Int J Colorectal Dis. 2011 Nov 25. [Epub ahead of print]

Misdiagnosis of an atypically located inflamed proctodeal gland mimicking deep infiltrating endometriosis.

Bernhardt GA, Gruber K, Glehr M, Asslaber M, Gruber G, Mischinger HJ.

Source

Division of General Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria, gerwinalexander.bernhardt@kages.at.

J Cell Biochem. 2011 Nov 22. doi: 10.1002/jcb.24000. [Epub ahead of print]

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.

Source

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

Abstract

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 in vitro model system of immortalized human endometriotic cell line taking advantage of the human telomerase reverse transcriptase (hTERT). 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.

Arch Dermatol. 2011 Nov;147(11):1317-22.

Umbilical nodule in a 32-year-old woman.

Bronfenbrener R, Shraga A, Mehregan DA.

Source

University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, East Brunswick, USA.

Obstet Gynecol. 2011 Dec;118(6):1280-6.

Trends in bilateral oophorectomy at the time of hysterectomy for benign disease.

Novetsky AP, Boyd LR, Curtin JP.

Source

New York University School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York University, New York, New York, USA. anovetsky@gmail.com

Abstract

OBJECTIVE:

To identify patient characteristics associated with bilateral oophorectomy or removal of remaining ovary at the time of benign hysterectomy, and to estimate trends in the performance of oophorectomy from 2001 to 2006.

METHODS:

This was a cross-sectional analysis using the New York State Department of Health Statewide Planning and Research Cooperative System. Women aged 18 years or older undergoing hysterectomies for benign gynecologic conditions were included. We evaluated factors associated with oophorectomy on both univariable and multivariable analyses and assessed for changes in performance of oophorectomy over the course of the study.

RESULTS:

Forty-seven percent of 144,877 hysterectomies included oophorectomy. Women who underwent oophorectomy were older and were more likely to have a family history of breast or ovarian cancer, a personal history of breast cancer, ovarian cysts, or endometriosis. Women who underwent vaginal or laparoscopic hysterectomy or had uterine prolapse were less likely to undergo oophorectomy. Both race and insurance status were associated with performance of oophorectomy. From 2001 to 2006, there was an 8% absolute decrease in the performance of oophorectomy at the time of benign hysterectomy for women of all ages, with a 10.4% decrease in women aged younger than 55 (P for trend <.001).

CONCLUSION:

Age, route of hysterectomy, and concomitant gynecologic diagnoses influence oophorectomy rate. From 2001 to 2006, a significant decrease in the performance of oophorectomy at the time of benign hysterectomy was noted in women aged younger than 55 years. Recent studies of complications of hormone therapy and prophylactic oophorectomy may have influenced patients’ and physicians’ decision-making, leading to lower oophorectomy rates.

LEVEL OF EVIDENCE:

II.

Gynecol Obstet Invest. 2011 Nov 22. [Epub ahead of print]

Spatial Analysis of the Distribution of Endometriosis in Northwestern Italy.

Migliaretti G, Deltetto F, Delpiano EM, Bonino L, Berchialla P, Dalmasso P, Cavallo F, Camanni M.

Source

Department of Public Health and Microbiology, Statistical Unit, University of Turin, Turin, Italy.

Abstract

Objective: The aim of this study is to estimate the incidence of endometriosis in a northwestern region of Italy. The potential sources of geographical variations in the incidence of endometriosis within the region are discussed. Methods: The patients selected were women between 18 and 45 years of age, born and residing in Piedmont who had undergone medical or surgical treatment for endometriosis between 2000 and 2005. The data were obtained from official hospital discharge records. Results: The number of women contributed to the study was 3,929. The age-standardized incidence rate of endometriosis was 81.8/100,000 patient-years (95% CI 79.1-84.2). The distribution of relative risks showed some areas with an increased rate of around 30% (southern and central Piedmont), while for other areas the disease risk was lower (southwestern Piedmont). These areas have greater exposure to environmental risk due to the presence of chemical pollutants. Conclusion: In order to achieve reliable data and good management of the disease, there is great need for national registers, as well as networks of excellence for the treatment of endometriosis. Our findings suggest that environmental factors may be associated with the development of the disease, but the observed results need to be cautiously interpreted in the context of ineligible biases.

Pathol Res Pract. 2012 Jan 15;208(1):59-61. Epub 2011 Nov 21.

Paratesticular endometriosis in a man with a prolonged hormonal therapy for prostatic carcinoma.

Fukunaga M.

Source

Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan.

Abstract

A rare case of paratesticular endometriosis in a 69-year-old male with prostatic carcinoma, who had a history of 9-year hormonal therapy, is presented. The lesion was a multilocular cyst, 5.2cm×3.1cm×3.0cm in size, in the left paratestis. The cysts were lined by a single layer of cuboidal cells. A small number of glands were scattered in the underling stroma composed of closely packed small round or ovoid cells with scant cytoplasm resembling endometrial stromal cells, and abundant capillaries. Hemosiderin deposits were observed. Immunohistochemically, the lining cells of the cysts and glands were positive for CAM5.2, vimentin and calretinin, and were negative for CD10, estrogen and progesterone-receptors, indicating mesothelial profiles. The stromal cells expressed vimentin, estrogen- and progesterone-receptors and CD10. The findings indicated stromal endometriosis associated with the tunica vaginalis. Mullerian or endometriotic metaplasia and stromal cell hyperplasia under the influence of prolonged estrogen therapy may be the mechanism of this lesion.

