Hum Reprod. 2012 Dec;27(12):3365-79. doi: 10.1093/humrep/des338. Epub 2012 Oct 23.

Best practices of ASRM and ESHRE: a journey through reproductive medicine.

Gianaroli L1Racowsky CGeraedts JCedars MMakrigiannakis ALobo R.

 

Abstract

BACKGROUND:

The American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) are the two largest societies in the world whose members comprise the major experts and professionals working in the field of reproductive medicine and embryology. These societies have never before had a joint scientific meeting.

METHODS:

A 3-day meeting was planned and took place in March of 2012. The goal was to present and debate key topics, as well as modes of practice in reproductive medicine and to discuss recent developments in the field.

RESULTS:

Presentations by members of ASRM and ESHRE were of three types: ‘state of the art’ lectures, ‘back-to-back’ presentations of two points of view and debates.

CONCLUSIONS:

For the first time, ASRM and ESHRE held a joint meeting where a special emphasis was given to presentations on the hottest topics in the field. Although different opinions and approaches sometimes exist on the two sides of the Atlantic, an appreciation and acceptance of these differences was evident, and there was more commonality than divergence of opinion.

 

 

 

Med Arch. 2012;66(5):353-4.

Primary cutaneous umbilical endometriosis.

Kesici U1Yenisolak AKesici SSiviloglu C.

 

Abstract

INTRODUCTION:

Primary umbilical endometriosis a rare case. It is mostly seen in women in the reproductive age group.

CASE REPORT:

In this case report, a 38 year old woman is discussed who received antibiotherapy for omphalitis diagnosis established due to many complaints of umbilical secretion but who was diagnosed with primary umbilical endometriosis after histopathological examination.

CONCLUSION:

Endometriosis must be certainly considered in differential diagnosis in especially inflammatory lesions resistant to noncyclic treatment, determined in umbilical region.

 

 

 

Prog Urol. 2012 Nov;22(15):913-9. doi: 10.1016/j.purol.2012.05.003. Epub 2012 Jun 27.

Aetiology and management of iatrogenic injury of the ureter: a review.

[Article in French]

Klap J1Phé VChartier-Kastler EMozer PBitker MORouprêt M.

 

Abstract

OBJECTIVE:

Ureteric injuries (IU) are common complications occurring during abdomino-pelvic surgical procedures. Our aim was to review risk factors, treatment and methods of prevention of these iatrogenic UI.

MATERIAL AND METHODS:

A literature review in English and French by Medline(®) was performed using the keywords: ureter; iatrogenic; injury; ureteroscopy; morbidity and endoscopy.

RESULTS:

The analysis of the epidemiology of IU shows that the first two causes are gynecological and urological surgery. In 80% of cases, the pelvic ureter was concerned. Mechanisms of injury were essentially ligation, section and ischemia by altering the ureteral vasculature. The main risk factors found were pelvic inflammation (endometriosis, radiation…) and the occurrence of bleeding during surgery. In the presence of risk factors, placing a double J stent or a CT may be useful preoperatively. The choice of reparation technique depended on the location of the PU, the circumstances of the occurrence and experience of the surgical team.

CONCLUSION:

Pelvic surgery is a provider of iatrogenic PU. Knowledge of the management of PU once occurred must be mastered before carrying out any risk surgery.

 

 

 

 

 

Int Surg. 2012 Apr-Jun;97(2):135-9. doi: 10.9738/CC124.1. R

Laparoscopic trocar port site endometriosis: a case report and brief literature review.

Emre A1Akbulut SYilmaz MBozdag Z.

 

Abstract

Endometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. It occurs most commonly in pelvic sites such as ovaries, cul-de-sac, and fallopian tubes but also can be found associated with the lungs, bowel, ureter, brain, and abdominal wall. Abdominal wall endometriosis, also known as scar endometriosis, is extremely rare and mainly occurs at surgical scar sites. Although many cases of scar endometriosis have been reported after a cesarean section, some cases of scar endometriosis have been reported after an episiotomy, hysterectomy, appendectomy, and laparoscopic trocar port tracts. To our knowledge, 14 case reports related to trocar site endometriosis have been published in the English language literature to date. Herein, we present the case of a 20-year-old woman (who had been previously operated on for left ovarian endometrioma 1.5 years ago by laparoscopy) with the complaint of a painful mass at the periumbilical trocar site with cyclic pattern. Consequently, although rare, if a painful mass in the surgical scar, such as the trocar site, is found in women of reproductive age with a history of pelvic or obstetric surgery, the physician should consider endometriosis.

 

 

 

Fertil Steril. 2013 Feb;99(2):543-50. doi: 10.1016/j.fertnstert.2012.10.007. Epub 2012 Oct 25.

Dietary fish oil supplementation inhibits formation of endometriosis-associated adhesions in a chimeric mouse model.

Herington JL1Glore DRLucas JAOsteen KGBruner-Tran KL.

 

Abstract

OBJECTIVE:

To examine whether dietary fish oil supplementation reduces development of spontaneous endometriosis-associated adhesions using an established model.

DESIGN:

Laboratory-based study.

SETTING:

Medical center research laboratory. PATIENT(S)/ANIMAL(S): Disease-free women of reproductive age and nude mice.

INTERVENTION(S):

Women were not provided any intervention. Mice were randomized to receive fish oil supplementation or control diet.

MAIN OUTCOME MEASURE(S):

Experimental endometriosis was established in mice via injection of human endometrial tissue within 16 hours of ovariectomy. Mice were provided standard or menhaden fish oil-supplemented diets for ≥ 2 weeks before initiation of experimental endometriosis and until killing them 1 week later. At necropsy, mice were examined for the presence and extent of adhesions and endometriotic-like lesions. Tissues were excised and morphologically characterized.

RESULT(S):

Adhesions/lesions were reduced in mice provided with dietary fish oil compared with control animals. Leukocytes were more numerous within the adhesions/lesions of the mice maintained on the standard diet compared with animals provided with fish oil. As indicated by staining intensity, collagen deposition was greater at adhesion sites within control mice compared with fish oil-supplemented animals.

CONCLUSION(S):

Wound-healing associated with surgery created an inflammatory peritoneal microenvironment that promoted the development of both experimental endometriosis and adhesions in a murine model. Targeting excessive inflammation with fish oil may be an effective adjuvant therapy to reduce the development of postsurgical adhesions related to endometriosis.

 

 

Nat Genet. 2012 Dec;44(12):1355-9. doi: 10.1038/ng.2445. Epub 2012 Oct 28.

Genome-wide association meta-analysis identifies new endometriosis risk loci.

Nyholt DR1Low SKAnderson CAPainter JNUno SMorris APMacGregor SGordon SDHenders AKMartin NGAttia JHolliday EGMcEvoy MScott RJKennedy SHTreloar SAMissmer SAAdachi STanaka KNakamura YZondervan KTZembutsu HMontgomery GW.

 

Abstract

We conducted a genome-wide association meta-analysis of 4,604 endometriosis cases and 9,393 controls of Japanese and European ancestry. We show that rs12700667 on chromosome 7p15.2, previously found to associate with disease in Europeans, replicates in Japanese (P = 3.6 × 10(-3)), and we confirm association of rs7521902 at 1p36.12 near WNT4. In addition, we establish an association of rs13394619 in GREB1 at 2p25.1 with endometriosis and identify a newly associated locus at 12q22 near VEZT (rs10859871). Excluding cases of European ancestry of minimal or unknown severity, we identified additional previously unknown loci at 2p14 (rs4141819), 6p22.3 (rs7739264) and 9p21.3 (rs1537377). All seven SNP effects were replicated in an independent cohort and associated at P <5 × 10(-8) in a combined analysis. Finally, we found a significant overlap in polygenic risk for endometriosis between the genome-wide association cohorts of European and Japanese descent (P = 8.8 × 10(-11)), indicating that many weakly associated SNPs represent true endometriosis risk loci and that risk prediction and future targeted disease therapy may be transferred across these populations.

 

 

Am J Obstet Gynecol. 2013 Jan;208(1):e12-4. doi: 10.1016/j.ajog.2012.10.001. Epub 2012 Oct 4.

A rare case of primary extranodal marginal zone B-cell lymphoma of the ovary, fallopian tube, and appendix in the setting of endometriosis.

Nezhat CH1Dun ECWieser FZapata M.

 

Abstract

Extranodal marginal zone B-cell lymphomas are uncommon. Most occur in the gastrointestinal tract. Marginal zone B-cell lymphomas of the female genital tract are rare, and few cases exist of marginal zone B-cell lymphomas of the uterus, cervix, and fallopian tubes. We report the first marginal zone B-cell lymphoma of the ovary, fallopian tube, and appendix arising in endometriosis.

 

 

 

Hum Reprod. 2013 Jan;28(1):109-18. doi: 10.1093/humrep/des364. Epub 2012 Oct 28.

Pelvic pain in women with ovarian endometrioma is mostly associated with coexisting peritoneal lesions.

Khan KN1Kitajima MFujishita AHiraki KMatsumoto ANakashima MMasuzaki H.

 

Abstract

STUDY QUESTION:

Is the occurrence of pelvic pain in women with ovarian endometrioma associated with coexisting peritoneal lesions (PLs)?

SUMMARY ANSWER:

Pelvic pain in women with ovarian endometrioma is usually associated with coexisting PLs. An increased tissue inflammatory reaction with elevated prostaglandin (PG) production may be responsible for the generation of pain.

WHAT IS KNOWN ALREADY:

Severe pelvic pain in women with ovarian endometrioma is reported to be associated with deeply infiltrating endometriosis. However, information on pelvic pain in women with ovarian endometriosis with and without coexistent peritoneal superficial lesions is limited.

