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Pag. 24

Gynecol Endocrinol. 2011 Dec;27 Suppl 1:1114-9.

Menometrorrhagia during the premenopause: an overview.

Donnez J.

Source

Department of Gynecology, Université Catholique de Louvain (UCL), Cliniques Universitaires St. Luc, Brussels, Belgium. jacques.donnez@uclouvain.be

Erratum in

  • Gynecol Endocrinol. 2012 Feb;28(2):156.

Abstract

Menometrorrhagia, defined as excessive and prolonged uterine bleeding occurring at irregular and/or frequent intervals, occurs in up to 24% of women aged 40-50 years. There are a wide range of causes of menometrorrhagia, although histological differences in endometrium between women aged <45 years compared with those aged 48-50 years indicate a much higher prevalence of myomas, adenomyosis, and dysfunctional endometrium (dysfunctional uterine bleeding, hyperplasia, neoplasia) around the time of the premenopause, emphasizing the importance of accurate diagnosis and appropriate management in women of this age group. In women presenting with menometrorrhagia, it is imperative to recognize that underlying lesions and diagnosis are frequently missed due to multiple causes. Primary diagnosis needs to exclude pregnancy and cancer, whereas secondary investigations (including ultrasound with instillation of saline solution, hysteroscopy and biopsy, and magnetic resonance imaging) can assist in accurately diagnosing the underlying cause of menometrorrhagia.

Gynecol Endocrinol. 2011 Dec;27(12):1099-102. Epub 2011 Apr 15.

COMT polymorphism and the risk of endometriosis-related infertility.

Christofolini DM, Teles JS, Vilarino FL, André GM, Bianco B, Barbosa CP.

Source

Department of Gynecology and Obstetrics, Faculdade de Medicina do ABC, Santo André/SP, Brazil.

Abstract

Estrogens are important factors in the development of endometriosis, and can induce cell proliferation and stimulate cell division. COMT constitutes a crucial element in estrogen metabolism and has been suggested to be involved in the development of endometriosis. This study had the objective of to determine whether the presence of COMT val/met polymorphism (rs4680) increases the risk to endometriosis in infertile patients. A case-control study that included 198 infertile women with endometriosis, 71 infertile women without endometriosis, and 168 fertile women as control group of the Faculdade de Medicina do ABC. COMT (val/met) genotypes were identified by real time PCR (genotyping TaqMan assay) and the results were analyzed statistically by χ² test. The data showed no statistical difference in the distribution of COMT genotypes neither between infertile patients with endometriosis and control group (p = 0.567), regardless disease degree, nor between infertile patients without endometriosis and control group (p = 0.460). In conclusion, the COMT val/met polymorphism is not associated to endometriosis-related infertility in the Brazilian population evaluated. However, more studies in larger populations are necessary to confirm these results.

Gynecol Obstet Fertil. 2011 Dec;39(12):709-21. Epub 2011 Nov 10.

Surgery for the management of ovarian endometriomas: from the physiopathology to the pre-, peri- and postoperative treatment.

[Article in French]

Bourdel N, Roman H, Mage G, Canis M.

Source

Pôle de gynécologie obstétrique, CHU Clermont-Ferrand, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France. nicolas.bourdel@gmail.com

Abstract

Good knowledge of physiopathology, surgical techniques and of the literature allows for an adequate treatment of ovarian endometrioma. Preoperative medical treatment has not shown to be efficient and might be adapted to each patient (continuation or initiation of hormonal treatment in case of symptomatology, will for contraception, association with functional cyst). Laparoscopy is the mandatory surgical approach. Cystectomy is the surgical technique of choice but may affect normal ovarian tissu. Surgical technique should be meticulous in particular with respect to the hilum of the ovary. Exclusive coagulation using bipolar is not recommended. A hybrid technique associating both cystectomy and vaporization (laser or Plasmajet(©)) at the level of the hilum of the ovary could be interesting. Hemostasis should be spontaneous or obtained with bipolar coagulation with parcimony. Ovarian suture is a solution. Extra-ovarian lesions should be carefully searched for and treated. Anti-adhesion products should be applied. Postoperative medical treatment decreases recurrence and should be systematic for patients who do not want to conceive. Multidisciplinary approach is essential.

Int J Clin Oncol. 2011 Dec;16(6):709-13. Epub 2011 Feb 8.

Primary squamous cell carcinoma associated with ovarian endometriosis: a case report and literature review.

Yamakawa Y, Ushijima M, Kato K.

Source

Department of Obstetrics and Gynecology, Takaoka City Hospital, 4-1 Takara-machi, Takaoka, Toyama 933-8550, Japan. yoshihiro_yamakawa@municipal-hp-takaoka.jp

Abstract

Primary squamous cell carcinoma (SCC) associated with ovarian endometriosis is extremely rare and has a poor prognosis due to insufficient information on the optimal postoperative treatment. Here, we describe the response of this tumor to the administration of paclitaxel-carboplatin. A 45-year-old woman diagnosed with stage IIIc primary SCC of the ovary associated with endometriosis underwent optimal surgery followed by six courses of chemotherapy at 3-week intervals with paclitaxel and carboplatin. She tolerated the chemotherapy well and remained without evidence of disease during first-line chemotherapy. Two months later, she was readmitted with recurrence of a pelvic tumor. Although she was treated with chemotherapy (weekly paclitaxel and chemotherapeutic regimen of irinotecan + mitomycin C), the tumor was resistant to second-line and third-line chemotherapy and she died 15 months after surgery. Paclitaxel-carboplatin administration may be an effective treatment for primary SCC of the ovary but further studies are required to investigate it true efficacy in the treatment of this disease.

