Pag. 5

Am J Reprod Immunol.2012 Jun 5. doi: 10.1111/j.1600-0897.2012.01152.x. [Epub ahead of print]

The role of tissue factor and protease-activated receptor 2 in endometriosis.

Lin M, Weng H, Wang X, Zhou B, Yu P, Wang Y.

Source

Department of Obstetrics and Gynaecology, Third Affiliated Hospital of Guangzhou Medical College, Guangzhou, China.

Abstract

PROBLEM:

Little is known about the roles of TF and PAR-2 in endometriosis. This article investigated the expression of TF and PAR-2 in ectopic and eutopic endometrium with endometriosis and their relationship with the menstrual cycle.

METHODS:

Ectopic and eutopic endometrium tissues from 42 women with ovarian endometrioma and endometrium tissues from 20 women without endometriosis were obtained. All the samples were assessed for TF and PAR-2 protein location using immunohistochemistry and for relative TF and PAR-2 mRNA expression using real-time florescent quantitative polymerase chain reaction (FQ-PCR).

RESULTS:

Total TF and PAR-2 expression were significantly higher in ectopic and eutopic endometrium of women with endometriosis when compared with controls. Moreover, TF expression in ectopic and eutopic endometrium and PAR-2 expression in ectopic endometrium were significantly increased through the whole menstrual cycle. However, in eutopic endometrium with endometriosis, PAR-2 expression only in secretory phase was higher than its cycle-matched normal controls. There is no such difference in the proliferative phase.

CONCLUSION:

The abnormal co-upregulated expression of TF and PAR-2 in eutopic and ectopic endometrium may affect the development and growth of endometriotic lesions and highlighted the pathologic role of TF and PAR-2 in eutopic endometrium in endometriosis.

Int J Urol.2012 Jun 5. doi: 10.1111/j.1442-2042.2012.03064.x. [Epub ahead of print]

Bladder endometriosis developed after long-term estrogen therapy for prostate cancer.

Taguchi S, Enomoto Y, Homma Y.

Source

Department of Urology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan, yenomoto-tky@umin.ac.jp.

Nat Med.2012 Jun 3. doi: 10.1038/nm.2826. [Epub ahead of print]

A new isoform of steroid receptor coactivator-1 is crucial for pathogenic progression of endometriosis.

Han SJ, Hawkins SM, Begum K, Jung SY, Kovanci E, Qin J, Lydon JP, Demayo FJ, O’Malley BW.

Source

Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas, USA.

Abstract

Endometriosis is considered to be an estrogen-dependent inflammatory disease, but its etiology is unclear. Thus far, a mechanistic role for steroid receptor coactivators (SRCs) in the progression of endometriosis has not been elucidated. An SRC-1-null mouse model reveals that the mouse SRC-1 gene has an essential role in endometriosis progression. Notably, a previously unidentified 70-kDa SRC-1 proteolytic isoform is highly elevated both in the endometriotic tissue of mice with surgically induced endometriosis and in endometriotic stromal cells biopsied from patients with endometriosis compared to normal endometrium. Tnf(-/-) and Mmp9(-/-) mice with surgically induced endometriosis showed that activation of tumor necrosis factor α (TNF-α)-induced matrix metallopeptidase 9 (MMP9) activity mediates formation of the 70-kDa SRC-1 C-terminal isoform in endometriotic mouse tissue. In contrast to full-length SRC-1, the endometriotic 70-kDa SRC-1 C-terminal fragment prevents TNF-α-mediated apoptosis in human endometrial epithelial cells and causes the epithelial-mesenchymal transition and the invasion of human endometrial cells that are hallmarks of progressive endometriosis. Collectively, the newly identified TNF-α-MMP9-SRC-1 isoform functional axis promotes pathogenic progression of endometriosis.

Acta Obstet Gynecol Scand.2012 Jun;91(6):692-8. doi: 10.1111/j.1600-0412.2012.01394.x. Epub 2012 Apr 30.

Sexual functioning, quality of life and pelvic pain 12 months after endometriosis surgery including vaginal resection.

Setälä M, Härkki P, Matomäki J, Mäkinen J, Kössi J.

Source

Department of Obstetrics and Gynaecology, Päijät-Häme Central Hospital, Lahti, Finland. marjaleena.setala@fimnet.fi

Abstract

OBJECTIVE:

To evaluate sexual function, quality of life and pelvic pain after endometriosis surgery including vaginal resection.

