Pag. 11


Int J Surg Pathol. 2012 Apr;20(2):205-7. Epub 2011 Aug 23.

Aggressive angiomyxoma admixed with endometriosis: a case report.

Coyne JD.


Department of Pathology, Royal Liverpool University Hospital, Liverpool, UK.


Aggressive angiomyxoma and endometriosis are two apparently unrelated lesions which commonly arise within the pelvis. However, whilst their simultaneous occurrence in this site may be fortuitous, a shared pathogenesis cannot be entirely excluded.

J Cell Biochem. 2012 Apr;113(4):1292-301.

In vitro model of stromal and epithelial immortalized endometriotic cells.

Boccellino M, Quagliuolo L, Verde A, La Porta R, Crispi S, Piccolo MT, Vitiello A, Baldi A, Signorile PG.


Department of Biochemistry and Biophysics, Second University of Naples, Naples, Italy.


Endometriosis is a relatively common chronic gynecologic disorder that usually presents with chronic pelvic pain or infertility. It results from implantation of endometrial tissue outside the uterine cavity. Despite its frequency and its impact on quality of life, the understanding of pathogenesis of endometriosis remains incomplete and its treatment remains controversial. In this work, we established a suitable in vitro model system of immortalized human endometriotic cell line taking advantage of the human telomerase reverse transcriptase. The results demonstrate that these cells retain the natural characteristics of endometrial cells in term of phenotype and of functional expression of estrogen and progesterone receptors, without chromosomal abnormalities. In conclusion, these cells are potentially useful as an experimental model to investigate endometriosis biology.

J Cell Physiol. 2012 Apr;227(4):1653-6. doi: 10.1002/jcp.22888.

Embryologic origin of endometriosis: analysis of 101 human female fetuses.

Signorile PG, Baldi F, Bussani R, Viceconte R, Bulzomi P, D’Armiento M, D’Avino A, Baldi A.


Fondazione Italiana Endometriosi, Rome, Italy.


The etiology of endometriosis, a gynecological disease characterized by the presence of endometrial glands and stroma outside the uterine cavity, is still unknown. Our research group has recently demonstrated the presence of ectopic endometrium in human female fetuses at different gestational ages. In this manuscript we describe four new cases of fetal endometriosis found among a series of 52 female fetuses analyzed at autopsy. The anatomical localization of this ectopic endometrium, and its histological and immunohistochemical characteristics are depicted. We suggest that endometriosis is caused by dislocation of primitive endometrial tissue outside the uterine cavity during organogenesis. The clinical and pathological implications of these findings are discussed.

J Gynecol Obstet Biol Reprod (Paris). 2012 Apr;41(2):128-35. Epub 2011 Nov 8.

Laparoscopic colorectal resection for deep pelvic endometriosis: Evaluation of post-operative outcome.

[Article in French]

Boileau L, Laporte S, Bourgaux JF, Rouanet JP, Filleron T, Mares P, de Tayrac R.


Service de gynécologie et d’obstétrique, CHU de Nîmes, place du Pr R.-Debré, 30029 Nîmes, France.



Evaluation of mid-term functional results and the quality of life after laparoscopic colorectal resection.


Twenty-three consecutive patients were included in a retrospective monocentric study. Postoperative functional outcomes and quality of life were analyzed.


The median follow-up after colorectal resection was of 24±15.7 months (6-72). Major complications occurred in three cases (12,9%) including one anastomotic stenosis, one digestive and one bladder fistula. A significant improvement in pelvic pain symptoms was observed. De novo constipation and pain on defecation occurred in respectively 23% and 42% of the cases. Transient de novo dysuria occurred in 18% of the cases. The quality of life has been significantly improved.


Laparoscopic colorectal resection is associated with unfavourable postoperative digestive and urological outcomes, such as bladder and rectal dysfunction. Radical treatment should be limited to selected patients.

J Minim Access Surg. 2012 Apr;8(2):50-3.

Type-I complex regional pain syndrome of umbilical port site: An unforeseen complication of laparoscopic surgery.

Munisamy R, Uppalu H, Raghavendra R, Venkata NP, Harshita S, Janarthanam SV.


Department of Pediatric Surgery, Narayana Medical College and Super-Speciality Hospital, Nellore, Andhra Pradesh, India.


Many complications have been observed after laparoscopic surgery. Persisting pain in the umbilical port site is due to infection, hernia, endometriosis, metastasis, etc. There is no case report due to neuralgic complex regional pain syndrome, and we have dealt a case which is described with relevant literature review and etiopathogenesis.

J Obstet Gynaecol. 2012 Apr;32(3):291-3.

High rate of allergies among women with endometriosis.