Int J Gynaecol Obstet. 2011 Dec;115(3):293-4. Epub 2011 Oct 5.

Prevalence, characteristics, and management of endometriosis in an infertile Maltese population.

Camilleri L, Schembri A, Inglott AS.

Source

Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta. loreta1511@gmail.com

Int J Gynaecol Obstet. 2011 Dec;115(3):277-81. Epub 2011 Sep 29.

Follicle loss after laparoscopic treatment of ovarian endometriotic cysts.

Shi J, Leng J, Cui Q, Lang J.

Source

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.

Abstract

OBJECTIVE:

To evaluate follicle loss and its associated factors during laparoscopic cystectomy for ovarian endometrioma.

METHOD:

Between October 2008 and December 2009, 140 patients with ovarian cysts undergoing laparoscopic cystectomy at Peking Union Medical Hospital were enrolled: 74 had ovarian endometrioma with no preoperative hormonal therapy (group A), 40 had ovarian endometrioma pretreated with GnRHa (group B), and 26 had non-endometriotic cysts (group C). Pre-, peri- , and postoperative clinical data were collected, and cyst specimens were evaluated histologically.

RESULTS:

The number of capsules showing follicles and the mean number of follicles per capsule were lower in group C than in group A or B (P<0.05). Fewer type IIC than type IIB endometriomas showed follicles (P<0.05). The number of follicles per cyst was related negatively to disease duration but positively to pain severity. Women in group A with unilateral endometrioma had a lower mean dysmenorrhea score after the surgery (P<0.05), but no change in basal follicle-stimulating hormone (FSH).

CONCLUSION:

The type of cyst, disease duration, and severity of dysmenorrhea were associated with ovarian follicle loss during laparoscopic excision of endometrioma. Laparoscopic unilateral cystectomy for endometrioma was effective in relieving pain but had little effect on serum FSH, which might reflect the remaining ovarian reserve.

Int J Gynaecol Obstet. 2011 Dec;115(3):273-6. Epub 2011 Sep 23.

Correlation between laparoscopic and histopathologic diagnosis of endometriosis.

Wanyonyi SZ, Sequeira E, Mukono SG.

Source

Department of Obstetrics and Gynecology, Aga Khan University Hospital, Nairobi, Kenya. sikolia.wanyonyi@aku.edu

Abstract

OBJECTIVE:

To review the histopathologic diagnosis of biopsies taken following visualization of endometriosis at laparoscopy and to correlate visual with microscopic diagnoses.

METHODS:

A retrospective review was undertaken of medical charts with a diagnosis of endometriosis at Aga Khan University Hospital, Nairobi, Kenya, between January 2001 and October 2010. Eligibility included visual diagnosis of endometriosis at laparoscopy, with a clear record of site, size, morphology, and number of lesions. The histopathologic diagnosis of the biopsies sampled was sought. Correlation was undertaken using κ statistics for diagnostic variability.

RESULTS:

Of the 204 relevant records, 152 (74.5%) met the eligibility criteria; from these cases, 239 specimens were submitted for histology. The most common symptom was chronic pelvic pain (108 [71.1%]). Most biopsies were obtained from the ovary and posterior cul-de-sac. Histopathologic diagnosis was confirmed in (152 [63.8%]) specimens and correlated with Asian race, multiparity, and chronic pelvic pain. Neither the site of the lesion nor the stage of disease influenced the histopathologic diagnosis.

CONCLUSION:

Laparoscopic visualization of endometriosis does not always correlate with histopathologic diagnosis; several other lesions may mimic endometriosis on histopathologic examination.

Int J Gynaecol Obstet. 2011 Dec;115(3):294-5. Epub 2011 Sep 19.

Vaginal danazol for the treatment of endometriosis-related pelvic pain.

Bhattacharya SM, Tolasaria A, Khan B.

Source

SC Das Memorial Medical and Research Center, Kolkata, India. drsudhindra54@gmail.com

J Clin Endocrinol Metab. 2011 Dec;96(12):E1925-33. Epub 2011 Sep 28.

MicroRNA 135 regulates HOXA10 expression in endometriosis.

Petracco R, Grechukhina O, Popkhadze S, Massasa E, Zhou Y, Taylor HS.

Source

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

Abstract

CONTEXT:

Homeo box A10 (HOXA10) regulates endometrial receptivity and its expression is decreased in women with endometriosis. Although sex steroids regulate HOXA10, these hormones are unaltered in endometriosis. We hypothesized a role for microRNA in the regulation of HOXA10.

OBJECTIVE:

MicroRNA 135a and -b are small noncoding RNA with predicted targets that include HOXA10. We evaluated miR135a/b expression and HOXA10 regulation in endometrium from subjects with and without endometriosis.

DESIGN:

The design of the study was the measurement of miR135a/b expression by quantitative PCR and in vitro analysis of HOXA10 regulation.

SETTING:

The study was conducted at a university medical center.

PATIENTS:

Patients included 50 controls and 32 women with endometriosis.

INTERVENTIONS:

Study interventions included endometrial biopsies and in vitro transfection. Main Outcome Measures: miR135a/b and HOXA10 expression were measured in the study.

