher than when treated with PF of patients without endometriosis. Furthermore, blocking NGF with both anti-NGF and K252a leads to a significant decrease in neurite outgrowth.

Fertil Steril. 2011 Mar 1;95(3):1164-7.

Increased immunoreactivity to SLIT/ROBO1 and its correlation with severity of dysmenorrhea in adenomyosis.

Nie J, Liu X, Zheng Y, Geng JG, Guo SW.

Source

Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People’s Republic of China.

Abstract

Compared with normal endometrium, SLIT expression was statistically significantly higher in ectopic endometrium from women with adenomyosis, while roundabout 1 (ROBO1) immunoreactivity and microvessel density (MVD) level were statistically significantly higher in both eutopic and ectopic endometrium than normal endometrium. Both SLIT immunoreactivity in ectopic endometrium and MVD in eutopic endometrium were positively correlated with the severity of dysmenorrhea and found to be significant predicators for dysmenorrhea severity in women with adenomyosis.

Fertil Steril. 2011 Mar 1;95(3):1152-5.

Short-term results of magnetic resonance imaging-guided focused ultrasound surgery for patients with adenomyosis: symptomatic relief and pain reduction.

Kim KA, Yoon SW, Lee C, Seong SJ, Yoon BS, Park H.

Source

Department of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Gyunggi-do, South Korea.

Abstract

The objective of this study was to evaluate the degree of symptomatic relief obtained after treatment with magnetic resonance-guided focused ultrasound surgery in patients with adenomyosis. Quality of life and pain assessment questionnaires from 35 women, collected on the day of treatment and up to 6 months after treatment, indicated that the treatment was safe and there was a significant reduction in symptoms.

Genet Test Mol Biomarkers. 2011 Mar;15(3):181-4. Epub 2011 Jan 8.

Molecular pathogenesis of endometriosis; Toll-like receptor-4 A896G (D299G) polymorphism: a novel explanation.

Latha M, Vaidya S, Movva S, Chava S, Govindan S, Govatati S, Banoori M, Hasan Q, Kodati VL.

Source

Department of Genetics and Molecular Medicine, Vasavi Medical and Research Centre, Hyderabad, India.

Abstract

BACKGROUND:

Endometriosis is a distressing gynecological disorder. Toll-like receptor 4 (TLR4) is specific for recognition of the molecular pattern of gram-negative bacteria. TLR4 is present on the surface of endometrial cells. Their role in the molecular pathogenesis of endometriosis is postulated through a novel explanation.

OBJECTIVE:

To study the TLR4 A896G polymorphism in cases of endometriosis and age- and sex-matched healthy controls and evaluate its role in the molecular pathogenesis of endometriosis.

DESIGN:

Case-control study, involving patients from four gynecological centers from Hyderabad Samples: The study was carried out on 400 women who include 200 surgically confirmed cases of endometriosis and 200 healthy women volunteers in whom endometriosis was excluded by the standard diagnostic criteria.

RESULTS:

An association of G allele, GG, and AG genotype of TLR4 A896G polymorphism was seen in cases of endometriosis. “G” allele was found to be significantly associated with endometriosis (odds ratio=4.4827; 95% confidence interval: 2.2829-8.8021; χ(2) p<0.0001). An eightfold increase of endometriosis risk was seen in women who carry GG genotype, whereas AA genotype can be considered as protective in our population.

CONCLUSION:

TLR4 A896G polymorphism (rs4986790) is a functional polymorphism resulting in hypo-responsiveness of the receptor, thus resulting in peritoneal inflammation. The molecular microenvironment becomes favorable for the endometrial cells to adhere to the peritonium, thereby resulting in the initiation of endometriosis.

Gynecol Endocrinol. 2011 Mar;27(3):185-9. Epub 2010 May 26.

Association between GSTM1 gene polymorphism in Iranian patients with endometriosis.

Hosseinzadeh Z, Mashayekhi F, Sorouri ZZ.

Source

Department of Biology, Faculty of Sciences, University of Guilan, Rasht, Iran.