Matalliotakis I, Cakmak H, Matalliotakis M, Kappou D, Arici A.


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


Women with endometriosis frequently suffer from autoimmune inflammatory diseases, allergies and asthma. This study was conducted to examine whether the prevalence of allergies is higher in patients with endometriosis than in the control group, and to show potential correlation with endometriosis stages. We evaluated the medical files of 501 women with laparoscopically-diagnosed endometriosis and 188 women without endometriosis enrolled in Yale University Hospital. Main outcome measures used were allergy on medications, complaints of sinus or perennial allergic rhinitis, asthma, family history of allergic disease, and correlation with stages of endometriosis. Our results indicated that the overall risk of women with endometriosis and positive history of allergies was 4.28 (95% CI, 2.9-6.3) (p < 0.001). Significant excesses were identified for medications, sinus allergic rhinitis, and asthma; also, women with endometriosis were significantly more likely to report a positive family history of allergies. Overall, our study indicated a link between endometriosis and increased risk of allergic autoimmune disorders that should further be explored.

J Obstet Gynaecol Res. 2012 Apr;38(4):729-32. doi: 10.1111/j.1447-0756.2011.01768.x. Epub 2012 Mar 2.

Abdominal radical trachelectomy for treatment of deep infiltrating endometriosis of the cervix.

Rodolakis A, Akrivos N, Haidopoulos D, Kyritsis N, Sotiropoulou M, Thomakos N, Biliatis I, Simou M, Antsaklis A.


First Department of Obstetrics and Gynecology, University of Athens, Athens, Greece.


Surgical management of deep infiltrating endometriosis can be very challenging even for experienced gynecologists. Radical procedures like bowel resection and nephrectomy have been reported for treatment of the disease. Our aim is to report abdominal radical trachelectomy for treatment of deep infiltrating endometriosis of the cervix causing obstructive uropathy and diminished kidney function. We present a 38-year-old woman who was treated in our department for cervical endometriosis involving the vagina and left parametrium. Abdominal radical trachelectomy, insertion of a pig-tail catheter in the left ureter and end-to-end anastomosis of the uterus with the vagina was performed to remove the endometriotic lesion. Cooperation between gynecologists, urologists and nephrologists enabled fertility preservation as well as improvement of renal function. Deep infiltrating endometriosis is a complex disease that requires a multidisciplinary approach. Abdominal radical trachelectomy for cervical lesions seems feasible in this setting and helps preserve fertility.

J Pediatr Adolesc Gynecol. 2012 Apr;25(2):105-8. Epub 2011 Dec 11.

Use of norethindrone acetate alone for postoperative suppression of endometriosis symptoms.

Kaser DJ, Missmer SA, Berry KF, Laufer MR.


Division of Gynecology, Children’s Hospital Boston, Boston, Massachusetts, USA.



To evaluate the efficacy and tolerability of norethindrone acetate (NA) as single-agent hormonal therapy for suppression of endometriosis symptoms in adolescents and young adults.


Retrospective study.


Two academic medical centers.


A keyword search using the query ‘NA’ was applied to the electronic medical records of all women treated by one gynecologist (M.R.L.) from 1992 to 2010. IRB-approved chart review was then conducted on the index records.


Continuous treatment with NA (5-15 mg daily).


Postoperative bleeding and pain scores; adverse effects.


One hundred and ninety-four patients with surgically diagnosed endometriosis initiated NA postoperatively during the study period. Median patient age was 18.9 years. 92.2% of patients had stage 1 or 2 disease, and distribution was similar among those excluded. Median pain scores decreased from 5 at NA initiation to 0 at follow-up (P = .0001) and bleeding scores from 2 to 0, respectively (P = .001) for all stages of endometriosis. Post-NA bleeding scores were improved regardless of prior hormonal regimen, and post-NA pain scores improved in all patients except for those previously prescribed GnRH-agonist plus add-back. Most patients (55.2%) did not report any side effects. The most common adverse effect was weight gain (16.1%), with a mean increase in BMI of 1.2 ± 1.6 kg/m(2) at 12 months.


NA alone is a well-tolerated, effective option to manage pain and bleeding for all stages of endometriosis. Among those on prior hormonal therapy, symptoms improved after NA initiation.

J Ultrasound Med. 2012 Apr;31(4):651-3.

Sonography should be the first imaging examination done to evaluate patients with suspected endometriosis.

Benacerraf BR, Groszmann Y.


Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA.

Lancet Oncol. 2012 Apr;13(4):385-94. Epub 2012 Feb 22.

Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies.

