J Ultrasound Med. 2011 Mar;30(3):391-5.

Echogenic foci in the ovary: are they predictive of endometriosis?

Wall DJ, Brown DL, Dudiak KM, Mandrekar J.

Source

Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA. wall.darci@mayo.edu.

Abstract

Objectives- The purpose of this study was to determine whether sonographically depicted echogenic foci are more common in the ovaries of women with endometriosis when compared to the ovaries of women who do not have endometriosis. Methods- Two radiologists blinded to the pathologic results reviewed the preoperative pelvic sonograms of consecutive women with a surgical diagnosis of endometriosis between June 2006 and October 2007. Results were compared with the preoperative sonograms of a control group of women without surgical evidence of endometriosis. The presence of echogenic foci in the ovaries and ovarian masses was recorded. Results- Echogenic foci were present in the ovaries of 33 of 70 women (47%) with endometriosis and in the ovaries of 21 of 76 women (28%) without endometriosis (P = 0.015). When only patients with sonographically normal ovaries were evaluated by excluding endometriomas and other ovarian masses, echogenic foci were present in 8 of 23 women (35%) with endometriosis and in 10 of 42 women (24%) without endometriosis (P = .344). Conclusions- Echogenic foci are more commonly seen on sonography in the ovaries of women with endometriosis than in those without endometriosis, but this result seems largely due to ovarian endometriomas with echogenic foci in the walls. Echogenic foci are not predictive of endometriosis in women with otherwise sonographically normal ovaries.

Mol Hum Reprod. 2011 Mar;17(3):175-81. Epub 2010 Oct 28.

Pyrrolidine dithiocarbamate inhibits nuclear factor-κB pathway activation, and regulates adhesion, migration, invasion and apoptosis of endometriotic stromal cells.

Zhang JJ, Xu ZM, Zhang CM, Dai HY, Ji XQ, Wang XF, Li C.

Source

Department of Obstetrics and Gynecology, Affiliated Hospital of Medical College of Qingdao University, Qingdao, Shandong, China. xzmzjj@163.com

Abstract

The activation of nuclear factor-κB (NF-κB) has been implicated in the development and progression of endometriosis. The aim of this study is to investigate the potential application of pyrrolidine dithiocarbamate (PDTC), a potent NF-κB inhibitor, in the treatment of endometriosis. NF-κB-DNA-binding activity, IκB phosphorylation and expression of nuclear p65 protein in endometriotic ectopic stromal cells (EcSCs), endometriotic eutopic stromal cells (EuSCs) and normal endometrial stromal cells (NESCs) were detected by electrophoretic mobility shift assay and western blot analysis. Adhesion, migration, invasion and apoptosis of EcSCs were observed by means of adhesion, migration, invasion and terminal deoxynucleotidyl transferase-mediated dUDP nick-end labeling assay, respectively. Gene and protein expressions of CD44s, matrix metalloproteinase (MMP)-2, MMP-9 and survivin in EcSCs were measured by RT-PCR and western blot analysis. The results showed that PDTC in the absence or presence of interleukin (IL)-1β showed stronger inhibitory effects on NF-κB-DNA-binding activity, IκB phosphorylation and expression of nuclear p65 protein in EcSCs than those in EuSCs or NESCs. PDTC enhanced apoptosis, and suppressed IL-1β-induced cellular adhesion, migration and invasion of EcSCs. Pretreatment of EcSCs with PDTC attenuated IL-1β-induced expressions of CD44s, MMP-2, MMP-9 and survivin at gene and protein levels. All these findings suggest that PDTC induces apoptosis and down-regulates adhesion, migration and invasion of EcSCs through the suppression of various molecules. Therefore, PDTC could be used as a therapeutic agent for the treatment of endometriosis.

Obstet Gynecol. 2011 Mar;117(3):727-8.

Gonadotrophin-releasing hormone analogues for pain associated with endometriosis.

Gilliam ML.

Source

University of Chicago, Department of Obstetrics and Gynecology, 5841 South Maryland Avenue, MC 2050, Chicago, IL 60637, USA. mgilliam@babies.bsd.uchicago.edu

Comment on

Photodiagnosis Photodyn Ther. 2011 Mar;8(1):58-63. Epub 2011 Jan 13.

Photodiagnosis and photodynamic therapy of endometriotic epithelial cells using 5-aminolevulinic acid and steroids.

Wołuń-Cholewa M, Szymanowski K, Nowak-Markwitz E, Warchoł W.

Source

Department of Cell Biology, Poznan University of Medical Sciences, Poznan, Poland. doskon@ump.edu.pl

Abstract

BACKGROUND:

The photodynamic diagnosis and therapy represent relatively new methods used, i.a., in the detection of some preneoplastic and neoplastic conditions. They are based on selective accumulation of photosensitizers in the altered cells, which can be identified by fluorescence of the sensitizers and, using light of an appropriate wavelength, can be eliminated. Currently, investigations continue on application of the methods in diagnosis and therapy of endometriosis, one of the most prevalent causes of a reduced fertility in women.

METHODS:

In this study protoporphyrin IX, a photosensitizer derived from 5-aminolevulinic acid, was used to locate and destroy endometrial epithelium. Material for the investigations involved primary epithelial cells, isolated from 15 normal endometria and 15 ovarian endometriotic epithelia. Taking into account the cyclical hormonal alterations, which affect endometrial cells in individual phases of the menstrual cycle, experiments were conducted on accumulation of the photosensitizer and photodestruction of the cells preceded by their hormonal stimulation (17β-estradiol and progesterone).