RESULTS:

All endometrial samples expressed miR135a and -b. miR135a expression in controls was increased during the proliferative phase, decreased at the time of ovulation, and increased during the luteal phase. Subjects with endometriosis had 3-fold higher expression of miR135a in the proliferative phase than controls. miR135b showed less variation across the menstrual cycle; however, it was significantly increased in women with endometriosis in the proliferative and secretory phases. HOXA10 expression was simultaneously repressed in the endometrium of women with endometriosis. Transfection of endometrial stromal cells with mir135a/b or miR135a/b inhibitors resulted in the altered expression of HOXA10 mRNA and protein. miR135a or -b decreased luciferase expression driven by the HOXA10 3′ untranslated region containing the miR135 binding site. miR135a regulation of HOXA10 was absent in MCF-7 cells, demonstrating cell specificity.

CONCLUSIONS:

HOXA10 was aberrantly regulated in the endometrium of women with endometriosis by both miR135a and miR135b. Increased microRNA expression likely suppresses genes required for implantation.

J Clin Endocrinol Metab. 2011 Dec;96(12):E1944-52. Epub 2011 Sep 14.

Fasudil inhibits the proliferation and contractility and induces cell cycle arrest and apoptosis of human endometriotic stromal cells: a promising agent for the treatment of endometriosis.

Tsuno A, Nasu K, Kawano Y, Yuge A, Li H, Abe W, Narahara H.

Source

Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan.

Abstract

CONTEXT:

During the development of endometriotic lesions, excess fibrosis may lead to scarring and to the alterations of tissue function that are the characteristic features of this disease. Enhanced extracellular matrix contractility of endometriotic stromal cells (ECSC) mediated by the mevalonate-Ras homology (Rho)/Rho-associated coiled-coil-forming protein kinase (ROCK) pathway has been shown to contribute to the pathogenesis of endometriosis.

DESIGN:

To assess the use of fasudil, a selective ROCK inhibitor, for the medical treatment of endometriosis-associated fibrosis, the effects of this agent on the cell proliferation, apoptosis, cell cycle, morphology, cell density, and contractility of ECSC were investigated. The effects of fasudil on the expression of contractility-related, apoptosis-related, and cell cycle-related molecules in ECSC were also evaluated.

RESULTS:

Fasudil significantly inhibited the proliferation and contractility of ECSC and induced the cell cycle arrest in the G2/M phase and apoptosis of these cells. Morphological observation revealed the suppression of ECSC attachment to collagen fibers and decrease of cell density by fasudil. The expression of α-smooth muscle actin, RhoA, ROCK-I, and ROCK-II proteins was inhibited by fasudil administration. The expression of the antiapoptotic factors, Bcl-2 and Bcl-X(L), in two-dimensional cultured ECSC were down-regulated by the addition of fasudil, whereas, the expression of p16(INK4a) and p21(Waf1/Cip1) was up-regulated by the addition of fasudil.

CONCLUSIONS:

The present findings suggest that fasudil is a promising agent for the treatment of endometriosis. The inhibition of cell proliferation, contractility, and myofibroblastic differentiation, the attenuation of attachment to collagen fibers, the decrease of cell density, and the induction of cell cycle arrest and apoptosis of ECSC are involved in the active mechanisms of fasudil.

J Neurosurg. 2011 Dec;115(6):1072-7. Epub 2011 Jul 22.

Family and personal medical history and risk of meningioma.

Claus EB, Calvocoressi L, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M.

Source

Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520-8034, USA. elizabeth.claus@yale.edu

Abstract

OBJECT:

Little is known about the epidemiology of meningioma, the most frequently reported primary brain tumor in the US. The authors undertook a case-control study to examine the relationship between family and personal medical history and meningioma risk.

METHODS:

The authors compared the personal and first-degree family histories of 1124 patients with meningioma (age range 20-79 years) in Connecticut, Massachusetts, North Carolina, the San Francisco Bay Area, and 8 Houston counties between May 1, 2006, and February 26, 2010, and the histories of 1000 control individuals who were frequency-matched for age, sex, and geography.

RESULTS:

The patients were more likely than the controls to report a first-degree family history of meningioma (OR 4.4, 95% CI 1.6-11.5), and there was an even stronger association in younger cases. The patients were less likely than controls to report immune conditions including allergy (OR 0.6, 95% CI 0.5-0.7) but were more likely to report a history of thyroid cancer (OR 4.7, 95% CI 1.02-21.5) or leukemia (OR 5.4, 95% CI 1.2-24.1) (most after radiotherapy). Among women, patients were more likely than controls to report hormonally related conditions–uterine fibroid tumors (OR 1.2, 95% CI 1.0-1.5), endometriosis (OR 1.5, 95% CI 1.5-2.1), and breast cancer (OR 1.4, 95% CI 0.8-2.3).

CONCLUSIONS:

The influence of genetics, the immune system, and radiation near the head on meningioma risk is suggested in the authors’ findings; the role of hormones is intriguing but requires further study.

J Pediatr Adolesc Gynecol. 2011 Dec;24(6):376-9. Epub 2011 Sep 9.

High rate of endometriosis recurrence in young women.

Tandoi I, Somigliana E, Riparini J, Ronzoni S, Vigano’ P, Candiani M.

Source

Obstetrics and Gynecology Unit, Scientific Institute San Raffaele, Milano, Italy.

Abstract

OBJECTIVE:

To evaluate rate and determinants of long-term recurrence of endometriosis in a population of young women.