STUDY DESIGN, SIZE AND DURATION:

Retrospective clinical study with case-controlled biological research using prospectively collected tissue samples derived from women with and without endometriosis and their retrospective evaluation.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

We performed a retrospective cohort study conducted in 2988 cases who had laparoscopic surgery for indications of ectopic pregnancy, tubal infertility and other benign gynecologic diseases. We analyzed the occurrence of pelvic pain in the cases with ovarian endometrioma according to the distribution of coexisting PLs and pattern of intrapelvic adhesions. Inflammatory reaction of eutopic and ectopic endometria was measured by immunoreaction to macrophage marker, CD68. The tissue expression of cyclooxygenase (COX) 2 was examined by immunohistochemistry and tissue concentrations of PG F2α were measured by ELISA.

MAIN RESULTS AND THE ROLE OF CHANCE:

Among the 2988 surgical cases, 350 (11.7%) were found to have ovarian endometrioma at laparoscopy. Coexisting PLs were present in 269 of these women and in this group 85.4% of cases experienced pelvic pain and 14.6% had no pain. In contrast, among the 81 women with ovarian endometrioma only, 38.3% cases experienced pelvic pain and 61.7% cases had no pain and the difference between the groups was statistically significant (P < 0.01). The infiltration of CD68-immunoreactive macrophages was significantly higher in the eutopic and ectopic endometria of women with peritoneal endometriosis than in ovarian endometrioma. The tissue expression of COX2 and levels of PGF2α were significantly higher in both the eutopic and ectopic endometria derived from women with peritoneal endometriosis than in similar tissues derived from women with ovarian endometrioma.

LIMITATIONS, REASONS FOR CAUTIONS:

Lack of evaluation in the detection of general or disseminated deeply infiltrating endometriosis in the pelvic cavity could be a bias or limitation in this study. Further multicenter prospective studies are needed to strengthen our current findings.

WIDER IMPLICATIONS OF THE FINDINGS:

Our findings may provide some new insights to understand the physiopathology of pelvic pain in women with ovarian cystic endometriosis and may hint at proper surgical manipulation to prevent the recurrence of pelvic pain in these women.

STUDY FUNDING/COMPETING INTEREST(S):

This work was supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Sports, Culture, Science and Technology of Japan. There is no conflict of interest related to this study.

 

 

Vopr Kurortol Fizioter Lech Fiz Kult. 2012 May-Jun;(3):26-9.

The use of restorative medicine technologies for the rehabilitation of the patients presenting with endometriosis of external genitalia.

Makarenko LVKrutova VAGordon KV.

 

Abstract

This paper reports the results of analysis of the psycho-emotional status and pain syndrome in the women presenting with endometriosis of external genitalia treated with a combination of hormonal preparations and balneotherapy. A total of 216 infertile patients were involved in the study. The duration of the infertility period varied from 1.5 to 19 years. All the patients underwent surgical intervention. The influence of rehabilitative therapy on the quantitative vital indices (psycho-emotional adaptation to the social environment and pain intensity) was estimated before and after the treatment. The patients were divided into 3 groups. Those of group 1 received an oral contraceptive (30 mcg of ethinylestradiol plus 2 mg dienogest) as a continuous three-cycle course (63 tablets) followed by its discontinuation for the 7 day menstrual period and the final three-cycle course (total duration of therapy 6 months). The patients of group 2 were treated with injections of agonists of gonadotropin releasing hormone (GnRH) at a dose of 3.75 mg once every 4 weeks (total duration 6 months). In group 3, the injections of GnRH agonists (3.75 mg once every 4 weeks, total duration 6 months) were combined with a course of balneotherapy using radon. All the three rehabilitative modalities produced a well-apparent positive effect. Chronic pelvic pain before treatment was reported by 90,3% of the patients. After the treatment, the number of such women in groups 1, 2, and 3 decreased to 20,8%, 12,5%, and 30,6% respectively Dyspareunia in the pre-treatment period was diagnosed in 66,7% of the patients. After treatment, this pathology persisted only in 23,6%, 18,1%, and 31,9% of the patients in groups 1, 2, and 3 respectively. Psycho-emotional disorders before treatment were documented in 90,3% of the patients compared with 27,8%, 25%, and 30,6% after therapy. It is concluded that all the three therapeutic modalities markedly improved health conditions of the patients presenting with endometriosis of external genitalia, but the combination of GnRH agonists with radon therapy produced the most pronounced clinical effect.

 

 

 

J Ovarian Res. 2012 Nov 1;5(1):31. doi: 10.1186/1757-2215-5-31.

Dienogest increases the progesterone receptor isoform B/A ratio in patients with ovarian endometriosis.

Hayashi A1Tanabe AKawabe SHayashi MYuguchi HYamashita YOkuda KOhmichi M.

 

Abstract

BACKGROUND:

The resistance of endometriotic tissue to progesterone can be explained by alterations in the distribution of progesterone receptor (PR) and estrogen receptor (ER) isoforms. The aims of this study were to examine the expressions of PR-A, PR-B, ERα and ERβ in endometrioma and assess whether these expressions are affected by dienogest or leuprolide acetate (LA) treatment.

METHODS:

We enrolled 60 females, including 43 patients with endometriosis (14 who received no medical treatment, 13 who received dienogest and 16 who received LA before undergoing laparoscopic surgery) and 17 patients with leiomyoma. The expression levels of PR and ER isoforms in eutopic and ectopic endometrium were assayed with quantitative real-time PCR, and confirmed with immunohistochemistry.

RESULTS:

A decreased PR-B/PR-A ratio and an increased ERβ/ERα ratio were demonstrated in ectopic endometrium derived from females with endometriosis compared with the ratios observed in eutopic endometrium obtained from females without endometriosis. Although LA treatment did not affect the PR-B/PR-A and ERβ/ERα ratios, dienogest treatment increased the PR-B/PR-A ratio and decreased the ERβ/ERα ratio in patients with endometriomas.

CONCLUSIONS:

Dienogest may improve progesterone resistance in endometriotic tissue by increasing the relative expressions of PR-B and PR-A, and decreasing the relative expressions of ERβ and ERα.

 

 

Acta Clin Croat. 2012 Jun;51(2):261-3.

Abdominal wall endometriosis: case report.

Eljuga D1Klarić PBolanca IGrbavac IKuna K.

 

Abstract

Abdominal wall endometriosis, also known as scar endometrioma, is a rare condition, in most cases occurring after previous cesarean section or pelvic surgery. The incidence of scar endometrioma is estimated to 0.03%-1.5% of all women with previous cesarean delivery. The predominant clinical picture is cyclic pain. Due to a wide range of mimicking conditions and a relative rarity, a significant delay is often observed from the onset of symptoms to proper treatment. We report on a case of a 36-year-old patient with scar endometrioma after two previous cesarean deliveries. The possible diagnostic pitfalls and treatment options are discussed.

 

 

Gynecol Oncol. 2013 Feb;128(2):260-4. doi: 10.1016/j.ygyno.2012.10.023. Epub 2012 Oct 29.

In vitro fertilization, endometriosis, nulliparity and ovarian cancer risk.

Stewart LM1Holman CDAboagye-Sarfo PFinn JCPreen DBHart R.

 

Abstract

OBJECTIVES:

To examine the risk of invasive epithelial ovarian cancer in a cohort of women seeking treatment for infertility.

METHODS:

Using whole-population linked hospital and registry data, we conducted a cohort study of 21,646 women commencing hospital investigation and treatment for infertility in Western Australia in the years 1982-2002. We examined the effects of IVF treatment, endometriosis and parity on risk of ovarian cancer and explored potential confounding by tubal ligation, hysterectomy and unilateral oophorectomy/salpingo-oophorectomy (USO).

RESULTS:

Parous women undergoing IVF had no observable increase in the rate of ovarian cancer (hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.35-2.90); the HR in women who had IVF and remained nulliparous was 1.76 (95% CI 0.74-4.16). Women diagnosed with endometriosis who remained nulliparous had a three-fold increase in the rate of ovarian cancer (HR 3.11; 95% CI 1.13-8.57); the HR in parous women was 1.52 (95% CI 0.34-6.75). In separate analyses, women who had a USO without hysterectomy had a four-fold increase in the rate of ovarian cancer (HR 4.23; 95% CI 1.30-13.77). Hysterectomy with or without USO appeared protective.

CONCLUSIONS:

There is no evidence of an increased risk of ovarian cancer following IVF in women who give birth. There is some uncertainty regarding the effect of IVF in women who remain nulliparous. Parous women diagnosed with endometriosis may have a slightly increased risk of ovarian cancer; nulliparous women have a marked increase in risk.

 

 

 

 

 

J Clin Endocrinol Metab. 2013 Jan;98(1):281-9. doi: 10.1210/jc.2012-2415. Epub 2012 Nov 1.

Circulating microRNAs identified in a genome-wide serum microRNA expression analysis as noninvasive biomarkers for endometriosis.

Wang WT1Zhao YNHan BWHong SJChen YQ.

 

Abstract

CONTEXT:

There is currently no reliable noninvasive biomarker for the clinical diagnosis of endometriosis. Previous analyses have reported that circulating microRNAs (miRNAs) can serve as biomarkers for a number of diseases.

OBJECTIVE:

The study aims to detect the serum miRNAs that are differentially expressed between endometriosis patients and negative controls to evaluate the potential of these miRNAs as diagnostic markers for endometriosis.

DESIGN:

A total of 765 serum miRNAs were profiled using a TaqMan microRNA array in a pool of 10 endometriosis patients and a pool of 10 negative controls, and a set of selected miRNAs were further analyzed in a validation cohort consisting of sera from 60 patients and 25 controls including 10 samples used in array profiling.