RESULTS AND CONCLUSION:

It was found that following 48 h stimulation with 17β-estradiol and/or progesterone a significantly augmented synthesis of protoporphyrin IX can be obtained in cells of endometrial epithelium as compared to the normal epithelium. Moreover, the endometriotic epithelial cells were most effectively eliminated following 48 h prestimulation with progesteron alone. The obtained result permits to assume that photodynamic diagnosis and photodynamic therapy of endometrial epithelium should be performed in the secretory phase of endometrium in order to optimise their results.

Radiographics. 2011 Mar-Apr;31(2):549-67.

MR Imaging in Deep Pelvic Endometriosis: A Pictorial Essay.

Coutinho A Jr, Bittencourt LK, Pires CE, Junqueira F, de Oliveira Lima CM, Coutinho E, Domingues MA, Domingues RC, Marchiori E.

Source

Clínica de Diagnóstico Por Imagem, Av das Américas 4666, Sala 325, Barra da Tijuca, Rio de Janeiro, RJ 22649900, Brazil.

Abstract

Deep pelvic endometriosis is an important gynecologic disorder that is responsible for severe pelvic pain and is defined as subperitoneal invasion that exceeds 5 mm in depth. Deep pelvic endometriosis can affect the retrocervical region, uterosacral ligaments, rectum, rectovaginal septum, vagina, urinary tract, and other extraperitoneal pelvic sites. It is commonly associated with dysmenorrhea, dyspareunia, pelvic pain, urinary tract symptoms, and infertility. Because surgery remains the best therapeutic option for affected patients, the accurate preoperative assessment of the extension of endometriotic disease is extremely important. Pelvic magnetic resonance (MR) imaging is a noninvasive method with high spatial resolution that allows multiplanar evaluation of deep pelvic endometriosis and good tissue characterization, but without the use of ionizing radiation or iodinated contrast agents. MR imaging yields important findings that help grade the disease and identify subperitoneal lesion extension and other associated disease entities, thereby facilitating accurate diagnosis and adequate treatment. Radiologists should be familiar with the MR imaging findings of deep infiltrating endometriosis in various anatomic locations so that they can provide information that allows adequate presurgical counseling. © RSNA, 2011.

Radiographics. 2011 Mar-Apr;31(2):527-48.

Fallopian tube disease in the nonpregnant patient.

Rezvani M, Shaaban AM.

Source

Department of Radiology, University of Utah, 30 N 1900 E, Room 1A71, Salt Lake City, UT 84132.

Abstract

The increasing use of imaging necessitates familiarity with a wide variety of pathologic conditions, both common and rare, that affect the fallopian tube. These conditions should be considered in the differential diagnosis for pelvic disease in the nonpregnant patient. The most common condition is pelvic inflammatory disease, which represents a spectrum ranging from salpingitis to pyosalpinx to tubo-ovarian abscess. Isolated tubal torsion is rare but is nevertheless an important diagnosis to consider in the acute setting. Hematosalpinx in a nonpregnant patient can be an indicator of tubal endometriosis; however, care should be taken to exclude tubal torsion or malignancy. Current evidence suggests that the prevalence of primary fallopian tube carcinoma (PFTC) is underestimated and that there is a relationship between PFTC and breast cancer. PFTC has characteristic imaging features that can aid in its detection and in differentiating it from other pelvic masses. Familiarity with fallopian tube disease and the imaging appearances of both the normal and abnormal fallopian tube is crucial for optimal diagnosis and management in emergent as well as ambulatory settings. © RSNA, 2011.

Reprod Sci. 2011 Mar;18(3):206-18. Epub 2010 Dec 30.

Aberrant expression of apoptosis-related molecules in endometriosis: a possible mechanism underlying the pathogenesis of endometriosis.

Nasu K, Nishida M, Kawano Y, Tsuno A, Abe W, Yuge A, Takai N, Narahara H.

Source

Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan. nasu@oita-u.ac.jp

Abstract

Endometriosis, a disease affecting 3% to 10% of women of reproductive age, is characterized by the ectopic growth of endometrial tissue under the influence of estrogen. It is also becoming recognized as a condition in which ectopic endometrial cells exhibit abnormal proliferative and apoptotic regulation in response to appropriate stimuli. Apoptosis plays a critical role in maintaining tissue homeostasis and represents a normal function to eliminate excess or dysfunctional cells. Accumulated evidence suggests that, in healthy women, endometrial cells expelled during menstruation do not survive in ectopic locations because of programmed cell death, while decreased apoptosis may lead to the ectopic survival and implantation of these cells, resulting in the development of endometriosis. Both the inability of endometrial cells to transmit a “death” signal and the ability of endometrial cells to avoid cell death have been associated with increased expression of antiapoptotic factors and decreased expression of preapoptotic factors. Further investigations may elucidate the role of apoptosis-associated molecules in the pathogenesis of endometriosis. Medical treatment with apoptosis-inducing agents may be novel and promising therapeutic strategy for endometriosis.

Reprod Sci. 2011 Mar;18(3):229-51. Epub 2010 Nov 9.

Molecular evidence for differences in endometrium in severe versus mild endometriosis.

Aghajanova L, Giudice LC.

Source

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco (UCSF), San Francisco, CA 94143,USA.