Pearce CL, Templeman C, Rossing MA, Lee A, Near AM, Webb PM, Nagle CM, Doherty JA, Cushing-Haugen KL, Wicklund KG, Chang-Claude J, Hein R, Lurie G, Wilkens LR, Carney ME, Goodman MT, Moysich K, Kjaer SK, Hogdall E, Jensen A, Goode EL, Fridley BL, Larson MC, Schildkraut JM, Palmieri RT, Cramer DW, Terry KL, Vitonis AF, Titus LJ, Ziogas A, Brewster W, Anton-Culver H, Gentry-Maharaj A, Ramus SJ, Anderson AR, Brueggmann D, Fasching PA, Gayther SA, Huntsman DG, Menon U, Ness RB, Pike MC, Risch H, Wu AH, Berchuck A; Ovarian Cancer Association Consortium.


Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.



Endometriosis is a risk factor for epithelial ovarian cancer; however, whether this risk extends to all invasive histological subtypes or borderline tumours is not clear. We undertook an international collaborative study to assess the association between endometriosis and histological subtypes of ovarian cancer.


Data from 13 ovarian cancer case-control studies, which were part of the Ovarian Cancer Association Consortium, were pooled and logistic regression analyses were undertaken to assess the association between self-reported endometriosis and risk of ovarian cancer. Analyses of invasive cases were done with respect to histological subtypes, grade, and stage, and analyses of borderline tumours by histological subtype. Age, ethnic origin, study site, parity, and duration of oral contraceptive use were included in all analytical models.


13 226 controls and 7911 women with invasive ovarian cancer were included in this analysis. 818 and 738, respectively, reported a history of endometriosis. 1907 women with borderline ovarian cancer were also included in the analysis, and 168 of these reported a history of endometriosis. Self-reported endometriosis was associated with a significantly increased risk of clear-cell (136 [20·2%] of 674 cases vs 818 [6·2%] of 13 226 controls, odds ratio 3·05, 95% CI 2·43-3·84, p<0·0001), low-grade serous (31 [9·2%] of 336 cases, 2·11, 1·39-3·20, p<0·0001), and endometrioid invasive ovarian cancers (169 [13·9%] of 1220 cases, 2·04, 1·67-2·48, p<0·0001). No association was noted between endometriosis and risk of mucinous (31 [6·0%] of 516 cases, 1·02, 0·69-1·50, p=0·93) or high-grade serous invasive ovarian cancer (261 [7·1%] of 3659 cases, 1·13, 0·97-1·32, p=0·13), or borderline tumours of either subtype (serous 103 [9·0%] of 1140 cases, 1·20, 0·95-1·52, p=0·12, and mucinous 65 [8·5%] of 767 cases, 1·12, 0·84-1·48, p=0·45).


Clinicians should be aware of the increased risk of specific subtypes of ovarian cancer in women with endometriosis. Future efforts should focus on understanding the mechanisms that might lead to malignant transformation of endometriosis so as to help identify subsets of women at increased risk of ovarian cancer.


Ovarian Cancer Research Fund, National Institutes of Health, California Cancer Research Program, California Department of Health Services, Lon V Smith Foundation, European Community’s Seventh Framework Programme, German Federal Ministry of Education and Research of Germany, Programme of Clinical Biomedical Research, German Cancer Research Centre, Eve Appeal, Oak Foundation, UK National Institute of Health Research, National Health and Medical Research Council of Australia, US Army Medical Research and Materiel Command, Cancer Council Tasmania, Cancer Foundation of Western Australia, Mermaid 1, Danish Cancer Society, and Roswell Park Alliance Foundation.

Comment in

Lancet Oncol. 2012 Apr;13(4):326-8. Epub 2012 Feb 22.

Link between endometriosis and ovarian-cancer subtypes.

Gourley C.


University of Edinburgh Cancer Research UK Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Crewe Road South, Edinburgh EH4 2XR, UK.

Comment on

Lasers Surg Med. 2012 Apr;44(4):282-95. doi: 10.1002/lsm.22014. Epub 2012 Mar 7.

Parallel factor analysis of ovarian autofluorescence as a cancer diagnostic.

George R, Michaelides M, Brewer MA, Utzinger U.


College of Optical Sciences, University of Arizona, Tucson, Arizona 85721, USA.



Endogenous fluorescence from certain amino acids, structural proteins, and enzymatic co-factors in tissue is altered by carcinogenesis. We evaluate the potential of these changes in fluorescence to predict a diagnosis of malignancy and to estimate the risk of developing ovarian cancer.


Ovarian biopsies were interrogated over 270-550 nm excitation and fluorescence was collected from 290 to 700 nm. Two hundred forty-nine measurements were performed on 49 IRB-consented patients undergoing oophorectomy. Data are analyzed using parallel factor analysis to determine excitation and emission spectra of the underlying fluorophores that contribute to the total detected fluorescence intensity.