Abstract

Endometriosis is defined as a condition in which tissue histologically similar to the endometrium is found outside the uterine cavity. It develops mostly in women of reproductive age. Endometriosis shows a drastically elevated frequency in industrial areas. GSTM1 gene encodes a major detoxification phase enzyme that helps detoxify various xenobiotics. Deficiency in GSTM1 activity is caused by homozygous deletion of GSTM1 and leads to various biological consequences. There are significant interethnic differences in GSTM1 allele frequencies. In this study, the relationship between GSTM1 genotypes and endometriosis in an Iranian population was investigated. The study included 120 patients and 200 healthy volunteers. Genomic DNA was prepared from peripheral blood leukocytes. Genotypes and allele frequencies were determined in patients and healthy controls using polymerase chain reaction (PCR). The GSTM1 null genotype was significantly associated with the increased risk of endometriosis (OR=3.75, 95% confidence interval (CI)=2.42-6.45, P<0.0001). The prevalence of GSTM1-null genotype in the patient group was 72.5%, compared to 40% in the control group. The proportion of GSTM1A/B genotype was higher in controls as compared to cases (20% vs. 2.5%). This study suggests that GSTM1 null genotype is associated with higher risk of endometriosis; these observations, however, requiring further confirmation in a larger multi-ethnic study.

Hum Fertil (Camb). 2011 Mar;14(1):64-7.

Antibodies to Chlamydia trachomatis in serum and peritoneal fluid of women with endometriosis.

Gazvani R, Coyne L, Anttila T, Saikku P, Paavonen J, Templeton A.

Source

The Hewitt Centre for Reproductive Medicine, Liverpool Women’s NHS Foundation Trust, Liverpool, UK.

Abstract

The specifics of inflammation created by infection with Chlamydia trachomatis could be favourable to the genesis of endometriosis. To investigate this hypothesis, we studied the association between Chlamydia trachomatis specific IgG and IgA antibodies in serum and the peritoneal fluid of 51 women undergoing laparoscopic surgery. There was no significant difference between women with and without endometriosis with respect to the incidence of IgG and IgA in serum or the peritoneal fluid. The results of our preliminary study did not show any significant link between past infection with Chlamydia trachomatis and the presence of endometriosis.

Hum Immunol. 2011 Mar;72(3):213-8. Epub 2010 Dec 15.

New insights into pattern recognition receptors and their ligands in gynecologic pathologies.

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

Source

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

Abstract

In the ovary, clear cell carcinoma (CCC) and endometrioid adenocarcinoma occur in the setting of endometriosis. In this review, we discuss the role of innate immune responses, specifically endogenous ligands (also known as “alarmins”), their pattern recognition receptors (PRRs) and their signaling pathways, in the pathogenesis of ovarian cancer, in particular, endometriosis-associated ovarian cancer. This article reviews the English-language literature for pathogenesis and pathophysiological studies on endometriosis and ovarian cancer. Here, we show that iron functions as an endogenous ligand and can induce chromosomal instability through production of reactive oxygen intermediates-induced oxidative stress. Several important CCC-related genes overlap with those known to be associated with hepatocyte nuclear factor-1β-dependent oxidative stress. Aberrant expression of PRRs and HNF-1β in endometriosis has been reported in the setting of chronic inflammation and oxidative stress pathways, which lie downstream of these genes. A concerted overexpression of alarmins, their receptors and HNF-1β might be required for endometriosis carcinogenesis. Recent advances in innate immunity illuminate the molecular mechanism underlying inflammation-induced carcinogenesis. Upregulation of PRRs expression may synergize with activation of HNF-1β signaling to accelerate endometriosis proliferation and cause carcinogenesis.

Hum Reprod. 2011 Mar;26(3):731-2; author reply 732. Epub 2010 Dec 21.

Dietary fat consumption and endometriosis risk.

Koninckx PR, Brosens IA.

Comment on

Hum Reprod Update. 2011 Mar-Apr;17(2):159-70. Epub 2010 Sep 10.

Oral contraceptives and risk of endometriosis: a systematic review and meta-analysis.

Vercellini P, Eskenazi B, Consonni D, Somigliana E, Parazzini F, Abbiati A, Fedele L.

Source

Clinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, Università Statale di Milano, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Via Commenda 12, Milan, Italy. paolo.vercellini@unimi.it

Abstract

BACKGROUND:

Combined oral contraceptives (OCs) inhibit ovulation, substantially reduce the volume of menstrual flow and may hypothetically interfere with implantation of refluxed endometrial cells. The aim of this review is to establish if OC use influences the risk of endometriosis.