DESIGN:

Prospective observational study with 12 months follow up.

SETTING:

Regional central hospital and university hospital.

POPULATION:

Twenty-two patients with deep endometriotic nodules in the posterior fornix of the vagina undergoing complete excision of endometriosis, including vaginal resection.

METHODS:

Sexual functioning was measured with the McCoy Female Sexuality Questionnaire, quality of life with a generic questionnaire (15D) and pain with a 10-point visual analog scale. Questionnaires were completed before and 12 months after the surgery. Main outcome measures. Changes in sexual function scores, quality-of-life scores and pain.

RESULTS:

Twelve months after surgery, the sexual satisfaction score was higher (p= 0.03) and the sexual problems score lower (p= 0.04) compared with baseline values. Health-related quality-of-life scores for discomfort and symptoms (p= 0.001), distress (p= 0.04), vitality (p= 0.03) and sexual activity (p= 0.001), and the overall 15D score (p < 0.001), were significantly improved. The severity of all studied types of pain was significantly decreased (p < 0.05).

CONCLUSIONS:

Complete excision of endometriosis, including vaginal resection, seems to offer a significant improvement in sexual functioning, quality of life and pelvic pain in symptomatic patients with deeply infiltrating endometriotic nodules in the posterior fornix of the vagina. This surgery may be associated with complications and adverse new-onset symptoms, and should be performed only after thorough consultation with the patient.

Acta Obstet Gynecol Scand.2012 Jun;91(6):648-57. doi: 10.1111/j.1600-0412.2012.01367.x. Epub 2012 Feb 28.

Diagnosis and treatment of rectovaginal endometriosis: an overview.

Kruse C, Seyer-Hansen M, Forman A.

Source

Department of Obstetrics and Gynecology, Aarhus University Hospital Skejby, Brendstrupgaardsvej, Aarhus, Denmark. ckruse@dadlnet.dk

Abstract

Rectovaginal endometriosis can be a cause of severe pain, dyspareunia and intestinal problems. A thorough examination is needed and should include diagnostic imaging, such as transvaginal or transrectal ultrasound or magnetic resonance imaging. Medical therapies, such as oral contraceptives, progestins and levonorgestrel-releasing intrauterine devices, all seem to reduce pain and should always be considered. Surgical treatment is challenging and implies a risk of severe complications. It is preferable to treat endometriotic lesions with superficial infiltration into the rectal wall by local laparoscopic excision, while segmental rectal resection is needed in the case of severe intestinal infiltration. This review describes available diagnostic tools, the possibilities for medical treatment and the alternative surgical approaches.

Acta Obstet Gynecol Scand.2012 Jun;91(6):699-703. doi: 10.1111/j.1600-0412.2012.01366.x. Epub 2012 Mar 5.

Continuous low-dose oral contraceptive in the treatment of colorectal endometriosis evaluated by rectal endoscopic ultrasonography.

Ferrari S, Persico P, DI Puppo F, Vigano P, Tandoi I, Garavaglia E, Giardina P, Mezzi G, Candiani M.

Source

Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy. ferrari.stefano@hsr.it

Abstract

OBJECTIVE:

Limited attention has been focused on the medical treatment of bowel endometriosis. This study evaluates the efficacy of administration of a continuous low-dose oral contraceptive in treating pain and other symptoms associated with colorectal endometriotic nodules, as evaluated by rectal endoscopic ultrasonography.

DESIGN:

Prospective observational study.

SETTING:

Academic Department of San Raffaele Scientific Institute, Obstetrics and Gynecology Unit.

POPULATION:

Symptomatic women of reproductive age (n=26) with colorectal nodules infiltrating at least the bowel muscularis propria and without a stenosis >50%. In 31% of the patients, endoscopic ultrasonography permitted diagnosis of nodules located more than 10 cm from the anal rim.

METHODS:

Patients received a continuous low-dose oral contraceptive containing 15 μg ethinylestradiol and 60 μg gestodene for 12 months. Subjective symptoms were prospectively evaluated, and nodule volumes were monitored using endoscopic ultrasonography.

MAIN OUTCOME MEASURES:

Nodule measurements were performed at baseline and after 12 months of treatment. Symptoms at the start and after 12 months were evaluated.