Using multivariate normal distribution fits and cross-validation techniques, sensitivity and specificity of 88% and 93%, respectively, are achieved when classifying malignant samples versus others, while 88% and 80%, respectively, are achieved when classifying normal post-menopausal patients as being either at high- or low-risk of developing ovarian cancer based on their personal and family history of cancer. Performance of classifying cancer increases when the normal group does not include benign neoplasm and endometriosis samples. Performance of high- versus low-risk classification decreases when normal samples include both pre- and post-menopausal women. Excitation over 270-400 and 380-560 nm, respectively, have the best diagnostic performance for cancer detection and risk-status assessment.


Assessing the endogenous fluorescence could be useful in screening women at increased risk of developing ovarian cancer.

Maturitas. 2012 Apr;71(4):337-44. Epub 2012 Feb 24.

The pharmacology of dienogest.

Ruan X, Seeger H, Mueck AO.


Department of Gynecological Endocrinology, Beijing OB/GYN Hospital, Capital Medical University, Beijing, China.


Dienogest (DNG) is a 19-nortestosterone derivative (a C-19 progestogen) with a cyanomethyl instead of an ethinyl group at the C-17 position, which may make the compound elicit fewer hepatic effects than other C-19 nortestosterone derivatives. Its similarity to norethisterone is reflected in its high endometrial efficacy, which could explain the high stability of the menstrual cycle women achieve when they use DNG in combination with ethinyl estradiol (EE) or with estradiol valerate (E2V). Its strong endometrial efficacy underlies the use of DNG (on its own) to treat endometriosis, and gives it antiproliferative and anti-inflammatory effects in the treatment of endometriotic lesions. Properties derived from its C-19 derivative structure include its short plasma half-life, of about 10h (which means the drug is not accumulated), and its high oral bioavailability, of more than 90%. However, DNG also has some of the properties of typical of progesterone derivatives, including a lack of effect on the metabolic and cardiovascular systems, and considerable antiandrogenic activity, the latter increased by its lack of affinity to the sex-hormone binding globulin (SHBG), in contrast to other C-19 progestogens. DNG has no glucocorticoid and no antimineralocorticoid activity. It also has no antiestrogenic activity, which suggests that it should not antagonize estradiol’s beneficial effects. This is important for its use in the treatment of endometriosis, because, due to DNG’s low gonadotropic activity, E2 levels are not decreased to zero, in contrast to treatments with gonadotropin-releasing hormone (GnRH) analogues. This maintenance beneficial E2 effects is of particular importance for the general tolerability of the first contraceptive pill to use E2V instead of EE, although clinical endpoint studies are still ongoing. These studies are expected, on the basis of its pharmacology, to demonstrate the cardiovascular safety of the new pill.

Mod Pathol. 2012 Apr;25(4):615-24. doi: 10.1038/modpathol.2011.189. Epub 2011 Dec 9.

Loss of ARID1A protein expression occurs as an early event in ovarian clear-cell carcinoma development and frequently coexists with PIK3CA mutations.

Yamamoto S, Tsuda H, Takano M, Tamai S, Matsubara O.


Department of Basic Pathology, National Defense Medical College, Tokorozawa, Japan.


ARID1A is a recently identified tumor suppressor gene that is mutated in ∼50% of ovarian clear-cell carcinomas. This mutation is associated with loss of ARID1A protein expression as assessed by immunohistochemistry. The present study aimed at determining the timing of the loss of ARID1A protein expression during the development of ovarian clear-cell carcinoma and assessing its relevance in correlation to PIK3CA gene mutations. A total of 42 clear-cell carcinoma cases with adjacent putative precursor lesions (endometriosis-associated carcinoma cases (n=28) and (clear-cell) adenofibroma-associated carcinoma cases (n=14)) were selected and subjected to immunohistochemical analysis for ARID1A protein expression and direct genomic DNA sequencing of exons 9 and 20 of the PIK3CA gene. ARID1A immunoreactivity was deficient in 17 (61%) of the 28 endometriosis-associated carcinomas and 6 (43%) of the 14 adenofibroma-associated carcinomas. Among the precursor lesions adjacent to the 23 ARID1A-deficient carcinomas, 86% of the non-atypical endometriosis (12 of 14) and 100% of the atypical endometriosis (14 of 14), benign (3 of 3), and borderline (6 of 6) clear-cell adenofibroma components were found to be ARID1A deficient. In contrast, in the 19 patients with ARID1A-intact carcinomas, all of the adjacent precursor lesions retained ARID1A expression regardless of their types and cytological atypia. Analysis of 22 solitary endometrioses and 10 endometrioses distant from ARID1A-deficient carcinomas showed that all of these lesions were diffusely immunoreactive for ARID1A. Among the 42 clear-cell carcinomas, somatic mutations of PIK3CA were detected in 17 (40%) tumors and majority (71%) of these were ARID1A-deficient carcinomas. These results suggest that loss of ARID1A protein expression occurs as a very early event in ovarian clear-cell carcinoma development, similar to the pattern of PIK3CA mutation recently reported by our group, and frequently coexists (not mutually exclusive) with PIK3CA mutations.

