Bibliografia 2011

Dal 26-04-11 al 8-8-11


Pag. 1

Eur J Radiol. 2011 Aug 2. [Epub ahead of print]

Deeply infiltrating endometriosis: Evaluation of retro-cervical space on MRI after vaginal opacification.

Fiaschetti V, Crusco S, Meschini A, Cama V, Di Vito L, Marziali M, Piccione E, Calabria F, Simonetti G.


Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, Fondazione Policlinico “Tor Vergata”, Viale Oxford 81, Rome, Italy.



To prospectively investigate diagnostic value and tolerability of MRI after intra-vaginal gel opacification for diagnosis and preoperative assessment of deeply infiltrating endometriosis.


Sixty-three women with clinical suspicion of deeply infiltrating endometriosis were previously examined with trans-vaginal ultrasonography and then with MRI pre and post administration of vaginal gel. We evaluated the tolerability of this procedure with a scoring scale from 0 to 3. We also assessed with a score from 1 to 4 the visibility of four regions: Douglas-pouch, utero-sacral-ligaments, posterior-vaginal-fornix and recto-vaginal-septum. All patients underwent laparoscopic surgery after MRI.


Five patients considered procedure intolerable. Visibility of utero-sacral-ligaments and posterior-vaginal-fornix showed to be increased with gel (p<0.001). In 57 out of 80 patients the MRI has allowed us to diagnose deeply infiltrating endometriosis. Overall, the percentages of MRI-sensitivity, specificity, positive predictive value and negative predictive value were respectively 67.8%, 95.3%, 89.4 and 83.5% without gel, and 90.8%, 94.6%, 90.8% and 94.6% with gel; trans-vaginal ultrasonography sensitivity, specificity, positive predictive value and negative predictive value were 57.5%, 96.6%, 90.9% and 79.5%. In evaluation of utero-sacral-ligaments trans-vaginal ultrasonography, MRI without gel and with gel sensitivity was respectively 61.9%, 47.6% and 81%; for recto-vaginal-septum these values were 12.5%, 68.7% and 93.7%; for pouch of Douglas 82%, 87% and 97.4%; finally for posterior-vaginal-fornix 27.3%, 36.4% and 81.8%.


MRI with gel opacification of vagina should be recommended for suspicion of deep infiltrating endometriosis, in particular for the added value in evaluation of recto-vaginal septum, utero-sacral ligaments and posterior vaginal fornix.

Dermatol Online J. 2011 Jul 15;17(7):5.

Spontaneous cutaneous umbilical endometriosis: Report of a new case with immunohistochemical study and literature review.

Kyamidis K, Lora V, Kanitakis J.


Department of Dermatology, Edouard Herriot Hospital Group, Lyon, France.


Endometriosis (i.e., the presence of functional endometrial tissue outside the uterine cavity) may rarely affect the skin either spontaneously or secondary to abdomino-pelvic surgery. Spontaneous cutaneous endometriosis appears most commonly on the umbilicus (Villar nodule) and manifests with a red-brown nodule that characteristically shows cyclic variations (tenderness or bleeding) with the menstrual cycle. We present herein a new case of spontaneous cutaneous endometriosis of the umbilicus that was studied immunohistochemically and review the salient clinicopathologic features of this rare condition.

Pathologe. 2011 Aug 3. [Epub ahead of print]

Preneoplasias of ovarian carcinoma : Biological and clinical aspects of different pathways of tumorigenesis.

[Article in German]

Staebler A.


Institut für Pathologie, Bereich Gynäkopathologie, Universitätsklinikum Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Deutschland,


Ovarian carcinomas consist of a heterogenous group of malignant epithelial neoplasms with specific pathogenic mechanisms. This review provides a brief introduction to the different pathways of tumor progression and the associated molecular changes. However, the main focus will be on two areas with major paradigm shifting developments in recent years. Mutational analysis of ovarian clear cell carcinomas, endometrioid carcinomas and endometriotic lesions identified mutations in the ARID1A gene as common and early genetic changes in carcinomas with associated endometriosis and in atypical endometriosis itself. Extensive pathological work-up of the fallopian tubes of BRCA1/2 mutation carriers have demonstrated the existence of serous tubal intraepithelial carcinomas (STIC). Further studies showed that this lesion can also be found in 50-60% of patients with serous ovarian carcinomas without BRCA1/2 germline mutations. Pre-precursors which share the p53 mutations with STICs but proliferate very little are called p53-signatures and provide conclusive evidence that STICs develop in the fallopian tubes.

