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Gene. 2013 Feb 15;515(1):49-55. doi: 10.1016/j.gene.2012.11.037. Epub 2012 Dec 10

Association between interleukin-10 promoter polymorphisms and endometriosis: a meta-analysis.

Fan W1Li SChen QHuang ZMa QXiao Z.



To investigate the influence of the interleukin-10 gene promoter polymorphisms on the susceptibility of endometriosis, we examined the association by performing a meta-analysis. The PubMed, Embase, HuGE Navigator and CNKI were searched to identify eligible studies. We then conducted a meta-analysis to examine the association between interleukin-10 gene promoter polymorphisms and endometriosis. Eight case-control studies which examined the association between the IL-10 gene promoter polymorphisms and the susceptibility to endometriosis were finally included in the meta-analysis. Meta-analysis of the IL-10 -592 A/C polymorphisms showed a significant increased risk of endometriosis in the overall and Asian population in all genetic models and allele contrast. However, meta-analysis of the IL-10 -1082 A/G and IL-10 -819 T/C polymorphisms showed no association with endometriosis in all genetic models and allele contrast in the overall and Asian population samples. In addition, there was not a significant association between the IL-10 -592 A/C gene promoter polymorphisms with the severity of endometriosis. In conclusion, this meta-analysis suggests that the IL-10 -592 A/C polymorphisms conferred susceptibility to endometriosis. However, no associations were found between the IL-10 -1082 A/G and -819 T/C polymorphisms and susceptibility to endometriosis. Further studies are required to elucidate these associations more clearly.


Exp Biol Med (Maywood). 2012 Nov;237(11):1350-8. doi: 10.1258/ebm.2012.012060

Stretch magnitude- and frequency-dependent cyclooxygenase 2 and prostaglandin E2 up-regulation in human endometrial stromal cells: possible implications in endometriosis.

Li X1Gong XZhu LLeng JFan QSun DLang JFan Y.



Endometriosis, with a prevalence rate ranging from 6% to 10%, is the major contributor to pelvic pain and subfertility, and considerably reduces the quality of life in affected women. However, the pathogenesis of this disease remains largely unknown. The present study aimed to uncover the role of hyperperistalsis in the pathogenesis of endometriosis, by exploring the response of human endometrial stromal cells (ESCs) to the cyclic stretch in vitro. ESCs isolated from 18 different endometrium biopsies undergoing hysterectomy for myoma were subjected to uniaxial cyclic stretches with different magnitude and frequency using the Uniaxial Tension System. Expression of cyclooxygenase-2 (COX-2) and microsomal prostaglandin E2 synthase-1 (mPGES-1) in stretched and unstretched ESCs were assessed by realtime quantitative polymerase chain reaction and Western blot. Production of prostaglandin E2 (PGE(2)) in the culture medium was measured by enzyme-linked immunosorbent assay. The cyclic stretch mimicking hyperperistalsis in endometriosis (5% elongation at 4 cycles/min) stimulated quick up-regulations of COX-2 and mPGES-1 simultaneously on both transcriptional and translational levels, and delayed PGE(2) overproduction was also noted in ESCs. As the stretch magnitude or frequency increased, so did overexpression of COX-2 and PGE(2) (P < 0.05). By contrast, the cyclic stretch mimicking physiological peristalsis (3% elongation at 2 cycles/min) did not induce significant COX-2, mPGES-1 or PGE(2) production within 12 h. Both COX-2 and mPEGS-1 are PGE(2) synthases, and the aberrant COX-2 and PGE(2) production play important roles in the pathogenesis of endometriosis. Therefore, the present findings revealed that increased stretch stimuli from the hyperperistalsis of endometriosis were capable of causing the aberrant COX-2 and PGE(2) expression in the endometrium by mechanotransduction, in a magnitude and frequency-dependent manner. It implied possible roles of hyperperistalsis in the pathogenesis of endometriosis, particularly in the view of COX-2 and PGE(2).



Ginecol Obstet Mex. 2012 Oct;80(10):637-43. Spanish.

Risk factors associated, diagnostic methods and treatment for endometriosis, used in clinical service endometriosis gynecology Hospital General de Mexico (2009-2011).

Guerrero Hernández A1Oropeza Rechy GGómez García E.



Endometriosis no ectopic endometrial stroma and glands. Have different risk factors. Four theories explain it: the theory of coelomic metaplasia, embryonic cell debris, deployment and immunological. Clinical data are pain and infertility. For the American Fertility Society (AFS) is divided into minimal, mild, moderate and severe. Diagnostic studies are antigen Ca 125, Magnetic Resonance, and abdominal ultrasound. The ideal method is direct visualization with histological confirmation. The medical and surgical treatment.


To determine the risk factors, diagnosis of Endometriosis and effectiveness of treatments used in clinical Endometriosis Gynecology Unit at the General Hospital of Mexico OD.


A descriptive, longitudinal and retrospective duration of 2 years 6 months in 30 patients diagnosed with endometriosis in the clinical treatment of Endometriosis General Hospital of Mexico OD.


The most affected age group was 21 to 25 years, the risk factors are Gesta 1, a resident of Mexico, Mullerian malformation. The symptom was dysmenorrhea. In 16 were diagnosed as a surgical finding and laparoscopically diagnosed.


It is important to study the risk factors. The diagnosis is made using clinical data, quantification of CA125 antigen and imaging studies. Medical treatment is indicated both in the preoperative as well as postoperative surgical treatment and seeks to eradicate the lesions.



Ginecol Obstet Mex. 2012 Oct;80(10):663-7. Review.

Mayer-Rokitansky-Küster-Hauser syndrome. A report of two cases.

Bautista-Gómez E1Morales-García VGalván Espinosa HFlores-Romero ALVásquez Santiago EPizarro Osorno N.



The Mayer-Rokitansky-Kuster-Hauser is a rare congenital anomaly characterized by lack of vaginal and uterine development variable and normal ovaries. It results from agenesis or hypoplasia Müller duct system. Cervicovaginal agenesis as part of the complex syndrome, is even rarer. We report two cases: adolescent patient with primary amenorrhea, cervicovaginal agenesis and chronic pelvic pain, and a 28-year-old patient with primary amenorrhea, congenital absence of uterus and vagina.




Biol Reprod. 2013 Mar 28;88(3):77. doi: 10.1095/biolreprod.112.100883. Print 2013 Mar.

Selective inhibition of prostaglandin E2 receptors EP2 and EP4 inhibits adhesion of human endometriotic epithelial and stromal cells through suppression of integrin-mediated mechanisms.

Lee J1Banu SKBurghardt RCStarzinski-Powitz AArosh JA.



Endometriosis is a chronic gynecological disease of reproductive age women characterized by the presence of functional endometrial tissues outside the uterine cavity. Interactions between the endometriotic cells and the peritoneal extracellular matrix proteins (ECM) are crucial mechanisms that allow adhesion of the endometriotic cells into peritoneal mesothelia. Prostaglandin E2 (PGE2) plays an important role in the pathogenesis of endometriosis. In previous studies, we have reported that selective inhibition of PGE2 receptors PTGER2 and PTGER4 decreases survival and invasion of human endometriotic epithelial and stromal cells through multiple mechanisms. Results of the present study indicates that selective inhibition of PTGER2- and PTGER4-mediated PGE2 signaling 1) decreases the expression and/or activity of specific integrin receptor subunits Itgb1 (beta1) and Itgb3 (beta3) but not Itgb5 (beta5), Itga1 (alpha1), Itga2 (alpha2), Itga5 (alpha5), and Itgav (alphav); 2) decreases integrin-signaling components focal adhesion kinase or protein kinase 2 (PTK2) and talin proteins; 3) inhibits interactions between Itgb1/Itgb3 subunits, PTK2, and talin and PTGER2/PTGER4 proteins through beta-arrestin-1 and Src kinase protein complex in human endometriotic epithelial cells 12Z and stromal cells 22B; and 4) decreases adhesion of 12Z and 22B cells to ECM collagen I, collagen IV, fibronectin, and vitronectin in a substrate-specific manner. These novel findings provide an important molecular framework for further evaluation of selective inhibition of PTGER2 and PTGER4 as potential nonsteroidal therapy to expand the spectrum of currently available treatment options for endometriosis in child-bearing age women.