Presse Med. 2012 Apr;41(4):358-66. Epub 2011 Oct 19.

Intestinal endometriosis.

[Article in French]

Leconte M, Borghese B, Chapron C, Dousset B.


AP-HP, hôpital Cochin, université Paris-Descartes, service de chirurgie digestive, hépatobiliaire et endocrinienne, 75679 Paris cedex 14, France.


Endometriosis affects 6 to 10 % of all women of childbearing age. Intestinal involvement is defined by muscularis infiltration and has been estimated to occur in 8 % to 12 % of women with endometriosis. The most common sites are rectum, sigmoid and ileocaecal junction. In most cases, intestinal endometriosis is associated with deep infiltrating endometriosis, multifocal and aggressive form of endometriosis, responsible for refractory pelvic pain and infertility. The symptoms are nonspecific but are characterized by cyclic exacerbation of pain. The preoperative work-up includes a rectal endoscopic ultrasonography, a transvaginal ultrasonography, a pelvic magnetic resonance imaging and a multidetector CT scan. There is currently no cure other than surgical removal of lesions. Medical treatments are based on a hormone used to block ovarian function.

Reprod Biomed Online. 2012 Apr;24(4):389-95. Epub 2012 Jan 24.

Effect of patient selection on estimate of reproductive success after surgery for rectovaginal endometriosis: literature review.

Vercellini P, Barbara G, Buggio L, Frattaruolo MP, Somigliana E, Fedele L.


Department of Obstetrics and Gynecology, Istituto Luigi Mangiagalli, University of Milan, Milan, Italy.


The effect of rectovaginal endometriosis on fertility is unclear. Several authors foster radical surgery, including colorectal resection, as a fertility-enhancing procedure. However, interpretation of data is difficult, as the baseline fertility status is often undefined and it is not always possible to discriminate between spontaneous conceptions and those resulting from IVF. A systematic literature review was performed with the aim of defining the pregnancy rate specifically in patients who were infertile before surgery and who sought spontaneous pregnancy. A PubMed search was conducted to identify English language studies published between 2005 and 2011 evaluating reproductive performance after surgery for rectovaginal and rectosigmoid endometriosis. According to the results of the 11 selected studies, the mean post-operative conception rate in all women seeking pregnancy independently of preoperative fertility status and IVF performance was 39% (95% CI 35-43%; 223/571), but dropped to 24% (95% CI 20-28%; 123/510) in infertile patients who sought spontaneous conception (odds ratio 0.50, 95% CI 0.38-0.65%). Patients’ selection significantly influences the estimate of the effect of rectovaginal endometriosis excision on infertility. This should be carefully taken into consideration at preoperative counselling. Rectovaginal endometriosis usually is associated with pain symptoms, but the effect of this disease form on fertility is uncertain, as burial of foci beneath rectouterine adhesions with exclusion of the deepest part of the pelvis may limit interference with fertilization processes. Several authors foster radical surgery, including colorectal resection, as a fertility-enhancing procedure. However, interpretation of data is difficult, as the baseline fertility status is often undefined and it is not always possible to discriminate between spontaneous conceptions and those resulting from IVF. A systematic literature review was performed with the aim of defining the pregnancy rate specifically in patients who were infertile before surgery and who sought pregnancy spontaneously. A PubMed search was conducted to identify English language studies published between 2005 and 2011 evaluating reproductive performance after surgery for rectovaginal and rectosigmoid endometriosis. According to the results of the 11 selected studies, the mean post-operative conception rate in all women seeking pregnancy independently of preoperative fertility status and IVF performance was 39% (223/571), but dropped to 24% (123/510) in infertile patients who sought conception spontaneously. The 15% difference is statistically significant. Infertile patients with rectovaginal endometriosis considering surgery, should be carefully informed of the real probability of post-operative conception avoiding generic overestimations.

Reprod Sci. 2012 Apr;19(4):360-73. Epub 2012 Feb 16.

Valproic acid and progestin inhibit lesion growth and reduce hyperalgesia in experimentally induced endometriosis in rats.

Liu M, Liu X, Zhang Y, Guo SW.


Shanghai OB/GYN Hospital, Fudan University, Shanghai, China.