Med Hypotheses. 2011 Jul 30. [Epub ahead of print]

Serum Anti-Müllerian hormone (AMH) levels are differentially modulated by both serum gonadotropins and not only by serum Follicle Stimulating Hormone (FSH) levels.

Panidis D, Katsikis I, Karkanaki A, Piouka A, Armeni AK, Georgopoulos NA.


Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece.


It is generally accepted that serum AMH levels are thought to reflect the size of the ovarian follicle pool. Therefore, an inverse correlation between serum AMH and Follicle Stimulating Hormone (FSH) levels has been noted in older women with abnormal or exhausted follicular development, such as menopause, leading to the use of serum AMH as a marker of ovarian reserve. In clinical practice the use of serum AMH for the assessment of ovarian reserve has been expanding to women irrespective of age, such as women in early menopause or women undergoing ovarian stimulation for in vitro fertilization (IVF). To our knowledge, this opinion article aims to show that serum AMH levels are differentially modulated by both serum gonadotropins, depending on the degree of ovarian reserve. For instance, in conditions of increased LH and normal to low FSH such as young PCOS women with hyperandrogenemia, serum AMH levels are increased and tend to be associated to serum LH, while in conditions of increased FSH such as premature ovarian failure, serum AMH levels are decreased and tend to be associated to serum FSH. The evidence that supports the theory of a link between AMH and LH in PCOS comes from both in vitro and in vivo experiments. Serum AMH levels have been directly linked to serum LH levels in the most severe forms of PCOS. LH has also been shown in vitro to directly increase serum AMH levels in PCOS derived granulosa cells. Finally, hyperandrogenism, obesity, insulin resistance and OCs administration, indirectly affect serum AMH levels, by modulating serum LH. Concerning PCOS, the correlation between AMH and LH can be used in the future for the assessment of the severity of PCOS, of the amelioration of PCOS under OCs treatment, as well as of the efficacy of infertility treatment in clomiphene resistant PCOS women. Apart from PCOS, the clinical implications of this theoretical approach might become important in a variety of medical conditions. For instance, serum AMH levels might be used in the future as a marker of cysts formation in the ovaries as well as of ovarian endometriosis, or as a marker of ovarian response to treatment of ovarian cysts or ovarian endometriosis by oral contraceptives, etc. Additionally, in infertile women with hypothalamic amenorrhea, serum AMH levels might be used for the assessment of ovarian recovery under treatment.

Mymensingh Med J. 2011 Jul;20(3):391-6.

Laparoscopic findings of subfertile female patients in a tertiary hospital.

Anwary SA, Alfazzaman M, Nasreen ZA.


Dr Shaheen Ara Anwary, Assistant Professor, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.


Sub-fertility affects approximately 15% of couples. Approximately 40% of cases involve a male factor, 40% involve a female factor and the remainder involves both sexes. The polycystic ovary syndrome (PCOS) is one of the most common causes of sub-fertility due to anovulation in women. Treatment of sub-fertility in female partners mainly depends on the laparoscopic findings of patients with PCOS, pelvic inflammatory disease (PID), endometriosis and fibroid uterus. Between February 2007 and April 2009, 73 subfertile women with PCOS were evaluated on their laparoscopic findings in a tertiary hospital in Dhaka city. Mean±SD age was 28.55±3.98 years and primary sub-fertility was 68.5% vs. secondary 31.5% (p<0.01). In most cases, uterine size and position was normal (91.8%, p<0.001 and 89%, p<0.001) and 78.1% mobile. In most of the cases pouch of douglas was normal (78.1%, p<0.001) and adhesion absent (72.6%, p<0.001). In majority of the cases both right and left fallopian tubes were patent (80.8% vs. 75.3%) and ovary healthy (65.8% vs. 64.4%). Positive dye test of right and left fallopian tubes was significantly high (p<0.001). Careful evaluation of laparoscopic findings, are likely to help appropriate treatment modalities for desired outcome.