RESULTS:

The relative expression levels of miR-199a and miR-122 were found to be up-regulated in endometriosis patient samples compared with control samples, whereas miR-145*, miR-141*, miR-542-3p, and miR-9* were down-regulated in endometriosis patients. Importantly, the relative expression of miR-199a (P < 0.05) and miR-122 can be used to discriminate between severe and mild endometriosis. We also found that miR-199a is well correlated with pelvic adhesion and lesion distribution (P < 0.05) and associated with hormone-mediated signaling pathways. Furthermore, we investigated the diagnostic value of these molecules and confirmed the optimal combination of miR-199a, miR-122, miR-145*, and miR-542-3p with area under the curve of 0.994 (95% confidence interval = 0.984-1.000, P < 0.001) and a cutoff point (0.4950) of 93.22% sensitivity and 96.00% specificity.

CONCLUSIONS:

Our study demonstrated that the circulating miRNAs miR-199a, miR-122, miR-145*, and miR-542-3p could potentially serve as noninvasive biomarkers for endometriosis. miR-199a may also play an important role in the progression of the disease. This is the first report that circulating miRNAs serve as biomarkers of endometriosis.

 

 

Int J Clin Exp Pathol. 2012;5(9):924-7. Epub 2012 Oct 20.

Endometrioid adenocarcinoma of the ovary arising in atypical endometriosis.

Terada T1.

 

Abstract

Ovarian endometriosis can transform into malignant tumors, and ovarian carcinomas relatively frequently contain foci of endometriosis. In this study, the author reviewed 15 cases of endometrioid adenocarcinoma of the ovary in the last 15 years of our pathology laboratory in search for the presence of endometriosis within the tumor. Six (40%) of the 15 endometrioid adenocarcinoma were found to have endometriosis in the tumor. All of the endometriosis were atypical. The age of the 6 patients ranged from 44 year to 78 year with a median of 59 years. Grossly, the endometrial adenocarcinomas with endometriosis were characterized by unilocular cystic tumors in 5 cases and multilocular cystic tumor in one case. Histologically, the grade of endometrioid carcinoma was grade I in 3 cases, grade II in 2 cases and grade III in 1 case. Endometriosis was mixed with the tumors or was present adjacent to the tumor. The endometriosis was composed of a layer of atypical epithelium (atypical endometriosis), and gradual merges between endometriosis and carcinoma were present in 3 cases. These findings suggest that atypical endometriosis can transform into endometrioid carcinoma.

 

 

Eur J Obstet Gynecol Reprod Biol. 2013 Jan;166(1):99-103. doi: 10.1016/j.ejogrb.2012.10.012. Epub 2012 Nov 2.

Preoperative planning of surgery for deeply infiltrating endometriosis using the ENZIAN classification.

Haas D1Chvatal RHabelsberger ASchimetta WWayand WShamiyeh AOppelt P.

 

Abstract

OBJECTIVE:

To use the ENZIAN classification for preoperative estimation of laparoscopic operating time in patients with deeply infiltrating endometriosis (DIE).

STUDY DESIGN:

Retrospective study of women with DIE (n=151) who underwent laparoscopic surgery.

RESULTS:

151 of 470 patients had DIE (n=205 lesions) exclusively in compartments A (rectovaginal septum, vagina), B (sacrouterine ligament to the pelvic wall) and C (rectum, sigmoid colon). These laparoscopically treated lesions were used to calculate a model for estimating operating time for DIE, assuming complication-free procedures (overall significance for model’s predictive power: P<0.001). The error of estimation for the operating time prediction is 0 ± 35.35 min (mean ± SD; range -83 to +117 min). The actual operating time for all operations was 109.32 ± 74.38 min (mean ± standard deviation).

CONCLUSIONS:

Using a model for predicting operating time based on the ENZIAN classification enables resources to be planned more precisely in surgery management. Patients with DIE can also be given more precise information regarding the expected operating time.

 

 

Gynecol Obstet Fertil. 2012 Nov;40(11):634-41. doi: 10.1016/j.gyobfe.2012.09.014. Epub 2012 Nov 2. French.

Preoperative imaging of deeply infiltrating endometriosis in: Transvaginal sonography, rectal endoscopic sonography and magnetic resonance imaging.

[Article in French]

Gauche Cazalis C1Koskas MMartin BPalazzo LMadelenat PYazbeck C.

 

Abstract

OBJECTIVES:

Compare the accuracy of transvaginal ultrasonography (TVUS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI) before deeply infiltrating endometriosis surgery.

PATIENTS AND METHODS:

A retrospective study with 25 deeply endometriosis patients underwent the three imaging examinations before surgery. Calculation of sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the different locations: ovaries, uterosacral ligaments and torus, rectovaginal septum, rectosigmoid junction, bladder.

RESULTS:

Ovarian and deep pelvic endometriosis was found in surgery and confirmed by histology in all patients. Sensitivity and specificity are respectively: for ovaries: 88.2% and 71% of TVUS; 80% and 81.2% of RES; 87.5% and 71% of MRI. For uterosacral ligaments: 63% and 82,6% of TVUS; 37% and 100% of RES; 69% and 82.6% of MRI. For torus: 57.1% and 100% of TVUS; 76.2% and 100% of RES; 76.2% and 100% of MRI. For rectovaginal septum: 63.2% and 100% for TVUS; 89.5% and 66.7% of EER; 47.4% and 100% of MRI. For rectosigmoid junction: 73.7% and 66.7% of TVUS; 94.7% and 66.7% of RES; 89.5% and 50% of MRI. For bladder: 16.7% and 100% of TVUS; 16.7% and 100% of RES; 33.3% and 89.5% of MRI.

DISCUSSION AND CONCLUSION:

We found that TVUS is the more performant for endometriomas, it is MRI for torus, uterosacral ligaments and little bladder lesions, RES for rectovaginal septum and rectosigmoid junction. So in the clinical practice, the three imaging examinations are complementary for the preoperative assessment of deeply endometriosis.

 

Int J Surg Case Rep. 2013;4(1):54-7. doi: 10.1016/j.ijscr.2012.07.018. Epub 2012 Sep 19.

An unusual cause of acute appendicitis: Appendiceal endometriosis.

Emre A1Akbulut SYilmaz MBozdag Z.

 

Abstract

INTRODUCTION:

While endometriosis is a common disorder in women of reproductive age, appendiceal endometriosis accounts for less than 1% of all pelvic endometriotic lesions. Appendiceal involvement may present as acute appendicitis and definitive diagnosis is made by only postoperative histological examination.

PRESENTATION OF CASE:

In this study, we present two cases of female patients who underwent an appendectomy presumed diagnosis as acute appendicitis, and a histopathological examination of the retrieved specimen revealed appendiceal endometriosis.

DISCUSSION:

Endometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. Gastrointestinal endometriosis is observed in 3-37% of all endometriosis cases, whereas appendiceal endometriosis accounts for only about 3% of gastrointestinal endometriosis. Appendiceal endometriosis is usually asymptomatic, although it sometimes causes abdominal cramps, nausea, chronic pelvic pain, lower gastrointestinal hemorrhage, intussusception, perforation, or acute appendicitis.

CONCLUSION:

Appendiceal endometriosis is an unusual histopathological finding. A preoperative diagnosis is difficult, but this condition should be considered when women of childbearing age present with clinical symptoms of acute appendicitis.

 

 

 

J Environ Prot (Irvine, Calif). 2012 Jun 1;3(6):462-468. Epub 2012 Jun 11.

Assessing Chemical Mixtures and Human Health: Use of Bayesian Belief Net Analysis.

Roy A1Perkins NJBuck Louis GM.

 

Abstract

BACKGROUND:

Despite humans being exposed to complex chemical mixtures, much of the available research continues to focus on a single compound or metabolite or a select subgroup of compounds inconsistent with the nature of human exposure. Uncertainty regarding how best to model chemical mixtures coupled with few analytic approaches remains a formidable challenge and served as the impetus for study.

OBJECTIVES:

To identify the polychlorinated biphenyl (PCB) congener(s) within a chemical mixture that was most associated with an endometriosis diagnosis using novel graphical modeling techniques.

METHODS:

Bayesian Belief Network (BBN) models were developed and empirically assessed in a cohort comprising 84 women aged 18-40 years who underwent a laparoscopy or laparotomy between 1999 and 2000; 79 (94%) women had serum concentrations for 68 PCB congeners quantified. Adjusted odds ratios (AOR) for endometriosis were estimated for individual PCB congeners using BBN models.

RESULTS:

PCB congeners #114 (AOR = 3.01; 95% CI = 2.25, 3.77) and #136 (AOR = 1.79; 95% CI = 1.03, 2.55) were associated with an endometriosis diagnosis. Combinations of mixtures inclusive of PCB #114 were all associated with higher odds of endometriosis, underscoring its potential relation with endometriosis.

CONCLUSIONS:

BBN models identified PCB congener 114 as the most influential congener for the odds of an endometriosis diagnosis in the context of a 68 congener chemical mixture. BBN models offer investigators the opportunity to assess which compounds within a mixture may drive a human health effect.

 

 

 

Neurourol Urodyn. 2013 Sep;32(7):980-5. doi: 10.1002/nau.22348. Epub 2012 Nov 5.

A case-control study on the association between rheumatoid arthritis and bladder pain syndrome/interstitial cystitis.

Keller JJ1Liu SPLin HC.

 

Abstract

AIM:

While bladder pain syndrome/interstitial cystitis (BPS/IC) has been suggested by a number of studies to have autoimmune character, no population-based study to date has been conducted investigating its association with rheumatoid arthritis (RA). This study aimed to examine the association between IC/BPS and having previously been diagnosed with RA.