Mod Pathol. 2012 Feb;25(2):282-8. doi: 10.1038/modpathol.2011.161. Epub 2011 Nov 18.

Loss of ARID1A expression is related to shorter progression-free survival and chemoresistance in ovarian clear cell carcinoma.

Katagiri A, Nakayama K, Rahman MT, Rahman M, Katagiri H, Nakayama N, Ishikawa M, Ishibashi T, Iida K, Kobayashi H, Otsuki Y, Nakayama S, Miyazaki K.

Source

Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Japan.

Abstract

Recently, the ARID1A gene has been identified as a novel tumor suppressor in ovarian clear cell carcinoma. The prognostic significance of the loss of ARID1A expression is not known. The current study was designed to evaluate whether ARID1A was a prognostic factor for progression, survival, and chemoresistance in ovarian clear cell carcinoma. A total of 60 patients, who were surgically treated for primary ovarian clear cell adenocarcinoma, were enrolled. Surgical specimens were examined for ARID1A protein expression by immunohistochemistry. The correlations between the loss of ARID1A expression and clinicopathological characteristics, prognosis, and chemosensitivity were investigated. Loss of ARID1A expression was identified in 9 (15.0%) of 60 ovarian clear cell carcinoma samples. Loss of ARID1A staining intensity (0+) was more frequently found in cells of clear cell carcinomas than in high-grade serous carcinomas (P<0.01). Loss of ARID1A expression was significantly correlated with advanced FIGO stage and high CA125 levels (P=0.02, 0.01). There were no significant correlations between loss of ARID1A expression and patient age, status of residual tumor, Ki-67 labeling index, or the status of endometriosis. Loss of ARID1A correlated with shorter progression-free survival of patients with clear cell carcinomas treated with platinum-based chemotherapy (P<0.01). Loss of ARID1A expression tended to correlate with shorter overall survival in patients with ovarian clear cell carcinomas treated with platinum-based chemotherapy. When data were stratified for the multivariate analysis, only the loss of ARID1A expression remained a significant (P=0.03) predictor of reduced progression-free survival. Of the 60 patients with ovarian clear cell carcinomas, 14 patients had measurable residual tumor after primary cytoreductive surgery. Tumors with loss of ARID1A expression were more likely to be chemoresistant than tumors with positive ARID1A expression (100.0 vs 40.0%, P=0.04). This study demonstrates that loss of ARID1A in ovarian clear cell carcinoma is a negative prognostic factor in patients treated with platinum-based chemotherapy. Measurement of ARID1A expression may be a method to predict resistance to platinum-based chemotherapy in patients with ovarian clear cell carcinoma.

J Minim Invasive Gynecol. 2012 Jan;19(1):68-75. Epub 2011 Nov 18.

Outcome of laparoscopic repair of ureteral injury: follow-up of twelve cases.

Han CM, Tan HH, Kay N, Wang CJ, Su H, Yen CF, Lee CL.

Source

Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.

Abstract

STUDY OBJECTIVE:

To review the feasibility of laparoscopic repair in cases of ureteral injuries occurring during gynecologic laparoscopy.

DESIGN:

Retrospective study (Canadian Task Force classification II-3).

SETTING:

Institution-specific retrospective review of data from a tertiary referral medical center.

PATIENTS:

Patients suffering from iatrogenic ureteral injuries diagnosed during or after surgery, and cases with deliberate ureteral resection and repair because of underlying disease.

MEASUREMENTS AND MAIN RESULTS:

We conducted a retrospective review of all (10 345) laparoscopic gynecologic surgeries performed in our institute between February 2004 and November 2008. Twelve cases (median: 45.5 years, range: 27-63) of ureter transections were diagnosed and repaired laparoscopically by endoscopists. Of these, 10 had previous surgeries, pelvic adhesions, or a large pelvic-abdominal mass. One patient had undergone a segmental resection and laparoscopic ureteroureterostomy for deep infiltrative endometriosis. Of the remaining 11 iatrogenic ureteral transections, 10 were repaired via laparoscopic ureteroureterostomy, whereas 1 had undergone a laparoscopic ureteroneocystostomy. One injury was recognized on the second postoperative day, but intraoperative recognition was attained in 11 cases. The median duration of double J stenting was 73 days. Three patients had development of strictures (between 42 and 79 days after surgery) treated with restenting, but 1 had to undergo an ureteroneocystostomy for ureter disruption when trying to restent. One patient had development of leakage of the anastomotic site but recovered with a change of the double J stent. Only 1 case required another laparotomy for ureteroneocystostomy. Laparoscopic primary repair of ureteral injury was successful for 11 of 12 patients. All the patients were well and symptom free at the conclusion of the study period.

CONCLUSION:

Early recognition and treatment of ureteral injuries are important to prevent morbidity. Laparoscopic ureteroureterostomy could be considered in transections of the ureter where technical expertise is available. To the best of our knowledge, this is the largest series, to date, of ureteral repairs via laparoscopy.

Eur J Obstet Gynecol Reprod Biol. 2012 Jan;160(1):35-9. Epub 2011 Nov 17.