Fertil Steril. 2013 Mar 1;99(3):738-744.e4. doi: 10.1016/j.fertnstert.2012.11.028. Epub 2012 Dec 11.

Effect of oxygen concentration on human embryo development evaluated by time-lapse monitoring.

Kirkegaard K1Hindkjaer JJIngerslev HJ.



To evaluate, using time-lapse monitoring, the temporal influence of culture in 5% O2 or 20% O2 on human embryonic development.


Retrospective cohort study.


University-based fertility clinic.


In vitro fertilized embryos from women aged <38 years with no endometriosis and ≥8 oocytes retrieved.


Culture in 20% O2 exclusively (group 1), 20% and 5% O2 combined (group 2), or 5% O2 exclusively (group 3).


Developmental rates and timing of developmental stages.


The timing of the third cleavage cycle was delayed for embryos cultured in 20% O2 (group 1) compared with embryos cultured in 5% O2 (groups 2 and 3). No difference was observed in timing of the early and full blastocyst stages. More embryos in groups 2 and 3 reached the 8-cell, early blastocyst, and full blastocyst stages than in group 1. We found that embryos in group 3 (5% O2) reached the 8-cell stage faster than embryos in group 2 (5% + 20% O2), but none of the other parameters (i.e., other time points, cumulative development, and embryo score) differed between the two groups.


Culture in 20% O2 reduces developmental rates and delays completion of the third cell cycle. The delayed development after culture in atmospheric oxygen was seen in the precompaction embryo only and therefore appears to be stage specific.



Diagn Interv Imaging. 2013 Jan;94(1):3-25. doi: 10.1016/j.diii.2012.10.012. Epub 2012 Dec 12.

An update on adenomyosis.

Levy G1Dehaene ALaurent NLernout MCollinet PLucot JPLions CPoncelet E.



Adenomyosis is a common benign uterine pathology that is defined by the presence of islands of ectopic endometrial tissue within the myometrium. It is asymptomatic in one third of cases, but when there are clinical signs they remain non-specific. It can often be misdiagnosed on sonography as it may be taken to be multiple uterine leiomyomata or endometrial thickening, both of which have a different prognosis and treatment. Adenomyosis is often associated with hormone-dependent pelvic lesions (myoma, endometriosis, or endometrial hyperplasia). It is less commonly connected to infertility or obstetrical complications and indeed any direct relationship remains controversial. The purpose of imaging is to make the diagnosis, to determine the extent of spread (focal or diffuse, superficial or deep adenomyosis, adenomyoma), and to check whether there is any associated disease, in particular endometriosis. The aim of this article is to provide assistance in recognising adenomyosis on imaging and to identify the pathologies that are commonly associated with it in order to guide the therapeutic management of symptomatic patients. Pelvic ultrasonography is the first line investigation. Sonohysterography can assist with diagnosis in some cases (pseudothickening of the endometrium seen on sonography). MRI may be used in addition to sonography to back up the diagnosis and to look for any associated disease.



Am J Dermatopathol. 2013 Apr;35(2):254-60. doi: 10.1097/DAD.0b013e3182726e09.

Cutaneous inguinal scar endosalpingiosis and endometriosis: case report with review of literature.

Stojanovic M1Brasanac DStojicic M.



Endosalpingiosis and endometriosis represent ectopic growth of the fallopian tube epithelium and endometrial glands and stroma, respectively. Cutaneous endometriosis is a well-known entity, most often presented on scars after gynecological procedures. Cutaneous endosalpingiosis, however, appears to be a rare condition, with only 5 cases described in medical literature thus far. The authors report an unusual case of a woman with combined inguinal endosalpingiosis and endometriosis occurring in the cutaneous scar at the site of previously placed surgical drain, 10 years after myomectomy had been performed. The authors also provide an extensive review of medical literature in English regarding cutaneous endosalpingiosis and endometriosis and discuss their clinical, histopathological, and immunohistochemical features.



Hum Reprod. 2013 Mar;28(3):691-7. doi: 10.1093/humrep/des426. Epub 2012 Dec 18.

Translation and psychometric evaluation of the simplified Chinese-version Endometriosis Health Profile-30.

Jia SZ1Leng JHSun PRLang JH.



What are the psychometric properties in mainland China of the 30-item Endometriosis Health Profile (EHP-30) translated into simplified Chinese?


The simplified Chinese version of the EHP-30 is a valid, reliable and acceptable tool for the measurement of the health-related quality of life (HRQoL) of women with endometriosis in the context of mainland China.


Endometriosis can critically affect women’s HRQoL. The EHP-30 is currently the most reliable instrument to measure the HRQoL in women with endometriosis.


This cross-sectional study was conducted in a tertiary referral university hospital from February 2012 to August 2012 in Beijing, P. R. China.


The translation and cultural adaptation of the EHP-30 was performed according to accepted guidelines. The study included 336 women with endometriosis. Psychometric evaluation included factor analysis, convergent validity, measurement of internal consistency, item-total correlations and data completeness, descriptive statistics, and the determination of floor and ceiling effects.


Factor analysis confirmed the validity of the five-factor structure of the EHP-30 core questionnaire, which explained 79.51% of the total variance. The correlations of related subscale scores between EHP-30 and Short Form-36 were all significant. Cronbach’s α for internal consistency across each scale ranged 0.89-0.97 for the core questionnaire and 0.80-0.96 for the modular questionnaire. No <97.67% of data completeness was achieved. Floor effects were observed in three scales: self-image (19.64%), children (26.67%) and medical profession (15.19%). No ceiling effects were found. The control and powerlessness scale had the highest median score (54.17) in the core questionnaire, whereas the infertility module (median = 56.25) had the highest score in the modular section.


The study was conducted in a referral centre for the treatment of endometriosis, thereby leading to overrepresentation of severe symptoms of endometriosis. Furthermore, the test-retest reliability and responsiveness of the questionnaire were not evaluated in this study.


Our study addresses the urgent need for a valid and reliable instrument to measure the HRQoL of female patients with endometriosis in mainland China.


This work was supported by grants to J. Leng from the Key Project for Clinical Faculty Foundation, Ministry of Health, China (2010). None of the authors has any conflict of interest to declare.



J Med Assoc Thai. 2012 Nov;95(11):1389-95.

Ovarian reserve evaluation by anti-mullerian hormone in women undergoing laparoscopic cystectomy of endometrioma.

Suksompong S1Dejarkom SPetyim SDangrat COrachon DChoavaratana R.



To study the serial changes of serum AMH to determine ovarian reserve recovery after laparoscopic cystectomy of endometrioma.


Forty-three endometrioma patients who underwent laparoscopic cystectomy of endometrioma were tested for levels of serum AMH at preoperation, 1 week, and 3 months postoperation.


Median serum AMH was 2.11 ng/mL (range = 0.22 to 9.24 ng/mL) before surgery. This level also reduced at first week postoperation (p < 0.01) but did not reach a significant difference between the first week and the third month (1.02 ng/mL and 1.06 ng/mL, respectively). The recovery rate of AMH level in unilateral endometrioma was higher than bilateral endometrioma (32.4% vs. -3.6%, p = 0.02).


