Surg Res Pract. 2014

A Surgeon’s Perspective of Abdominal Wall Endometriosis at a Caesarean Section Incision: Nine Cases in a Single Institution.

Oh EM¹, Lee WS¹, Kang JM¹, Choi ST¹, Kim KK¹, Lee WK¹.

 

Abstract

Abdominal wall endometriosis in a Caesarean section scar (AEC) is an infrequent type of extrapelvic endometriosis which rarely transforms into a malignant lesion. A painful mass located in the scar of a Caesarean section is a typical sign of AEC. This condition is diagnosed preoperatively using imaging modalities such as computed tomography and ultrasonography, as well as fine-needle aspiration. Although AEC has typical signs, general surgeons often misdiagnose it due to its rarity. Herein, we report our experience of AEC in a single institution.

 

 

J Assist Reprod Genet. 2015 Feb;32(2):277-85.

BRCA1 alterations are associated with endometriosis, but BRCA2 alterations show no detectable endometriosis risk: a study in Indian population.

Govatati S¹, Challa K, Reddy SB, Pramod K, Deenadayal M, Chakravarty B, Shivaji S, Bhanoori M.

Abstract

PURPOSE:

To investigate the role of genetic variations and expression alterations of BRCA1 and BRCA2 genes in the pathophysiology of endometriosis.

METHODS:

A genetic association study was conducted in 573 endometriosis cases and 490 controls of Indian origin. We genotyped 13 selected promoter SNPs of BRCA1 gene and 2 selected promoter SNPs of BRCA2 gene by PCR-sequencing analysis. In addition, to better understand genetic contributions to the pathophysiology of endometriosis, the expression pattern of BRCA1 & 2 was analyzed in the eutopic endometria of endometriosiscases and controls by western-blot and immunohistochemical analysis.

RESULTS:

Our results revealed significant association between BRCA1 rs71361504 (-/GTT) SNP and endometriosis risk in Indian women (P < 0.0001), while the remaining SNPs of both BRCA1 & 2 genes showed no difference between cases and controls. Western-blot and immunohistochemical analysis revealed significantly decreased BRCA1 expression levels in eutopic endometria of patients compared with controls (P < 0.05). Furthermore, nuclear BRCA1 was frequently lost compared with cytoplasmic BRCA1 in eutopic endometria of patients. Expression of BRCA2 did not differ between patients and controls.

CONCLUSIONS:

BRCA1 rs71361504 SNP may modify the endometriosis risk in Indian women. In addition, decreased expression of BRCA1 may play an important role in the pathophysiology of endometriosis. The analysis of BRCA1 genetic variants and/or expression might help to identify patients at high risk for disease outcome.

 

 

Surg Endosc. 2015 Aug;29(8):2389-93.

Evaluation of pre- and post-operative symptoms in patients submitted to linear stapler nodulectomy due to anterior rectal wall endometriosis.

Kamergorodsky G¹, Lemos N, Rodrigues FC, Asanuma FY, D’Amora P, Schor E, Girão MJ.

Abstract

BACKGROUND:

The objective of this study was to evaluate the feasibility and safety of a more versatile rectosigmoid nodulectomy technique using a linear stapler.

METHODS:

Case series.

SETTING:

tertiary care (reference center for endometriosis surgery).

PATIENTS:

Sixty-one consecutive patients who were operated on between January 2006 and February 2013.

INTERVENTION:

anterior rectal wall nodulectomy technique using sequential bites of the linear stapler.

MEASUREMENTS:

Perioperative complications were recorded, and a condition-specific bowel dysfunction quality of life questionnaire (Rome III–Constipation) was applied pre-operatively and post-operatively during the first week of April 2013.

DESIGN CLASSIFICATION:

Canadian Task Force III RESULTS: A total of 61 patients were submitted to the intervention. After a mean follow-up period of 1.83 years (.25-7.1 ± 1.97), no post-operative fistula or leakage was observed. In addition, no cases of rectal stenosis or bowel obstruction were recorded, and two patients were excluded for not answering the post-operative questionnaire. According to the Rome III questionnaire, constipation symptoms improved significantly in 12 out of 17 questions. No patient reported worsening of symptoms in question.

CONCLUSIONS:

Linear stapler resection is a safe alternative to segmentar resection for endometriotic nodules on the anterior rectal wall.

 

 

PLoS One. 2014 Nov 11;9(11):e112630

High-throughput sequencing approach uncovers the miRNome of peritoneal endometriotic lesions and adjacent healthy tissues.