Ann Surg. 2011 Jul 29. [Epub ahead of print]

Rectovaginal Endometriosis.

Mangler M, Hasenbein K, Bartley J, Lanowska M, Schneider A, Köhler C.


Department of Gynecology, Charité Campus Mitte Charitéplatz 1, Berlin, Germany,

J Toxicol Sci. 2011;36(4):493-8.

Pathological study for the effects of in utero and postnatal exposure to diesel exhaust on a rat endometriosis model.

Umezawa M, Sakata C, Tanaka N, Tabata M, Takeda K, Ihara T, Sugamata M.


Department of Pathology, Tochigi Institute of Clinical Pathology.


Previous studies have shown that prenatal and postnatal exposure to diesel exhaust (DE), which is known to be one of the main constituents of air pollution, enhances the persistence of endometriosis in a rat model. The aim of this study is to investigate the pathological changes induced by DE exposure in a rat model of endometriosis. Pregnant Sprague-Dawley rats were exposed to DE or clean air beginning on gestational day 2 and neonatal rats were persistently exposed to DE or clean air. Endometriosis was induced by autotransplantation of endometrium onto the peritoneum of eight-week-old female offspring. Endometriotic lesions were examined at 7 and 14 days post-transplantation. As a result, infiltration of activated mast cells remained in deeper area of peritoneal tissue around the endometriosis model compared to the control group at 14 days post-autotransplantation. In the DE exposure group, 14 days post-transplant, the remaining lesions contained fibroblasts and activated mast cells, which were surrounded by collagen fibers. The data showed that prenatal and postnatal DE exposure enhances the activation of mast cells and prolongs the persistence of collagen fibers in the induced rat model of endometriosis.

Gynecol Oncol. 2011 Jul 28. [Epub ahead of print]

Use of metformin and the risk of ovarian cancer: A case-control analysis.

Bodmer M, Becker C, Meier C, Jick SS, Meier CR.


Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Switzerland; Emergency Department, University Hospital Basel, Switzerland.



To explore the association between use of metformin or other antidiabetic drugs and the risk of ovarian cancer.


Using the UK-based General Practice Research Database, we conducted a case-control analysis to evaluate whether users of metformin or other antidiabetic drugs had an altered risk of ovarian cancer. Cases had an incident diagnosis of ovarian cancer, and up to 6 controls per case were matched on age, sex, calendar time, general practice, and number of years of active history in the GPRD prior to the index date. Results were further adjusted by multivariate logistic regression analyses for BMI, polycystic ovaries, endometriosis, use of estrogens or oral contraceptives, a history of hysterectomy, and smoking.


We identified 1611 case patients with a recorded diagnosis of ovarian cancer. Mean age±SD was 61.2±13.1years at the time of cancer diagnosis. Long-term use (≥30 prescriptions) of metformin, but not of sulfonylureas, was associated with a tendency towards a reduced risk of ovarian cancer (OR 0.61, 95% CI 0.30-1.25 for metformin and 1.26, 95% CI 0.65-2.44 for sulfonylureas). Long-term use of insulin (≥40 prescriptions) was associated with a slightly increased risk for ovarian cancer (OR 2.29, 95% CI 1.13-4.65).


In this large epidemiological study long-term use of metformin, but not of sulfonylureas, was associated with a tendency towards a decreased risk of ovarian cancer. Long-term use of insulin was associated with an increased risk of ovarian cancer.

Fertil Steril. 2011 Jul 28. [Epub ahead of print]

Endometriomas as a possible cause of reduced ovarian reserve in women with endometriosis.