Accumulating evidence suggests that endometriosis is an epigenetic disease. This study was designed to evaluate the effect of valproic acid (VPA) and progesterone (P4) in a rat model of endometriosis on serum tumor necrosis factor-α (TNF-α) levels, hot plate and tail-flick latencies, lesion size, and body weight. We used 77 adult female rats, and endometriosis was induced by autotransplanting pieces of uterus (ENDO) or fat (SHAM) to the pelvic cavity. The BLANK group received no surgery. After 2 weeks, the ENDO group was further divided, randomly, into 5 groups, receiving, respectively, treatment with low- and high-dose VPA, P4 alone, VPA + P4, and no treatment. The SHAM rats received no treatment. The BLANK rats were further divided into 2 groups, one received VPA treatment and the other, no treatment. After 4 weeks, all rats were sacrificed. Response latency in hot plate and tail-flick tests, body weight, and serum TNF-α levels were measured before the surgery, before and after the treatment, along with lesion size. We found that induced endometriosis reduced response latency. ENDO rats receiving VPA and/or P4 treatment had significantly reduced lesion size as compared with untreated ones, and had significantly improved response to noxious thermal stimuli. They also had significantly increased weight gain. Serum TNF-α levels increased following surgery but eventually decreased regardless of treatment or not. In conclusion, VPA is well tolerated. Treatment with VPA significantly reduces lesion growth and improves sensitivity to nocifensive stimuli. The improvement is specific to endometriosis-induced hyperalgesia. Thus, histone deacetylase inhibitors may be a promising therapeutics for treating endometriosis.

Reproduction. 2012 Apr;143(4):531-8. Epub 2012 Jan 25.

FKBP4 is regulated by HOXA10 during decidualization and in endometriosis.

Yang H, Zhou Y, Edelshain B, Schatz F, Lockwood CJ, Taylor HS.


Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 06520, USA.


FKBP4 (FKBP52) and FKBP5 (FKBP51) are progestin receptor (PR) co-chaperone proteins that enhance and inhibit, respectively, progestin-mediated transcription by PR. Here, we examined FKBP4 and FKBP5 expression in the eutopic endometrium of fertile women with endometriosis and effects of FKBP4 and FKBP5 on the decidualization of human endometrial stromal cells (HESCs), and assessed HOXA10 regulation of FKBP4. Expression of FKBP4 mRNA was increased in the late proliferative phase and remained elevated throughout the secretory phase. FKBP5 expression was low and remained constant throughout the menstrual cycle. Compared with controls, FKBP4 mRNA expression was decreased in the endometrium of women with endometriosis, whereas no significant endometriosis-related change was seen for FKBP5. Cultured HESCs were treated with either FKBP4 or FKBP5 siRNA and then decidualized by incubation with progesterone (P(4)) and 8-bromoadenosine cAMP. Treatment of HESCs with FKBP4 siRNA resulted in 60% lower IGFBP1 expression. In contrast, incubation with FKBP5 siRNA did not significantly decrease IGFBP1 expression during in vitro decidualization. HOXA10 and FKBP4 expression increased in parallel during in vitro decidualization. In HESCs, overexpressed HOXA10 enhanced FKBP4 mRNA and protein levels, whereas HOXA10 knockdown decreased FKBP4 mRNA and protein levels compared with controls. Similarly, during in vitro decidualization, FKBP4 expression was decreased in HOXA10-silenced cells. Enhanced HOXA10 expression in HESCs elicits a decidualization mediating increase in FKBP4 expression. The findings are consistent with the observation that women with endometriosis have diminished FKBP4 expression leading to impaired decidualization and infertility. The P(4) resistance seen in endometriosis may be mediated through HOXA10-regulated FKBP4 expression.

Surg Endosc. 2012 Apr;26(4):1035-40. Epub 2011 Oct 25.

Laparoscopic rectal resection for severe endometriosis of the mid and low rectum: technique and operative results.

Ruffo G, Sartori A, Crippa S, Partelli S, Barugola G, Manzoni A, Steinasserer M, Minelli L, Falconi M.


Department of General Surgery, Ospedale Sacro Cuore-Don Calabria, Via Sempreboni 5, 37024, Negrar, VR, Italy.



Although several studies have shown that laparoscopic resection is safe and feasible in bowel endometriosis, limited data are available on the specific treatment for endometriosis of the rectum. The aim of this study is to describe operative and postoperative outcomes after laparoscopic resection of the mid/low rectum for endometriosis.


Between 2002 and 2010, 750 patients (median age 33 years) underwent laparoscopic resection of the mid/low rectum for deep infiltrating endometriosis at a single institution. All operations were performed with a standardized technique by a single surgeon.