The effect of the hormonal milieu of pregnancy on deep infiltrating endometriosis: serial ultrasound assessment of changes in size and pattern of deep endometriotic lesions.

Coccia ME, Rizzello F, Palagiano A, Scarselli G.

Source

Department of Science for the Woman and Child’s Health, University of Florence, via Ippolito Nievo, 2, 50100 Florence, Italy.

Abstract

BACKGROUND:

Deep infiltrating endometriosis (DIE) is associated with severe painful symptoms and represents a complex management challenge.

OBJECTIVE:

To analyse the effect of pregnancy on deep infiltrating lesions and related symptomatology.

STUDY DESIGN:

As part of a longitudinal study performed over the past 3 years to determine the efficacy of hormonal treatment in treating women with DIE, we identified three cases of advanced pelvic endometriosis, all with DIE (deep recto-vaginal and recto-sigmoid involvement) where patients achieved spontaneous pregnancies. They were followed up by transvaginal ultrasound (TV-US). The main outcome measures were analysis of the size and echographic pattern of deep infiltrating lesions of endometriosis and evaluation of clinical symptoms during pregnancy.

RESULTS:

We observed modifications in lesion size and pattern. In the two patients observed in the third trimester, the lesions were more homogeneous with less evident limits of nodules and band-like echoes, less fibrotic-like. All patients showed complete resolution of symptoms during pregnancy.

CONCLUSIONS:

The hormonal environment produced by pregnancy might determine significant modifications of endometriotic lesions and reduce painful symptoms. As surgery for DIE is difficult, complex and can lead to major complications, the achievement of a pregnancy-specific hormonal state, through pregnancy or hormonal treatment, may be a valid option in selected cases.

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2011 Oct;31(10):1394-7.

Effect of the combination of bushen xuguan recipe and ruanjian huayu recipe on the MMP-2 expression in endometriosis rats

[Article in Chinese]

Wei YQ, Tan Y, Qi D.

Source

Nanjing University of Traditional Chinese Medicine, Nanjing.

Abstract

OBJECTIVE:

To observe the effect of the combination of Bushen Xuguan Recipe (BXR) and Ruan-jian Huayu Recipe (RHR) on the matrix metalloproteinases-2 (MMP-2) expression of rats with endometriosis (EMS), and to study the pathogenesis and mechanism of EMS.

METHODS:

The EMS rat model was established. Successfully modeled female SD rats were randomly divided into the combination group (BXR+RHR), the RHR group, and the model group. And a normal control group was set up. After 4 weeks of medicinal treatment, rats were sacrificed in the oestrus cycle. MMP-2 distribution and the staining density in ectopic and eutopic endometrium of the rats were observed under microscope. The MMP-2 expression was determined by immunohistochemical assay (SP method).

RESULTS:

The MMP-2 expression in the ectopic endometrial tissues of rats in the model group were significantly higher than that of the normal control group (P<0.01). Compared with the model group, the MMP-2 expression decreased in the combination group and the RHR group (P<0.05). The therapeutic effect of the combination group was most obvious by observing the distribution of MMP-2 and changes of positive staining.

CONCLUSIONS:

The occurrence of EMS was correlated with increased activities of MMP-2. The combination method could inhibit the activities of MMP-2 in the ectopic endometrial tissues of EMS rats more effectively than RHR alone, which might be achieved through improving the endocrine environment, and reducing the “invasion” capability of the ectopic endometrium.

Int J Surg Case Rep. 2011;2(8):288-9. Epub 2011 Sep 20.

Endometriosis in the canal of Nuck hydrocele: An unusual presentation.

Bagul A, Jones S, Dundas S, Aly EH.

Source

Colorectal Surgical Unit, Aberdeen Royal Infirmary, Aberdeen AB25 2ZD, United Kingdom.

Abstract

The authors describe an unusual rare presentation of endometriosis in a hydrocoele of the canal of Nuck. A 43-year-old lady presented with a swelling in her right groin associated with mild discomfort. Examination revealed a cystic swelling in the groin for which she underwent an exploration and excision of the swelling. Surgery revealed a hydrocele of the canal of Nuck which was confirmed histologically. The unusual presentation of endometriosis in the sac was confirmed immunocytochemically.

Int J Surg Case Rep. 2011;2(7):181-4. Epub 2011 Jul 6.

Sigmoid endometriosis and a diagnostic dilemma – A case report and literature review.

Nasim H, Sikafi D, Nasr A.

Source

Department of Surgery, Our Lady of Lourdes Hospital, Drogheda, 1, Ard Seascann Blackrock Road, Dundalk, Co. Louth, Ireland.

Abstract

INTRODUCTION:

Intestinal endometriosis is often an infrequently considered diagnosis in female of childbearing age by general surgeon. There is a delay in diagnosis because of constellation of symptoms and lack of specific diagnostic modalities. Patients suffer from intestinal endometriosis for many years before they are diagnosed. Often, such patients are labelled with irritable bowel syndrome. Intestinal endometriosis has a diagnostic time delay of 8-11 years due to its non-specific clinical features and multi-system involvement. PRESENTATION OF CASE: Our patient was a 32 years old Caucasian female who was referred to us with features of intestinal obstruction. Despite repeated clinical assessments and use of different diagnostic modalities the diagnosis was still inconclusive even after 21 days of her first presentation to primary care physician. She had an exploratory laparotomy, sigmoid colectomy, and Hartmann’s procedure with a temporary colostomy with us. Histopathology confirmed endometriosis and also showed melanosis coli. She was referred to the gynaecological team for review and follow up.