Kitajima M, Defrère S, Dolmans MM, Colette S, Squifflet J, Van Langendonckt A, Donnez J.


Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Department of Gynecology, Brussels, Belgium.



To evaluate the adverse effects of endometriomas on ovarian reserve.


Analysis of prospectively collected biopsy samples.


Gynecology research unit in a university hospital.


Women younger than age 35 years with endometriomas.


Biopsy of normal cortex from ovaries affected by endometriomas (≤4 cm) and contralateral ovaries without cysts.


Presence of cortex-specific stroma, observation of superficial endometriosis, follicular density, and presence of fibrosis.


Twenty samples of cortical tissue from ovaries with endometriomas and 11 from contralateral ovaries without cysts were analyzed. Follicular density was significantly lower in cortex from ovaries with endometriomas than in cortex from contralateral ovaries without cysts (mean ± SD = 6.3 ± 4.1/mm(3) vs 25.1 ± 15.0/mm(3)). Eleven (55%) cortical samples from ovaries with endometriomas showed fibrosis and concomitant loss of cortex-specific stroma, not observed in contralateral normal ovaries. Multivariate analysis revealed that the presence of endometrioma and fibrosis were significantly and independently associated with follicular density.


Endometriotic cyst formation and associated structural tissue alterations in apparently normal ovarian cortex may be a cause of reduced ovarian reserve. Early diagnosis and intervention may be beneficial in women with endometriomas to protect their ovarian function.

J Minim Invasive Gynecol. 2011 Jul 27. [Epub ahead of print]

Infertile Women with Deep and Intraperitoneal Endometriosis: Comparison of Fertility Outcome According to the Extent of Surgery.

Douay-Hauser N, Yazbeck C, Walker F, Luton D, Madelenat P, Koskas M.


Department of Obstetrics and Gynecology, School of Medicine, Bichat Claude Bernard Hospital, Paris Diderot University, Paris, France.



This study was undertaken to ascertain whether the incidence of spontaneous pregnancy is increased in infertile women with deep and intraperitoneal endometriosis undergoing extensive surgery compared with those undergoing only intraperitoneal surgery.


Retrospective case control study (Canadian Task Force classification II-1).


University teaching hospital.


Infertile women under the age of 40 years with deep and intraperitoneal endometriosis and no other associated major infertility factors. Only patients with at least 1 year of postoperative follow-up were included.


Intraperitoneal surgery only (group 1) or extensive surgery (group 2) according to a shared decision-making approach.


Among the 34 women in group 1, 6 became pregnant, compared with 8 of the 41 women who had extensive surgery (12-month cumulative probabilities, 24.8% and 11.4%, respectively, and 24-month cumulative probabilities, 24.8% and 23.2%, respectively; p = .82). Perioperative surgical complication rate was higher in group 2 (6/41 versus 0/34; p = .02).


Extensive surgery for intraperitoneal and deep endometriosis in infertile women does not modify global fertility outcome but is associated with a higher complication rate.

Cancer Lett. 2011 Jul 8. [Epub ahead of print]

Ovarian clear cell carcinoma as a stress-responsive cancer: Influence of the microenvironment on the carcinogenesis and cancer phenotype.

Mandai M, Matsumura N, Baba T, Yamaguchi K, Hamanishi J, Konishi I.


Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.


Although it is well known that ovarian endometriosis occasionally gives rise to ovarian cancers with specific histology such as endometrioid and clear cell carcinomas, its etiology is not fully understood. We have shown that a stressful microenvironment within the endometriotic cyst may lead to cancer development by inducing unique gene expressions, which potentially serves as a molecular marker for treatment modality. In this review, by referring to other articles in this field, we explore how the carcinogenic microenvironment affects the phenotype and gene expression of a cancer, and how we can develop new treatment based on this concept.

Reprod Biol Endocrinol. 2011 Aug 1;9(1):104. [Epub ahead of print]

Establishment of an immortalized human endometrial stromal cell line with functional responses to ovarian stimuli.