Ovarian reserve was decreased after laparoscopic cystectomy of endometrioma and did not significantly restore after three months of postoperation. The recovery of ovarian reserve after unilateral endometriotic cystectomy was faster than that after bilateral endometriotic cystectomy.




Am J Reprod Immunol. 2013 Mar;69(3):231-9. doi: 10.1111/aji.12056. Epub 2012 Dec 17.

Relationship between Toll-like receptor-4 and mPGES-1 gene expression in local lesions of endometriosis patients.

Hayashi C1Chishima FSugitani MIchikawa GNakazawa-Watanabe TSugita KSuzuki MNemoto NYamamoto T.



Toll-like receptors (TLRs) are innate immune receptors that mediate the pattern recognition of, and response toward, pathogens and host-derived danger signals. We reported that cyclooxygenase-2 (COX-2) and microsomal prostaglandin E synthase (mPGES) mRNA were expressed in cases of endometriosis. The relationship between COX-2, mPGES-1, and TLR4 in endometriotic lesions has yet to be determined.


Endometriosis samples were obtained from 37 patients with endometrial cysts. Endometrial tissues were obtained from patients undergoing surgical procedures for benign gynecological conditions. COX-2, mPGES-1, and TLR4 mRNA expressions were examined by real-time quantitative reverse transcription PCR (qRT-PCR) and mPGES-1, and TLR4 protein localization was examined by immunohistochemistry.


TLR4 proteins were mostly located to the glandular epithelium. The immunoreactivities of TLR4 and mPGES-1 from endometriosis lesions were significantly higher than those in eutopic endometrium in the proliferative phase. The expression levels of mPGES-1 mRNA in peritoneal endometriosis were higher than those in eutopic endometrium in the proliferative phase. The expression of TLR4 mRNA correlates with that of mPGES-1 mRNA and not with that of COX-2 in endometriotic lesions.


Relationship between TLR4 and mPGES-1 mRNA in endometriotic lesions indicate that innate immunity may play an important role in the pathogenesis of endometriosis.




Wideochir Inne Tech Maloinwazyjne. 2012 Jun;7(2):122-31. doi: 10.5114/wiitm.2011.26758. Epub 2012 Jan 26.

Pericardial, pleural and diaphragmatic endometriosis in association with pelvic peritoneal and bowel endometriosis: a case report and review of the literature.

Ceccaroni M1Roviglione GRosenberg PPesci AClarizia RBruni FZardini CRuffo GPlacci ACrippa SMinelli L.



Diaphragmatic endometriosis is a rare entity, often asymptomatic, which has been described only in small series. It is almost always associated with severe pelvic involvement. The most plausible theory about this condition is based on retrograde menstruation and subsequent transportation of viable cells in peritoneal fluid from the pelvis up the right gutter to the right hemidiaphragm, thus demonstrating its asymmetric distribution on the diaphragm. Pre-operative diagnosis is poorly supported by imaging techniques. In most cases, it is an incidental finding because the lesions may hide behind the right hepatic lobe. In that case it cannot be easily demonstrated with a laparoscope from an umbilical port. Symptomatic diaphragmatic endometriosis is associated with deep lesions which can involve the entire thickness of the diaphragm. In these cases, treatment is more difficult with possible incomplete pain relief and a considerable possibility of recurrence. In this subset, abdominal surgery is recommended. Surgical treatment must be individualized on the basis of the patient’s age, fertility desires, type and location of disease and symptoms. We report the surgical treatment of a patient with synchronous pericardial, pleural and diaphragmatic endometriosis associated with pelvic peritoneal and bowel involvement. A review of the literature regarding pericardial and diaphragmatic endometriosis focusing on anatomical and surgical aspects of its management is undertaken.




Fertil Steril. 2013 Mar 1;99(3):656-662.e3. doi: 10.1016/j.fertnstert.2012.11.021. Epub 2012 Dec 17.

Aromatase inhibitor treatment limits progression of peritoneal endometriosisin baboons.

Langoi D1Pavone MEGurates BChai DFazleabas ABulun SE.



To determine the effect of inhibiting aromatase activity on endometrial lesion growth and aromatase expression in a baboon model of induced endometriosis.


Prospective study.


Primate research institute.


Sixteen olive baboons.


Sixteen olive baboons with induced endometriosis were examined with laparoscopy 10 months after disease inoculation. Animals in group 1 (n = 10) were treated with 1.25 mg/d of the aromatase inhibitor (AI) letrozole, and animals in group 2 (n = 6) were given a placebo for a total of 6 months.


Total number of endometriotic lesions, morphology, and volume of lesions, as well as semiquantitative reverse transcription-polymerase chain reaction and quantitative polymerase chain reaction for levels of aromatase cytochrome messenger RNA were measured. Ovarian volumes were evaluated before treatment initiation and every 2 months during the study.


Treatment of group 1 animals with an AI significantly decreased lesion volume from baseline measurements, whereas the placebo-treated animals showed an increase in lesion volume. Aromatase messenger RNA levels in lesions in the AI-treated animals were significantly lower compared with the placebo-treated animals. Ovarian volumes were significantly increased at 6 months of AI treatment compared with pretreatment volumes.


These findings suggest that suppression of aromatase cytochrome P450 may inhibit the in vivo growth of endometriotic lesions in baboons.




BMJ Case Rep. 2012 Dec 19;2012. pii: bcr2012007206. doi: 10.1136/bcr-2012-007206

Thoracic endometriosis syndrome manifesting as atraumatic haemothorax causing difficult ventilation under general anaesthesia.

Peterzan M1Reynolds TDulay KWooldridge R.



A 31-year-old woman underwent elective hysteroscopy and laparoscopy for investigation of primary infertility. The procedure was abandoned owing to intraoperative desaturation and reduced right-sided chest movement. Postoperative chest x-ray showed an opacified right hemithorax with tracheal deviation to the left. Retrospectively on direct questioning, she admitted to dry cough, mild dyspnoea and significant weight loss. Diagnostic thoracocentesis and contrast CT scan confirmed heavily blood-stained exudative pleural effusion but were otherwise non-diagnostic. After chest drain insertion, 4.6 litre drained but a hydropneumothorax developed upon drain removal, with no improvement on repeat drain insertion. Right video-assisted thoracic surgery was performed, converted to thoracotomy, with repair of diaphragmatic fenestrations, pleurectomy and decortication of trapped lung undertaken. Histological examination of samples of pleura and lung cortex was pathognomic of endometriosis. She was started on norethisterone with no recurrence to date.



Indian J Biochem Biophys. 2012 Oct;49(5):342-8.

Curcumin delays endometriosis development by inhibiting MMP-2 activity.

Jana S1Rudra DSPaul SSnehasikta S.



Endometriosis is a common reproductive disorder believed to be associated with matrix metalloproteinases (MMPs) activities for invasion and remodeling of endometrial tissues. Ectopic endometrium has higher capacity to produce proMMP-2 than eutopic tissues; however, the role of MMP-2 during early phase of endometriosisdevelopment is still unclear. In the present study, we investigated the role of MMP-2 in establishment and development of endometriosis in mouse model. The effect of curcumin on regression of endometriosis through protease/antiprotease balance between MMP-2 and TIMP-2 was also examined. After endometrial inoculation into peritoneum, we observed a significant elevation of proMMP-2 activity from day 2 onwards. This increased MMP-2 activity was associated with decreased expression of tissue inhibitor of MMP (TIMP)-2, while a significant up-regulation of active MMP-2 activity was observed from day 3 onwards. The activation of proMMP-2 to active MMP-2 was associated with increased expression of membrane type 1 matrix metalloproteinase (MT1MMP). Curcumin at a dose of 48 mg/kg b.w. repressed the MMP-2 activity via up-regulation of bound TIMP-2 expression, thus delayed endometriosis development. In addition, curcumin inhibited production of active MMP-2 by down-regulating MT1MMP expression. Moreover, endometriotic progression was directly linked with increased MMP-2/TIMP-2 ratio which was delayed by curcumin pretreatment. In summary, our study documents the regulation of MMP-2 activity by TIMP-2 during the early phase of endometriosis development and inhibitory action of curcumin thereon.