DESIGN:

Retrospective cohort study.

SETTING:

University tertiary care referral center for women with benign gynecologic diseases.

PARTICIPANTS:

Young women undergoing first-line conservative surgery for endometriosis were eligible for the study. Data on age at surgery, disease stage, anatomical characteristics of endometriotic lesions, and endometriosis-related symptoms were collected. After diagnosis, patients were treated according to the standard care of the center. The protocol required all women to be followed up 1 month after surgery, and every 6 months afterward, with an interview to investigate persistence of symptoms, a clinical examination, and an ultrasound pelvic assessment.

RESULTS:

Fifty-seven women aged ≤ 21 (mean age at diagnosis ± SD: 19.0 ± 1.1 years) entered the study. During a 5-year follow-up, 32 (56%, 95% confidence interval [CI]: 43%-68%) recurrences of endometriosis were diagnosed. A second laparoscopy to treat the recurrence was performed in 11 (34%) cases and confirmed the presence of the disease in all of them. In the remaining 21 (66%) cases, the recurrence was based on the reappearance of the symptoms or clinical or sonographic findings. The recurrence rate increased constantly with time from first surgery. No association emerged between recurrence rate and endometriosis-related symptoms, site/stage of the disease, type of surgery, and post-surgical medical treatment.

CONCLUSIONS:

The recurrence rate of endometriosis in young women appears higher than in older women. Since no determinants for recurrence have been detected among the factors examined, a profile of women at increased risk cannot be drawn.

J Reprod Immunol. 2011 Dec;92(1-2):74-81. Epub 2011 Oct 5.

Dysregulation of the Fas/FasL system in mononuclear cells recovered from peritoneal fluid of women with endometriosis.

Sturlese E, Salmeri FM, Retto G, Pizzo A, De Dominici R, Ardita FV, Borrielli I, Licata N, Laganà AS, Sofo V.

Source

Department of Gynecological Sciences, School of Medicine, Policlinico Universitario G. Martino, Via C. Valeria -Gazzi-, University of Messina, 98125 Messina, Italy. esturlese@unime.it

Abstract

In endometriosis, regurgitating endometrial cells fail to undergo apoptosis and implant themselves outside the uterus, particularly in the peritoneum. We studied Fas and FasL behaviour by evaluating the percentages of mFas and mFasL-bearing mononuclear cells from peritoneal fluid, the level of Fas and FasL gene expression at both mRNA and protein levels in the same cells, and the sFas and sFasL values in peritoneal fluid of 80 endometriotic women, at four stages of disease severity. We found no variation in percentage of mFas-bearing mononuclear cells; high and unchanging levels of Fas mRNA and protein, and high and invariable sFas values. Overproduction of sFas antagonises mFas function and plays a role as a decoy in the peritoneal fluid. The mFasL-bearing mononuclear cells and protein levels decreased from the minimal to the severe stage of disease. In contrast to FasL protein, FasL mRNA was overexpressed throughout the course of the disease. sFasL values were high and increased as the disease worsened. Our results showed a non-linear ratio between FasL mRNA and FasL protein levels. Abnormally elevated FasL mRNA may be due to dysregulation in several mechanisms controlling mRNA turnover. The high level of sFasL would be expected to down-regulate FasL activity and compete with the membrane form for mFas binding. As a consequence, mFas-bearing mononuclear cells may be unable to kill and in turn, may themselves become targets for killing by FasL-expressing endometriotic cells.

J Reprod Immunol. 2011 Dec;92(1-2):68-73. Epub 2011 Sep 28.

Decreased concentrations of soluble interleukin-1 receptor accessory protein levels in the peritoneal fluid of women with endometriosis.

Michaud N, Al-Akoum M, Gagnon G, Girard K, Blanchet P, Rousseau JA, Akoum A.

Source

Endocrinologie de la Reproduction, Centre de Recherche, Hôpital Saint-François d’Assise, Centre Hospitalier Universitaire de Québec, Québec, Canada.

Abstract

Interleukin 1 (IL1) may play an important role in endometriosis-associated pelvic inflammation, and natural specific inhibitors, including soluble IL1 receptor accessory protein (sIL1RAcP) and soluble IL1 receptor type 2 (sIL1R2), are critical for counterbalancing the pleiotropic effects of IL1. The objective of this study was to evaluate the levels of sIL1RAcP, together with those of sIL1R2 and IL1β, in the peritoneal fluid of women with and without endometriosis. Peritoneal fluid samples were obtained at laparoscopy and assessed by ELISA. sIL1RAcP concentrations were reduced in endometriosis stages I-II and III-IV. sIL1R2 concentrations were decreased, and those of IL1β were significantly increased in endometriosis stages I-II. sIL1RAcP and sIL1R2 concentrations were significantly decreased in the secretory phase of the menstrual cycle, and IL1β concentrations were elevated in the proliferative and the secretory phases. sIL1RAcP and sIL1R2 concentrations were reduced in women with endometriosis who were infertile, fertile, suffering from pelvic pain or pain-free. However, IL1β concentrations were significantly reduced in women with endometriosis who were infertile or had pelvic pain. These changes may exacerbate the local peritoneal inflammatory reaction observed in women with endometriosis and contribute to endometriosis pathophysiology and the major symptoms of this disease.

J Zoo Wildl Med. 2011 Dec;42(4):747-50.