Yuhki M, Kajitani T, Mizuno T, Aoki Y, Maruyama T.


ABSTRACT: Studies on the mechanisms of decidualization and endometriosis are often hampered by lack of primary endometrial cells. To facilitate in vitro studies, we established a human endometrial stromal cell line, KC02-44D, immortalized with human telomerase reverse transcriptase. Upon exposure to ovarian stimuli, KC02-44D cells showed similar cytoskeletal marker or gene expression and biochemical phenotype to primary endometrial stromal cells. KC02-44D would be useful for studies of human endometrial function and its associated pathologies.

Reprod Sci. 2011 Aug;18(8):702-12.

Sex Steroid Hormones and Reproductive Disorders: Impact on Women’s Health.

Fauser BC, Laven JS, Tarlatzis BC, Moley KH, Critchley HO, Taylor RN, Berga SL, Mermelstein PG, Devroey P, Gianaroli L, D’Hooghe T, Vercellini P, Hummelshoj L, Rubin S, Goverde AJ, Leo VD, Petraglia F.


1Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, Netherlands.


The role of sex steroid hormones in reproductive function in women is well established. However, in the last two decades it has been shown that receptors for estrogens, progesterone and androgens are expressed in non reproductive tissue /organs (bone, brain, cardiovascular system) playing a role in their function. Therefore, it is critical to evaluate the impact of sex steroid hormones in the pathophysiology of some diseases (osteoporosis, Alzheimer, atherosclerosis). In particular, women with primary ovarian insufficiency, polycystic ovary syndrome, endometriosis and climacteric syndrome may have more health problems and therefore an hormonal treatment may be crucial for these women.

Rev Port Pneumol. 2011 Jul 25. [Epub ahead of print]

Diaphragmatic patch: A useful adjunct in surgical treatment of recurrent catamenial hemothorax.

[Article in English, Portuguese]

Nwiloh J.


Section of Cardiothoracic Surgery, Atlanta Medical Center, Atlanta, GA, United States.


Although catamenial hemothorax compared to pneumothorax is a rarer clinical presentation of thoracic endometriosis syndrome (TES), it is more commonly associated with diaphragmatic fenestrations. These openings may serve as entry portals for peritoneal fluid to access into the pleural space thereby perpetuating recurrent pleural effusion even after prior surgical pleurodesis. We report our experience with two patients with recurrent right catamenial hemothorax after previous interventions that were subsequently treated by talc pleurodesis and goretex diaphragmatic patch, and who have had no further recurrence at a mean follow up of 15 months. We therefore recommend that diaphragmatic patch should be considered as an adjunct to talc pleurodesis in patients with recurrent catamenial hemothorax when either multiple diaphragmatic fenestrations are seen at surgery or if there is concomitant bloody peritoneal fluid which could potentially lead to recurrence. The patch by sealing any occult pores and possible future fenestrations appear to decrease recurrent pleural effusion at an intermediate term follow up.

J Ovarian Res. 2011 Jul 27;4(1):11. [Epub ahead of print]

The short form Endometriosis Health Profile (EHP-5): translation and validation study of the Iranian version.

Goshtasebi A, Nematollahzadeh M, Hariri FZ, Montazeri A.




Endometriosis Health Profile (EHP-5) is a valid instrument to measure healthrelated quality of life in endometriosis. This study was conducted to culturally adapt and validate the EHP-5 in Iran.


Using a standard “forward-backward’ translation procedure, the English language version of the questionnaire was translated into Persian (Iranian language). Then a sample of 199 women aged 18-50 years completed the questionnaire. To test reliability the internal consistency was assessed by Cronbach’s alpha coefficient. Validity was evaluated using known groups comparison.


The mean age of respondents was 31.4 (5.4) years. Reliability analysis showed satisfactory result (Cronbach’s alpha coefficient = 0.71). The questionnaire discriminated well between sub-groups of women differing in infertility and premenstrual syndrome (PMS) in the expected direction.