RESULTS:

A significant improvement in the intensity of all the considered symptoms (dysmenorrhea, non-menstrual pelvic pain, deep dyspareunia and painful defecation) was seen when evaluated by a visual analog scale. A reduction in terms of both diameter (mean reduction 26%) and volume of the nodules (mean reduction 62%) was observed after a 12 month period.

CONCLUSIONS:

A continuous low-dose oral contraceptive therapy may reduce bowel endometriosis-associated symptoms. In addition, this therapy induces a significant volumetric reduction of colorectal plaques when evaluated by endoscopic ultrasonography.

Am J Reprod Immunol.2012 Jun;67(6):491-7. doi: 10.1111/j.1600-0897.2011.01101.x. Epub 2012 Jan 9.

Lipoxin A4 inhibits the development of endometriosis in mice: the role of anti-inflammation and anti-angiogenesis.

Xu Z, Zhao F, Lin F, Chen J, Huang Y.

Source

Department of Obstetrics and Gynecology, 1st Affiliated Hospital, Wenzhou Medical College, Zhejiang, China.

Abstract

PROBLEM:

To evaluate the effects of the anti-inflammatory and anti-angiogenic roles of LXA4 on endometriosis in mice.

METHOD OF STUDY:

Endometriosis was induced in 40 mice and separated into two groups. LXA4 group was administered by LXA4 for 3 weeks. The endometriotic lesions were counted, measured, and identified by pathology. The presence of a panel of pro-inflammatory factors was assessed by real-time RT-PCR, and enzyme-linked immunoassay, the mRNA, protein levels of matrix metalloproteinase (MMPs), and vascular endothelial growth factor (VEGF) were determined by real-time RT-PCR and immunohistochemistry; the activity of MMPs was evaluated by gelatin zymography.

RESULTS:

Treatment with LXA4 significantly inhibited endometriotic lesion development (13.58 ± 4.01 mm(2) in LXA4 group and 23.20 ± 7.49 mm(2) , P = 0.0002), downregulated pro-inflammatory factors, suppressed the activity of MMP9, and reduced the VEGF levels associated with endometriosis in mice.

CONCLUSION:

LXA4 may inhibit the progression of endometriosis possibly by anti-inflammation and anti-angiogenesis.

Angiogenesis.2012 Jun;15(2):243-52. doi: 10.1007/s10456-012-9256-2. Epub 2012 Feb 22.

Protein kinase CK2 is a regulator of angiogenesis in endometriotic lesions.

Feng D, Welker S, Körbel C, Rudzitis-Auth J, Menger MD, Montenarh M, Laschke MW.

Source

Institute for Clinical and Experimental Surgery, University of Saarland, Homburg Saar, Germany.

Abstract

Endometriosis is a frequent gynecological disease, which is crucially dependent on the process of angiogenesis. However, the underlying regulatory mechanisms of blood vessel development are still poorly understood. CK2 is a pleiotropic protein kinase, which is implicated in the regulation of various cellular processes including angiogenesis. Herein we studied for the first time the function of protein kinase CK2 in angiogenesis of endometriotic lesions. For this purpose, we analyzed the anti-angiogenic activity of the CK2 inhibitor quinalizarin in a rat aortic ring assay and its effect on the expression of individual CK2 subunits and on kinase activity in endometrial tissue. Moreover, endometriotic lesions were induced in dorsal skinfold chambers of quinalizarin- and vehicle-treated C57BL/6 mice to study their vascularization and morphology by means of repetitive intravital fluorescence microscopy and histology. Our results demonstrate that quinalizarin dose-dependently inhibits vascular sprouting. In addition, treatment of endometrial tissue with quinalizarin reduces CK2 activity without affecting the expression of the three CK2 subunits α, α‘ and β. In the dorsal skinfold chamber model of endometriosis, quinalizarin inhibits the vascularization of endometriotic lesions, which exhibit a significantly decreased vascularized area and functional capillary density when compared to those of vehicle-treated controls. This is associated with a reduced lesion size and histological fraction of endometrial glands. These findings indicate that CK2 is a regulator of angiogenesis in endometriotic lesions. Accordingly, inhibition of CK2 represents a novel option in the development of anti-angiogenic strategies for the treatment of endometriosis.

Arch Gynecol Obstet.2012 Jun;285(6):1657-61. Epub 2012 Jan 19.

p53 codon 72 polymorphism and endometriosis: a meta-analysis.