DISCUSSION:

Intestinal endometriosis should be considered as a differential diagnosis in female patients of childbearing age group presenting with non-specific gastrointestinal signs and symptoms. Our patient manifested intestinal endometriosis and melanosis coli on histopathology suggesting symptoms of long duration.

CONCLUSION:

Bowel endometriosis is a less considered and often ignored differential diagnosis in acute and chronic abdomen. This condition has considerable effect on patient’s health both physically and psychologically.

Int J Surg Case Rep. 2011;2(6):150-3. Epub 2011 Apr 15.

Perineal scar endometriosis ten years after Miles’ procedure for rectal cancer: Case report and review of the literature.

Cinardi N, Franco S, Centonze D, Giannone G.

Source

Surgical Oncology Unit, Department of Oncology, Garibaldi-Nesima Hospital, Via Palermo 636, 95122 Catania, Italy.

Abstract

Endometriosis within a perineal scar after a Miles’ procedure has not been previously reported in literature. We report a case of a 35-year-old-female who was treated 10 years before at the same institution for a low rectal cancer that presents with two discrete subcutaneous bulges within her perineal wound. Since the patient was asymptomatic and the complete work up for recurrent disease showed no evidence of malignancy, first line therapy was conservative. After two pregnancies and a caesarean section, the patient presented at our observation with enlarged and tender perineal nodules. The patient was treated with a wide excision of the perineal scar en-bloc with the nodules. Final pathology report was consistent with scar endometriosis.

Int J Surg Case Rep. 2011;2(2):16-9. Epub 2010 Nov 20.

Endometriosis of the appendix: Report of three cases.

Saleem A, Navarro P, Munson JL, Hall J.

Source

Tufts Clinical and Translational Science Institute, Boston, MA, United States.

Abstract

Endometriosis of the appendix is an entity of extragonadal endometriosis. It commonly affects women in the childbearing age with a wide spectrum of clinical manifestations. Women can present with symptoms mimicking acute appendicitis or chronic pelvic pain. The surgical management varies from simple appendectomy to right hemicolectomy depending on the clinical findings. We report 3 cases of endometriosis of the appendix presenting with appendiceal intussusception. The surgical literature is reviewed and current surgical management is discussed.

Hum Reprod. 2012 Jan;27(1):173-82. Epub 2011 Nov 16.

Cold-shock domain family member YB-1 expression in endometrium and endometriosis.

Silveira CG, Krampe J, Ruhland B, Diedrich K, Hornung D, Agic A.

Source

Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Luebeck, Ratzeburgerallee 160, 23538 Luebeck, Germany.

Abstract

BACKGROUND:

The Y-box-binding protein (YB-1) is described as a potential oncogene highly expressed in tumors and associated with increased cell survival, proliferation, migration and anti-apoptotic signaling. The aim of our study was to examine the expression and role of YB-1 in human endometriosis (Eo) and its association with cell survival, proliferation and invasion.

METHODS:

We analyzed the gene and protein expression levels of YB-1 by quantitative real-time RT-PCR and immunoassays, respectively, in peritoneal macrophages, ovarian endometrioma and eutopic endometrial tissues/cells derived from women with (n= 120) and without (n= 91) Eo. We also evaluated the functional consequences of YB-1 knockdown in the Z12 Eo cell line by measuring cell proliferation [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromid cell proliferation assay], invasion (Matrigel invasion assay) and spontaneous and tumour necrosis factor (TNFα)-induced RANTES (regulated upon activation, normal T-cell expressed and secreted chemokine) expression and apoptosis (ELISA-based assay).

RESULTS:

YB-1 gene and protein expression was statistically significantly higher in ovarian lesions, eutopic endometrium and peritoneal macrophages of patients with Eo in comparison with the control group. Interestingly, the strongest YB-1 expression was observed in the epithelial compartment of endometrial tissues. In the Z12 cell line, YB-1 knockdown resulted in significant cell growth inhibitory effects including reduced cell proliferation and increased rates of spontaneous and TNFα-induced apoptosis. Significantly, higher RANTES expression and decreased cell invasion in vitro were also associated with YB-1 inactivation.

CONCLUSION:

High YB-1 expression could have an impact on the development and progression of Eo. This study suggests the role of YB-1 as a potential therapeutic target for Eo patients.

Int J Gynaecol Obstet. 2012 Feb;116(2):109-11. Epub 2011 Nov 17.

Laparoscopic hysterectomy versus abdominal hysterectomy for severe pelvic endometriosis.

Chalermchockchareonkit A, Tekasakul P, Chaisilwattana P, Sirimai K, Wahab N.

Source

Department of Obstetrics and Gynecology, Thai-German Multidisciplinary Endoscopic Training Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Abstract

OBJECTIVE:

To compare the surgical outcomes of laparoscopic hysterectomy (LH) versus abdominal hysterectomy (AH) in patients with severe pelvic endometriosis.