J Obstet Gynaecol. 2013 Jan;33(1):32-7. doi: 10.3109/01443615.2012.727044

The effect of chronic pelvic pain scoring on pre-term delivery rate.

Bayram C1Osmanağaoğlu MAAran TGüven SBozkaya H.



A total of 57 pregnant women, who were admitted to the outpatient clinic having high visual analogue scale (VAS) and a history of chronic pelvic pain before pregnancy, were evaluated with the international pelvic pain assessment form (IPPAF). Gynaecological disorders, pain at ovulation, dysmenorrhoea, level of cramps with period and suspicion of endometriosis were determined to be higher in the pre-term group (p < 0.05). Regarding urological disorders, pain when the bladder was full, pain with urination, a positive answer to the question, ‘Does your urgency bother you?’ and suspicion of interstitial cystitis were also determined to be higher in the pre-term group (p < 0.05). Thus, the total IPPAF scores were significantly higher in the pre-term group (p < 0.05). The pregnant women with a higher total IPPAF score before pregnancy may thus have a higher probability of pre-term labour.


Fertil Steril. 2013 Apr;99(5):1340-5. doi: 10.1016/j.fertnstert.2012.11.036. Epub 2012 Dec 20.

Dopamine receptor D2 genotype (3438) is associated with moderate/severe endometriosis in infertile women in Brazil.

Bilibio JP1Matte Ude Conto EGenro VKSouza CACunha-Filho JS.



To compare the prevalence of dopamine receptor D2 polymorphisms in patients with peritoneal endometriosis and in healthy control subjects.


Case-control study.


University hospital.


One hundred seven women aged ≥18 years who were enrolled when seeking care for infertility caused by peritoneal endometriosis or for tubal ligation.


We performed DNA extraction of peripheral blood, followed by polymerase chain reaction to confirm single-strand polymorphisms and to sequence two polymorphisms.


We sequenced two polymorphisms in exon 7 of the dopamine receptor D2 (DRD2) gene. Polymorphism 1 occurs in nucleotide 3420 (cytosine to thymine, 313 histidine), and polymorphism 2 occurs in nucleotide 3438 (cytosine to thymine, 319 proline).


The frequency of the DRD2 polymorphism 2 was increased in subjects with peritoneal moderate/severe endometriosis. Analysis of the DRD2 genotypes demonstrates an odds ratio of 2.98 (95% confidence interval 1.47-6.04) for polymorphism 2 in peritoneal moderate/severe endometriosis.


Our results revealed that an excess of DRD2 polymorphism 2 was found in exon 7 in women with peritoneal moderate/severe endometriosis. The presence of polymorphism 2 could cause a defect in a post-receptor signaling mechanism, resulting in a mild increase in serum prolactin levels. Thus, the potential angiogenic role of prolactin may play a role in the implantation of ectopic endometriosis tissue.



Med Hypotheses. 2013 Feb;80(2):167-71. doi: 10.1016/j.mehy.2012.11.021. Epub 2012 Dec 21.

Are oestrogens and genetic predisposition etiologic factors in the development of clear cell carcinoma of the peritoneum?

Wuntakal R1Lawrence A.



A literature search was carried out for clinical observations that could explain the possible aetiology of primary peritoneal clear cell carcinoma (CCC) including diagnostic dilemmas, various theories of origin, oestrogen dependence and genetic association. It was found to be an extremely rare tumour (CCC) arising in the peritoneum and is often misdiagnosed as mesothelioma or serous carcinoma or metastatic adenocarcinoma due to overlapping morphological features. The awareness of such dilemmas is important even before making a diagnosis. Clinicopathological features and immunohistochemical studies like WT1, CK20 and calretinin are usually helpful in differentiating CCC from serous carcinoma, metastatic carcinoma from bowel and mesothelioma. (CK7 is common to all epithelial tumours, CEA can be expressed in clear cell carcinoma, WT1 is normally expressed in serous carcinoma, calretinin is expressed in mesothelioma and CK20 in colon carcinoma). The distinction between the above tumours is important as correct diagnosis is required in initiating appropriate treatment. Less than ten cases have been reported in the English language medical literature. Mullerian metaplasia and malignant transformation in endometriosis are two theories proposed for its existence. Peritoneal CCC can be oestrogen dependent in view of association with oestrogen dependent conditions which include endometriosis, adenomyosis and endometrial carcinoma. A genetic ascertain is difficult to be associated and needs further evaluation in a research setting in the familial cancer genetic clinics.



J Gynecol Obstet Biol Reprod (Paris). 2014 Jan;43(1):12-8. doi: 10.1016/j.jgyn.2012.11.009. Epub 2012 Dec 21

Recurrence of pain after surgery for deeply infiltrating endometriosis: How does it happen? How to manage?.

Borghese B1Santulli P2Streuli I2Lafay-Pillet MC3de Ziegler D3Chapron C2.



Recurrence of deep endometriosis remains a major issue in the management of endometriosis. The main cause for recurrence appears to be an incomplete excisional surgery. Therefore, the goal of the primary surgery should be the complete resection of all endometriotic lesions. If surgical skills cannot meet this objective it seems preferable to refer the patient to a center with a recognized expertise in this field rather than performing an incomplete surgery. It seems also possible to tailor the indications according to the symptoms, especially when endometriosis affects the bladder in association with an asymptomatic vaginal and/or rectal involvement. This strategy does not increase the rate of recurrence. Postoperative medical treatment based on ovarian function suppression is attractive as it diminishes the recurrence rate. Facing the recurrence, appropriate assessment of the benefit risk balance must be performed. Medical treatment is an option. When surgery is chosen, it seems interesting to discuss carefully the indication of hysterectomy with bilateral oophorectomy, especially for women over 40 years old with no desire for pregnancy and/or symptomatic adenomyosis. Risks of induced ovarian castration must be taken into account.



Radiologia. 2013 Sep;55(5):385-97. doi: 10.1016/j.rx.2012.10.003. Epub 2012 Dec 23.

Fallopian tube disease on magnetic resonance imaging.

La Parra Casado C1Molina Fàbrega RForment Navarro MCano Gimeno J.

Author information


Knowledge about fallopian tube disease is essential in the assessment of the pelvis in female patients. Primary and secondary changes in the tubes vary widely, regardless of whether associated changes in the ovaries are present. Ultrasonography is the initial technique in the study of adnexal disease because it is very sensitive and widely available; however, MRI is also very useful in this context because its high tissue resolution and anatomic detail make it more specific. The morphologic findings and the characteristics of the contents of the tubes on MRI enable a more accurate diagnosis or limit the differential diagnosis, helping to ensure that the most appropriate treatment is provided in each case.




Arch Gynecol Obstet. 2013 Jun;287(6):1151-7. doi: 10.1007/s00404-012-2686-7. Epub 2012 Dec 27.

Expression of human β-defensin-2 in the eutopic and ectopic endometrial tissues in patients with endometriosis.