Jia S, Xu L, Chan Y, Wu X, Yang S, Yu H, Yang H, Luo Y, Tang W.

Source

Laboratory of Molecular Genetics of Aging and Tumor, Faculty of Life Science and Technology, Kunming University of Science and Technology, Chenggong Campus, 727 South Jingming Road, Kunming, 650500 Yunnan, China.

Abstract

BACKGROUND:

p53 tumour suppressor gene Arg72Pro polymorphism has been associated with endometriosis. However, the current available data were inconsistent. We performed this meta-analysis to estimate the association between p53 Arg72Pro polymorphism and endometriosis.

METHODS:

Electronic screening of PubMed library was conducted to select studies. Studies containing available genotype frequencies of Arg72Pro were chosen, and pooled odds ratio (OR) with 95% confidence interval (CI) was used to assess the association.

RESULTS:

Six published studies, including 749 endometriosis and 857 controls were identified. The overall results suggested that the variant genotypes were not associated with the endometriosis risk (Pro/Pro + Arg/Pro vs. Arg/Arg: OR = 1.552, 95% CI 0.916-2.632, p = 0.103). In the stratified analysis, individuals carried the Pro allele in a dominant model had increased risk of endometriosis (OR = 2.595, 95% CI 1.005-6.702, p = 0.049) in Asian subjects. The symmetric funnel plot, the Egger’s test (p = 0.602), and the Begg’s test (p = 0.167) were all suggestive of the lack of publication bias. However, the association was not significant between this polymorphism and endometriosis in Caucasian (OR = 1.005, 95% CI 0.755-1.337, p = 0.972).

CONCLUSION:

This meta-analysis suggests that p53 codon 72 Pro/Pro + Arg/Pro genotypes are associated with increased risk of endometriosis in Asian. To validate the association between p53 codon 72 polymorphism and endometriosis, further studies with larger participants worldwide are needed.

Cancer Biol Ther.2012 Jun 1;13(8):671-80. Epub 2012 Jun 1.

Impaired CXCL4 expression in tumor-associated macrophages (TAMs) of ovarian cancers arising in endometriosis.

Furuya M, Tanaka R, Miyagi E, Kami D, Nagahama K, Miyagi Y, Nagashima Y, Hirahara F, Inayama Y, Aoki I.

Source

Department of Molecular Pathology; Yokohama City University Graduate School of Medicine; Yokohama, Japan.

Abstract

Inflammatory cells play important roles in progression of solid neoplasms including ovarian cancers. Tumor-associated macrophages (TAMs) contribute to angiogenesis and immune suppression by modulating microenvironment. Ovarian cancer develops occasionally on the bases of endometriosis, a chronic inflammatory disease. We have recently demonstrated differential expressions of CXCR3 variants in endometriosis and ovarian cancers. In this study, we showed impaired CXCL4 expression in TAMs of ovarian cancers arising in endometriosis. The expressions of CXCL4 and its variant CXCL4L1 were investigated among normal ovaries (n = 26), endometriosis (n = 18) and endometriosis-associated ovarian cancers (EAOCs) composed of clear cell (n = 13) and endometrioid (n = 11) types. In addition, four cases of EAOCs that contained both benign and cancer lesions contiguously in single cysts were investigated in the study. Western blot and quantitative RT-PCR analyses revealed significant downregulation of CXCL4 and CXCL4L1 in EAOCs compared with those in endometriosis. In all EAOCs coexisting with endometriosis in the single cyst, the expression levels of CXCL4 and CXCL4L1 were significantly lower in cancer lesions than in corresponding endometriosis. Histopathological study revealed that CXCL4 was strongly expressed in CD68 (+) infiltrating macrophages of endometriosis. In microscopically transitional zone between endometriosis and EAOC, CD68 (+) macrophages often demonstrated CXCL4 (-) pattern. The majority of CD68 (+) TAMs in overt cancer lesions were negative for CXCL4. Collective data indicate that that CXCL4 insufficiency may be involved in specific inflammatory microenvironment of ovarian cancers arising in endometriosis. Suppression of CXCL4 in cancer lesions is likely to be attributable to TAMs in part.

Environ Health Perspect.2012 Jun;120(6):811-6. Epub 2012 Mar 14.