METHODS:

We performed a MEDLINE search to identify all studies published in the last four decades (January 1970 to January 2010) in the English language on the relationship between OC exposure and risk of endometriosis. Two authors abstracted data on standardized forms.

RESULTS:

We identified 608 potentially relevant studies and 18 studies (6 cross-sectional, 7 case-control and 5 cohort) were selected. Pooling of the results derived from all the included reports independently from study design, yielded a common relative risk of 0.63 [95% confidence interval (CI), 0.47-0.85] for current OC users, 1.21 (95% CI, 0.94-1.56) for past users and 1.19 (95% CI, 0.89-1.60) for ever users. Methodological drawbacks, such as uncertain temporal relationship between exposure and outcome in cross-sectional studies and suboptimal selection of controls in case-control studies, limit the quality of the available evidence.

CONCLUSIONS:

The risk of endometriosis appears reduced during OC use. However, it is not possible to exclude the possibility that the apparent protective effect of OC against endometriosis is the result of postponement of surgical evaluation due to temporary suppression of pain symptoms. Confounding by selection and indication biases may explain the trend towards an increase in risk of endometriosis observed after discontinuation, but further clarification is needed. To date, the hypothesis of recommending OCs for primary prevention of endometriosis does not seem sufficiently substantiated.

Hum Reprod Update. 2011 Mar-Apr;17(2):242-53. Epub 2010 Aug 21.

Implantation failure: molecular mechanisms and clinical treatment.

Cakmak H, Taylor HS.

Source

Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.

Abstract

BACKGROUND:

Implantation is a complex initial step in the establishment of a successful pregnancy. Although embryo quality is an important determinant of implantation, temporally coordinated differentiation of endometrial cells to attain uterine receptivity and a synchronized dialog between maternal and embryonic tissues are crucial. The exact mechanism of implantation failure is still poorly understood.

METHODS:

This review summarizes the current knowledge about the proposed mechanisms of implantation failure in gynecological diseases, the evaluation of endometrial receptivity and the treatment methods to improve implantation.

RESULTS:

The absence or suppression of molecules essential for endometrial receptivity results in decreased implantation rates in animal models and gynecological diseases, including endometriosis, hydrosalpinx, leiomyoma and polycystic ovarian syndrome. The mechanisms are diverse and include abnormal cytokine and hormonal signaling as well as epigenetic alterations.

CONCLUSIONS:

Optimizing endometrial receptivity in fertility treatment will improve success rates. Evaluation of implantation markers may help to predict pregnancy outcome and detect occult implantation deficiency. Treating the underlying gynecological disease with medical or surgical interventions is the optimal current therapy. Manipulating the expression of key endometrial genes with gene or stem cell-based therapies may some day be used to further improve implantation rates.

Int J Gynecol Pathol. 2011 Mar;30(2):151-7.

Relationship between endometriosis, endometrioid adenocarcinoma, gliomatosis peritonei, and carcinoid tumor in a patient with recurrent ovarian teratoma.

Alexander M, Cope N, Renninson J, Hong A, Simpson RH, Hirschowitz L.

Source

Department of Histopathology, Royal Devon and Exeter Foundation Trust, Exeter, UK.

Abstract

Gliomatosis peritonei (GP) describes the implantation of mature neuroglial tissue in the peritoneum and is usually associated with mature ovarian teratoma but is also found in cases of immature teratoma. We report the case of a patient with recurrent mature ovarian teratoma, GP, endometriosis (with malignant transformation), and carcinoid tumor, found at the time of hysterectomy for a primary endometrial adenocarcinoma. This unusual combination of tumor types has not been reported earlier. Metaplasia of the totipotential subcoelomic or submesothelial stem cells is a recognized pathway for the development of endometriosis. Evidence from molecular genetic studies suggests that a similar process of stem cell differentiation may explain at least some cases of GP. The coexistence (and colocalization) of endometriosis, GP, and carcinoid tumor in this case raises the possibility that peritoneal stem cells may occasionally show an even wider spectrum of aberrant differentiation. This has relevance for the assessment and management of patients with synchronous gynecologic tumors or presumed metastatic disease.

Int J Gynecol Pathol. 2011 Mar;30(2):163-6.

Multicystic mesothelioma caused by endometriosis: 2 case reports and review of the literature.

Kurisu Y, Tsuji M, Shibayama Y, Yamada T, Ohmichi M.