METHODS:

We conducted this study by using administrative claims data sourced from the Taiwan National Health Insurance Database. Our study included 9,269 cases with BPS/IC and 46,345 randomly selected controls. Conditional logistic regression was performed to calculate the odds ratio (OR) for the association between previously diagnosed RA and IC/BPS.

RESULTS:

RA was found among 202 (2.2%) cases and 504 (1.12%) controls. Conditional logistic regression analysis suggested that when compared with controls, the OR for prior RA among cases was 1.66 (95% CI = 1.47-1.87, P < 0.001) after adjusting for diabetes, hypertension, coronary heart disease, obesity, hyperlipidemia, chronic pelvic pain, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, depression, panic disorder, migraine, sicca syndrome, allergy, endometriosis, asthma, overactive bladder, tobacco use disorder, and alcohol abuse. Additionally, BPS/IC was consistently and significantly associated with a previous diagnosis of RA regardless of prescription drug use; the OR for prior RA among groups prescribed ≤1 type of disease-modifying antirheumatic drug (DMARD), two types of DMARDs, and ≥3 types of DMARDs or TNF-alpha inhibitor when compared to controls were 1.49 (95% CI = 1.28-1.72), 1.91 (95% CI = 1.38-2.68), and 2.36 (95% CI = 1.77-3.17), respectively.

CONCLUSIONS:

There is an association between RA and BPS/IC after adjusting for socio-demographic characteristics and medical co-morbidities.

 

 

 

J Minim Invasive Gynecol. 2013 Jan-Feb;20(1):49-55. doi: 10.1016/j.jmig.2012.08.775. Epub 2012 Nov 4.

Partial colpectomy is a risk factor for urologic complications of colorectal resection for endometriosis.

Zilberman S1Ballester MTouboul CChéreau ESèbe PBazot MDaraï E.

 

Abstract

STUDY OBJECTIVE:

To evaluate urologic complications after colorectal resection for endometriosis.

DESIGN:

Cohort study (Canadian Task Force classification II-2).

SETTING:

Tertiary referral university hospital and expert center in endometriosis.

PATIENTS:

One hundred sixty-six women with colorectal endometriosis proven by transvaginal sonography and magnetic resonance imaging.

INTERVENTION:

Open or laparoscopic colorectal resection for endometriosis.

MEASUREMENTS AND MAIN RESULTS:

Forty-four patients (26.5%) experienced at least 1 urologic complication, including infection. Eight patients (4.8%) experienced postoperative symptomatic hydronephrosis requiring ureteral stent in 3 cases, a percutaneous nephrostomy in 1 case, and expectant management for the last 4. Urologic fistulas occurred in 5 patients (3%). Postoperative voiding dysfunction requiring self-catheterization was observed in 48 patients (28.9%). With univariate analysis, a relationship was found between voiding dysfunction and partial colpectomy (p = .001) and American Society of Reproductive Medicine total score (p = .02), and between the occurrence of urinary fistula and the use of prophylactic ureteral catheterization (p = .015) and parametrectomy (p = .02). A relationship was found between postoperative symptomatic hydronephrosis and the use of prophylactic ureteral catheterization (p = .003).

CONCLUSION:

Colorectal resection for endometriosis can lead to urologic complications, particularly for patients requiring partial colpectomy, of which patients need to be informed.

 

 

 

J Reprod Immunol. 2012 Dec;96(1-2):95-100. doi: 10.1016/j.jri.2012.10.001. Epub 2012 Nov 3.

Survivin promoter polymorphisms and autoantibodies in endometriosis.

Lamp M1Saare MKadastik ÜKarro HSalumets AUibo RPeters M.

 

Abstract

Expression of survivin, an inhibitor of apoptosis, is increased in endometriotic lesions and probably favors the survival of endometrial fragments in the peritoneal cavity. The aim of this study was to evaluate associations between survivin promoter polymorphisms and the risk of endometriosis, as well as to compare the immunoreactivity to survivin in sera of patients with and without endometriosis. We studied 149 women with endometriosis, 196 fertile women from the general population (control group A) and 47 women who had undergone diagnostic laparoscopy and had no evidence of endometriosis (control group B). There were no significant differences in the genotypic distribution of the survivin gene promoter region -241C/T, -235G/A and -31G/C single nucleotide polymorphisms (SNP) between endometriosis patients and the two control groups. In addition, also median anti-survivin autoantibody levels were similar among patients and controls (group B). However, anti-survivin antibody concentrations seemed to be influenced by cigarette smoking, being significantly lower in sera of actively smoking women compared to non-smokers (median OD: 0.019 vs. 0.155, respectively, P<0.001), and by the -235G/A SNP, as A allele carriers were significantly more frequent among women with a high antibody level (OD≥2.0) compared to those with lower concentrations (OD<2.0) (23.1% vs. 4.1%, respectively, P=0.008). Based on these results, we conclude that survivin promoter polymorphisms are not associated with susceptibility to endometriosis in the Estonian population, and though the expression of survivin is increased in endometriotic lesions, autoimmune reactivity against it is similar in women with and without the disease.

 

 

 

Expert Opin Ther Pat. 2013 Jan;23(1):79-98. doi: 10.1517/13543776.2013.736965. Epub 2012 Nov 8.

Sulfatase inhibitors: a patent review.

Williams SJ1.

 

Abstract

INTRODUCTION:

Steroid sulfatase (STS) converts sulfated hormones to free hormones of importance in hormone-dependent diseases such as breast cancer and endometriosis. Carbohydrate sulfatases degrade complex carbohydrates as part of normal cellular turnover; certain lysosomal storage disorders (LSDs) involve defective processing of sulfated glycosaminoglycans by mutant sulfatases.

AREAS COVERED:

Aryl sulfamates have been developed as STS inhibitors, and STX64 and PGL2001 are under evaluation in Phase I and II clinical trials for treatment of endometrial and metastatic breast and prostate cancers and endometriosis. Dual-acting compounds have emerged that are aromatase inhibitors (AIs), selective estrogen receptor antagonists, or inhibitors of microtubule polymerization. Sulfamidase inhibitors as pharmacological chaperones to assist maturation of folding-defective mutants for the treatment of Sanfilippo type A disease are under investigation. Coverage: The patent literature after the mid-1990s.

EXPERT OPINION:

The failure of STX64 in a Phase II monotherapy clinical trial should not dissuade further investigations in multidrug regimens, particularly in combination with AIs. The recent development of dual-acting compounds may enhance the potential for success in the clinic. Further investigations into aryl sulfamates are required to clarify the molecular mechanism of action; additionally, new reversible sulfatase inhibition concepts are needed for the development of pharmacological chaperones for sulfatase LSDs.

 

 

Emerg Med Clin North Am. 2012 Nov;30(4):991-1006. doi: 10.1016/j.emc.2012.08.010.

Emergency evaluation and management of vaginal bleeding in the nonpregnant patient.

Cirilli AR1Cipot SJ.

 

Abstract

Evaluation of the nonpregnant patient presenting to the emergency department with vaginal bleeding requires the emergency physician to be aware of the potential for a variety of underlying causes. Patients with vaginal bleeding may have non-life-threatening problems such as fibroids, endometriosis, or treatable sexually transmitted diseases such as gonorrhea and chlamydial infection. However, care must be taken to differentiate these from more serious causes of pelvic pain and bleeding such as ectopic pregnancy, hemorrhagic cyst, ovarian torsion, and rare complications from fibroids such as intraperitoneal hemorrhage. Abnormal bleeding unrelated to structural problems could have an anovulatory or ovulatory cause.

 

 

 

Hum Immunol. 2013 Feb;74(2):215-8. doi: 10.1016/j.humimm.2012.10.025. Epub 2012 Nov 5.

Association between two single nucleotide polymorphisms of PDCD6 gene and increased endometriosis risk.

Shi S1Zhou BZhang KZhang L.

 

Abstract

Programmed cell death 6 (PDCD6), a calcium binding protein of the penta EF-hand protein family, and its receptors are involved in regulation of apoptosis pathways. To evaluate the relationship between genetic polymorphisms of PDCD6 gene and endometriosis (ED) risk, we investigated the association of two single nucleotide polymorphisms (SNPs) of PDCD6 gene (rs4957014 and rs3756712) in 220 endometriosis patients and 386 unrelated healthy controls. The genotypes of these two SNPs were determined by using polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) and DNA sequencing methods. Significantly increased endometriosis risk was observed to be associated with G allele of rs4957014 locus (OR=1.31, 95% CI=1.03-1.69). We have also observed increased ED risk was statistically associated with rs4957014 polymorphism in a dominant model (OR=1.52, 95% CI=1.09-2.13). Although no association has been found between ED risk and the allele frequencies of rs3756712 locus (a marginal P=0.066, OR=1.27, 95% CI=0.98-1.65), but in a dominant model, increased endometriosis risk was significantly associated with rs3756712 polymorphism (OR=1.54, 95% CI=1.11-2.17). In conclusion, the current study indicates that PDCD6 gene may be a new susceptibility gene to endometriosis.

 

 

 

PLoS One. 2012;7(11):e47374. doi: 10.1371/journal.pone.0047374. Epub 2012 Nov 6.

Functional analyses of endometriosis-related polymorphisms in the estrogen synthesis and metabolism-related genes.

Wang HS1Wu HMCheng BHYen CFChang PYChao ALee YSHuang HDWang TH.