Median operative time was 255 min, and median blood loss 150 ml. Of patients, 7% required blood transfusions. Laparotomic conversion rate was 1.6%. Mechanical low and very low colorectal anastomoses were carried out in 92.5 and 7.5% of patients, respectively. Temporary ileostomy rate was 14.5%. Median length of stay was 8 days. Overall surgical morbidity was 9% with no mortality. Rates of anastomotic leak, rectovaginal fistula, and intraabdominal bleeding were 3, 2, and 1.2%. Forty patients (5.5%) required reoperation.


Laparoscopic resection of the mid/low rectum for endometriosis can be performed safely with acceptable rates of morbidity/reoperation and with low rates of specific complications, including anastomotic leak and rectovaginal fistula. The very high surgical volume of the operating surgeon is probably one of the most important factors in order to maximize postoperative outcomes.

Vojnosanit Pregl. 2012 Apr;69(4):301-7.

Success rate of intrauterine insemination in patients with unknown infertility.

[Article in Serbian]

Jasović V, Jasović-Siveska E.


Institut za radiologiju, Medicinski fakultet, Skopje, Makedonija.



Unknown cause of infertility exists in 10%-26% of couples with infertility problems. Treatment of these couples depends on the posibility of correcting the unidentified defect over time. Intrauterine insemination (IUI) and ovaluation stimulation are methods of choice in treatment of unexplained fertility, but if a woman is older than 37 years, in vitro fertilization (IVF) could be directly recommended. The aim of this research was to compare the success rate of pregnancies with IUI between the patients with unexplained infertility and the patients with mild form endometriosis.


The study included on 50 patients diagnosed with mild form endometriosis (group A) and 50 patients with unknown cause infertility (group B). Using the same therapeutical protocol, human menopausal gonadothropin (hMG) stimulation and horionic gonadropin (hCG) induction were applied, as well as IUI.


The percentage of achieved ovulation was higher in the group B (p < 0.05). During the 3 simulated sequential periods 102 IUI were performed in the group A and 97 IUI in the group B. In the group A there were 6 single and 1 twin pregnancies sucesfully conceived (14%), while in group B there were 9 (18%) single pregnancies.


The use of a combination of controled ovarian hyperstimulation and IUI is an effective, cheap and safe method for treating infertility couples, especially couples with unknown cause infertility. Mild form endometriosis, as etiological infertility factor, has a negative impact on IUI success rate.

Arch Gynecol Obstet. 2012 Mar 31. [Epub ahead of print]

Comparison of tissue effects quantified histologically between PlasmaJet coagulator and Helica thermal coagulator.

Deb S, Sahu B, Deen S, Newman C, Powell M.


Nottingham University Hospitals, QMC Campus, Derby Road, Nottingham, UK,



The PlasmaJet (PJ) coagulator uses neutral pure argon plasma to achieve coagulation. Helica thermal coagulator (HTC) achieves coagulation with helium gas. HTC is currently used in the treatment of mild to moderate endometriosis.


The objective of this study was to compare the tissue damage caused by PJ to the HTC in the uterus, ovary and fallopian tube. Our hypothesis was that PJ is a safe technology to use and the tissue damage caused is comparable to HTC.


Fifteen subjects undergoing hysterectomy with or without salpingo-oophorectomy were prospectively recruited for in vivo assessment of the two instruments. Both instruments were used on a small area of uterus, ovary and fallopian tube following the ligation of uterine artery pedicle. PJ was used at a power setting of 20 % for duration of 5 s at a clinically acceptable distance of 0.5 to 1 cm from the tissue surface. HTC was used at a widely accepted low power setting in the treatment of endometriosis for a similar duration and distance. Tissue damage was evaluated histologically. ANOVA was used to compare the mean differences.


Data were normally distributed. Five subjects had a subtotal hysterectomy and 10 had hysterectomy with salpingo-oophorectomy. A total of 15 uteri, 10 ovaries and 10 fallopian tubes were histologically analysed for the tissue effect of PJ and HTC. There was no significant difference in the mean ± SD depth of tissue damage seen between PJ and HTC in the uterus (0.63 ± 0.19 vs. 0.68 ± 0.18; P = 0.481), ovary (0.61 ± 0.14 vs. 0.67 ± 0.15; P = 0.420) and fallopian tube (0.63 ± 0.18 vs. 0.60 ± 0.13; P = 0.688). A significantly lesser lateral spread of tissue damage (width) was seen with PJ than HTC in all three tissue types (uterus: 4.66 ± 0.91 vs. 7.67 ± 1.21, P < 0.001; ovary: 4.05 ± 0.61 vs. 5.90 ± 0.95, P < 0.001; fallopian tube: 4.50 ± 0.77 vs. 6.00 ± 1.28, P = 0.034).