Chen SQ1Li JBJiang HYYuan LNiu GYao SZ.



To investigate the expression of human β-defensin-2 (hBD-2) in the endometrium of patients with endometriosis (EMS) and explore the potential role of hBD-2 in the pathogenesis of EMS.


Prospective controlled study.


50 women including EMS patients undergoing laparoscopic ovarian cystectomy and non-EMS patients undergoing hysterectomy for uterine fibroids.


Large university teaching hospital.


Patients were divided into EMS and non-EMS groups. The gene expressions of hBD-2, interleukin (IL)-1β and tumor necrosis factor (TNF)-α in the endometrial tissues of each group were detected with real-time quantitative polymerase chain reaction (PCR), and hBD-2 protein expression with immunohistochemical method.


The gene expression levels of hBD-2, TNF-α, and IL-1β as well as the positive expression rate of hBD-2 protein in the ectopic endometrium of EMS patients were significantly higher than those in the eutopic endometrium of EMS and non-EMS patients (all P < 0.05). Correlation analysis showed that the gene expression levels of hBD-2 in the ectopic and eutopic endometrium of EMS patients were positively correlated with the gene expression levels of IL-1β and TNF-α (P < 0.01).


High levels of hBD-2 gene and protein expressions in the ectopic endometrium of EMS patients may be an important contributor in the pathogenesis of EMS. TNF-α and IL-1β may promote the upregulation of hBD-2 expression.




Am J Vet Res. 2013 Jan;74(1):161-5. doi: 10.2460/ajvr.74.1.161.

Development of a broad-range quantitative polymerase chain reaction assay to detect and identify fungal DNA in equine endometrial samples.

Ferris RA1Dern KVeir JKHawley JRLappin MRMcCue PM.



To develop a broad-range 28S ribosomal DNA quantitative PCR (qPCR) assay for detection of fungal DNA in equine endometrial samples.


12 fungal samples from a clinical diagnostic laboratory and 29 samples obtained from 17 mares.


The qPCR assay was optimized with commercially acquired fungal organisms and validated with samples obtained from the clinical diagnostic laboratory. Subsequently, 29 samples from 17 mares suspected of having fungal endometritis were evaluated via the qPCR assay and via traditional fungal culture and endometrial cytology. Amplicons from the qPCR assay were subjected to genetic sequencing to identify the organisms.


The qPCR assay theoretically had a detection threshold of 2 organisms of Candida albicans. Fungal DNA was amplified from all 12 fungal samples from the commercial diagnostic laboratory. Fungal identification by use of genetic sequencing was successful for 34 of 36 amplicons from the 12 samples assayed. A fungal agent was identified via qPCR assay and genetic sequencing in all 12 samples; in contrast, a fungal agent was identified in only 8 of 12 samples via standard fungal culture and biochemical analysis. The qPCR assay detected fungal DNA in samples from 12 of 17 mares suspected of having fungal endometritis.


A rapid, sensitive, and repeatable qPCR assay was developed for detection of fungal DNA from equine endometrial samples. The qPCR may prove to be clinically useful as an adjunct to microbial culture and cytologic examination to provide identification of fungal organisms in a timely manner.




Theriogenology. 2013 Mar 15;79(5):744-50. doi: 10.1016/j.theriogenology.2012.11.030. Epub 2012 Dec 25.

A novel strategy of mesenchymal stem cells delivery in the uterus of mares with endometrosis.

Mambelli LI1Winter GHKerkis AMalschitzky EMattos RCKerkis I.



Mesenchymal stem cells (MSCs), because of their immunomodulation and trophic activities, in addition to their capacity to regenerate damaged tissues, have potential for treatment of many diseases. The success of stem cell therapies depends, in part, on the method of cell delivery, which should provide wide cell distribution and homing in to injured sites. The objective of the present study was to developing a novel strategy for delivery of MSCs into the uterus of mares with endometrosis (degenerative alteration of uterine glands and surrounding stroma). Endometrosis was confirmed in all mares (N = 6) used in this study. To trace multipotent equine adipose tissue-derived MSCs (eAT-MSCs) in endometrial tissue, before transplantation, cells were stained with a fluorescent dye. During a synchronized estrus, the eAT-MSCs (2 × 10(7) diluted in 20 mL of sodium chloride 0.9%) were inoculated into uterus using a simple technique, similar to artificial insemination (AI) in mares. At 7 and 21 days after transplantation, homing of fluorescently labeled eAT-MSCs was observed by confocal microscopy of uterine biopsies collected from the uterine body and in both uterine horns, including glandular and periglandular spaces, in three of four treated mares. Herein, we propose a new method of MSCs delivery in uterus of mares with endometrosis, which was minimally invasive and technically simple.




J Assist Reprod Genet. 2013 Feb;30(2):251-7. doi: 10.1007/s10815-012-9922-8. Epub 2012 Dec 28.

Conventional IVF versus ICSI in sibling oocytes from couples with endometriosis and normozoospermic semen.

Komsky-Elbaz A1Raziel AFriedler SStrassburger DKasterstein EKomarovsky DRon-El RBen-Ami I.



This study compares the fertilization rate and embryonic development of oocytes randomly inseminated by conventional IVF or ICSI in patients with endometriosis and normozoospermic semen during IVF cycles.


Sibling oocytes were randomized to be inseminated either by ICSI or IVF. Rates of fertilization, cleavage, blastulation and embryonic morphology were assessed.


A total of 786 sibling cumulus-oocyte complexes (COC) were randomized between insemination by conventional IVF (387 COC) or ICSI (399 COC). A significantly higher fertilization rate was found in the ICSI group (ICSI versus IVF, 73.3±23 % versus 54.7±31.9 % respectively; P=0.003), yielding a higher mean number of day 2 embryos (5.2±3.4 versus 3.6±2.9 respectively; P=0.002). Triploid fertilization rate (3PN/COC) was significantly higher in the IVF group compared to the ICSI group (3.9±8.7 % versus 0.9±3.1 % respectively; P=0.02). The morphology score and rate of development of day 2 and 3 embryos were not different between the two groups. Comparison of embryo transfer cycles in which either IVF or ICSI only embryos were transferred did not reveal any statistically significant differences in pregnancy or implantation rates.


ICSI appears to be a better treatment option than conventional IVF in endometriosis-associated infertility, since it offers the advantages of higher fertilization rate and mean number of embryos and lower rate of total fertilization failure and triploid fertilization.




Int J Gen Med. 2012;5:999-1002. doi: 10.2147/IJGM.S37302. Epub 2012 Dec 5.

Primary umbilical endometrioma: a rare case of spontaneous abdominal wall endometriosis.

Efremidou EI1Kouklakis GMitrakas ALiratzopoulos NPolychronidis ACh.



Umbilical endometrioma is a rare condition, with an estimated incidence of 0.5%-1% in all patients with endometrial ectopia. Spontaneous abdominal wall endometriosis is an even rarer and more unusual condition with unclear pathogenetic mechanisms. A 44-year-old parous woman presented with an umbilical skin lesion, and no history of bleeding from the umbilical mass or swelling in the umbilical area. The initial clinical diagnosis was granuloma, and excision was planned. Pathology examination revealed endometrial glands with mucinous-type metaplasia surrounded by a disintegrating mantle of endometrial stroma. Clinical examination and magnetic resonance imaging did not reveal pelvic endometriosis lesions, and given that the umbilical endometrioma was totally excised, no further treatment with hormonal therapy was proposed for the patient. Three years after excision, she was free of disease and no recurrence has been observed. Complete excision and histology is highly recommended for obtaining a definitive diagnosis and optimal treatment in spontaneous abdominal wall endometriosis.