Source

Department of Pathology, Osaka Medical College, Osaka, Japan. pa1021@art.osaka-med.ac.jp

Abstract

Multicystic mesothelioma was described as a benign neoplasm in most reports. But, whether it is neoplastic or reactive is still controversial. Although multicystic mesothelioma is often accompanied by endometriosis, histologic findings of the lesion with endometriosis have not been well documented. In this report, 2 cases of multicystic mesothelioma with endometriosis were studied histologically. The first lesion consisted of multiple cysts having thin walls lined with single-layered cuboidal mesothelia, and in the cystic walls, small foci of endometriosis were found. The second lesion was next to the endometriotic cysts in the pelvic space. These histologic findings suggest that endometriosis greatly contributes to the origin of the lesions. In addition, from the review of the literature, cystic mesothelioma was divided into 2 categories, that is, neoplastic or non-neoplastic lesions. Differentiation of both disorders might be possible by the following: size of the lesion, macroscopic and microscopic solid proliferation, features of adenomatoid tumor, and common mesothelioma-like histology. In conclusion, multicystic mesothelioma accompanied by endometriosis is thought to be a secondary non-neoplastic lesion induced by adhesion or inflammation rather than a neoplasm.

J Minim Invasive Gynecol. 2011 Mar-Apr;18(2):257-61.

Laparoscopically resected uterine adenomatoid tumor with coexisting endometriosis: case report.

Sakurai N, Yamamoto Y, Asakawa Y, Taoka H, Takahashi K, Kubushiro K.

Source

Department of Obstetrics and Gynecology, Toho University School of Medicine, Ohashi Medical Center, Ohashi, Meguro-ku, Tokyo, Japan.

Abstract

Adenomatoid tumors are rare benign mesothelial tumors of the genital tract, and only a few cases of uterine adenomatoid tumors treated at laparoscopic surgery have been reported. Herein is reported the case of a laparoscopically resected uterine adenomatoid tumor with coexisting endometriosis. A 34-year-old nulliparous woman with suspected uterine fibroma and endometrial cysts underwent laparoscopic surgery in which both the uterine tumor and the endometrial cysts were enucleated. Enucleation of the uterine tumor was difficult, and, therefore, the border between the tumor and normal myometrium was divided using a harmonic scalpel for tumor resection. Microscopic examination of the tumor showed irregularly proliferating smooth muscle cells and many round hiatuses lined by epithelial-like cells. These epithelial-like cells were immunohistochemically positive for mesothelin and podoplanin, and negative for CD34, which suggests that the tumor was an adenomatoid tumor. This may be the fourth reported case of an adenomatoid tumor resected using the laparoscopic approach.

J Minim Invasive Gynecol. 2011 Mar-Apr;18(2):211-7.

Use of the Short-Form McGill Pain Questionnaire as a diagnostic tool in women with chronic pelvic pain.

Droz J, Howard FM.

Source

Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York.

Abstract

STUDY OBJECTIVE:

To estimate the usefulness of the Short-Form McGill Pain Questionnaire (MPQ) pain descriptors in the diagnostic evaluation of chronic pelvic pain.

DESIGN:

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

SETTING:

University-based center specializing in chronic pelvic pain.

PATIENTS:

Three hundred thirty-one consecutively evaluated women with chronic pelvic pain who had data sufficient for evaluation.

INTERVENTIONS:

The relationships between MPQ pain descriptors and subsequent diagnoses were evaluated using odds ratios, sensitivity, specificity, and positive and negative predictive values.

MEASUREMENTS AND MAIN RESULTS:

The most common diagnoses were endometriosis, interstitial cystitis and painful bladder syndrome, and irritable bowel syndrome. Seventy-one percent of the patients had more than one diagnosis. Relative risks for pain descriptors as diagnostic tools for specific diagnoses were most significant, with “cramping” for endometriosis (4.0), “cramping” for interstitial cystitis and painful bladder syndrome (2.0), “sickening” for irritable bowel syndrome (1.5), and “aching” for abdominal myofascial pain syndrome (4.27).

CONCLUSION:

Several of the MPQ descriptors had high negative predictive values but not high positive predictive values, which suggests that they have diagnostic usefulness in excluding but not predicting pelvic pain-related diagnoses. This was especially the case with cramping as an MPQ descriptor in women with endometriosis. However, overall the MPQ descriptors were not robust as diagnostic tools, which suggests that inclusion of the MPQ descriptors in the evaluation of women with chronic pelvic pain is of limited diagnostic value.