Abstract

Women with stage III/IV versus stage I/II endometriosis have lower implantation and pregnancy rates in natural and assisted reproduction cycles. To elucidate potential molecular mechanisms underlying these clinical observations, herein we investigated the transcriptome of eutopic endometrium across the menstrual cycle in the setting of severe versus mild endometriosis. Proliferative (PE), early secretory (ESE), and mid-secretory (MSE) endometrial tissues were obtained from 63 participants with endometriosis (19 mild and 44 severe). Purified RNA was subjected to microarray analysis using the Gene 1.0 ST Affymetrix platform. Data were analyzed with GeneSpring and Ingenuity Pathway Analysis and subsequently validated. Comparison of differentially regulated genes, analyzed by cycle phase, revealed dysregulation of progesterone and/or cyclic adenosine monophosphate (cAMP)-regulated genes and genes related to thyroid hormone action and metabolism. Also, members of the epidermal growth factor receptor (EGFR) signaling pathway were observed, with the greatest upregulation of EGFR in severe versus mild disease during the early secretory phase. The extracellular matrix proteoglycan versican (VCAN), which regulates cell proliferation and apoptosis, was the most highly expressed gene in severe versus mild disease. Upregulation of microRNA 21 (MIR21) and DICER1 transcripts suggests roles for microRNAs (miRNAs) in the pathogenesis of severe versus mild endometriosis, potentially through regulation of gene silencing and epigenetic mechanisms. These observed differences in transcriptomic signatures and signaling pathways may result in poorly programmed endometrium during the cycle, contributing to lower implantation and pregnancy rates in women with severe versus mild endometriosis.

Rev Esp Med Nucl. 2011 March – April;30(2):97-100. Epub 2010 Jun 8.

Abdominal splenosis: An often underdiagnosed entity.

[Article in English, Spanish]

Vercher-Conejero JL, Bello-Arqués P, Pelegrí-Martínez L, Hervás-Benito I, Loaiza-Góngora JL, Falgas-Lacueva M, Ruiz-Llorca C, Pérez-Velasco R, Mateo-Navarro A.

Source

Servicio de Medicina Nuclear, Hospital Universitario La Fe, Valencia, España.

Abstract

Splenosis is defined as the heterotopic autotransplantation of splenic tissue because of a ruptured spleen due to trauma or surgery. It is a benign and incidental finding, although imaging tests may sometimes orient toward malignancy simulating renal tumors, abdominal lymphomas, endometriosis, among other. We report the case of a 42-year old male in whom a MRI was performed after a study due to abdominal pain. Multiple enlarged lymph nodes were observed in the abdomen, suggestive of lymphoproliferative disease. As an important background, splenectomy was carried out due to abdominal trauma at age 9. After several studies, it was decided to perform a (99m)Tc-labeled heat-damaged red blood cell scintigraphy that showed multiple pathological deposits distributed throughout the abdomen, and even the pelvis, being consistent with splenosis.

Semin Reprod Med. 2011 Mar;29(2):124-9. Epub 2011 Mar 24.

Surgical management of pain and infertility secondary to endometriosis.

Diwadkar GB, Falcone T.

Source

Department of Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio.

Abstract

The management of pain and infertility secondary to endometriosis remains a challenge. Surgical management of early-stage endometriosis-associated infertility has only a mild effect with a number needed to treat of at least 12 to achieve one pregnancy. Excision of endometriomas provides the best outcome for fertility and pain; however, there is a potential to reduce the ovarian reserve. Pain relief is seen in most patients undergoing surgical management but with a high recurrence rate over time. Long-term postoperative medical suppressive therapy with oral contraceptives may have some benefit in reducing recurrence of symptoms. Hysterectomy is effective in the long-term management of chronic pain associated with endometriosis.

Semin Reprod Med. 2011 Mar;29(2):95-100. Epub 2011 Mar 24.

Transvaginal hydrolaparoscopy.

Catenacci M, Goldberg JM.

Source

Section of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio.

Abstract

Transvaginal hydrolaparoscopy (THL) is a modification of culdoscopy that can be used to evaluate the posterior uterus, pelvic sidewalls, and adnexae. Diagnostic THL can be done in the office under local anesthesia. Combined with diagnostic hysteroscopy and chromotubation, it can replace hysterosalpingography (HSG) as the first-line diagnostic test for the infertile woman. Studies have shown high patient tolerability with less pain reported postprocedure than with HSG. THL has been shown to have a high concordance with HSG for tubal patency, but THL diagnosed more intrauterine abnormalities as well as finding adhesions and endometriosis not visible with HSG. In addition, salpingoscopy may be performed during THL to assess the tubal lumen. THL also has a high concordance rate with laparoscopy when a complete evaluation is accomplished during THL. Complications of THL are uncommon and minor. Finally, operative procedures such as ovarian drilling, coagulation of endometriosis, lysis of adhesions, treatment of ovarian cysts, and salpingostomy may be performed via THL.

© Thieme Medical Publishers.

Semin Reprod Med. 2011 Mar;29(2):83-94. Epub 2011 Mar 24.

Asherman’s Syndrome.

March CM.

Source

Division of Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California.