Persistent Lipophilic Environmental Chemicals and Endometriosis: The ENDO Study.

Louis GM, Chen Z, Peterson CM, Hediger ML, Croughan MS, Sundaram R, Stanford JB, Varner MW, Fujimoto VY, Giudice LC, Trumble A, Parsons PJ, Kannan K.

Source

Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Health, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland, USA.

Abstract

Background: An equivocal literature exists regarding the relation between persistent organochlorine pollutants (POPs) and endometriosis in women, with differences attributed to methodologies.Objectives: We assessed the association between POPs and the odds of an endometriosis diagnosis and the consistency of findings by biological medium and study cohort.Methods: Using a matched cohort design, we assembled an operative cohort of women 18-44 years of age undergoing laparoscopy or laparotomy at 14 participating clinical centers from 2007 to 2009 and a population-based cohort matched on age and residence within a 50-mile catchment area of the clinical centers. Endometriosis was defined as visualized disease in the operative cohort and as diagnosed by magnetic resonance imaging in the population cohort. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for each POP in relation to an endometriosis diagnosis, with separate models run for each medium (omental fat in the operative cohort, serum in both cohorts) and cohort. Adjusted models included age, body mass index, breast-feeding conditional on parity, cotinine, and lipids.Results: Concentrations were higher in omental fat than in serum for all POPs. In the operative cohort, γ-hexachlorocyclohexane (γ-HCH) was the only POP with a significant positive association with endometriosis [per 1-SD increase in log-transformed γ-HCH: adjusted OR (AOR) = 1.27; 95% CI: 1.01, 1.59]; β-HCH was the only significant predictor in the population cohort (per 1-SD increase in log-transformed β-HCH: AOR = 1.72; 95% CI: 1.09, 2.72).Conclusions: Using a matched cohort design, we found that cohort-specific and biological-medium-specific POPs were associated with endometriosis, underscoring the importance of methodological considerations when interpreting findings.

Eur J Obstet Gynecol Reprod Biol.2012 Jun;162(2):121-4. Epub 2012 Apr 24.

Rectosigmoid deep infiltrating endometriosis and ureteral involvement with loss of renal function.

Muñoz JL, Jiménez JS, Tejerizo A, Lopez G, Duarte J, Sánchez Bustos F.

Source

Endometriosis Unit, Gynecology Service, Hospital 12 de Octubre, Madrid, Spain.

Abstract

Endometriosis is a complex disease with unclear pathogenesis, defined as the presence of endometrial tissue (glands and stroma) outside its usual location in the uterine cavity. Ureteral involvement is rare, with an estimated frequency of 10-14% in cases of deep endometriosis with nodules of 3cm or larger. An important complication of ureteral involvement is asymptomatic loss of renal function. In a patient with asymptomatic renal failure the relevance of extrinsic ureteral involvement by deep endometriosis has been taken to account. CASE REPORT: A 32-year-old nulliparous woman presented with chronic pelvic pain associated with severe dysmenorrhea, dyspareunia and digestive problems including diarrhea, occasional constipation and rectal bleeding. She reported no urological symptoms. Magnetic resonance imaging (MRI) identified a 4cm nodule in the recto-vaginal septum, compressing and infiltrating the rectal wall, and chronic left hydronephrosis. Isotope renogram revealed 91% function in the right kidney and 9% in the left kidney. A multidisciplinary surgical team including consultants from the departments of digestive surgery and urology assessed the patient. The treatment recommended was a joint approach of laparoscopic surgery to perform adhesiolysis, ureterolysis, freeing of the uterus and appendages, resection of the rectovaginal septum nodule, and left nephrectomy. COMMENT: Diagnosis and treatment of deep endometriosis should be performed in specialized centers and in the context of multidisciplinary collaboration. We must be aware of the potential risk of ureteral involvement and the asymptomatic loss of renal function in any patient with endometriosis nodules of 3cm or larger.

Eur J Obstet Gynecol Reprod Biol.2012 Jun;162(2):211-5. Epub 2012 Mar 26.

Effects of progressive muscular relaxation training on anxiety, depression and quality of life of endometriosis patients under gonadotrophin-releasing hormone agonist therapy.

Zhao L, Wu H, Zhou X, Wang Q, Zhu W, Chen J.

Source

Department of Nursing, Second Xiangya Hospital, Central South University, Changsha 410011, PR China.