This preliminary validation study of the Iranian version of the EHP-5 proved that it is an acceptable, reliable and valid measure of quality of life in endometriosis patients.

Acta Obstet Gynecol Scand. 2011 Jul 27. doi: 10.1111/j.1600-0412.2011.01247.x. [Epub ahead of print]

Impact of endometriosis on IVF-ET cycles in young women: a stage dependent interference.

Coccia ME, Rizzello F, Mariani G, Bulletti C, Palagiano A, Scarselli G.


Department of Science for the Woman and Child’s Health, University of Florence, Florence, Department of Medical Pathophysiology, Sapienza University of Rome, Rome, Unit of Physiopathology of Reproduction, Cattolica General Hospital and University of Bologna, Bologna, and Department of Obstetrics, Gynecology, and Reproductive Sciences, Second University of Naples, Naples, Italy.


Objective. Endometriosis is a frequent indication for in-vitro fertilization and embryo transfer (IVF-ET). Its influence on IVF-ET cycles remains controversial. We evaluated the impact of severity of endometriosis on IVF-ET cycles in young women. Design. Retrospective cohort study. Setting. Academic tertiary referral centre. Population and methods. One-hundred and sixty four IVF-ET cycles on 148 women with endometriosis-associated infertility. Eighty cycles performed during the same period on 72 consecutive women with tubal infertility were considered as controls. All patients were younger than 35 years old. Main outcome measures. Response to controlled ovarian hyperstimulation (COH), number of oocytes retrieved, fertilization, implantation, pregnancy rates (PR). Results. Clinical PR waslower in the endometriosis (all stages) group in comparison to tubal-factor. Higher total gonadotropin requirements, lower response to COH and oocyte yield were also found in the endometriosis-group. Stage-stratified analysis showed a lower fertilization rate in stage I-II (52.6% stage I-II, 70.5% stage III-IV, 71.9% tubal factor). In stage III-IV endometriosis there was a higher cycle cancellation rate, a reduced response to COH and a lower PR compared to both the stage I-II and the tubal infertility (PR 9.7%, 25%, 26.1% respectively). Conclusions. Stage III-IV was strongly associated with poor IVF outcome. A decreased fertilization rate in stage I-II might be a cause of subfertility in these women due to a hostile environment caused by the disease.

Clin Exp Obstet Gynecol. 2011;38(2):184-5.

Nobel medical management of primary bladder endometriosis with dienogest: a case report.

Takagi H, Matsunami K, Ichigo S, Imai A.


Department of Obstetrics and Gynecology, Matsunami General Hospital, Gifu, Japan.



Because of its low incidence, medical treatment of has not yet been well established although surgical excision is generally considered effective. We report the first case of primary bladder endometriosis successfully managed with a novel progestin dienogest.


A 39-year-old woman, nulligravida, presented with lower urinary tract symptoms, especially during menstruation. Cystoscopy, with subsequent cold cup biopsy, revealed a solitary submucosal mass (2 x 2 cm) in the bladder on the posterior wall; histopathology revealed the diagnosis of extraperitoneal endometriosis. MRI and laparoscopy confirmed no peritoneal endometriosis implants or adenomyosis. She was treated with oral 2 mg/day dienogest for six months. The measurable lesion exhibited a remarkable reduction in its size, accompanied with immediate relief of the lesion-related symptoms. At one year after medication cessation, she is well and symptom-free.


Dienogest may be a novel conservative alternative for bladder endometriosis, in particular for women who wish to avoid surgical intervention.

Clin Exp Obstet Gynecol. 2011;38(2):119-22.

Anti-müllerian hormone is the best predictor of poor response in ICSI cycles of patients with endometriosis.

de Carvalho BR, Rosa-e-Silva AC, Rosa-e-Silva JC, dos Reis RM, Ferriani RA, de Sá MF.


Sector of Human Reproduction, Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.



To correlate ovarian reserve (OR) markers with response in assisted reproduction techniques (ART) and determine their ability to predict poor response among patients with endometriosis (EDT).