Abstract

Asherman’s syndrome is being diagnosed with increasing frequency. Although it usually occurs following curettage of the pregnant or recently pregnant uterus, any uterine surgery can lead to intrauterine adhesions (IUA). Most women with IUA have amenorrhea or hypomenorrhea, but up to a fourth have painless menses of normal flow and duration. Those who have amenorrhea may also have cyclic pelvic pain caused by outflow obstruction. The accompanying retrograde menstruation may lead to endometriosis. In addition to abnormal menses, infertility and recurrent spontaneous abortion are common complaints. Hysteroscopy is the standard method to both diagnose and treat this condition. Various techniques for adhesiolysis and for prevention of scar reformation have been advocated. The most efficacious appears to be the use of miniature scissors for adhesiolysis and the placement of a balloon stent inside the uterus immediately after surgery. Postoperative estrogen therapy is prescribed to stimulate endometrial regrowth. Follow-up studies to assure resolution of the scarring are mandatory before the patient attempts to conceive as is careful monitoring of pregnancies for cervical incompetence, placenta accreta, and intrauterine growth retardation.

Taiwan J Obstet Gynecol. 2011 Mar;50(1):95-7.

Intrapartum uterine rupture associated with a scarred cervix because of a previous rupture of cystic cervical endometriosis.

Chen ZH, Chen M, Tsai HD, Wu CH.

Source

Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.

Ultrasound Obstet Gynecol. 2011 Mar;37(3):257-63. doi: 10.1002/uog.8858.

Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis.

Hudelist G, English J, Thomas AE, Tinelli A, Singer CF, Keckstein J.

Source

Department of Obstetrics and Gynaecology, Endometriosis and Pelvic Pain Clinic, Wilhelminen Hospital, Vienna, Austria. gernot_hudelist@yahoo.de

Abstract

OBJECTIVE:

To critically analyze the diagnostic value of transvaginal sonography (TVS) for non-invasive, presurgical detection of bowel endometriosis.

METHODS:

MEDLINE (1966-2010) and EMBASE (1980-2010) databases were searched for relevant studies investigating the diagnostic accuracy of TVS for diagnosing deep infiltrating endometriosis involving the bowel. Diagnosis was established by laparoscopy and/or histopathological analysis. Likelihood ratios (LRs) were recalculated in addition to traditional measures of effectiveness.

RESULTS:

Out of 188 papers, a total of 10 studies fulfilled predefined inclusion criteria involving 1106 patients with suspected endometriosis. The prevalence of bowel endometriosis varied from 24 to 73.3%. LR+ ranged from 4.8 to 48.56 and LR- ranged from 0.02 to 0.36, with wide confidence intervals. Pooled estimates of sensitivities and specificities were 91 and 98%; LR+ and LR- were 30.36 and 0.09; and positive and negative predictive values were 98 and 95%, respectively. Three of the studies used bowel preparations to enhance the visibility of the rectal wall; one study directly compared the use of water contrast vs. no prior bowel enema, for which the LR- was 0.04 and 0.47, respectively.

CONCLUSIONS:

TVS with or without the use of prior bowel preparation is an accurate test for non-invasive, presurgical detection of deep infiltrating endometriosis of the rectosigmoid.

Urology. 2011 Mar;77(3):576-80. Epub 2011 Jan 7.

Prevalence and correlates of sexual dysfunction among women with bladder pain syndrome/interstitial cystitis.

Bogart LM, Suttorp MJ, Elliott MN, Clemens JQ, Berry SH.

Source

Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts 02215, USA. laura.bogart@childrens.harvard.edu

Abstract

OBJECTIVES:

To examine the prevalence and correlates of general and bladder pain syndrome/interstitial cystitis (BPS/IC)-specific sexual dysfunction among women in the RAND Interstitial Cystitis Epidemiology study using a probability sample survey of U.S. households. Sexual dysfunction can contribute to a reduced quality of life for women with bladder pain syndrome/interstitial cystitis (BPS/IC).

METHODS:

We telephoned 146,231 households to identify women who reported bladder symptoms or a BPS/IC diagnosis. Those who reported either underwent a second-stage screening using the RAND Interstitial Cystitis Epidemiology study high-specificity symptom criteria. The criteria were pain, pressure, or discomfort in pelvic area; daytime urinary frequency ≥10 times or urgency due to pain, pressure, or discomfort (not fear of wetting); pain that worsened as the bladder filled; bladder symptoms did not resolve after antibiotic treatment; and patients never treated with hormone injections for endometriosis. Women who met the RAND Interstitial Cystitis Epidemiology criteria (n = 1469) completed measures of BPS/IC-specific and general sexual dysfunction symptoms, bladder symptom severity, general physical health, depression, medical care-seeking, and sociodemographic characteristics.

RESULTS:

Of those with a current sexual partner (75%), 88% reported ≥1 general sexual dysfunction symptom and 90% reported ≥1 BPS/IC-specific sexual dysfunction symptom in the past 4 weeks. In the multivariate models, BPS/IC-specific sexual dysfunction was significantly associated with more severe BPS/IC symptoms, younger age, worse depression symptoms, and worse perceived general health. Multivariate correlates of general sexual dysfunction included non-Latino race/ethnicity, being married, and having depression symptoms.

CONCLUSIONS:

The results of our study have shown that women with BPS/IC symptoms experience very high levels of sexual dysfunction. Also, sexual dysfunction covaries with symptoms.

Womens Health Issues. 2011 Mar-Apr;21(2):160-4. Epub 2011 Jan 26.

A case-control investigation of adenomyosis: impact of control group selection on risk factor strength.

Trabert B, Weiss NS, Rudra CB, Scholes D, Holt VL.