 

Abstract

Endometriosis is determined by genetic factors, and the prevalence of genetic polymorphisms varies greatly depending on the ethnic group studied. The objective of this study was to investigate the relationship between single nucleotide polymorphisms (SNPs) of 9 genes involved in estrogen biosynthesis and metabolism and the risks of endometriosis. Three hundred patients with endometriosis and 337 non-endometriotic controls were recruited. Thirty four non-synonymous SNPs, which change amino acid residues, were analyzed using matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS). The functions of SNP-resulted amino acid changes were analyzed using multiple web-accessible databases and phosphorylation predicting algorithms. Among the 34 NCBI-listed SNPs, 22 did not exhibit polymorphism in this study of more than 600 Taiwanese Chinese women. However, homozygous and heterozygous mutants of 4 SNPs – rs6165 (genotype GG+GA, 307(Ala/Ala)+307(Ala/Thr)) of FSHR, rs 6166 (genotype GG+GA, 680(Ser/Asn)+680(Ser/Ser)) of FSHR, rs2066479 (genotype AA+AG, 289(Ser/Ser)+289(Ser/Gly)) of HSD17B3 and rs700519 (genotype TT+TC, 264(Cys/Cys)+264(Cys/Arg)) of CYP19, alone or in combination, were significantly associated with decreased risks of endometriosis. Bioinformatics results identified 307(Thr) of FSHR to be a site for O-linked glycosylation, 680(Ser) of FSHR a phosphorylated site by protein kinase B, and 289(Ser) of HSD17B3 a phosphorylated site by protein kinase B or ribosomal protein S6 kinase 1. Results of this study suggest that non-synonymous polymorphisms of FSHR, HSD17B3 and CYP19 genes may modulate the risk of endometriosis in Taiwanese Chinese women. Identification of the endometrosis-preferential non-synonymous SNPs and the conformational changes in those proteins may pave the way for the development of more disease-specific drugs.

 

J Med Assoc Thai. 2012 Sep;95(9):1136-40.

Prevalence of endometriosis among patients with adenomyosis and/or myoma uteri scheduled for a hysterectomy.

Naphatthalung W1Cheewadhanaraks S.

 

Abstract

OBJECTIVE:

To estimate the prevalence of endometriosis among patients between 40 and 50-years-old that required a hysterectomy with an indication of adenomyosis and/or myoma uteri.

MATERIAL AND METHOD:

This cross-sectional study was conducted in a university hospital. Two hundred twenty consecutive premenopausal women, aged 40 to 50-years-old, with symptomatic adenomyosis and/or myoma uteri, and scheduled for a total abdominal hysterectomy were enrolled. During laparotomy, a systematic inspection of the pelvis was carried out to identify endometriosis.

RESULTS:

The presence of endometriosis was observed in 63 (28.6%) of 220 patients. The prevalence of endometriosis was 19 in 47 (40.4%) patients with adenomyosis, 30 in 132 (22.7%) patients with leiomyomas, and 14 in 41 (34.1%) patients with adenomyosis and leiomyomas. The rate of coexistence of endometriosis in the women with adenomyosis was statistically significantly higher than in the patients with leiomyomas (p-value = 0.032). Younger age, moderate-severe pain, and short menstrual interval were shown to be independent risk factors for endometriosis among these patients.

CONCLUSION:

The prevalence of endometriosis in the women with adenomyosis was higher than in those with leiomyomas.

 

 

 

Zhonghua Fu Chan Ke Za Zhi. 2012 Jul;47(7):522-5.

Relationship of polymorphisms of AhR -1661G/A with GSTP1 -313A/G and susceptibility to endometriosis.

Wang YF1Zong LLMao TWang YFFu YGZeng JRao XQ.

 

Abstract

OBJECTIVE:

To investigate the association of polymorphisms of arylhydrocarbon receptor (AhR)-1661G/A with glutathione S-transferase pi (GSTP1) -313A/G and the susceptibility to endometriosis in southern Han Chinese.

METHODS:

Total of 432 endometriosis patients undergoing laparoscopic or laparotomy surgery matched with 493 patients with fallopian tube ligation, tubal recanalization, laparoscopic hydrotubation, benign ovarian tumor and teratoma surgeries without endometriosis as control group were enrolled in this study. The single nucleotide polymorphism (SNP) of AhR -1661G/A and GSTP1 -313A/G were detected by using a fluorescent quantitative PCR-based high resolution melting (HRM).

RESULTS:

The numbers of combined genotypes AhR -1661G/A and GSTP1 -313A/G were 120 patients with AG + AA, 64 patients with AG + AG, 8 patients with AG + GG, 109 patients with GG + AA, 84 patients with GG + AG, 4 patients with GG + GG, 31 patients with AA + AA, 10 patients with AA + AG, 1 patient with AA + GG at endometriosis group and 131 patients with AG + AA, 68 patients with AG + AG, 6 patients with AG + GG, 157 patients with GG + AA, 66 patients with GG + AG, 4 patients with GG + GG, 35 patients with AA + AA, 20 patients with AA + AG, 3 patients with AA + GG at endometriosis group. There was no statistically different frequencies of genotypes between endometriosis group and control group (χ(2) = 12.558, P = 0.128). Compared with genotype GG + AA, the risk of endometriosis with genotype GG + AG was increased 1.833 time (95%CI: 1.233 – 2.274).

CONCLUSION:

The combined genotype GG + AG [from AhR -1661G/A (GG) and GSTP1 -313A/G (AG)] might be related with susceptibility to endometriosis.

 

 

Zhonghua Fu Chan Ke Za Zhi. 2012 Aug;47(8):603-7.

Efficacy of conservative laparoscopic surgery combined with goserelin in treatment of 206 patients with severe ovarian endometriosis at short-term and long-term follow-up.

Ge CX1Zhu XHTang XQ.

 

Abstract

OBJECTIVE:

To evaluate the short-term and long-term efficacy of conservative laparoscopic surgery combine with goserelin in treatment of severe ovarian endometriosis.

METHODS:

From January 2004 to December 2008, 206 patients with severe ovarian endometriosisunderwent laparoscopy surgery in Nanjing Drum Tower Hospital, Affiliated Nanjing University Medical School were enrolled in this retrospective study. According to the revised classification American Fertility Society (r-AFS), 123 (123/206, 59.7%) cases were at stage III and 83 (83/206, 40.3%) patients were at stage IV. Among 138 cases presented pelvic pain. All the patients underwent laparoscopic cystectomy, of which 117 patients with childbearing preserving underwent hysteroscopy and hydrotubation examination, including 7 cases with bilateral salpingectomy, 2 cases with bilateral tubal obstruction and 108 cases with normal reproduction. After surgery, all cases were administered by goserelin treatment at dose of 3.6 mg per 28 days for 3 to 6 months. At 1 to 5 years following up, pelvic pain, pregnancy and recurrence were observed, those factors associated with pregnancy rate and endometriosis recurrence were analyzed.

RESULTS:

(1) Pelvic pain: complete remission rate of pelvic pain was 76.1% (105/138) at 1 to 5 years after surgery. (2) Pregnancy: total pregnancy rate was 70.4% (76/108), spontaneous pregnancy rate was 68.8% (66/96) and pregnant rate of in vitro fertilization and embryo transfer (IVF-ET) was 10/12. Pregnancy rate at 1 year was 57.3% (55/96) and accounting for 83.3% (55/66) in all pregnant women. Live birth rates of spontaneous pregnant and IVF-ET were 86.4% (57/66) and 9/10, respectively. (3) Recurrence: the total recurrence rate was 8.3% (17/206) at 1 to 5 years. The recurrence rates and the cumulative recurrence rates were 3.9% (8/206) and 3.9% (8/206) at the first year after operation, 2.0% (3/149) and 6.7% (10/149) at the second year, 1.0% (1/99) and 8.0% (8/99) at the third year, 10.9% (5/46) and 17.4% (8/46) at the fourth year, 0 and 2/18 at the fifth year, respectively.

CONCLUSION:

It was suggested that conservative laparoscopic surgery combined with goserelin in treatment of stage III or IV ovarian endometriosis could reduce the recurrence risk of severe ovarian endometriosis and improve the pregnant rate of endometriosis-associated infertility.

 

 

 

J Med Genet. 2013 Jan;50(1):43-6. doi: 10.1136/jmedgenet-2012-101257. Epub 2012 Nov 9.

An Italian association study and meta-analysis with previous GWAS confirm WNT4, CDKN2BAS and FN1 as the first identified susceptibility loci for endometriosis.

Pagliardini L1Gentilini DVigano’ PPanina-Bordignon PBusacca MCandiani MDi Blasio AM.

 

Abstract

BACKGROUND:

Although endometriosis may benefit from primary prevention measures, the epidemiological risk factors identified are equivocal. Two genome-wide association studies (GWAS) have been conducted for endometriosis in two different ethnic populations but results are still to be replicated consistently and across various ethnicities. To confirm the association of GWAS-derived susceptibility loci, we conducted a replication Italian case-control study and a meta-analysis.

METHODS:

An independent set of 305 laparoscopically-proven endometriosis patients and 2710 controls were recruited. Four SNPs-CDKN2BAS rs1333049, rs7521902 close to WNT4, rs12700667 in an inter-genic region on 7p15.2 and fibronectin 1 rs1250248-were selected for this association study.

RESULTS:

Rs1333049 risk allele G frequency resulted significantly higher in endometriosis patients compared with controls (OR 1.32, 95% CI 1.11 to 1.57), confirming the role of this locus also in the Caucasian population. The meta-analysis showed that rs7521902 was associated with endometriosis at a genome-wide significance (p(meta)=2.23×10(-9)) while for rs1250248, a genome-wide significant p(meta) value of 3.89×10(-9) was detected only in association with severe forms. An epistatic interaction between rs7521902 and rs1250248 (OR 1.56, p=1.19×10(-2)) was found especially in presence of ovarian disease (OR=2.15, p=3.12×10(-4)).