METHODS:

A retrospective review of patients undergoing hysterectomy for endometriosis was conducted between January 2002 and December 2007. A total of 503 patients had severe pelvic endometriosis; of these, 115 patients underwent LH and 388 patients underwent AH. Surgical outcomes-including operative time, blood loss, length of hospital stay, and need for blood transfusion-were analyzed and compared between the 2 treatment groups.

RESULTS:

Operative time was significantly longer for LH than for AH (185.1 ± 48.7 minutes and 139.9 ± 52.4 minutes, respectively; P<0.001). However, estimated volume of blood loss, length of hospital stay, and complication rates were significantly less for patients in the LH group than for those in the AH group (302.6 ± 255.1 mL versus 760.9 ± 633.2 mL [P<0.001]; 3.5 ± 1.1 days versus 6.4 ± 3.0 days [P<0.001]; and 18.3% versus 49.0% [P<0.001], respectively).

CONCLUSION:

Compared with AH, LH was associated with fewer complications. LH should, therefore, be the preferred surgical option for women with severe pelvic endometriosis who require a hysterectomy.

J Minim Invasive Gynecol. 2012 Jan;19(1):46-51. Epub 2011 Nov 16.

Endometriosis of the round ligament of the uterus.

Crispi CP, de Souza CA, Oliveira MA, Dibi RP, Cardeman L, Sato H, Schor E.

Source

Fernandes Figueira Institute-FIOCRUZ, Rio de Janeiro, Brazil.

Abstract

STUDY OBJECTIVE:

To demonstrate the prevalence of endometriosis in the intrapelvic portion of the round ligaments of the uterus (RLUs) and to propose criteria for their excision.

DESIGN:

Retrospective case series analysis of women undergoing laparoscopy for the treatment of deep infiltrating endometriosis (Canadian Task Force classification II-3).

SETTING:

Tertiary referral hospital.

PATIENTS:

We evaluated 174 patients who underwent laparoscopy for the treatment of deep infiltrating endometriosis (DIE) between April 2006 and May 2009.

INTERVENTIONS:

All patients underwent laparoscopy for the treatment of DIE and had their RLUs removed when there was shortening, deviation, or thickening. After removal, the RLUs were sent for histopathologic analysis to verify the presence or absence of endometriosis.

MEASUREMENTS AND MAIN RESULTS:

The prevalence of endometriosis in the RLUs and the association between the macroscopic alterations and the anatomic pathology results were determined. After the identification of macroscopic alterations, 1 or both RLUs (for a total of 42) were removed from 27 of the 174 patients who underwent laparoscopy. The positive predictive value (PPV) of the macroscopic criteria proposed for endometriosis of the RLU was 83.3% (95% confidence interval [CI] = 72.1%-94.5%), with 35 positive RLUs out of the 42 that were excised. The prevalence of endometriosis of the RLU was 13.8% (95% CI = 8.7%-18.9%), with 24 patients having a positive histopathologic examination result for endometriosis.

CONCLUSIONS:

The prevalence of RLU endometriosis in patients with DIE was 13.8%, which emphasizes that a rigorous evaluation of this structure must be part of the routine surgical treatment of patients with endometriosis.

J Cytol. 2011 Oct;28(4):214-6.

Primary umbilical endometriosis – Diagnosis by fine needle aspiration.

Fernandes H, Marla NJ, Pailoor K, Kini R.

Source

Department of Pathology, Fr Muller Medical College, Mangalore, India.

Abstract

Primary (spontaneous) umbilical endometriosis is very rare with an estimated incidence of 0.5-1% of all patients with endometrial ectopia. Endometriosis is a common gynecological condition, the pelvis being the most common site of the disease. Extrapelvic site is less common and even more difficult to diagnose due to the extreme variability in presentation. A 38-year-old woman presented with a blackish nodule over the umbilicus of 3 years duration. Fine needle aspiration cytology of the lesion showed cells in clusters and sheets with background of scant stromal fragment, hemosiderin laden macrophages and RBCs, leading to a suggestion of umbilical endometriosis. Histopathological examination of the excised lesion confirmed the same.

Gynecol Endocrinol. 2011 Nov 16. [Epub ahead of print]

Expression of ghrelin and its receptors in ovarian endometrioma.

Milewski U, W Jtowicz K, Roszkowski PI, Barcz E, Ziarkiewicz-Wr Blewska B, Kami Ski P, Malejczyk J.

Source

Department of Histology and Embryology, Centre of Biostructure Research, Medical University of Warsaw , Warsaw , Poland.

Abstract

Endometriosis is a common gynaecological disorder manifesting by implantation and growth of endometrial tissue outside the uterine cavity. The evidence accumulates that endometriosis may be associated with abrogated regulation of energy balance. Ghrelin is one of the most important orexigenic factor which may also play a role in regulation of inflammatory and angiogenic reactions. The present study was aimed at investigating expression profile of ghrelin and its receptors (GHSR1? and GHSR1?) in endometriotic lesions. The study included ovarian cysts and peritoneal fluid specimens obtained laparoscopically from 20 women with revised American Fertility Society stage III or IV endometriosis. Expression of specific mRNAs was assessed by reverse transcription-polymerase chain reaction. Expression of ghrelin and GHSR1? protein was studied by immunohistochemical staining with specific antibodies. Ghrelin and its receptors mRNA expression was found in all tested specimens. Specific mRNAs for these factors were also expressed in the peritoneal leukocytes. Immunohistochemical staining revealed expression of ghrelin and GHSR1? both in glandular endometrioid epithelium and in some stromal cells, particularly in some fibroblasts, blood vessels and infiltrating leukocytes. Co-localization of ghrelin and its receptors strongly suggests that this neuropeptide may affect development and growth of endometriotic lesions and may influence local inflammatory and angiogenic response.