Source

Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA. trabertbl@mail.nih.gov

Abstract

OBJECTIVE:

Using a medical record abstraction-based case-control study with two control groups, we evaluated adenomyosis risk factors and investigated differences related to comparison group selection.

MATERIALS AND METHODS:

Medical records of all female 18- to 49-year-old Group Health (GH) enrollees with ICD-9 code 617.0 were abstracted using a standard data collection form. Cases were enrollees diagnosed with adenomyosis (n = 174) between April 1996 and September 2001. For comparison, medical records of two control groups were selected from the GH population: An age-matched sample of female enrollees (population-based controls; n = 149) and all female 18- to 49-year-old enrollees undergoing a hysterectomy (hysterectomy controls; n = 106) during the same time without adenomyosis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression, adjusted for identified covariates.

RESULTS:

Compared with normal and underweight women, overweight and obese women had increased adenomyosis risk using hysterectomy controls (OR, 2.2, 95% CI, 1.0-4.5; obese: OR, 2.2; 95% CI, 1.1-4.3) and population controls (overweight: OR, 2.1; 95% CI, 1.2-4.0; obese: OR, 3.8; 95% CI, 2.0-7.0). Using population controls, women with at least one live birth were more likely to have adenomyosis than nulliparous women (OR, 3.4; 95% CI, 1.9-6.2).

CONCLUSION:

Although some risk factors persisted in analyses using either control group, divergent results in relation to other risk factors for adenomyosis suggest that results of investigations of this disease may be affected by the choice of the comparison population.

Published by Elsevier Inc.

Climacteric. 2011 Feb 28. [Epub ahead of print]

HRT in difficult circumstances: are there any absolute contraindications?

Maclennan AH.

Source

The Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Medicine, The University of Adelaide, South Australia, Australia.

Abstract

Many traditional contraindications to hormone replacement therapy (HRT) are based on the theoretical potential for these hormones to worsen a disease process and are rarely based on supporting data. This review addresses the available data and lack of data that make the prescription of HRT difficult in a variety of common morbidities. In each circumstance, it is assumed that conservative evidence-based therapies have been tried and that menopausal symptoms remain debilitating and are reducing quality of life. Tailoring of the product, dose, route and regimen may avoid some of the theoretical risks of HRT in particular women or conditions and guidelines are given for each co-morbidity. Specifically, it is discussed that tailored HRT may be used without strong evidence of a deleterious effect after ovarian cancer, endometrial cancer, most other gynecological cancers, bowel cancer, melanoma, a family history of breast cancer, benign breast disease, in carriers of BRACA mutations, after breast cancer if adjuvant therapy is not being used, past thromboembolism, varicose veins, fibroids and past endometriosis. Relative contraindications are existing cardiovascular and cerebrovascular disease and breast cancer being treated with adjuvant therapies. Consultation with other carers and written consent are recommended in all these difficult circumstances, but no condition is an absolute contraindication to HRT if potential risk is understood, if HRT is effective in symptom control and if quality of remaining life is paramount.

Am J Obstet Gynecol. 2011 Feb 27. [Epub ahead of print]

Factors associated with age of onset and type of menopause in a cohort of UK women.

Pokoradi AJ, Iversen L, Hannaford PC.

Source

Centre of Academic Primary Care, University of Aberdeen, Aberdeen, Scotland, United Kingdom.

Abstract

OBJECTIVE:

We sought to describe the pattern of age at menopause and factors associated with type of menopause.

STUDY DESIGN:

This was a prospective cohort study of 5113 postmenopausal health survey respondents in the Royal College of General Practitioners’ Oral Contraception Study. Logistic regression was used to evaluate associations between sociodemographics, lifestyle, and medical history and menopause type.

RESULTS:

Median age at natural menopause (n = 3650) was 49.0 years (interquartile range, 45.0-51.0), and at surgical menopause (n = 1463) was 42.4 years (38.0-46.4). Early natural menopause was associated with smoking, ever-use of oral contraception, sterilization, and history of endometriosis (all increased odds ratios) and ever-use of hormone replacement therapy (decreased). Surgical menopause was associated with manual social class, sterilization, and having a history of endometriosis, menorrhagia, or painful menstruation (all increased), and ever-use of hormone replacement therapy (decreased).

CONCLUSION:

Age at natural menopause was younger in this cohort than in other studies. More associations were found for surgical menopause than early natural menopause.

Fertil Steril. 2011 Feb 26. [Epub ahead of print]

Endometriosis in para-aortic lymph nodes during pregnancy: case report and review of literature.

Beavis AL, Matsuo K, Grubbs BH, Srivastava SA, Truong CM, Moffitt MN, Maliglig AM, Lin YG.

Source

Department of Obstetrics and Gynecology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.

Abstract

OBJECTIVE:

To report a case of endometriosis in para-aortic lymph nodes during pregnancy.

DESIGN:

Case report.

SETTING:

Tertiary care center.

PATIENT(S):

A 25-year-old multipara pregnant woman with a history of chronic pelvic pain and ovarian cystectomies for bilateral endometriomas.

INTERVENTION(S):

The patient was admitted with a placenta previa and a subchorionic hemorrhage at 24 weeks 5 days’ gestation, and subsequently developed uterine contractions. Magnetic resonance imaging revealed a large complex adnexal mass adherent to the uterus and pelvic and para-aortic lymphadenopathy. Tocolysis could not be achieved and the patient underwent cesarean delivery at 26 weeks 3 days. An implant on the uterus and an enlarged para-aortic lymph node were removed surgically at that time.