The depth of tissue damage caused by PJ at 20 % power is comparable to that with HTC on gynaecological tissues. The lateral spread (width of tissue damage) is however lesser with PJ than with HTC.

Abdom Imaging. 2012 Mar 29. [Epub ahead of print]

Gallbladder and muscular endometriosis: a case report.

Iafrate F, Ciolina M, Iannitti M, Baldassari P, Pichi A, Rengo M, De Cecco CN, Laghi A.


Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy,


A 55-year-old woman referred to Radiology Department, with abdominal mass and chronic indefinite and vague abdominal pain, most severe in right hypochondrium and accentuated during menstruation. A history of two cesarean sections was revealed. The patient underwent an ultrasound and Computed Tomography with intravenous contrast media revealing the presence of gallbladder and abdominal wall hyperenhancing masses. Finally, Magnetic Resonance study with intravenous administration of paramagnetic contrast media confirmed the involvement of gallbladder by a solid tissue and the presence of a solid nodule on the abdominal wall. Considering imaging features and the contrast enhancement of the nodules, the patient was sent to surgery. Surgical removal of both gallbladder and abdominal solid implant was performed and histology confirmed the diagnosis of gallbladder and abdominal wall endometriosis.

J Low Genit Tract Dis. 2012 Mar 28. [Epub ahead of print]

Vaginal Polypoid Endometriosis Simulating Neoplasia in a Young Woman.

Dadhwal V, Deka D, Mathur S, Kaushal S, Sharma AK, Mittal S.


Departments of 1Obstetrics and Gynaecology, and 2Pathology, All India Institute of Medical Sciences, New Delhi, India.



The study aimed to describe a case of vaginal polypoid endometriosis and its management.


This study is a case report. The patient was a nulliparous woman aged 27 years who presented with pain in her lower abdomen and continuous bleeding per vaginum for 2 months. On speculum examination, multiple, smooth, polypoid masses were seen arising all around the vaginal fornices; cervix was healthy. Ultrasound revealed a bulky uterus with a 5 × 6-cm fibroid in the posterior wall with echogenic area adjacent to cervix and gross left hydroureteronephrosis. The right kidney was removed 6 years consequent to pyonephrosis. Biopsy of the vaginal polypoidal mass was reported as vaginal polypoid endometriosis. The patient was planned for myomectomy and vaginal mass excision. On examination under anesthesia, the base of polypoid mass was thick and fixed and could not be excised completely. Myomectomy was done. Postoperatively, the patient received 3 injections of gonadotropin-releasing hormone agonist, but the size of the mass did not decrease. She was then planned for ureteric reimplantation and panhysterectomy. Hysterectomy was not possible because of extensive parametrial involvement, but Boari flap ureteric implantation with bilateral salpingo-oophorectomy was done.


Vaginal polypoid endometriosis did not respond to medical treatment. However, the widespread vaginal polypoidal masses regressed significantly after oophorectomy.


Bilateral oophorectomy was resorted to as an option in this case of vaginal polypoid and extensive pelvic endometriosis not amenable to medical treatment and surgical excision.

J Ethnopharmacol. 2012 Mar 27;140(2):391-7. Epub 2012 Jan 31.

Deer (Cervus elaphus) antler extract suppresses adhesion and migration of endometriotic cells and regulates MMP-2 and MMP-9 expression.

Kim JH, Yang YI, Ahn JH, Lee JG, Lee KT, Choi JH.


Department of Life and Nanopharamceutical Science, Kyung Hee University, Seoul 130-701, Republic of Korea.



Deer antler has been used for centuries as medicine for a wide range of health problems, including various women’s diseases. However, there is a safety concern related to its use in hormone-sensitive conditions, such as breast cancer and endometriosis. In the present study, we investigated the effect of deer (Cervus elaphus) antler extract (DAE) on adhesion and migration of human endometriotic cells.


Adhesion, wound-healing, and transwell migration assays were performed in endometriotic cells 11Z and 12Z. Expression of matrix metalloproteinase (MMP)-2, MMP-9, TNF-α, and IL-6 were measured by real-time RT-PCR and Western blot analysis.


DAE (50 and 100μg/ml) decreased the adhesion of 11Z and 12Z cells on peritoneal mesothelial Met5-A cells. Wound-healing and transwell migration assays revealed that DAE (50 and 100μg/ml) inhibited migration in 11Z and 12Z cells. It was further demonstrated that treatment with DAE (50 and 100μg/ml) significantly decreased the levels of MMP-2, MMP-9, TNF-α, and IL-6.


These results indicate that DAE is a potential anti-endometriotic agent to inhibit the adhesion and migration of endometrial cells through the suppression of various related molecules.



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