Mol Cell Endocrinol. 2011 Nov 9. [Epub ahead of print]

Mechanisms of endometrial progesterone resistance.

Al-Sabbagh M, Lam EW, Brosens JJ.

Source

Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom.

Abstract

Throughout the reproductive years, the rise and fall in ovarian hormones elicit in the endometrium waves of cell proliferation, differentiation, recruitment of inflammatory cells, apoptosis, tissue breakdown and regeneration. The activated progesterone receptor, a member of the superfamily of ligand-dependent transcription factors, is the master regulator of this intense tissue remodelling process in the uterus. Its activity is tightly regulated by interaction with cell-specific transcription factors and coregulators as well as by specific posttranslational modifications that respond dynamically to a variety of environmental and inflammatory signals. Endometriosis, a chronic inflammatory disorder, disrupts coordinated progesterone responses throughout the reproductive tract, including in the endometrium. This phenomenon is increasingly referred to as ‘progesterone resistance’. Emerging evidence suggests that progesterone resistance in endometriosis is not just a consequence of perturbed progesterone signal transduction caused by chronic inflammation but associated with epigenetic chromatin changes that determine the intrinsic responsiveness of endometrial cells to differentiation cues.

Gynecol Endocrinol. 2011 Nov 15. [Epub ahead of print]

XRCC1 399 * Arg-related genotype and allele, but not XRCC1 His107Arg, XRCC1 Trp194Arg, KCNQ2, AT1R, and hOGG1 polymorphisms, are associated with higher susceptibility of endometriosis.

Hsieh YY, Chang CC, Chen SY, Chen CP, Lin WH, Tsai FJ.

Source

School of Chinese Medicine, College of Chinese Medicine, China Medical University , Taichung , Taiwan.

Abstract

X-ray repair cross-complementing group 1 (XRCC1) and human 8-oxoguanine glycosylase 1 (hOGG1) play important roles in base excision repair. KCNQ genes comprising voltage-gated ion-channels related with cell stability. Angiotensin II type 1 receptor (AT1R) is related with angiogenesis, which influence endometriosis growth, invasion and regression. We aimed to investigate whether these polymorphisms were associated with endometriosis susceptibility. Women were divided [ 1 ]: endometriosis (n?=?136 [ 2 ]); non-endometriosis groups (n?=?112). XRCC1 (codon 107, 194, 399), hOGG1, KCNQ2, AT1R polymorphisms were amplified by PCR and detected by electrophoresis after restriction enzyme (RsaI, HpaII, MspI, Fnu4HI, Ava II, Dde I) digestions. Genotypes and allelic frequencies in both groups were compared. Proportions of XRCC1 Arg399Gln*GG/GA/AA and G/A allele between both groups were [ 1 ]: 41.9/53.7/4.4% and 68.8/31.2% [ 2 ]; 30.4/54.5/15.1% and 57.6/42.4% (p < 0.05). Other 5 polymorphisms (XRCC1 codon 107 and 194, hOGG1, KCNQ2, and AT1R) between both groups were non-significantly different. Proportions of XRCC1 107*AA/AG/GG and XRCC1 194*TT/TC/CC between both groups were [ 1 ]: 3.7/27.2/69.1% and 5.8/34.6/59.6% [ 2 ]; 2.6/21.4/75.8% and 11.6/37.5/50.9%. HOGG1*CC/CG/GG, KCNQ2*AA/AC/CCC and AT1R*AA/AC/CC were [ 1 ]: 14.8/42.6/42.6, 14/41.9/44.1 and 92.6/7.4/0% [ 2 ]; 11.6/50/38.4, 17/50/33 and 100/0/0%. We concluded that XRCC1 399 Arg-related genotype and allele are correlated with higher susceptibility to endometriosis, which suggested its association with endometriosis pathogenesis. XRCC1 107 and 194, hOGG1, KCNQ2, and AT1R are not associated with endometriosis susceptibility.

ISRN Surg. 2011;2011:837501. Epub 2011 May 2.

Recurrent chest pain, as a presenting sign of ovarian endometrioma.

Yildirim M, Oztekin O, Oztekin D.

Source

Department of Surgery, Izmir Bozyaka Teaching and Research Hospital, 35540 Izmir, Turkey.

Abstract

Chest pain is a rare sign of thoracal endometriosis associated with endometrioma of the tubo-ovarian endometrioma. We report the case periodic episodes of chest pain concurrent with menstruation in a 35-year-old female, in which ovarian endometrioma was diagnosed and left-sided oophorectomy was performed. After surgery, patient underwent medical treatment which included a Gn-RH agonist and a combined oral contraceptive. In the follow-up period, there was no evidence of chest pain.

J Obstet Gynaecol Can. 2011 Nov;33(11):1141-5.