 

 

 

Gynecol Surg. 2012 Nov;9(4):365-368. Epub 2012 Aug 24.

Prevention of adhesions in gynaecological surgery: the 2012 European field guideline.

De Wilde RL1Brölmann HKoninckx PRLundorff PLower AMWattiez AMara MWallwiener MThe Anti-Adhesions in Gynecology Expert Panel (ANGEL).

 

Abstract

Postoperative adhesions have become the most common complication of open or laparoscopic abdominal surgery and a source of major concern because of their potentially dramatic consequences. The proposed guideline is the beginning of a major campaign to enhance the awareness of adhesions and to provide surgeons with a reference guide to adhesion prevention adapted to the conditions of their daily practice. The risk of postoperative adhesions should be systematically discussed with any patient scheduled for open or laparoscopic abdominal surgery prior to obtaining her informed consent. Surgeons should adopt a routine adhesion reduction strategy with good surgical technique. Anti-adhesion agents are an additional option, especially in procedures with a high risk of adhesion formation, such as ovarian, endometriosis and tubal surgery and myomectomy. We conclude that good surgical practice is paramount to reduce adhesion formation and that anti-adhesion agents may contribute to adhesion prevention in certain cases.

 

 

 

Gynecol Obstet Invest. 2013;75(1):9-15. doi: 10.1159/000343748. Epub 2012 Nov 8.

Gonadotropin-releasing hormone analogues reduce the proliferation of endometrial stromal cells but not endometriotic cells.

Taniguchi F1Higaki HAzuma YDeura IIwabe THarada TTerakawa N.

 

Abstract

AIMS:

We investigated the potential of gonadotropin-releasing hormone (GnRH) agonists and GnRH antagonists to inhibit cell proliferation in endometriotic and endometrial stromal cells.

METHODS:

Twenty patients with ovarian endometriomas and 18 patients with uterine fibromas were recruited. Endometriotic and endometrial stromal cells were obtained from the ovarian chocolate cyst linings and the eutopic endometria of premenopausal women with uterine fibromas, respectively.

RESULTS:

GnRH agonist or antagonist treatment attenuated tumor necrosis factor (TNF)-α-induced cell proliferation in the endometrial stromal cells, whereas endometriotic stromal cells did not respond to treatment. The endometriotic stromal cells exhibited a decreased expression of the type I GnRH receptor compared with the endometrial stromal cells. GnRH agonists or antagonists did not repress TNF-α-induced IL-8 production in endometriotic stromal cells.

CONCLUSION:

GnRH agonists and antagonists have similar effects in slowing the growth of endometrial stromal cells. Endometriotic stromal cells resist the antiproliferative effect of GnRH agonists and antagonists.

 

 

 

Reproduction. 2013 Jan 24;145(2):119-26. doi: 10.1530/REP-12-0386. Print 2013 Feb.

Anastrozole and celecoxib for endometriosis treatment, good to keep them apart?

Olivares CN1Bilotas MARicci AGBarañao RIMeresman GF.

 

Abstract

Endometriosis is a benign gynecological disease. Cyclooxygenase-2 (COX-2) and aromatase proteins have been shown to be overexpressed in eutopic endometrium from women suffering from this disease compared to disease-free women. Furthermore, inhibition of these molecules individually was demonstrated to have antiproliferative and proapoptotic effects both in vitro and in vivo in several models. In this study, the effect of combining celecoxib, a selective COX-2 inhibitor, and anastrozole, an aromatase inhibitor, on the implantation and growth of endometriotic like lesions in a murine model of endometriosis was evaluated. Endometriosiswas surgically induced in female BALB/c mice. After 28 days of treatment with celecoxib, anastrozole, or their combination, animals were killed and lesions were counted, measured, excised, and fixed. Immunohistochemistry for proliferating cell nuclear antigen and CD34 was performed for assessment of cell proliferation and vascularization. TUNEL technique was performed for apoptosis evaluation. Celecoxib was the only treatment to significantly reduce the number of lesions established per mouse, their size and vascularized area. In addition, cell proliferation was significantly diminished and apoptosis was significantly enhanced by both individual treatments. When the therapies were combined, they reversed their effects. These results confirm that celecoxib and anastrozole separately decrease endometriotic growth, but when combined they might have antagonizing effects.

 

 

 

Hum Reprod. 2013 Feb;28(2):509-18. doi: 10.1093/humrep/des394. Epub 2012 Nov 11.

Sequential comprehensive chromosome analysis on polar bodies, blastomeres and trophoblast: insights into female meiotic errors and chromosomal segregation in the preimplantation window of embryo development.

Capalbo A1Bono SSpizzichino LBiricik ABaldi MColamaria SUbaldi FMRienzi LFiorentino F.

 

Abstract

STUDY QUESTION:

What is the optimal stage from oocyte through preimplantation embryo development for biopsy and preimplantation genetic screening (PGS) to detect abnormal chromosome segregation patterns in eggs or embryos from advanced maternal age (AMA) patients?

SUMMARY ANSWER:

Testing at the polar body (PB) stage was the least accurate mainly due to the high incidence of post-zygotic events. This suggests that postponing the time of biopsy to the blastocyst stage of preimplantation embryo development may provide the most reliable results for PGS.

WHAT IS KNOWN ALREADY:

In the PGS field there is an ongoing debate about the optimal biopsy stage for PGS. This is a result of the lack of understanding of how aneuploidy arises in the human embryo. To date, most of the cytogenetic data obtained during PGS investigations have been derived through the analysis of cells at isolated points in the preimplantation window, thus potentially missing critical information on chromosomal segregation. Understanding the chromosome segregation patterns during preimplantation development holds the potential to significantly increase the success rates of IVF. In this study, a sequential comprehensive chromosome analysis of both the PBs and the corresponding embryos at both the cleavage and the blastocyst stages is presented.

STUDY DESIGN, SIZE, DURATION:

This is a prospective longitudinal cohort study performed between October 2009 and August 2011 involving 9 infertile couples and 21 sets of complete comprehensive chromosomal screening data, including PB1, PB2, corresponding blastomeres and trophectoderm (TE) samples.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Infertile couples undergoing IVF cycles with PGS where the female partner was older than 40 years and with a good response to controlled ovarian stimulation (>10 MII oocytes retrieved) were enrolled into the study. The exclusion criteria were (i) patients presenting with abnormal karyotype; (ii) specific ovarian pathologies including polycystic ovary syndrome, endometriosisgrade III or higher and premature ovarian failure and (iii) severe male factor infertility (motile sperm count of <500 000/ml after preparation of a fresh ejaculate). The PBs, blastomere and TE samples were sequentially biopsied and analyzed by array comparative genomic hybridization (aCGH). The analysis of chromosome segregation patterns was performed to infer the origin of aneuploidy and to investigate the diagnostic accuracy of both PB and cleavage-stage PGS strategies.

MAIN RESULTS AND THE ROLE OF CHANCE:

Twenty-one sets of complete data (PB1/PB2/blastomere/TE) including 84 aCGH experiments showed a pattern of multiple meiotic errors typically caused by sister chromatid separation errors and predominantly arising in the second meiotic division. Twenty-two of the 24 (91.7%) errors in the first meiotic division arose as a consequence of premature sister chromatid predivision. In half of these cases, the second meiotic division resulted in a balancing chromosome segregation event producing a normal female complement for that chromosome in the resulting embryo. Overall, only 62 out of 78 (79.5%) of the abnormal meiotic segregations had errors in the either one or both PBs consistent with the aneuploidies observed in their resulting embryos. Ten of the 21 (47.6%) embryos had aneuploidies other than female meiotic-derived ones, most of which detected on Day 3 and confirmed on Day 5 or 6 of embryo development (20/25) with chromosomal loss being three times more frequent than gains. Notably, as high as 20% of female-derived aneuploidies detected on PBs and confirmed on Day 3 were rescued at the blastocyst stage, mainly as a result of diploidization of trisomic chromosomes. On a per chromosome basis, the sensitivity in predicting blastocyst chromosomal complement was significantly lower for PB approach, 61.7%, compared with blastomeres analysis, 86.4% (P < 0.01).

LIMITATIONS, REASONS FOR CAUTION:

The study was limited to the analysis of oocytes and embryos from AMA patients. Thus, these findings apply only to this patient group. Comparisons with other patient populations including patients with different indications for PGS should be made in future research. In addition, higher resolution and/or more accurate chromosomal screening tests could be used in future studies to corroborate the current findings.

WIDER IMPLICATIONS OF THE FINDINGS:

These findings provide critical insights into the mechanisms causing errors during female meiosis and the preimplantation embryo development period to improve the design and treatment outcome of PGS.

 

 

 

Fertil Steril. 2013 Mar 1;99(3):783-789.e3. doi: 10.1016/j.fertnstert.2012.10.032. Epub 2012 Nov 10.

Induction of endometriotic nodules in an experimental baboon model mimicking human deep nodular lesions.

Donnez O1Van Langendonckt ADefrère SColette SVan Kerk ODehoux JPSquifflet JDonnez J.

 

Abstract

OBJECTIVE:

To establish an experimental model for the study of deep nodular endometriosis.

DESIGN:

Induction of nodular endometriosis in baboons by grafting different uterine specimens to the peritoneal cavity.

SETTING:

Research and university facilities.

ANIMAL(S):

Ten baboons, to develop a model of induced deep nodular endometriosis.

INTERVENTION(S):

Biopsies of endometrium, and endometrium plus the junctional zone (JZ), full uterine thickness, and myometrium grafted to the peritoneum.