J Turk Ger Gynecol Assoc. 2013 Jun 1;14(2):81-6. doi: 10.5152/jtgga.2013.53179. eCollection 2013.

Melatonin treatment results in regression of endometriotic lesions in an ooferectomized rat endometriosis model.

Kocadal NÇ1Attar R1Yıldırım G1Fıçıcıoğlu C1Ozkan F2Yılmaz B3Yesildaglar N1.



We aimed to determine the effects of melatonin treatment on endometrial implants in an oopherectomized rat endometriosis model.


This study is a prospective, randomised, controlled experimental study. It was carried out at the Experimental Research Center of Yeditepe University (YUDETAM). Twenty-two, female, non-pregnant, nulligravid Spraque-Dawley albino rats were included in our study. Endometriosis was surgically induced in oopherectomized rats. Rats were randomised into two groups: control group and melatonin group. In the melatonin group, rats were treated with melatonin (20 mg/kg/day) for two weeks. After the operations were performed to assess the regression of the endometriotic lesions, melatonin treatment was stopped. At the end of the sixth week necropsies were performed to assess the rate of recurrence. The volume and histopathological scores of endometriotic foci were examined.


Volumes of the endometriotic lesions significantly decreased in the melatonin group. Also, when the melatonin group was analysed within itself, endometriotic lesion volumes decreased and histopathological scores increased significantly.


Melatonin causes regression of the endometriotic lesions in rats and improvement in their histopathological scores.



J Turk Ger Gynecol Assoc. 2013 Jun 1;14(2):98-103. doi: 10.5152/jtgga.2013.52385. eCollection 2013.

Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature.

Selçuk I1Bozdağ G2.



Endometriosis has a wide clinical spectrum and induces a chronic inflammatory process. The incidence of endometriosis in women with dysmenorrhoea is up to 40-60%, whereas in women with subfertility is up to 20-30%. Recurrence of endometriosis varies greatly among different studies. The overall recurrence rates range between 6 to 67% according to the criteria that are taken into consideration. Which of the various reasons is more predictive for recurrence is still unclear and controversial. The main aim of post-operative medical treatment is suppressing ovarian activity leading to atrophy of endometriotic lesions. The success of treatment depends on the resorption of all residual visible lesions and the eradication of microscopic implants. The recurrent lesions might originate from residual lesions or from de novo cells. Determining risk factors for recurrence may allow the identification of subgroups at risk for disease control. Potential biomarkers for recurrence could also maintain targeted therapy.




J Turk Ger Gynecol Assoc. 2013 Dec 1;14(4):210-5. doi: 10.5152/jtgga.2013.55452. eCollection 2013.

Evaluation of mean platelet volume, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in advanced stage endometriosis with endometrioma.

Yavuzcan A1Cağlar M1Ustün Y1Dilbaz S1Ozdemir I2Yıldız E1Ozkara A1Kumru S1.



We compared the preoperative values of mean platelet volume (MPV) and peripheral systemic inflammatory response (SIR) markers (neutrophil/lymphocyte ratio and platelet/lymphocyte ratio) between patients with advanced-stage (stage 3/4) endometriosis having endometrioma (OMA) and patients with a non-neoplastic adnexal mass other than endometrioma (non-OMA).


Patients who underwent operations with the pre-diagnosis of infertility or adnexal mass and who underwent laparoscopic tubal ligation were included.


Haemoglobin levels, leucocyte count, platelet count, neutrophil count and lymphocyte count were not significantly different between patients with advanced stage endometriosis having OMA, patients with non-OMA and patients in the control group (p=0.970, p=0.902, p=0.373, p=0.501 and p=0.463, respectively). Patients with stage 3/4 endometriosis having OMA, patients with non-OMA and control patients were also not significantly different in terms of MPV (p=0.836), neutrophil/lymphocyte ratio (NLR) (p=0.555) and platelet/lymphocyte ratio (PLR) (p=0.358). Preoperative cancer antigen 125 (Ca-125) levels were significantly higher in patients with OMA (p=0.006). Mean size of the OMAs was significantly lower than non-OMAs (p=0.000).


It is very important to determine advanced stage endometriosis and OMAs during preoperative evaluation in order to inform patients and plan an appropriate surgical approach. We demonstrate that MPV, NLR and PLR values are not useful for this purpose in patients with advanced stage endometriosis that are proven to develop severe inflammation at either the cellular or molecular level.



Clin Exp Obstet Gynecol. 2013;40(4):492-8.

Chronic pelvic pain: evaluation of the epidemiology, baseline demographics, and clinical variables via a prospective and multidisciplinary approach.

Hooker AB1van Moorst BR2van Haarst EP3van Ootegehem NA2van Dijken DK2Heres MH2.



Chronic pelvic pain (CPP) is a common clinical condition with significant impact on quality of life. The etiology and pathogenesis of CPP is poorly understood.


To examine the epidemiology, base line demographics, and clinical variables, women with CPP were prospectively analysed by an integrated and synchronised approach.


Of the 89 women with CPP analysed, the majority were assessed earlier, had a variety of surgical interventions and used pharmacological agents. Irritable bowel syndrome, dysfunction of the pelvic floor musculoskeletal system, and physical or sexual abuse were the most common diagnosed etiologies. Evaluation revealed an increased level of psychological impairment.


CPP is a debilitating clinical condition and a result of complex interaction between different contributing factors. Patients will benefit from an orchestrated, multidisciplinary, and synchronized approach with attention paid to the different domains of pain. Treatment is mostly not curative; avoiding profound suffering despite persisting pain should be the goal.



Clin Exp Obstet Gynecol. 2013;40(4):524-30. Review.

New horizons in the non-invasive diagnosis of endometriosis.

Patacchiola F1D’Alfonso A2Di Fonso A2Di Febbo G2Di Giovanni S3Carta A4Carta G2.



Endometriosis is a chronic disorder, clinically associated with chronic pelvic pain, dyspareunia, dysmenorrhea, and infertility. Its socio-economic impact is extensive, given the large number of affected women in reproductive age, its symptomatology (that interferes with normal social life and the patient’s ability to work), and its frequent association with infertility. Nonetheless, the diagnosis of endometriosis is still difficult and late in the evolution of the disorder. The authors have used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria to make a systematic review of the literature of the last 28 years, seeking to identify potential biomarkers useful for a non-invasive diagnosis of endometriosis. The authors have highlighted more than 50 biomarkers in the studies included in the present report, but they have not succeeded in identifying a clinically useful non-invasive diagnostic biomarker or panel of biomarkers. More studies are needed before biomarkers can be introduced in clinical practice.




Clin Exp Obstet Gynecol. 2013;40(4):565-7. Review.

Role of environmental organochlorinated pollutants in the development of endometriosis.

Porpora MG1Resta S1Fuggetta E1Storelli P1Megiorni F1Manganaro L1De Felip E1.



Endometriosis is a gynecological disease, which involves the growth of endometrial tissue outside the uterine cavity, commonly in the pelvic region. The etiology of the disease is unclear, but multiple factors may contribute to its pathogenesis. Environmental organochlorinated pollutants, particularly dioxins and polychlorinated biphenyls (PCBs), are thought to play a role in the development of this disease; however, the results of clinical trials are discordant, and it is not clear how the effect of exposure to these compounds is linked to endometriosis. Their effects on cytokines, immune system, hormones, and growth factors are thought to increase the risk of endometriosis. The purpose of this review is to provide an overview of epidemiological studies, which have evaluated the relationship between endometriosis and exposure to persistent organochlorinated pollutants.




Clin Exp Obstet Gynecol. 2013;40(4):599-600.