Revisiting the association between endometriosis and bipolar disorder.

Kumar V, Khan M, Vilos GA, Sharma V.

Source

Department of Medicine, University of Toronto, Toronto ON.

Abstract

OBJECTIVE:

We sought to study the association between endometriosis and bipolar disorder.

METHODS:

Using the Structured Clinical Interview for DSM-IV Axis I Disorders, the prevalence of bipolar disorder was compared in 27 patients with endometriosis and 12 women with pelvic pain not related to endometriosis who were seen at a specialty gynaecology clinic for women with chronic pelvic pain.

RESULTS:

A significantly greater proportion of women in the endometriosis group were found to have bipolar disorder and a poorer quality of life than women with pelvic pain not related to endometriosis.

CONCLUSION:

There may be an association between endometriosis and bipolar disorder. An optimal approach to managing endometriosis should include evaluation and treatment of psychiatric comorbidity, particularly bipolar disorder.

BJOG. 2011 Dec;118(13):1678; author reply 1678-9. doi: 10.1111/j.1471-0528.2011.03162.x.

Complications after surgery for deeply infiltrating pelvic endometriosis.

Padavala J, Navaneetham N.

Comment on

J Clin Endocrinol Metab. 2012 Jan;97(1):E35-43. Epub 2011 Nov 9.

Increased Activation of the PI3K/AKT Pathway Compromises Decidualization of Stromal Cells from Endometriosis.

Yin X, Pavone ME, Lu Z, Wei J, Kim JJ.

Source

Department of Obstetrics and Gynecology, Robert H. Lurie Comprehensive Cancer Center, 303 East Superior, Room 4-117, Northwestern University, Chicago, Illinois 60611. j-kim4@northwestern.edu.

Abstract

Context: Endometriosis affects approximately 10% of women in the United States and causes pain and infertility. Decidualization of endometrial stromal cells from women with endometriosis is aberrant. Objective: The objective of this study was to investigate a potential mechanism for the inadequate decidual response in stromal cells from ovarian endometriomas. Design: Stromal cells of the endometrium from women without endometriosis (HSC) or from ovarian endometriomas (OsisSC) were grown in culture and treated with 10 μm LY294002 or 250 nm MK2206, 100 nm medroxyprogesterone acetate (M), and 0.5 mm dibutyryl cAMP (A) or infection with 100 multiplicity of infection adenoviral constructs containing wild-type Forkhead box O1 or triple-mutant FOXO1. Real-time PCR was used to measure the expression of FOXO1, IGF binding protein-1 (IGFBP1), and prolactin (PRL) mRNA, and Western blot and immunohistochemical staining were used to detect the levels of progesterone receptor (PR), FOXO1, AKT, and p(Ser473)-AKT protein in vitro or in vivo. Results: Expression of the decidua-specific genes, IGFBP1 and PRL, were significantly lower in OsisSC compared with normal HSC in response to M+A treatment. Basal expression levels of PRA, PRB, and FOXO1 proteins were dramatically lower in OsisSC. Overexpression of triple-mutant FOXO1 increased mRNA levels of IGFBP1 and PRL in OsisSC in the presence of M+A, whereas the overexpression of wild-type FOXO1 had no effect. AKT was highly phosphorylated in OsisSC compared with HSC and inhibition of phosphatidylinositol 3-kinase, with LY294002, increased levels of FOXO1 protein as well as IGFBP1 mRNA in the presence of M+A. Moreover, inhibition of AKT with MK2206, an allosteric AKT inhibitor, dramatically increased the accumulation of nuclear FOXO1 as well as expression of IGFBP1. Finally, immunohistochemical staining demonstrated higher p(Ser473)-AKT and lower FOXO1 levels in endometriosis tissues, compared with normal endometrial tissues. Conclusions: In endometriotic stromal cells, overactivation of the phosphatidylinositol 3-kinase/AKT signaling pathway contributes to the reduced expression of the decidua-specific gene, IGFBP1, potentially through reduced levels of nuclear FOXO1.

Curr Treat Options Neurol. 2012 Feb;14(1):1-14.

Menstrual migraine: update on pathophysiology and approach to therapy and management.

Calhoun AH.

Source

Carolina Headache Institute, 103 Market Street, Chapel Hill, NC, 27516, USA, calhouna@carolinaheadacheinstitute.com.

Abstract

OPINION STATEMENT: Menstrual migraine (MM) is often reported to be more severe and more resistant to treatment than other migraines. Nevertheless, initial treatment should be the same as for any migraine. When results of acute therapy are incomplete or unsatisfactory, preventive strategies are warranted, including both pharmacologic preventives and careful adherence to lifestyle modifications. Where MM differs from other attacks is in its predictable timing and discrete precipitants. These differences allow for unique preventive strategies that target either the timing of the attacks or their hormonal precipitants. Nonspecific MM strategies-those that do not address the hormonal mechanism-include scheduled dosing of nonsteroidal anti-inflammatory drugs (NSAIDs) or triptans throughout the menstrual window. NSAIDs are a good choice when there is comorbid dysmenorrhea and allow for treatment of breakthrough headaches with triptans. Both strategies require that the timing of MM is highly predictable. Specific strategies for MM are those that reduce or eliminate the premenstrual decline in estradiol that predictably precipitates attacks. These include continuous or extended-cycle dosing of combined hormonal contraceptives (CHCs). A number of common gynecologic comorbidities argue for early adoption of these treatments, as CHCs effectively treat dysmenorrhea, menorrhagia, ovarian cysts, endometriosis, and irregular cycles. In the author’s experience, hormonal preventives are the best approach for most women whose menstrual attacks are resistant to acute therapy. They afford the greatest therapeutic benefit in prevention while treating common comorbidities and allowing for acute treatment with triptans when needed.