MAIN OUTCOME MEASURE(S):

Macroscopic descriptions recorded for observed induced lesions; staining with hematoxylin and eosin for histological evaluation and specific antibodies (CK22, CD10) for immunohistochemical studies; and analysis of surface area and volume of lesions, glandular density, and invasion of surrounding organs.

RESULT(S):

The incidence of induced nodular endometriosis was 100%, but the extent depended on the tissue grafted. Lesions induced after grafting specimens containing the JZ were statistically significantly larger than those not containing the JZ. Surrounding organ invasion was reported in more than 40% of lesions after grafting specimens containing the JZ.

CONCLUSION(S):

The first experimental model of nodular endometriosis allows investigation of deeper nodular lesions as well as invasion phenomena associated with nodular lesions.

 

 

Radiographics. 2012 Nov-Dec;32(7):2031-43. doi: 10.1148/rg.327125024.

Endometriosis of abdominal and pelvic wall scars: multimodality imaging findings, pathologic correlation, and radiologic mimics.

Gidwaney R1Badler RLYam BLHines JJAlexeeva VDonovan VKatz DS.

 

Abstract

Implantation of an endometriotic lesion within a pelvic or abdominal wall scar is an uncommon but well-described condition that may be the underlying cause of acute or chronic recurrent abdominal or pelvic pain, especially after cesarean section. Radiologists may not consider scar endometriosis when it is encountered at cross-sectional imaging. Cesarean section scars are the most common site of extraovarian or extrauterine endometriosis. The condition also has been identified in other uterine surgery-related scars and in the skin, subcutaneous tissues, and abdominal and pelvic wall musculature adjacent to these scars. The most plausible cause of scar endometriosis is implantation of endometrial stem cells at the surgical site at the time of uterine surgery. Patients with scar endometriosis may be asymptomatic or present with cyclical pain corresponding to the menstrual cycle. Cross-sectional imaging findings vary from the nonspecific to those suggestive of the diagnosis when combined with clinical history. In particular, the presence of blood products in an anterior abdominal wall mass at magnetic resonance (MR) imaging with no other explanation is strongly suggestive of scar endometriosis. Ultrasonography, computed tomography, and MR imaging may be used to depict an endometriotic lesion, exclude endometriosis, or provide evidence for an alternative diagnosis.

 

 

Neuroimmunomodulation. 2013;20(1):9-18. doi: 10.1159/000342163. Epub 2012 Nov 14.

Neuroimmunomodulatory alterations in non-lesional peritoneum close to peritoneal endometriosis.

Arnold J1Vercellino GFChiantera VSchneider AMechsner SBarcena de Arellano ML.

 

Abstract

OBJECTIVES:

An imbalance in the ratio of sensory to sympathetic nerve fibre (NF) density in peritoneal endometriotic lesions (pEL) has recently been demonstrated and leads to the assumption that this preponderance of the sensory pro-inflammatory milieu is a major cause of pain in endometriosis. Therefore, the density of sensory and sympathetic NFs was determined in distal unaffected peritoneum of endometriosispatients to be able to detect possible alterations in unaffected peritoneum.

METHODS:

In serial pEL sections (n = 40), lesional and matching unaffected peritoneum as well as healthy peritoneum (HP) from patients without endometriosis (n = 15) were immunohistochemically analysed to identify protein gene product 9.5-, substance P- and tyrosine hydroxylase-positive NFs (intact, sensory and sympathetic NFs, respectively). In addition, the amount of immune cell infiltrates and the expression of nerve growth factor (NGF) and interleukin (IL)-1β in nerves of peritoneal endometriotic specimens were compared to those in the HP.

RESULTS:

The overall NF density in the non-lesional, unaffected peritoneum of endometriosis patients is significantly reduced in comparison to both HP and pEL, while sensory NFs remain the same; the sympathetic NF density is significantly decreased compared to HP, but is still higher than the density close to the pEL. Immune cell infiltrates as well as NGF and IL-1β expression in nerves is significantly elevated in distal unaffected peritoneum in comparison to HP.

CONCLUSION:

The altered NF density in the non-lesional, unaffected peritoneum of endometriosis patients suggests new aspects in the understanding of the development of endometriosis and pain management in endometriosis.

 

 

Clin Exp Obstet Gynecol. 2012;39(3):379-81.

Peritoneal enterobiasis causing endometriosis-like symptoms.

Reipen J1Becker CWilliam MHemmerlein BFriedrich MSalehin D.

 

Abstract

PURPOSE:

Enterobiasis is the most common parasitic disease of the temperate zones and infects the human intestinal tract. In rare cases extraintestinal infections with Enterobius vermicularis may occur and can affect the female genital tract and peritoneal cavity. In most cases the infection is asymptomatic, but there are also cases described in which peritoneal enterobiasis can cause abdominal pain.

METHODS:

A case report and review of the pertinent literature.

RESULTS:

A 32-year-old patient was admitted with cyclical lower abdominal pain. With suspected endometriosis a diagnostic autofluorescence laparoscopy (DAFE) was performed. At surgery extensive peritoneal deposits were seen. Macroscopically these deposits were not typical for endometriosis. The histological examination showed granuloma caused by E. vermicularis eggs. The patient was treated with mebendazole. After completion of treatment the patient was asymptomatic. At the second-look laparoscopy no more peritoneal changes were detected.

CONCLUSION:

Enterobius vermicularis may cause symptoms similar to endometriosis. In cases with reasonable suspicion it should therefore be considered in the differential diagnosis.

 

 

 

J Am Chem Soc. 2013 Feb 6;135(5):1645-8. doi: 10.1021/ja307866z. Epub 2012 Nov 29.

Multiplexed protease activity assay for low-volume clinical samples using droplet-based microfluidics and its application to endometriosis.

Chen CH1Miller MASarkar ABeste MTIsaacson KBLauffenburger DAGriffith LGHan J.

 

Abstract

As principal degrading enzymes of the extracellular matrix, metalloproteinases (MPs) contribute to various pathologies and represent a family of promising drug targets and biomarker candidates. However, multiple proteases and endogenous inhibitors interact to govern MP activity, often leading to highly context-dependent protease function that unfortunately has impeded associated clinical utility. We present a method for rapidly assessing the activity of multiple specific proteases in small volumes (<20 μL) of complex biological fluids such as clinical samples that are available only in very limited amounts. It uses a droplet-based microfluidic platform that injects the sample into thousands of picoliter-scale droplets from a barcoded droplet library (DL) containing mixtures of unique, moderately selective FRET-based protease substrates and specific inhibitors and monitors hundreds of the reactions thus initiated simultaneously by tracking these droplets. Specific protease activities in the sample are then inferred from the reaction rates using a deconvolution technique, proteolytic activity matrix analysis (PrAMA). Using a nine-member DL with three inhibitors and four FRET substrates, we applied the method to the peritoneal fluid of subjects with and without the invasive disease endometriosis. The results showed clear and physiologically relevant differences with disease, in particular, decreased MMP-2 and ADAM-9 activities.

 

 

Chin Med J (Engl). 2012 Nov;125(22):3985-90.

Follicular fluid levels of prostaglandin E2 and the effect of prostaglandin E2 on steroidogenesis in granulosa-lutein cells in women with moderate and severe endometriosis undergoing in vitro fertilization and embryo transfer.

Wang J1Shen XXHuang XHZhao ZM.

 

Abstract

BACKGROUND:

The mechanisms of endometriosis with infertility have not been fully studied. The present study aimed to assess the follicular fluid (FF) levels of prostaglandin E2 (PGE2), which plays a critical role within the ovary, and to investigate the effect of PGE2 on steroidogenesis in granulosa-lutein cells (GLCs) from women with and without endometriosis.

METHODS:

Thirty-three women with laparoscopically documented endometriosis and 40 controls undergoing in vitro fertilization (IVF) were studied. We assayed the concentrations of PGE2 in FF, the production of E2 and progesterone in FF and in culture medium, and the expression of steroidogenic acute regulatory protein (StAR) and CYP19A1 in GLCs with the intervention of PGE2.

RESULTS:

PGE2 and progesterone concentrations were increased and displayed positive correlation in endometriotic FF. PGE2 induced the expression of StAR and the production of progesterone in GLCs from women with endometriosis, and the expression of StAR and the production of progesterone were increased in GLCs from women with endometriosis. However, there were no significant effects of PGE2 on promoting the production of E2 or the expression of CYP19A1 in GLCs. Moreover, the production of E2 and the expression of CYP19A1 in GLCs from women with endometriosis were significantly decreased compared to the controls.

CONCLUSIONS:

PGE2 concentrations are increased in endometriotic FF, along with concomitant increases in progesterone and StAR. In contrast, the E2 and CYP19A1 are decreased in GLCs, which may delay the development of the follicles and cause an imbalance in the follicular steroid hormone levels. These changes may have close relationship with endometriosis-associated infertility.

 

 

J Pediatr Adolesc Gynecol. 2013 Feb;26(1):e1-4. doi: 10.1016/j.jpag.2012.06.005. Epub 2012 Nov 15.

Tubal endometrioma within a twisted fallopian tube: a clinically complex diagnosis.

Wenger JM1Soave ILo Monte GPetignat PMarci R.

 

Abstract

BACKGROUND:

Endometriotic lesions affect the fallopian tubes in 6% of patients with endometriosis and adhesions involve the salpinges in 26%. Different studies report that 45%-70% of adolescents with chronic pelvic pain have endometriosis diagnosed at the time of laparoscopy.

CASE:

We report a case of an 18-year-old girl with a tubal torsion due to a tubal endometrioma. The endometriotic nodule before laparoscopy appeared to be located in the rectovaginal septum. At laparoscopy, a right fallopian tube torsion was visible and several adhesions were connecting the lesion to the pouch of Douglas’ walls.