We evaluated ART cycles of 27 women with EDT and 50 with exclusive male factor. Basal follicle stimulating hormone (FSH) and anti-müllerian hormone (AMH) levels were determined. Ovarian response to gonadotropin stimulation was assessed and correlation coefficients calculated between the variables and reserve markers. Areas under the curve (AUC) determined ability of tests to predict poor response.


AMH was significantly correlated with response in both groups and it was the only marker with significant discriminative capacity to predict poor response among EDT (AUC = 0.842; 95% CI: 0.651-0.952) and control group (AUC = 0.869; 95% CI: 0.743-0.947).


Infertile patients with endometriosis can benefit from the pre-therapeutic assessment of OR markers. However, regardless of disease presence, only AMH predicts poor response to stimulus.

Ultrasound Obstet Gynecol. 2011 Jul 26:132. doi: 10.1002/uog.10052. [Epub ahead of print]

Endometriosis of the abdominal wall: ultrasonographic and doppler characteristics.

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


Gynecology and Reproductive Medicine Unit, S.Orsola-Malpighi Hospital, University of Bologna, Italy.



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


Twenty-one consecutive women with proven pathological endometriosis of the abdominal wall were retrospectively recruited. Ultrasonographic and Doppler examinations were performed before surgery with a high frequency linear transducer. The clinical data and the results of the sonographic examinations were reviewed and described.


At ultrasound, all the nodules appeared as discrete solid masses, less echogenic than the surrounding hyperechoic fat. The nodules had a mean diameter of 21 mm (range: 5-50 mm) and a round/oval shape in 18/21 cases (86%). In 8/21 (38%) women, the AWE was located at the umbilicus, in 6/21 (29%) it was between the transverse suprapubic line and the umbilicus and, in 5/21 (24%), it was found along the scar of a previous cesarean section. In 2/21 (9%) cases, the AWE was in the right inguinal canal. The content was homogeneously hypoechoic in 12/21 (57%) women and inhomogeneous in 9 (43%). The outer borders were invariably ill defined. Scarce blood vessels were found at power Doppler in all cases. Cyclic or continuous spontaneous pain at the level of the AWE was present in 19/21 cases (91%) while two patients (9%) were asymptomatic.


Hypoechoic round/oval nodules with ill-defined borders and a hyperechoic rim should raise the suspicion of abdominal wall endometriosis, even in patients with no history of endometriosis or previous laparotomic surgery. Pushing with the ultrasound probe against the nodule can reinforce such a diagnostic suspicion, thanks to the pain induced. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Int J Womens Health. 2011;3:175-84. Epub 2011 Jul 6.

Dienogest in long-term treatment of endometriosis.

Schindler AE.


Institute for Medical Research and Education, Essen, Germany.


Endometriosis is a chronic disease primarily affecting women of childbearing age, in which endometriotic lesions form outside the uterus, typically leading to painful symptoms, fatigue, and infertility. The symptoms of endometriosis may cause significant impairment in quality of life and represent a substantial economic burden to patients, families, and society. There is no cure for endometriosis; management consists of alleviating pain and other symptoms, reducing endometriotic lesions, and improving quality of life. Recurrence after surgical intervention is common, while the clinical evidence to support the efficacy and safety of many medications currently used in endometriosis is limited. Dienogest is an oral progestin that has been investigated extensively in the treatment of endometriosis in two clinical programs performed in Europe and Japan, including dose-ranging, placebo-controlled, active comparator-controlled, and long-term (up to 65 weeks) studies. These studies demonstrated that dienogest 2 mg daily effectively alleviates the painful symptoms of endometriosis, reduces endometriotic lesions, and improves indices of quality of life. Dienogest showed a favorable safety and tolerability profile in these studies, with predictable adverse effects, high rates of patient compliance, and low withdrawal rates. This review article describes the clinical trial evidence that characterizes the efficacy and safety of dienogest in endometriosis, including two studies characterizing dienogest in long-term use. The relevance of these findings to the management of endometriosis in clinical practice is discussed.


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