Bilateral hydronephrosis secondary to endometriosis managed by endoscopic ureteral stent placement in a captive Guinea baboon (Papio papio).

Dallwig RK, Langan JN, Hatch DA, Terio KA, Demitros C.

Source

Chicago Zoological and Aquatic Animal Residency Program, University of Illinois, College of Veterinary Medicine, Urbana, Illinois 61802, USA. rdallwig@gmail.com

Abstract

Spontaneous endometriosis is an estrogen-dependent, progressive and painful disease that affects a variety of nonhuman primates, including several species of baboons (Papio sp.). This case documents multimodal management of severe endometriosis in a captive female baboon within a zoological institution. An 18-yr-old, intact female Guinea baboon (Papio papio) was found to have an enlarged uterus. Fifteen months post ovariohysterctomy, scarring associated with endometrial tissue resulted in ureteral strictures, bilateral hydronephrosis, and azotemia. Cystoscopic placement of bilateral ureteral stents with fluoroscopy was performed and resulted in short-term clinical improvement. The animal’s condition declined and euthanasia was elected 4 mo after ureteral stent placement. Severe endometriosis with secondary inflammation resulting in bilateral hydroureter and hydronephrosis, as well as concurrent cystitis, ureteritis, and pyelonephritis were confirmed at necropsy. Despite possible complications, ureteral stents can be considered a useful therapeutic option in patients with ureteral disease.

Kyobu Geka. 2011 Dec;64(13):1201-3.

Diaphragmatic endometriosis-associated pneumothorax triggered by abortion; report of a case.

[Article in Japanese]

Hayashi T, Tachibana S, Nakao K, Tokitsu K, Nakata K.

Source

Department of Chest Surgery, Hokusetsu General Hospital, Takatsuki, Japan.

Abstract

The patient was a 36-year-old woman. She had previously undergone surgery for hysteromyoma and endometriosis. At 8 week of pregnancy, the fetus’s heart stopped beating, and the woman underwent abortion. On the same day, she began experiencing difficulty in breathing in the evening. After 4 days, she was referred to our hospital with dyspnea. Chest X-ray finding showed a right pneumothorax. Tube toracotomy was performed, and the right lung re-expanded immediately. Two months later, pneumothorax recurred without any association with the menstruation cycle. Thoracoscopic surgery was performed. No lesion was detected in the lung or visceral pleura, but a small hole and some thinned areas were noted in the diaphragm. Partial resection of the diaphragm was performed. Microscopic examination revealed endometriosis and localized lymphocyte infiltration in the resected diaphragm. It was suggested that the recurrence of pneumothorax without menstruation was caused by the thinning of the diaphragm due to endometriosis.

Minerva Ginecol. 2011 Dec;63(6):571-6.

Update in endometriosis and IVF.

Gryparis I, Nardo LG.

Source

Department of Reproductive Medicine, Manchester Children’s University Hospitals, Manchester, UK. j_gryparis@yahoo.gr

Abstract

The impact of endometriosis on in vitro fertilization (IVF) has been the subject of numerous publications, although a number of critical issues related to the management of affected patients remain unsolved. Accurate assessment of the effect of this disease on IVF outcome requires an appraisal of the diagnostic limitations, the consequences of surgical and hormonal management of endometriosis and the potential impact of both disease and IVF on feto-maternal well-being. We have addressed all these aspects by attempting an overview of the literature of the last decade and we present an update which may be useful regarding the treatment options of subfertile women seeking pregnancy.

Minerva Ginecol. 2011 Dec;63(6):563-70.

Endometrial seedlings. A survival instinct? Immunomodulation and its role in the pathophysiology of endometriosis.

Portelli M, Pollacco J, Sacco K, Schembri-Wismayer P, Calleja-Agius J.

Source

Department of Anatomy, University of Malta, Tal-Qroqq, Malta. markportellicaruana@gmail.com

Abstract

Endometriosis occurs when ectopic cells from the endometrium implant within the peritoneum. It is considered as a disease of multifactorial aetiology and affects 7-10% of women of reproductive age worldwide. In endometriosis, the immune system is thought to be dysfunctional and various studies have shown cytokine imbalance. Commonly upregulated cytokines include Tumour necrosis factor-alpha, interferon gamma and interleukin-10. Through analysis of the molecular makeup of the peritoneal fluid, a change is shown to occur, conferring resistance from macrophages and lymphocytes to endometrial cells. This is possibly due to a reduced Inter-cellular adhesion molecule-1 synthesis. Survival of ectopic endometrial cells also arises through the expression of human leukocyte antigens. Apart from the survival of ectopic/eutopic cells in endometriosis, there is marked cellular proliferation, which has also been attributed to a change in the expression of proteins such as Bcl-2-Associated X protein, B-cell lymphoma-2 protein, transforming growth factor-beta and the enzyme aromatase. Danazol and aromatase inhibitors modulate the immune system, thus allowing partial restoration of cytokine levels. Pharmacogenomics may be the way forward in developing novel treatment modalities for endometriosis.

Mol Hum Reprod. 2011 Dec;17(12):758-61. Epub 2011 Jun 30.

Oncogenic events associated with endometrial and ovarian cancers are rare in endometriosis.

Vestergaard AL, Thorup K, Knudsen UB, Munk T, Rosbach H, Poulsen JB, Guldberg P, Martensen PM.

Source

Department of Molecular Biology, Aarhus University, 8000 Aarhus C, Denmark.