MAIN OUTCOME MEASURE(S):

Involvement of lymph node by endometriosis and presence of a recurrent endometrioma.

RESULT(S):

Endometriosis was confirmed pathologically in para-aortic lymph nodes. Uterine serosal biopsy demonstrated endometriosis, and the large adnexal cyst was grossly consistent with endometrioma. The patient delivered a viable male infant at 26 weeks 3 days.

CONCLUSION(S):

To our knowledge, this is the first reported case of endometriosis in para-aortic lymph nodes. Its presence supports the hypothesis that endometriosis travels lymphatically, and not simply via locoregional spread. Lymphatic spread also further supports the theory that endometriosis is an aggressive chronic systemic disease.

BMC Med. 2011 Feb 24;9:19.

MUC4 gene polymorphisms associate with endometriosis development and endometriosis-related infertility.

Chang CY, Chang HW, Chen CM, Lin CY, Chen CP, Lai CH, Lin WY, Liu HP, Sheu JJ, Tsai FJ.

Source

Human Genetic Center, China Medical University Hospital, Taichung, Taiwan.

Abstract

BACKGROUND:

Mucin 4 (MUC4) plays an important role in protecting and lubricating the epithelial surface of reproductive tracts, but its role in the pathogenesis of endometriosis is largely unknown.

METHODS:

To correlate MUC4 polymorphism with the risk of endometriosis and endometriosis-related infertility, we performed a case-control study of 140 patients and 150 healthy women. Six unique single-nucleotide polymorphisms (SNPs) (rs882605, rs1104760, rs2688513, rs2246901, rs2258447 and rs2291652) were selected for this study. DNA fragments containing the target SNP sites were amplified by polymerase chain reaction using the TaqMan SNP Genotyping Assay System to evaluate allele frequency and distribution of genotype in MUC4 polymorphisms.

RESULTS:

Both the T/G genotype of rs882605 and the frequency of haplotype T-T (rs882605 and rs1104760) were higher in patients than in controls and were statistically significant. The frequency of the C allele at rs1104760, the C allele at rs2688513, the G allele at rs2246901 and the A allele at rs2258447 were associated with advanced stage of endometriosis. Moreover, the G allele at rs882605 was verified as a key genetic factor for infertility in patients. Protein sequence analysis indicated that amino acid substitutions by genetic variations at rs882605, rs2688513 and rs2246901 occur in the putative functional loops and the type D von Willebrand factor (VWFD) domain in the MUC4 sequence.

CONCLUSIONS:

MUC4 polymorphisms are associated with endometriosis development and endometriosis-related infertility in the Taiwanese population.

Cir Esp. 2011 Feb 24. [Epub ahead of print]

Extrapelvic endometriosis: a diagnosis to consider in the patient with a perianal tumour.

[Article in English, Spanish]

Maturana Ibáñez V, Ferrer Márquez M, Moreno Serrano A, Reina Duarte A, Belda Lozano R.

Source

Servicio de Cirugía General y del Aparato Digestivo, CH Torrecárdenas, Almería, España.

Eur J Obstet Gynecol Reprod Biol. 2011 Feb 24. [Epub ahead of print]

Live birth rate in fresh and frozen embryo transfer cycles in women with endometriosis.

Mohamed AM, Chouliaras S, Jones CJ, Nardo LG.

Source

IVF Unit, Reproductive Medicine Department, Saint Mary’s Hospital, Manchester, UK; Obstetrics and Gynaecology Department, University of Alexandria, Egypt.

Abstract

OBJECTIVES:

To test the hypothesise that the treatment protocol used for preparation of the endometrium for frozen embryo transfer (ET) has a beneficial effect on the disorganised endometrium in women with endometriosis and leads to a higher pregnancy rate.

STUDY DESIGN:

We performed a retrospective, database-searched cohort study. Relevant information was collected from the electronic records of women who underwent IVF/ICSI between 1/1/2000 and 31/12/2008 in our unit. Endometriosis patients formed the study group. The rest of the women formed the control group. The two groups were subdivided, depending on whether they had fresh or frozen ET. The main outcome was live birth rate (LBR). Secondary outcomes were clinical pregnancy rate (CPR) and miscarriage rate (MR). Comparisons were performed by Chi-square and Mann-Whitney tests (SPSS 16.0).

RESULTS:

A total of 3763 fresh and 3523 frozen ET IVF cycles were included in our study, of which 415 (5.7%) were due to endometriosis related subfertility. In the non-endometriosis group, fresh ET had significantly higher LBR, CBR and MR than frozen ET. In women with endometriosis, down-regulated frozen ET cycles had a markedly high LBR and CPR (16.9%, 18.2%), comparable to the LBR and CPR of fresh ET cycles in the same group (19.5%, 20.2%). No significant differences were found in the LBR and CPR in fresh ET cycles between the study and the control group. In frozen ET, however, the CPR was significantly higher in the endometriosis group (18.2% versus 12.7%, P=0.048).

CONCLUSION:

Unlike the general IVF population, in women with endometriosis undergoing IVF, the preparation of the endometrium for frozen ET with GnRH agonists compared to fresh cycles is associated with higher LBR (16.9% versus 11.9%) and a significantly higher CPR (18.2% versus 12.7%, P=0.048). These results suggest that, in cases of endometriosis, the combined effect of GnRHa on the endometrium and the low level of ovarian steroids may simultaneously offer a better endometrial environment for implantation which may lead to better outcomes.