Abstract

OBJECTIVES:

To explore the effects of progressive muscle relaxation (PMR) training on anxiety, depression and quality of life (QOL) of endometriosis patients under gonadotrophin-releasing hormone (GnRH) agonist therapy.

STUDY DESIGN:

This was a controlled, randomized, open-label study. One hundred consecutive Han Chinese endometriosis patients, aged 18-48 years, were randomly assigned to a PMR group (n=50) and a control group (n=50). In a study of 12 weeks’ duration, both groups received one dose of depot leuprolide, 11.25mg IM. In addition to the GnRH agonist therapy, the PMR group received 12 weeks of PMR training. Anxiety level was measured using the state-trait anxiety inventory (STAI). Depression was assessed using subscale D of the hospital anxiety and depression scale (HADS-D). Health-related QOL was measured with SF-36 instrument. The patients were evaluated with STAI, HADS-D and SF-36 before and after the PMR intervention.

RESULTS:

The control group and the PMR group were comparable at baseline. After 12 weeks of intervention, both groups showed significant improvement in overall QOL (P<0.05). The PMR group, but not the control group, showed significant improvement in state anxiety, trait anxiety and depression after intervention (P<0.05). Moreover, the PMR group showed significant improvement in all QOL domains after intervention; by contrast, the control group showed significant improvement in all physical health domains and only two mental health domains after intervention. Between-group comparisons of the improvement in scores after intervention showed that the PMR group had significantly better improvement in the scores of anxiety, depression and overall/domain QOL than the control group (P<0.05). Repeated measures ANOVA revealed that both PMR intervention and time had significant individual as well as interactive effects on state anxiety, trait anxiety depression and overall QOL (P<0.05).

CONCLUSIONS:

This study suggests that PMR training is effective in improving anxiety, depression and QOL of endometriosis patients under GnRH agonist therapy. This is the first study to explore the effects of psychosomatic therapy on emotional status and QOL of endometriosis patients, and may serve as an important reference for future psychosomatic interventions on endometriosis.

Eur J Radiol.2012 Jun;81(6):1381-7. Epub 2011 Apr 14.

Feasibility of 3.0T pelvic MR imaging in the evaluation of endometriosis.

Manganaro L, Fierro F, Tomei A, Irimia D, Lodise P, Sergi ME, Vinci V, Sollazzo P, Porpora MG, Delfini R, Vittori G, Marini M.

Source

Umberto I Hospital, Radiological Science Department, Sapienza University of Rome, Viale R. Elena 324, Italy. lucia.manganaro@uniroma1.it

Abstract

INTRODUCTION:

Endometriosis represents an important clinical problem in women of reproductive age with high impact on quality of life, work productivity and health care management. The aim of this study is to define the role of 3T magnetom system MRI in the evaluation of endometriosis.

MATERIALS AND METHODS:

Forty-six women, with transvaginal (TV) ultrasound examination positive for endometriosis, with pelvic pain, or infertile underwent an MR 3.0T examination with the following protocol: T2 weighted FRFSE HR sequences, T2 weighted FRFSE HR CUBE 3D sequences, T1 w FSE sequences, LAVA-flex sequences. Pelvic anatomy, macroscopic endometriosis implants, deep endometriosis implants, fallopian tube involvement, adhesions presence, fluid effusion in Douglas pouch, uterus and kidney pathologies or anomalies associated and sacral nervous routes were considered by two radiologists in consensus. Laparoscopy was considered the gold standard.

RESULTS:

MRI imaging diagnosed deep endometriosis in 22/46 patients, endometriomas not associated to deep implants in 9/46 patients, 15/46 patients resulted negative for endometriosis, 11 of 22 patients with deep endometriosis reported ovarian endometriosis cyst. We obtained high percentages of sensibility (96.97%), specificity (100.00%), VPP (100.00%), VPN (92.86%).

CONCLUSION:

Pelvic MRI performed with 3T system guarantees high spatial and contrast resolution, providing accurate information about endometriosis implants, with a good pre-surgery mapping of the lesions involving both bowels and bladder surface and recto-uterine ligaments.

Eur J Radiol.2012 Jun;81(6):1376-80. Epub 2011 Apr 13.

Evaluation of MR diffusion-weighted imaging in differentiating endometriosis infiltrating the bowel from colorectal carcinoma.