Rectus abdominal muscle endometriosis in a patient with cesarian scar: case report.

Sahin L1Dinçel O2Türk BA3.



Endometriosis is the existence of endometrial tissue out of the intrauterine cavity. Abdominal wall endometrioma is a well-defined mass composed of endometrial glands and stroma that may develop after gynecologic and obstetrical surgeries. A cyclic painful mass at the site of a cesarean section scar is most likely due to an endometrioma, and wide local excision is the advisable treatment. The authors present a case of endometrioma in the abdominal wall, which was treated with local excision.


J Clin Imaging Sci. 2013 Dec 31;3:67. doi: 10.4103/2156-7514.124105. eCollection 2013.

Venous intravasation as a complication and potential pitfall during hysterosalpingography: re-emerging study with a novel classification.

Dusak A1Soydinc HE2Onder H1Ekinci F1Görük NY2Hamidi C1Bilici A1.



Presently, hysterosalpingography (HSG) is used as a means to evaluate women with infertility and repetitive pregnancy loss. Venous intravasation is a complication and potential pitfall during HSG and analogous procedures including hysteroscopy. The aim of our study was to assess the venous intravasation and to obtain critical information for more secure and more accurate procedures. In particular, the primary goal of the present study was to compare HSG without and with intravasation to identify differences seen on HSG and to assess the predisposing factors of intravasation. The secondary goal was to describe clinical- and imaging-based novel classification of intravasation.


This study included a patient cohort of 569 patients who underwent HSG between 2008 and 2011 at our center in the absence (control group) or presence (study group) of intravasation. Intravasation classified from level 0 (no intravasation) to level 3 (severe intravasation) was compared with preprocedural (demographic and clinical) and procedural (HSG) data. Data were analyzed using Statistical Package for Social Sciences (SPSS) statistical software.


Of the 569 patients undergoing HSG, 528 showed no intravasation and 41 (7.2%) patients showed intravasation when associated with preprocedural (leukocytes, menometrorrhagia, secondary infertility, ectopic pregnancy, abortus, polycystic ovaries, endometriosis, and interventions) and procedural (pain, scheduling, endometrial-uterine nature, and spillage) parameters. Moreover, intravasation was lower in women with smooth endometrium, triangular uterus, and homogeneous peritoneal spillage. No association was found between age, tubal patency, increased pressure, and intravasation.


Using a novel classification method, intravasation can be observed in women during HSG and associates with preprocedural and procedural predisposing factors in subsumed conditions. This classification method will be useful for improving the efficiency and accuracy of HSG and related procedures by minimization of severe complications caused by intravasation.




Biomed Rep. 2013 Jan;1(1):13-17. Epub 2012 Oct 11.

Hepatocyte nuclear factor (HNF)-1β and its physiological importance in endometriosis.

Akasaka J1Uekuri C1Shigetomi H1Koike M1Kobayashi H1.



Endometriosis is associated with pelvic pain and female infertility. Endometriosis induces inflammation and is vulnerable to oxidative stress damage. To update and summarize the literature concerning the mechanisms that serve to protect genomic DNA from the oxidative damage, the present study reviews the English-language literature for biochemical studies on the transcription factor hepatocyte nuclear factor (HNF)-1β target genes. Findings demonstrated that retrograde flow of the menstrual blood might give rise to endometriosis. Iron may have a significant impact on endometriosis gene expression. HNF-1β regulates tissue-specific gene expression in endometriosis, as well as the expression of several genes, including CD44v9, which binds several molecules, including hyaluronan, epidermal growth factor receptor (EGFR), leukemia-associated Rho-guanine nucleotide exchange factor (LARG), IQ motif containing GTPase activating protein 1 (IQGAP1), macrophage migration inhibitory factor (MIF), major histocompatibility complex, class II invariant chain (CD74), cystine transporter subunit (xCT), Fas and extracellular matrix (ECM) proteins. The CD44v9 system is involved in cell migration, growth, survival, anti-apoptosis, immune response and anti-oxidative stress through maintaining higher levels of antioxidants. HNF-1β may serve to alleviate damage and promote survival of cells experiencing stress by upregulating antioxidant protein expression. This review expands current knowledge on the molecular mechanisms underlying the oxidative stress protection provided by HNF-1β and provides evidence that elevated HNF-1β activity might be associated with the CD44v9-dependent signaling cascades.



Clin Med Insights Womens Health. 2013 Jan 30;6:31-5. doi: 10.4137/CMWH.S11214. eCollection 2013.

De materia medica versus codex alimentarius for the reinforcement of the gynecologic immune system: the case of endometriosis.

Vassiliadis S1.



Since the first Pharmacopoeia under the title “De Materia Medica,” the importance of the utilization of plants and herbs has been an invaluable medicinal tool successfully employed for strengthening the immune system for combating a number of diseases in general, or assisting fertility and reproductive issues in particular. The beneficial use of herbal extracts, constituting the basis of modern medicines, is lately under the shadow of Codex Alimentarius that threatens, if not properly applied, serious immunity features rendering the host defenseless for intercepting harmful invaders, one of which is the mesenchymal endometriotic stem cell causing endometriosis.



Facts Views Vis Obgyn. 2013;5(4):309-14.

Early stage management of ovarian endometrioma to prevent infertility.

Brosens I1Puttemans P1Gordts S1Campo R1Gordts S1Benagiano G2.



There are now convincing data showing that cystectomy of the endometrioma is not only no cure of infertility, but may harm follicle reserve. The question arises why is cystectomy for an endometrioma, in contrast with other -benign cysts, a risk for follicle reserve and how can ovarian damage be prevented. Surgical specimens of ovaries with endometrioma in situ show in the majority of cases manifestly a combined -extra-ovarian and intra-ovarian pathology with the cortex invaginated to form a pseudocyst. The extra-ovarian pathology includes endometrial lining of the cortex, bleeding and adhesions with surrounding tissues. The intra-ovarian pathology is characterized by microscopic stromal implants, fibrosis, smooth muscle metaplasia and -arteriosclerosis, all affecting follicle reserve in the endometrioma bed. Clinically, ovarioscopy allows differential diagnosis (e.g. luteal cyst) and evaluation of the degree of fibrosis and darkening of the cortical wall. Transvaginal colour Doppler sonography can demonstrate the presence and extent of devascularisation in the endometrioma bed. Given this reality, surgery should be based on evaluation of the pathology of the endometrioma bed, but not on the mere size of the chocolate cyst. The main clinical problem is indeed the delayed diagnosis and consequently advanced irreversible cortical damage. Therefore, the sooner endometriomas are diagnosed, the better, because it increases the chances that vascularisation of the endometrioma bed is preserved. Finally, ablation, but not excision is the treatment of choice. The diagnosis of endometriosis is traditionally based on laparoscopy, but in a sexually active adolescent transvaginal endoscopy can be proposed.




J Surg Case Rep. 2013 Dec 16;2013(12). pii: rjt104. doi: 10.1093/jscr/rjt104.

Appendiceal endometriosis in a pregnant woman presenting with acute perforated appendicitis.

Lebastchi AH1Prieto PA2Chen C2Lui FY3.



Endometriosis is a common disease in women of childbearing age and is defined as the presence of endometrial glands and stroma in organs outside of the uterine cavity. Appendiceal endometriosis is very uncommon and accounts for a small fraction of all cases of extrapelvic endometriosis. Cases of that which occur during pregnancy are extremely rare with an incidence that ranges between 3 and 8 deliveries per 10 000. This makes the diagnosis extremely difficult and represents a challenge in the management of the patient. In this report we describe the case of a pregnant woman who underwent ileocecectomy for perforated appendicitis stemming from endometriosis and subsequent pre-term delivery of a 31-week-old fetus.