J Gynecol Obstet Biol Reprod (Paris). 2011 Nov 7. [Epub ahead of print]

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.

Source

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

Abstract

OBJECTIVES:

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

PATIENTS AND METHODS:

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

RESULTS:

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.

CONCLUSION:

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.

Arch Gynecol Obstet. 2011 Nov 8. [Epub ahead of print]

Performance of peripheral (serum and molecular) blood markers for diagnosis of endometriosis.

Mabrouk M, Elmakky A, Caramelli E, Farina A, Mignemi G, Venturoli S, Villa G, Guerrini M, Manuzzi L, Montanari G, De Sanctis P, Valvassori L, Zucchini C, Seracchioli R.

Source

Reproductive Medicine Unit, S. Orsola-Malpighi Hospital, via Massarenti 9, 40138, Bologna, Italy.

Abstract

PURPOSE:

To quantify the mRNA levels of MMP-3, MMP-9, VEGF and Survivin in peripheral blood and the serum levels of CA-125 and Ca19-9 in women with and without endometriosis and to investigate the performance of these markers to differentiate between deep and ovarian endometriosis.

METHODS:

A case control study enrolled a series of 60 patients. Twenty controls have been matched with 20 cases of ovarian and 20 cases of deep endometriosis. Univariable and multivariable performance of serum CA125 and CA19-9, mRNA for Survivin, MMP9, MMP3 and VEGF genes have been evaluated by means of ROC curves and logistic regression, respectively.

RESULTS:

No difference in markers’ concentration was detected between ovarian and deep endometriosis. In comparison with controls, serum CA125 and CA19 yielded the better sensitivity followed by mRNA for Survivin gene (81.5, 51.9 and 7.5% at 10% false positive rate, respectively). Multivariable estimated odds of endometriosis yielded a sensitivity of 87% at the same false positive rate.

CONCLUSIONS:

A combination of serum and molecular markers could allow a better diagnosis of endometriosis.

J Midwifery Womens Health. 2011 Nov-Dec;56(6):628-35. doi: 10.1111/j.1542-2011.2011.00118.x. Epub 2011 Oct 17.

Noncontraceptive uses of hormonal contraception.

King J.

Source

Emory University, Atlanta, GA 30322, USA. Jking01@emory.edu

Abstract

Hormonal contraceptives are not only effective methods of birth control but also are effective at treating and/or preventing a variety of gynecologic and general disorders. Hormonal contraceptives can decrease the severity of acne, correct menstrual irregularities, treat endometriosis-associated pain, decrease bleeding associated with uterine myomas, decrease pain associated with menstrual periods, moderate symptoms associated with premenstrual syndrome, reduce menstrual migraine frequency, and increase bone mineral density as well as decrease the risk of specific cancers such as endometrial and ovarian cancer. Women need to receive this information to guide them in their decisions regarding choice of contraception as well as treatment options for gynecologic disorders.

Arch Gynecol Obstet. 2011 Nov 6. [Epub ahead of print]

The investigation of ABO and Rh blood groups distribution in patients with endometriosis needs new project design.

Tabei SM, Daliri K, Amini A.

Source

Department of Medical Genetics, Shiraz University of Medical Sciences, Shiraz, Iran, tabeismb@sums.ac.ir.

Abstract

We carefully studied all the three published papers in your journal as “ABO and Rh Blood group distribution in patients with endometriosis” and “Associations of ABO blood groups with various gynecologic diseases” and would like to express our point of view about them.

Bioessays. 2012 Jan;34(1):26-35. doi: 10.1002/bies.201100099. Epub 2011 Nov 7.

The evolution of menstruation: a new model for genetic assimilation: explaining molecular origins of maternal responses to fetal invasiveness.

Emera D, Romero R, Wagner G.

Source

Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.

Abstract

Why do humans menstruate while most mammals do not? Here, we present our answer to this long-debated question, arguing that (i) menstruation occurs as a mechanistic consequence of hormone-induced differentiation of the endometrium (referred to as spontaneous decidualization, or SD); (ii) SD evolved because of maternal-fetal conflict; and (iii) SD evolved by genetic assimilation of the decidualization reaction, which is induced by the fetus in non-menstruating species. The idea that menstruation occurs as a consequence of SD has been proposed in the past, but here we present a novel hypothesis on how SD evolved. We argue that decidualization became genetically stabilized in menstruating lineages, allowing females to prepare for pregnancy without any signal from the fetus. We present three models for the evolution of SD by genetic assimilation, based on recent advances in our understanding of the mechanisms of endometrial differentiation and implantation. Testing these models will ultimately shed light on the evolutionary significance of menstruation, as well as on the etiology of human reproductive disorders like endometriosis and recurrent pregnancy loss.

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