J Cutan Pathol. 2011 Feb 24. doi: 10.1111/j.1600-0560.2011.01681.x. [Epub ahead of print]

Cutaneous endometriosis: diagnostic immunohistochemistry and clinicopathologic correlation.

Farooq U, Laureano AC, Miteva M, Elgart GW.

Source

Kendall Medical Laboratory, Coral Gables, FL, USA New York University School of Medicine, New York, NY, USA Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

Abstract

Endometriosis is a condition where endometrial glands and stroma are ectopically located in sites other than the uterine cavity. Cutaneous endometriosis is very rare, representing approximately 1.1% of cases of extrapelvic endometriosis. We report a case of a 44-year-old female with no prior surgical history who presented with multiple tan brown periumbilical nodules. Histopathological examination revealed multiple glandular structures in the dermis with surrounding stroma. Immunohistochemistry cinches the diagnosis, as CD10, estrogen receptor and progesterone receptor are strongly positive in our case. The mainstay of treatment of cutaneous endometriosis is surgical excision of the lesion. Farooq U, Laureano AC, Miteva M, Elgart GW. Cutaneous endometriosis: diagnostic immunohistochemistry and clinicopathologic correlation.

Ultrasound Obstet Gynecol. 2011 Feb 23. doi: 10.1002/uog.8971. [Epub ahead of print]

Multidetector computerized tomography enteroclysis vs. rectal water contrast transvaginal ultrasonography in determining the presence and extent of bowel endometriosis.

Ferrero S, Biscaldi E, Morotti M, Venturini PL, Remorgida V, Rollandi GA, Valenzano Menada M.

Source

Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Genoa, Italy. dr@simoneferrero.com.

Abstract

OBJECTIVES:

To compare the accuracy of multidetector computerized tomography enteroclysis (MDCT-e) and rectal water contrast transvaginal ultrasonography (RWC-TVS) in determining the presence and extent of bowel endometriosis.

METHODS:

This prospective study included 96 patients of reproductive age with suspicion of bowel endometriosis. Patients underwent MDCT-e and RWC-TVS before operative laparoscopy. Findings of MDCT-e and RWC-TVS were compared with histological results. The severity of pain experienced during MDCT-e and RWC-TVS was measured by a 10-cm visual analog scale.

RESULTS:

Fifty-one patients had bowel endometriotic nodules at surgery. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the diagnosis of rectosigmoid endometriosis were 95.8% (46/48), 100.0% (48/48), 100.0% (46/46), 96.0% (48/50) and 97.9% (94/96) for MDCT-e and 93.8% (45/48), 97.9% (47/48), 97.8% (45/46), 94.0% (47/50) and 95.8% (92/96) for RWC-TVS. MDCT-e was associated with more intense pain than was RWC-TVS.

CONCLUSIONS:

J Cancer. 2011 Feb 21;2:94-106.

Pathogenesis of ovarian clear cell adenofibroma, atypical proliferative (borderline) tumor, and carcinoma: clinicopathologic features of tumors with endometriosis or adenofibromatous components support two related pathways of tumor development.

Zhao C, Wu LS, Barner R.

Source

1. Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;

Abstract

The clinicopathologic features of 472 ovarian epithelial clear cell neoplasms (4 adenofibromas [AFs], 41 atypical proliferative [borderline] tumors [APTs], and 427 carcinomas [CAs]) were studied in order to elucidate the morphologic steps involved in the pathogenesis of these tumors and determine whether clear cell CA is a type I or type II tumor in the dualistic model of ovarian carcinogenesis. Thirty-three percent of the CAs had an adenofibromatous background [CA(AF+)], and 67% did not [CA(AF-)]. Endometriosis was found in all types of tumors, but tumors arising in endometriotic cysts were more frequent with CA(AF-)s (p<0.0001). The subset of women with CA(AF-)s with endometriosis were younger (p<0.0001), their tumors were more frequently cystic (p<0.0001), they more commonly had a mixed carcinoma component of non-clear cell type (p=0.006), and they were more frequently oxyphilic (p=0.015) compared with CA(AF+)s. The architecture of the former tumors was more commonly papillary compared to tubulocystic in the latter (p=0.0006). Atypical endometriosis was more common in CA(AF-)s than in AFs, APTs, and CC(AF+)s [p=0.004]. The subset of CA(AF-)s without endometriosis presented more frequently in advanced stage (>I) and were higher grade compared to CA(AF+)s or CA(AF-) with endometriosis (p-values, <0.0001 to 0.0071). All AFs and APTs were stage I compared to 79% of CA(AF+)s. An increase in mean tumor size correlated with each respective tumor category from AF (6.8 cm) to CA(AF+) [12.9 cm]. Notable nuclear atypia was absent in all AFs but was focally present in 27% of APTs and in the adenofibromatous background of 24% of the CA(AF+)s. An increase in the proportion of carcinoma in the CA(AF+)s correlated with an increase in grade and advanced stage. In summary, ovarian clear cell CA appears to develop along two pathways, both of which are related to endometriosis. We speculate that, in one, epithelial atypia arises in an endometriotic cyst and then evolves into clear cell CA, and, in the other, non-cystic endometriosis induces a fibromatous reaction resulting in the formation of AF, which then develops into APT and subsequently a clear cell CA. The absence of endometriosis or adenofibromatous components in CC(AF-)s may be due to overgrowth and obliteration by the invasive carcinoma. Finally, the findings in this study support the view that both types of clear cell CA [CC(AF+) and CC(AF-)] are more closely related to type I tumors.