Wiad Lek. 2013;66(2 Pt 2):192-4. Review.

Endometriosis in adolescents.

Polak G1Bednarek WWertel IKwaśniewski WWasyluk TRaganowski PKotarski J.



The majority of adult women with endometriosis report that their symptoms started in adolescence. Early diagnosis and optimal treatment prevent disease progression and mitigate long-term morbidities, such as infertility and chronic pelvic pain.



Int J Chronic Dis. 2013;2013:452134. doi: 10.1155/2013/452134. Epub 2013 Jul 24.

Quality of Life Assessment Using EuroQOL EQ-5D Questionnaire in Patients with Deep Infiltrating Endometriosis: The Relation with Symptoms and Locations.

Touboul C1Amate P2Ballester M2Bazot M3Fauconnier A4Daraï E1.



The objective of this study was to evaluate the quality of life (QOL) of patients with deep infiltrating endometriosis(DIE) using EuroQOL (EQ-5D) and its correlation with symptoms and locations of endometriotic lesions. One hundred and fifty-nine patients referred for DIE from January 2011 to April 2011 were prospectively invited to complete questionnaires evaluating symptoms associated with endometriosis as well as the EQ-5D questionnaire and health state. Patients also had locations of DIE evaluated by clinical examination and magnetic resonance imaging (MRI). All 159 patients completed the questionnaires. Item response rate was 91.1%. The most intense symptoms were dysmenorrhea (7.1/10), painful defecation (6.3/10), and fatigue (6.0/10). Mean (SD) scores were 77 (14) for the EQ-5D questionnaire and 63.4 (21) for the health state. A relation was observed between the EQ-5D questionnaire and the presence of dysmenorrhea, dyspareunia, cyclic pelvic pain, painful defecation, and diarrhea or constipation. Vaginal and rectal infiltrations were significantly associated with altered EQ-5D and health state scores. The EQ-5D questionnaire is easy to complete and well related to symptoms of DIE. Rectal and vaginal infiltrations were found to be determinant factors of altered QOL by the EQ-5D questionnaire and health state.



Best Pract Res Clin Obstet Gynaecol. 2013 Jun;27(3):471-8. doi: 10.1016/j.bpobgyn.2012.12.001. Epub 2012 Dec 28.

Future research in gynaecological surgery.

Tirlapur SA1Leung EBall EKhan KSClark TJ.



Gynaecological surgery is constantly evolving. To inform practice with high-impact research, clinicians need to focus on areas of importance. Surveys of specialist members of the British Society of Gynaecological Endoscopy have revealed a range of areas for research: diagnostic performance of laparoscopies; therapeutic laparoscopies in endometriosis; laparoscopic versus hysteroscopic sterilisation; and laparoscopic surgical techniques, among others. Clinical and economic outcomes are important in evaluating effectiveness and use of surgical health technology. For studies to be valid, reliable and generalisable, they would have to be free of bias, large and multi-centred. In a time of financial constraints, it is important to encourage clinicians and trainees to participate in important research studies to improve outcomes for patients.



Fertil Steril. 2013 Jan;99(1):23-9. doi: 10.1016/j.fertnstert.2012.11.039.

Telomeres and human reproduction.

Kalmbach KH1Fontes Antunes DMDracxler RCKnier TWSeth-Smith MLWang FLiu LKeefe DL.



Telomeres mediate biologic aging in organisms as diverse as plants, yeast, and mammals. We propose a telomere theory of reproductive aging that posits telomere shortening in the female germ line as the primary driver of reproductive aging in women. Experimental shortening of telomeres in mice, which normally do not exhibit appreciable oocyte aging, and which have exceptionally long telomeres, recapitulates the aging phenotype of human oocytes. Telomere shortening in mice reduces synapsis and chiasmata, increases embryo fragmentation, cell cycle arrest, apoptosis, spindle dysmorphologies, and chromosome abnormalities. Telomeres are shorter in the oocytes from women undergoing in vitro fertilization, who then produce fragmented, aneuploid embryos that fail to implant. In contrast, the testes are replete with spermatogonia that can rejuvenate telomere reserves throughout the life of the man by expressing telomerase. Differences in telomere dynamics across the life span of men and women may have evolved because of the difference in the inherent risks of aging on reproduction between men and women. Additionally, growing evidence links altered telomere biology to endometriosis and gynecologic cancers, thus future studies should examine the role of telomeres in pathologies of the reproductive tract.



Chin J Integr Med. 2013 Jan;19(1):15-21. doi: 10.1007/s11655-012-1196-6. Epub 2012 Dec 29.

Chinese medicine improves postoperative quality of life in endometriosis patients: a randomized controlled trial.

Zhao RH1Liu YTan YHao ZPMeng QWWang RLong DDing YFSong DRXu CRen ZZYang YHWang AM.



To investigate the effect of Chinese medicine (CM) and Western medicine (WM) on quality of life (QOL) after conservative surgery for endometriosis.


A total of 320 patients with endometriosis were randomized into two groups by using random block design, CM group (160 cases, activating blood circulation and removing blood stasis treatment based on syndrome differentiation) and WM group (160 cases, gonadotropin-releasing hormone agonist or gestrinone treatment) after conservative surgery. Treatment was given for 3-6 months (according to the revised American Fertility Society scoring system stage), and the World Health Organization QOL-BREF (WHOQOL-BREF) was applied to patients before and after treatment to assess QOL.


There were 136 cases in the CM group and 141 cases in the WM group completing therapy. In the CM group, the use of the WHOQOL-BREF showed that the physical, psychological and environmental scores posttreatment were significantly higher than those at pre-treatment (P < 0.05), and for 12 items (pain and discomfort, energy and fatigue, sleep and rest, mobility, activities of daily living, work capacity, negative feelings, health and social care: accessibility and quality, participation in and opportunities for recreation/leisure activities, appetite, QOL score, overall health status and QOL), the difference in scores was significant (P < 0.05). In the WM group, 4 items (pain and discomfort, opportunities for acquiring new information and skills, QOL score, overall health status and QOL) had significantly different scores post-treatment compared with those at pre-treatment (P < 0.05). Before treatment, the QOL in the two groups of patients showed no significant difference (P > 0.05). After treatment, the scores for physical health in the CM group were significantly higher than those of the WM group (P < 0.05) and the scores of 4 items (mobility, activities of daily living, sexual activity, QOL score) in the CM group were significantly higher than those in the WM group (P < 0.05).


CM and WM treatment could improve the QOL of patients with endometriosis after conservative surgery. CM treatment is more effective than WM.




Arch Pathol Lab Med. 2013 Jan;137(1):126-9. doi: 10.5858/arpa.2011-0312-CR.

Papillary syncytial metaplasia of fallopian tube endometriosis: a potential pitfall in the diagnosis of serous tubal intraepithelial carcinoma.

Kaur H1Levinsky EColgan TJ.



Histopathologic diagnosis of tubal intraepithelial carcinoma (TIC) has emerged as a significant challenge in the last few years. The avoidance of pitfalls in the diagnosis of TIC is crucial if a better understanding of its natural history and outcome is to be achieved. Herein, we present a case of a 52-year-old woman who underwent a risk-reducing salpingo-oophorectomy procedure. Histologic examination of a fallopian tube demonstrated a focus of atypical epithelial proliferation, which was initially considered to be a TIC. Complete study of the case indicated that the focus was, in fact, papillary syncytial metaplasia of tubal mucosal endometriosis. Papillary syncytial metaplasia may resemble TIC and should be considered in cases of proliferative lesions of the tubal epithelium.


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