Busard MP, Pieters-van den Bos IC, Mijatovic V, Van Kuijk C, Bleeker MC, van Waesberghe JH.

Source

VU University Medical Center, Department of Radiology, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands. m.busard@vumc.nl

Abstract

OBJECTIVE:

Endometriosis infiltrating the bowel may be difficult to differentiate from colorectal carcinoma in cases that present with non-specific clinical and imaging features. The aim of this study is to assess the value of MR diffusion-weighted imaging (DWI) in differentiating endometriosis infiltrating the bowel from colorectal carcinoma.

METHODS:

In 66 patients, MR DWI was added to the standard imaging protocol in patients visiting our outdoor MR clinic for the analysis of suspected or known deep infiltrating endometriosis (DIE). In patients diagnosed with DIE infiltrating the bowel on MR imaging, high b-value diffusion-weighted images were qualitatively assessed by two readers in consensus and compared to high b-value diffusion weighted images in 15 patients evaluated for colorectal carcinoma. In addition, ADC values of lesions were calculated, using b-values of 50, 400 and 800 s/mm(2).

RESULTS:

A total of 15 patients were diagnosed with DIE infiltrating the bowel on MR imaging. Endometriosis infiltrating the bowel showed low signal intensity on high b-value diffusion-weighted images in all patients, whereas colorectal carcinoma showed high signal intensity on high b-value diffusion-weighted images in all patients. Mean ADC value in endometriosis infiltrating the bowel (0.80 ± 0.06 × 10(-3)mm(2)/s) was significantly lower compared to mean ADC value in colorectal carcinoma (0.86 ± 0.06 × 10(-3 )mm(2)/s), but with considerable overlap between ADC values.

CONCLUSION:

Only qualitative assessment of MR DWI may be valuable to facilitate differentiation between endometriosis infiltrating the bowel and colorectal carcinoma.

Fertil Steril.2012 Jun;97(6):1380-1386.e1. Epub 2012 Apr 28.

Peritoneal cytokines and adhesion formation in endometriosis: an inverse association with vascular endothelial growth factor concentration.

Barcz E, Milewski L, Dziunycz P, Kamiński P, Płoski R, Malejczyk J.

Source

Department of Obstetrics and Gynecology, Center for Biostructure Research, Medical University of Warsaw, Warsaw, Poland.

Abstract

OBJECTIVE:

To evaluate inflammatory/angiogenic cytokines-interleukin-1β (IL-1β), IL-6, IL-8, IL-12, interferon-γ (IFN-γ), tumor necrosis factor (TNF), and vascular endothelial growth factor A (VEGF-A)-in the peritoneal fluid of patients with endometriosis in relation to the occurrence and severity of pelvic adhesions and in control women without pelvic pathology.

DESIGN:

Case-control study.

SETTING:

University research institution and hospital.

PATIENT(S):

Sixty-five women with laparoscopically and histopathologically confirmed endometriosis, including 40 women with pelvic adhesions, and 37 control women without pelvic pathology.

INTERVENTION(S):

Peritoneal fluid aspirated during routine diagnostic laparoscopic examination.

MAIN OUTCOME MEASURE(S):

Cytokines evaluated in the peritoneal fluid via specific enzyme-linked immunosorbent assays.

RESULT(S):

Endometriosis and the revised American Fertility Society score of this disease were associated with statistically significantly increased levels of peritoneal IL-6 and IL-8 whereas the incidence and score of endometriosis-related pelvic adhesions were negatively associated with increased levels of VEGF-A. Notably, the concentration of VEGF-A predicted adhesion development and severity after adjustment for endometriosis severity. The adhesion score also correlated with increased levels of IL-6; however, after adjustment for endometriosis severity, the effect of this cytokine was no longer statistically significant.

CONCLUSION(S):

Increased levels of VEGF-A may be associated with a decreased rate of pelvic adhesion formation in the course of endometriosis.

Fertil Steril.2012 Jun;97(6):1297. Epub 2012 Apr 21.

The role of the peritoneal cavity in adhesion formation.

Koninckx PR, Ussia A, Adamyan L.

Source

Gruppo Italo Belga, Leuven Endometriosis Center, Heilig Hart Ziekenhuis, Leuven, Belgium; Gruppo Italo Belga, Rome Endometriosis Center, Villa del Rosario, Rome, Italy.

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