J Minim Invasive Gynecol. 2011 Mar-Apr;18(2):194-9. Epub 2011 Feb 3.

Laparoscopic excision of ovarian remnants: retrospective cohort study with long-term follow-up.

Arden D, Lee T.

Source

Division of Gynecologic Specialties, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. deboraharden@gmail.com

Abstract

STUDY OBJECTIVE:

To review the clinical presentation, surgical and pathologic findings, and long-term outcomes after excision of ovarian remnants using a predominantly laparoscopic approach.

DESIGN:

Retrospective medical record review and long-term follow-up via telephone interview (Canadian Task Force classification II-3).

SETTING:

Large academic medical institution.

PATIENTS:

Thirty women who underwent excision of pathologically confirmed ovarian remnants by a single surgeon between 2001 and 2009.

INTERVENTION:

Excision of ovarian remnants, 29 at laparoscopy and 1 at laparotomy.

MEASUREMENTS AND MAIN RESULTS:

Of the 30 patients, 29 had pain and 1 had a persistent adnexal mass. Of the 29 patients who underwent preoperative ultrasonography, 26 (89.6%) had an adnexal mass on the side of previous salpingo-oophorectomy. Masses ranged in size from 0.8 to 7.4 cm in greatest diameter and most commonly contained debris-filled cysts. Intraoperatively, 29 excisions (96.7%) required retroperitoneal dissection, 27 (90.0%) required enterolysis, 28 (93.3%) required ureterolysis, and 20 (66.7%) required ligation of the uterine artery at its origin. All pathology reports confirmed ovarian tissue, often associated with endometriosis, corpus luteal cysts, and simple cysts. Four bowel injuries and 2 bladder injuries were laparoscopically repaired by the primary surgeon. Three patients required bowel resections by a general surgeon. Records from postoperative visits were available for 28 patients, of whom 17 (60.7%) reported resolution of pain, 9 (32.1%) reported improvement, and 2 (7.1%) reported persistent pain. Of the 18 women who returned written consent for the telephone interview, 11 (61.1%) reported resolution of pain, 5 (27.8%) reported improvement, and 2 (11.1%) reported persistent pain.

CONCLUSION:

While laparoscopic excision of ovarian remnants is feasible, the procedure almost always requires a retroperitoneal dissection and is associated with high risk of complications. Careful surgical planning and preparation are essential.

J Reprod Immunol. 2011 Mar;88(2):149-55. Epub 2011 Jan 26.

Regulatory T cells and other leukocytes in the pathogenesis of endometriosis.

Berbic M, Fraser IS.

Source

Department of Obstetrics, Gynaecology and Neonatology, Queen Elizabeth II Research Institute for Mothers and Infants, The University of Sydney, NSW 2006, Australia.

Abstract

Endometriosis is a common and puzzling gynaecological condition which shows a great deal of variability between women. It affects up to 15% of all women of reproductive age. There is a strong familial component, but the aetiology and pathogenesis are still uncertain. Endometriosis is an ‘inflammatory’ condition with substantial numbers of leukocytes recruited into the lesion sites. There is increasing evidence to demonstrate marked changes in numbers and functions of these leukocytes in the eutopic endometrium and peritoneal fluid as well as in the lesions. We hypothesise that endometriosis is primarily an endometrial disease with underlying genetic disturbances which lead to a number of major molecular changes in function, enhancing the likelihood that viable fragments of endometrial tissue will pass through the fallopian tubes and attach and grow on the peritoneum. We have demonstrated disturbances in the populations of T cells, B cells, mast cells, dendritic cells and macrophages within the endometrium and ectopic lesions, and are intrigued by the potential for changes in regulatory T cells to influence disease establishment and progression. Interestingly, we have shown that in endometriosis, naturally occurring FOXP3+ regulatory T cells fail to undergo the expected decline in number during the secretory phase, which may account for a decreased ability of newly recruited leukocytes to initiate effective immune responses against viable endometrial fragments, permitting their survival and subsequent establishment. To better understand the pathogenesis of endometriosis, we must learn about how the immune system recognises this disease and how the endometrial immune response is regulated.

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