Eur Radiol. 2011 Feb 19. [Epub ahead of print]

Diagnosis of colorectal endometriosis: contribution of contrast enhanced MR-colonography.

Scardapane A, Bettocchi S, Lorusso F, Stabile Ianora AA, Vimercati A, Ceci O, Lasciarrea M, Angelelli G.

Source

Department of Internal Medicine and Public Health (Di.M.I.M.P.)-Section of Diagnostic Imaging, University Hospital “Policlinico”, Piazza Giulio Cesare, 11, 70124, Bari, Italy, a.scardapane@radiologia.uniba.it.

Abstract

OBJECTIVE:

To investigate the contribution of contrast-enhanced MR-colonography (CE-MR-C) for the diagnosis of intestinal endometriosis.

METHODS:

One hundred and four women with suspected endometriosis were prospectively enrolled. All patients were subjected to MRI consisting of two phases: pelvic high-resolution MRI (HR-MRI) followed by CE-MR-C after colonic distension using a 1.5-liter water enema and injection of 0.15 ml/kg of 0.5 M gadolinium-DTPA with T1w high-resolution isotropic volume (THRIVE) and balanced turbo field echo (BTFE) images. HR-MRI and CE-MR-C were considered as two datasets, which were independently reviewed by two radiologists with 12 and 2 years’ experience respectively. The presence of deep pelvic endometriotic lesions with particular attention to colorectal involvement was recorded.

RESULTS:

MRI findings correlated with laparoscopy in all cases. Thanks to CE-MR-C images, sensitivity, specificity, PPV, NPV and accuracy for diagnosis of colorectal endometriosis increased from 76%, 96%, 84%, 93% and 91%, to 95%, 97%, 91%, 99% and 97% for the most experienced radiologist and from 62%, 93%, 72%, 89% and 85%, to 86%, 94%, 82%, 96% and 92% for the less experienced radiologist; moreover, the interobserver agreement increased from 0.63 to 0.80 (Cohen’s K test).

CONCLUSION:

CE-MR-C allows easier recognition of colorectal endometriosis and higher interobserver agreement.

Fertil Steril. 2011 Feb 18. [Epub ahead of print]

Nerve fibers and menstrual cycle in peritoneal endometriosis.

Wang G, Tokushige N, Fraser IS.

Source

Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China.

Abstract

There was no difference in the density of nerve fibers across the menstrual cycle in peritoneal endometriotic lesions. These findings may explain why patients with peritoneal endometriosis often have painful symptoms throughout the menstrual cycle.

Cir Esp. 2011 Feb 17. [Epub ahead of print]

Inguinal endometriosis of the round ligament.

[Article in English, Spanish]

Silberman EA, Quildrian SD, Vigovich FA, Porto EA.

Source

Servicio de Cirugía General, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.

Biol Reprod. 2011 Feb 16. [Epub ahead of print]

Cigarette Smoke Increases Progesterone Receptor and Homeobox A10 Expression in Human Endometrium and Endometrial Cells: A Potential Role in the Decreased Prevalence of Endometrial Pathology in Smokers.

Zhou Y, Jorgensen EM, Gan Y, Taylor HS.

Abstract

Cigarette smoking has long been tied to a multitude of poor health outcomes; however, in reproductive biology, smoking has shown several unintuitive findings. Smoking is associated with significantly decreased rates of endometriosis and endometrial cancer. Here we show that treatment with cigarette smoke extract leads to increased mRNA and protein expression of HOXA10 and progesterone receptor (PGR) as well as more rapid decidualization of endometrial stromal cells in vitro. In vivo, mice exposed to cigarette smoke similarly showed increased expression of HOXA10 and PGR in the endometrium. Both HOXA10 and PGR drive endometrial differentiation and are suppressed in endometrial tumors and in endometriosis. The increased expression found upon exposure to cigarette smoke may provide a protective effect, mediating the decreased incidence of endometrial disease among smokers. This mechanism contrasts with the accepted paradigm that the effects of smoking on the uterus are secondary to ovarian alterations, rather than the direct effects on endometrium demonstrated here.

Fertil Steril. 2011 Feb 15. [Epub ahead of print]

The steroidogenic factor-1 protein is not expressed in various forms of endometriosis but is strongly present in ovarian cortical or medullary mesenchymatous cells adjacent to endometriotic foci.

Noël JC, Anaf V, Borghese B, Vaiman D, Fayt I, Chapron C.

Source

Department of Gynecopathology, Erasme University Hospital, Free University of Brussels, Brussels, Belgium.

Abstract

Steroidogenic factor-1 (SF-1) protein expression was not observed in any form of endometriosis (peritoneal, ovarian, or deep infiltrating endometriosis), which suggests that SF-1 locally produced by endometrial or stromal cells may not play a major role in the development of endometriosis. However, the strong expression of SF-1 in cortical and medullary ovarian mesenchymatous cells may be capable of creating a favorable steroidogenic environment and the development of the disease.

Lascia un commento

Cerca

Utilizzando il sito, accetti l'utilizzo dei cookie da parte nostra. maggiori informazioni

Questo sito utilizza i cookie per fornire la migliore esperienza di navigazione possibile. Continuando a utilizzare questo sito senza modificare le impostazioni dei cookie o cliccando su "Accetta" permetti il loro utilizzo.

Chiudi