Abstract

Endometriosis displays some features that resemble malignant processes, including invasive growth, resistance to apoptosis and distant implantation. The objective of this study was to investigate whether gene alterations that are frequent in endometrial and/or ovarian cancers contribute to the pathogenesis of endometriosis. Biopsies were obtained from ectopic endometriosis lesions from 23 patients with revised American Fertility Score stage 1 (n= 1), 2 (n= 10), 3 (n= 11) or 4 (n= 1) endometriosis. Six genes (APC, CDKN2A, PYCARD, RARB, RASSF1 and ESR1) were analyzed for promoter hypermethylation using methylation-specific melting curve analysis, and 9 genes (BRAF, HRAS, NRAS, CTNNB1, CDK4, FGFR3, PIK3CA, TP53 and PTEN) were analyzed for mutations using denaturing gradient gel electrophoresis and direct sequencing. An oncogenic mutation in KRAS (c.34G > T; p.G12C) was detected in a single lesion. No gene alterations were found in the remaining samples. Our data suggest that genetic and epigenetic events contributing to endometrial and ovarian cancers are rare in endometriosis. However, other proto-oncogenes and tumor suppressor genes should be tested for alterations in order to identify the molecular basis of the susceptibility of endometriosis to malignant transformation.

Comment in

Obstet Gynecol Clin North Am. 2011 Dec;38(4):757-76.

Laparoscopy in pregnancy and the pediatric patient.

Biscette S, Yoost J, Hertweck P, Reinstine J.

Source

Department of Obstetrics, Gynecology and Women’s Health, Kosair Children’s Hospital, Louisville, KY 40207, USA.

Abstract

Minimally invasive surgery is now standard of care for many procedures in pediatric gynecology. Laparoscopy has been well documented to produce faster recovery,decreased postoperative pain, and because of smaller incisions, a better cosmetic result. These are important when considering an active pediatric patient. Although a laparoscopic approach to endometriosis, adnexal masses, and ovarian torsion are well supported in the literature in the pediatric patient, more data are needed with regard to SILS in younger patients. Laparoscopy seems to be a better approach to oopheropexy in children undergoing radiation, and in resection of certain mullerian anomalies; however, the numbers are low.Similarly in pregnant patients, laparoscopy provides for shorter recovery times,decrease analgesic use and shorter hospital stays. Concerns about poor fetal outcomes in surgery during pregnancy for non gynecologic problems have been brought to light; however, the evidence indicates that these outcomes can be attributed to the nature of the underlying disease and not the surgical approach. With regard to pneumoperitoneum the effect of CO2 insufflation on fetal physiology and long-term outcomes remains unclear, and will continue to be an issue of controversy until larger studies are published.With both the pediatric and pregnant populations, laparoscopic complications can be diminished when performed by skilled surgeons with strict adherence to good technical principles. The advantages of laparoscopy are great, and this approach should be considered in pediatric and pregnant patients.

Obstet Gynecol Clin North Am. 2011 Dec;38(4):677-86.

Surgical treatment of endometriosis.

Howard FM.

Source

Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. fred_howard@urmc.rochester.edu

Abstract

In this review, the pitfalls that still exist with the surgical treatment of endometriosisassociatedpelvic pain have been discussed and the best evidence regarding various aspects of surgical techniques have been reviewed. When laparoscopy is performed to evaluate a woman with pelvic pain symptoms, it is important she be counseled that the primary function of the surgery is to confirm the presence (and allow surgical treatment) of endometriosis, and that it is not the penultimate diagnostic modality for her pelvic pain. There are many etiologies of pelvic pain that present with symptoms resembling those of endometriosis-associated pelvic pain that are not diagnosable with laparoscopy, such as interstitial cystitis and irritable bowel syndrome. It is unfortunate that many women are left with the belief that if a laparoscopy fails to provide a diagnosis of a pain generator, then it means there are no diagnoses other than that the “pain is in her head,” often disparagingly termed “supratentorial” byclinicians. In fact, the pain-related diagnoses that are amenable to and possibly require a laparoscopy are quite limited, a group of diagnoses that this author terms the “dirty dozen” because there are just 12, and only the first 4 have good evidence to clearly associate them with chronic pelvic pain:1. Endometriosis 2. Ovarian remnant syndrome 3. Pelvic inflammatory disease 4. Tuberculous salpingitis 5. Adhesions 6. Benign cystic mesothelioma 7. Postoperative peritoneal cysts 8. Adnexal cysts (nonendometriotic)9. Chronic ectopic pregnancy 10. Endosalpingiosis 11. Residual accessory ovary 12. Hernias: ventral, inguinal, femoral, spigelian.I would argue that diagnostic laparoscopy in modern gynecology has a limited, if any role, and that when laparoscopy is planned for women with chronic pelvic pain, it should be with a very high suspicion of a diagnosis and with plans to treat the disease operatively. In this era, a negative diagnostic laparoscopy should be a rare event.

Oncol Rep. 2011 Dec;26(6):1347-56. doi: 10.3892/or.2011.1456. Epub 2011 Sep 12.

Molecular genetics and epidemiology of epithelial ovarian cancer (Review).

Haruta S, Furukawa N, Yoshizawa Y, Tsunemi T, Nagai A, Kawaguchi R, Tanase Y, Yoshida S, Kobayashi H.

Source

Department of Obstetrics and Gynecology, Nara Medical University, Nara 634-8522, Japan.