SUMMARY AND CONCLUSION:

The tenacious adhesions, which welded the nodule to the walls of the pouch of Douglas, did not allow to distinguish at the MRI a tubal endometrioma from a rectovaginal endometriotic mass, justifying the false diagnosis.

 

 

Zhonghua Zhong Liu Za Zhi. 2012 Sep;34(9):688-91. doi: 10.3760/cma.j.issn.0253-3766.2012.09.010.

Clinical features and drug resistance characteristics of ovarian clear cell adenocarcinoma and analysis of its prognostic factors.

Zhang CY1Guo HYLi HWen HWLiang XDQiao J.

 

Abstract

OBJECTIVE:

To investigate the clinical features and factors involved in the drug resistance and prognosis of ovarian clear cell adenocarcinoma (OCCA).

METHODS:

Forty-seven OCCA patients and 53 ovarian serous cyst adenocarcinoma (OSCA) patients were included in this study. Their clinical characteristics, drug resistance, and prognostic factors were analyzed.

RESULTS:

The onset age of OCCA was (49.09 + 11.80) years old, and that of OSCA was (55.51 + 1.38) year old. There were 53.3% (24/45) of OCCA and 98.0% (50/51) of OSCA patients who had elevated CA125 levels. There were 46.8% (22/47) of OCCA patients and 7.5% (4/53) of OSCA patients who suffered from endometriosis (EMS). The percentage of early stage (stage I and stage II) OCCA was 80.9% (38/47), and that of OSCA was 11.3% (6/53). A statistically significant difference was observed on all these aspects (P < 0.05). The percentage of drug resistant OCCA was 26.1% (12/46), and that of OSCA was 24.0% (12/50), with a non-significant difference (P = 0.814).Among the patients with advanced stage disease, the percentage of drug resistance was 87.5% (7/8) for OCCA, while that of OSCA was 25.0% (11/44), showing a statistically significant difference (P = 0.003). Multiple logistic regression analysis revealed that OCCA (OR = 21.774, 95%CI: 2.438 to 194.431) and advanced stage (OR = 58.329, 95%CI: 5.750 to 591.703) were independent risk factors of drug resistance in ovarian epithelial cancers. For the advanced stage patients, the median overall survival time of OCCA and OSCA were 11 and 29 months, respectively, with a statistically significant difference (P = 0.000). Cox survival analysis showed that OCCA, advanced stage, suboptimal surgery, fewer than 6 cycles of chemotherapy and drug resistance were all risk factors of OS in ovarian cancer patients (P < 0.05).

CONCLUSIONS:

The age of onset in OCCA patients is younger than that of OSCA patients. The proportion of combination with endometriosis (EMS) is higher, and more early stage disease is observed in OCCA patients. The percentage of drug resistant in OCCA is higher, especially in advanced stage patients. The prognosis of advanced stage OCCA patients is poorer than that of OSCA patients in advanced stage.

 

 

J Hum Reprod Sci. 2012 May;5(2):187-93. doi: 10.4103/0974-1208.101020.

Assessment of oocyte quality in polycystic ovarian syndrome and endometriosis by spindle imaging and reactive oxygen species levels in follicular fluid and its relationship with IVF-ET outcome.

Rajani S1Chattopadhyay RGoswami SKGhosh SSharma SChakravarty B.

 

Abstract

OBJECTIVES:

The aim of this study is to examine meiotic spindle in oocytes along with reactive oxygen species (ROS) levels in follicular fluid of women undergoing IVF and to correlate these findings with embryo quality and pregnancy outcome.

MATERIALS AND METHODS:

167 women aged 25-35 years with endometriosis (Group A), polycystic ovarian syndrome (PCOS) (Group B) and tubal block (Group C) were included. Long protocol downregulation using recombinant follicular stimulating hormone was used for ovarian stimulation. Aspirated follicular fluid containing mature oocytes were analyzed for ROS levels and the oocytes were assessed for the presence of meiotic spindle using Cri-Oosight™ Polscope. Fertilization, embryo quality, endometrial assessment, and final pregnancy outcome were assessed.

RESULTS:

Meiotic spindles were visualized in a higher proportion of mature oocytes retrieved from women with endometriosis (66%) as compared to those with PCOS (50.5%) and tubal block (62.3%). ROS levels were also observed to be significantly less in the follicular fluid of oocytes in women with endometriosis(Group A) as compared to the other two groups (P ≤ 0.001). However, pregnancy rates were observed to be lower in Group A (32%) than Groups B (39%) and C (44%), respectively. Within each group, oocytes with spindle visualization yielded a higher number of Grade 1 embryos (P < 0.05) as well as lower ROS levels in follicular fluid (P ≤ 0.001) as compared to those where spindle could not be visualized.

CONCLUSIONS:

There was good correlation between spindle imaging and ROS levels as reliable predictors of oocyte assessment. Women with endometriosis had low ROS levels and good spindle imaging results suggesting a possible role of endometrial receptivity accounting for lower pregnancy rates in these women. Poor oocyte quality, as reflected by higher mean ROS levels and low number of oocytes with spindle visualization, could be the factor impeding pregnancy in women with PCOS as compared to women with tubal block.

 

 

Rev Med Suisse. 2012 Oct 24;8(359):1998, 2000-2.

Endometriosis: an essential differential diagnosis of chronic pelvic pain.

Wenger JM1Zormpa MDällenbach PWeber L.

 

Abstract

In the context of chronic pelvic pain, endometriosis plays a significant role due to its frequency and its effects on the quality of women’s lives. It affects 3-10% of women of reproductive age. The clinical signs are part from chronic pelvic pain, dysmenorrhea, dyspareunia, urinary and digestive symptoms as well as infertility. The clinical signs and symptoms may vary and the clinical examination may be difficult to interpret for a physician who is not familiar with the condition. This explains the fact that it takes more time to make the diagnosis of endometriosis. Delay of diagnosis, multiple consultations and complex surgical procedures implicate physical and psychological suffering for the patient with serious complications. For all these reasons, the differential diagnosis of chronic pelvic pain in women should include endometriosis.

 

 

 

Am J Reprod Immunol. 2013 Jan;69(1):92-5. doi: 10.1111/aji.12034. Epub 2012 Nov 20.

A search to identify genetic risk factors for endometriosis.

Rotman C1Fischel LCortez GGreiss HRana NRinehart JCoulam CB.

 

Abstract

PROBLEM:

To search for molecular markers of endometriosis the following polymorphisms: p53 codon 72 Pro (apoptosis), TNF alpha-308 (inflammation), VEGF-1164AA (angiogenesis), and SOD2 (oxidative stress) were investigated.

METHOD OF STUDY:

Forty-two women-24 with surgically proven endometriosis and 18 with no endometriosisfound at the time of laparoscopy-had buccal swabs taken for DNA analyses of 4 gene polymorphisms including p53codon72, TNF-308 G/A, VEGF-1154G/A, SOD Ala16Val DNA. The frequencies of genotypes and alleles of these polymorphisms were compared between women with and without endometriosis.

RESULTS:

No specific gene mutation differences for the four genes tested nor differences in the frequencies of heterozygous and homozygous mutations were found between patients with endometriosis and controls. In addition, no differences in allelic frequencies of the four genetic polymorphisms were observed between patients with endometriosis and control.

CONCLUSION:

Endometriosis is not associated with gene mutations for p53codon72, TNF-308 G/A, VEGF-1154G/A, SOD Ala16Val.

 

 

AJR Am J Roentgenol. 2012 Dec;199(6):1410-5. doi: 10.2214/AJR.11.7898.

The value of pelvic MRI in the diagnosis of posterior cul-de-sac obliteration in cases of deep pelvic endometriosis.

Macario S1Chassang MNovellas SBaudin GDelotte JToullalan OChevallier P.

 

Abstract

OBJECTIVE:

The objective of our study was to define relevant MRI signs allowing preoperative diagnosis of posterior cul-de-sac obliteration in patients with deep pelvic endometriosis.

MATERIALS AND METHODS:

This retrospective study included patients who underwent pelvic MRI completed by a laparoscopic examination. Three radiologists performed the MRI review blinded and recorded the following signs: sign 1, retroflexed uterus; sign 2, retrouterine mass; sign 3, displacement of intraperitoneal fluid; sign 4, elevation of the fornix; and sign 5, adherence of bowel loops. Laparoscopic results provided the criterion standard for diagnosis of posterior cul-de-sac obliteration. The performance of MRI was evaluated by calculating the average sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI results of the two more experienced radiologists for each sign and for combinations of signs. Interobserver agreement for each sign and impression for posterior cul-de-sac obliteration were calculated for all radiologists.

RESULTS:

Sixty-three patients were included in the study. Posterior cul-de-sac obliteration was diagnosed in 43 patients at laparoscopy. The mean sensitivity, specificity, and accuracy of each sign and impression of posterior cul-de-sac obliteration were, respectively, as follows: sign 1, 24.4%, 77.5%, 41.3%; sign 2, 97.1%, 83.7%, 92.8%; sign 3, 95.0%, 88.7%, 93.1%; sign 4, 30.2%, 97.5%, 51.6%; sign 5, 83.7%, 91.2%, 86.1%; and impression of posterior cul-de-sac obliteration, 91.9%, 91.2%, 91.7%. Interobserver concordance varied from 0.26 to 0.81 with best results obtained with the combination of signs 2, 3, and 5. Best concordances for junior radiologist evaluations were obtained with assessment of sign 3.

CONCLUSION:

MRI allows posterior cul-de-sac obliteration diagnosis. Pelvic fluid displacement may be the sign with greatest utility when considering both diagnostic accuracy and interobserver agreement.

 

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