Abstract

This review summarizes data from recent molecular genetic and epidemiology studies of the generic term ‘female pelvic cancer’. The English-language literature was reviewed for genetic, epigenetic, epidemiologic and environmental risk factors. There are well-documented disparities among racial and ethnic groups with respect to epithelial ovarian cancer (EOC) prevalence. In the case of the serous histological subtype, primary EOC, fallopian tube cancer and peritoneal cancer could be regarded as a single disease entity. However, EOC is not a single disease. Comparing the profile of EOC between Japanese and Caucasians, clear cell carcinomas (27.6%) are more common in Japan, possibly with fewer serous adenocarcinomas (40.7%). This may reflect a proportional increase. The Japanese may exhibit a higher proportion of malignant transformation of endometriosis compared to the United States population. Although some part of the molecular genetic pathogenesis has been unveiled, the complete events of molecular genetic epidemiological changes associated with EOC remain to be identified. This review focuses on current knowledge of the genetic and environmental factors affecting the development of EOC, and outlines future challenges in its pathogenesis research.

Prescrire Int. 2011 Dec;20(122):292.

Dienogest. Endometriosis: still no progress.

[No authors listed]

Abstract

No more effective for relief of pelvic pain than a GnRH agonist alone (without hormone replacement therapy).

Radiol Med. 2011 Dec;116(8):1267-87. Epub 2011 Sep 2.

Adenomyosis: from the sign to the diagnosis. Imaging, diagnostic pitfalls and differential diagnosis: a pictorial review.

[Article in English, Italian]

Valentini AL, Speca S, Gui B, Soglia G, Miccò M, Bonomo L.

Source

Dipartimento di Bioimmagini e Scienze Radiologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore di Roma, L.go A. Gemelli 8, 00168, Rome, Italy. alvalentini@rm.unicatt.it

Erratum in

  • Radiol Med. 2011 Dec;116(8):1314. Soglia, B G [corrected to Soglia, G].

Abstract

Adenomyosis is a pathological gynaecological condition characterised by benign invasion of the endometrium into the myometrium. It is often misdiagnosed, or is not easily recognised, although it is responsible for disabling symptoms such as menorrhagia, abnormal uterine bleeding, dysmenorrhoea and infertility in premenopausal women. The aim of this pictorial review is to analyse the features of adenomyosis by illustrating the most usual and typical imaging patterns, along with the unusual appearances, seen in a vast array of gynaecological imaging modalities. The different findings of focal and diffuse adenomyosis along with the diagnostic limitations of ultrasound, hysterosalpingography and magnetic resonance imaging are described, as are the pitfalls and differential diagnosis with other pathological conditions that are often misdiagnosed as adenomyosis. The role of the different imaging modalities in planning appropriate treatment and their usefulness in monitoring therapy are also discussed.

Reprod Sci. 2011 Dec;18(12):1202-10. Epub 2011 Jun 14.

Influence of nerve growth factor in endometriosis-associated symptoms.

Barcena de Arellano ML, Arnold J, Vercellino GF, Chiantera V, Ebert AD, Schneider A, Mechsner S.

Source

Endometriosis Research Centre Charité, Department of Gynaecology, Charité, Campus Benjamin Franklin, Berlin, Germany.

Abstract

To investigate the role of the nerve growth factor (NGF) in the development of dysmenorrhea/pelvic pain in patients with endometriosis, we performed a prospective, clinical, blind study. Peritoneal fluids (PFs) were obtained from patients with histologically proven endometriosis. Patients with endometriosis were divided into 7 different groups depending on their preoperative pain score and symptomatology: patients with no pain, patients with minimal pain (dysmenorrhea, pelvic pain, or both), and patients with severe pain (dysmenorrhea, pelvic pain, or both) and were used for the neuronal growth assay with cultured chicken dorsal root ganglia (DRG) and for Western blot analyses. Dorsal root ganglia were stained with anti-calcitonin gene-related peptide (CGRP) and anti-growth-associated protein 43 (GAP 43). Peritoneal fluids from patients with endometriosis induce neurite outgrowth. There was no significant difference in the outgrowth between the 7 pain groups. Western blot analyses showed a moderate NGF expression in the PFs from patients with endometriosis, without significant differences in the 7 pain groups. The present study suggests that the neurotrophic properties of endometriotic tissues are endometriosis- and not pain-associated.

Rev Endocr Metab Disord. 2011 Dec;12(4):323-32.

Extragonadal actions of chorionic gonadotropin.

Banerjee P, Fazleabas AT.

Source

Department of Medicine/Oncology, Stanford University, Stanford, CA 94305, USA.

Abstract

The primary embryonic signal in primates is chorionic gonadotropin (CG, designated hCG in humans), that is classically associated with corpus luteum rescue and progesterone production. However, research over the past decade has revealed the presence of the hCG receptor in a variety of extragonadal tissues. Additionally, discoveries of the multiple variants of hCG, namely, native hCG, hyperglycosylated hCG (hyp-hCG) and the β– subunit of the hyperglycosylated hCG (hCG-free β) has established a role for extragonadal actions of hCG. For the initiation and maintenance of pregnancy, hCG mediates multiple placental, uterine and fetal functions. Some of these include development of syncytiotrophoblast cells, mitotic growth and differentiation of the endometrium, localized suppression of the maternal immune system, modulation of uterine morphology and gene expression and coordination of intricate signal transduction between the endometrium. Recurrent pregnancy loss, pre-eclampsia and endometriosis are associated with altered responses of hCG, all of which have a detrimental effect on pregnancy. A role for hyp-hCG in mediating the development of both trophoblastic and non-trophoblastic tumors has also been suggested. Other significant non-gonadal applications of hCG include predicting preeclampsia, determining the risk of Down’s syndrome and gestational trophoblastic disease, along with relaxing myometrial contractility and preventing recurrent miscarriages. Presence of hCG free-β in serum of cancer patients enables its usage as a diagnostic tumor marker. Thus, the extragonadal functions of hCG encompasses a wide spectrum of applications and is an open area for continued investigation.

Tumour Biol. 2011 Dec;32(6):1087-95. Epub 2011 Aug 24.

HE4 a novel tumour marker for ovarian cancer: comparison with CA 125 and ROMA algorithm in patients with gynaecological diseases.

Molina R, Escudero JM, Augé JM, Filella X, Foj L, Torné A, Lejarcegui J, Pahisa J.

Source

Laboratory of Clinical Biochemistry (Unit for Cancer Research), Hospital Clínic, Medical School, Barcelona, Spain. rmolina@clinic.ub.es

Abstract

The aim of this study is to evaluate a new tumour marker, HE4, in comparison with CA 125 and the Risk of Ovarian Malignancy Algorithm (ROMA) in healthy women and in patients with benign and malignant gynaecological diseases. CA 125 and HE4 serum levels were determined in 66 healthy women, 285 patients with benign gynaecological diseases (68 endometriosis, 56 myomas, 137 ovarian cysts and 24 with other diseases), 33 patients with non-active gynaecological cancer and 143 with active gynaecological cancer (111 ovarian cancers). CA 125 and HE4 cut-offs were 35 U/mL and 150 pmol/L, respectively. ROMA algorithm cut-off was 13.1 and 27.7 for premenopausal or postmenopausal women, respectively. HE4, CA 125 and ROMA results were abnormal in 1.5%, 13.6% and 25.8% of healthy women and in 1.1%, 30.2% and 12.3% of patients with benign diseases, respectively. Among patients with cancer, HE4 (in contrast to CA 125) had significantly higher concentrations in ovarian cancer than in other malignancies (p < 0.001). Tumour marker sensitivity in ovarian cancer was 79.3% for HE4, 82.9% for CA 125 and 90.1% for ROMA. Both tumour markers, HE4 and CA 125 were related to tumour stage and histological type, with the lowest concentrations in mucinous tumours. A significantly higher area under the ROC curve was obtained with ROMA and HE4 than with CA 125 in the differential diagnosis of benign gynaecological diseases versus malignant ovarian cancer (0.952, 0.936 and 0.853, respectively). Data from our population indicate that ROMA algorithm might be further improved if it is used only in patients with normal HE4 and abnormal CA 125 serum levels (cancer risk for this profile is 44.4%). ROMA algorithm in HE4 positive had a similar sensitivity and only increases the specificity by 3.2% compared to HE4 alone.

Urology. 2011 Dec;78(6):1269-74. Epub 2011 Sep 29.

Prevalence and management of urinary tract endometriosis: a clinical case series.

Gabriel B, Nassif J, Trompoukis P, Barata S, Wattiez A.

Source

Department of Gynecologic Surgery, Strasbourg University Hospital Hautepierre and CMCO, and IRCAD/EITS, Strasbourg, France. boris.gabriel@uniklinik-freiburg.de

Abstract

OBJECTIVE:

To report on the prevalence, surgical management, and outcome of urinary tract endometriosis (UTE) in a cohort of 221 patients undergoing laparoscopic surgery for severe endometriosis. UTE can cause significant morbidity, such as silent kidney or progressive renal function loss. Its frequency is underestimated and data on laparoscopic management are scarce.

METHODS:

Between 2007 and 2010, 43 patients were eligible for this single-center, retrospective study. The inclusion criterion was the presence of UTE (ie, bladder and/or ureteral endometriosis). All patients were operated laparoscopically.

RESULTS:

The prevalence of UTE was 19.5% (43/221). There was no correlation between bladder and ureteral endometriosis (P >.05). Ureteral endometriosis was associated with patient’s age (P <.01). Patients with bladder, but not ureteral, involvement complained more frequently about dysuria, hematuria, and urinary tract infections. Intraoperative and magnetic resonance imaging (MRI) findings revealed a moderate to good correlation. UTE was not associated with rectovaginal or bowel endometriosis, but rather with involvement of the uterosacral ligaments (P <.01). Twenty-two patients with bladder endometriosis were treated by mucosal skinning and 11 patients underwent partial cystectomy. Superficial ureteral excision was performed in 4 patients, whereas resection with ureteroureterostomy was done in 9 patients. There was no difference regarding the intra- and postoperative complications in patients with or without UTE.

CONCLUSION:

In severe pelvic endometriosis, involvement of the urinary tract is quite common. Laparoscopic management is feasible and safe. Because of the lack of specific symptoms, the preoperative diagnosis of ureteral endometriosis still remains a challenge. Pelvic MRI represents a useful preoperative diagnostic tool.

Zhonghua Bing Li Xue Za Zhi. 2011 Dec;40(12):846-7.

Endometriosis of spinal canal with vertebral involvement: report of a case.

[Article in Chinese]

Qu LM, Zhao DX, Zhong YP, Guo K, Bi LR.

 

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