Saare M¹, Rekker K², Laisk-Podar T², Sõritsa D³, Roost AM⁴, Simm J⁵, Velthut-Meikas A⁶, Samuel K⁴, Metsalu T⁷, Karro H⁸, Sõritsa A⁹, Salumets A¹, Peters M².

 

Abstract

Accumulating data have shown the involvement of microRNAs (miRNAs) in endometriosis pathogenesis. In this study, we used a novel approach to determine the endometriotic lesion-specific miRNAs by high-throughput small RNA sequencing of paired samples of peritoneal endometriotic lesions and matched healthy surrounding tissues together with eutopic endometria of the same patients. We found five miRNAs specific to epithelial cells–miR-34c, miR-449a, miR-200a, miR-200b and miR-141 showing significantly higher expression in peritoneal endometriotic lesions compared to healthy peritoneal tissues. We also determined the expression levels of miR-200 family target genes E-cadherin, ZEB1 and ZEB2 and found that the expression level of E-cadherin was significantly higher in endometriotic lesions compared to healthy tissues. Further evaluation verified that studied miRNAs could be used as diagnostic markers for confirming the presence of endometrial cells in endometriotic lesion biopsy samples. Furthermore, we demonstrated that the miRNA profile of peritoneal endometriotic lesion biopsies is largely masked by the surrounding peritoneal tissue, challenging the discovery of an accurate lesion-specific miRNA profile. Taken together, our findings indicate that only particular miRNAs with a significantly higher expression in endometriotic cells can be detected from lesion biopsies, and can serve as diagnostic markers for endometriosis.

 

 

 

 

 

J Cell Mol Med. 2015 Feb;19(2):452-62.

Telocytes damage in endometriosis-affected rat oviduct and potential impact on fertility.

Yang XJ¹, Yang J, Liu Z, Yang G, Shen ZJ.

 

Abstract

Women with endometriosis (EMs) have unexplained infertility. The recently identified telocytes (TCs) might participate in the maintenance of structural and functional integrity of oviduct tissue, but so far the involvement of TCs in EMs-affected oviduct tissue and potential impact on fertility capacity remain unknown. By an integrated technique of haematoxylin and eosin staining, in situ immunohistochemistry and double-labelled immunofluorescence staining and electron microscopy approach, TCs were studied in the autotransplantation Sprague-Dawley rat model of EMs-affected oviduct tissue and in sham control, respectively, together with determination of iNOS, COX-2, LPO and estradiol. TCs were found in perivascular connective tissue and smooth muscle bundles in sham oviduct, with typical ultrastructural features (a slender piriform/spindle/triangular cell body, and one or more extremely long prolongations, emerged from cell bodies and extend to various directions), and specific immunophenotype of CD34-positive/vimentin-positive/c-kit-negative. However, in EMs-affected oviduct tissue (grade III), extensive ultrastructural damage (degeneration, discontinue, dissolution and destruction), significant decrease or loss of TCs and interstitial fibrosis were observed, together with elevated level of iNOS, COX-2, LPO and estradiol, thus suggestive of inflammation and ischaemia-induced TCs damage. Based on TCs distribution and intercellular connections, we proposed that such damage might be involved in structural and functional abnormalities of oviduct, such as attenuated intercellular signalling and oviduct contractility, impaired immunoregulation and stem cell-mediated tissue repair, 3-D interstitial architectural derangement and tissue fibrosis. Therefore, TCs damage might provide a new explanation and potential target for EMs-induced tubal damage and fertility disorders.

 

 

JSLS. 2014 Jul-Sep;18(3).

Surgical therapy of ovarian endometrioma: recurrence and pregnancy rates.

Maul LV¹, Morrision JE², Schollmeyer T¹, Alkatout I¹, Mettler L¹.

Abstract

BACKGROUND AND OBJECTIVES:

The study was designed to analyze preoperative clinical and surgical findings at enucleation of ovarian endometrioma with their impact on recurrence and pregnancy rates.

METHODS:

This is a retrospective study of 550 histologically verified ovarian endometriomas operated on at the Department of Obstetrics and Gynecology, University Hospital Kiel, Germany, between 1995 and 2004. Preoperative data, surgical findings, and postoperative outcomes of 289 cases were analyzed. The average follow-up period was 12.9 years.

RESULTS:

Ovarian endometriomas recurred in 23.9% of patients. Risk factors identified for recurrence of endometriomas were preoperative pain (P=.013), dysmenorrhea (P=.013), larger cyst size (>8 cm), younger age (<25 years), and preoperative cyst rupture. Factors associated with postoperative dysmenorrhea were younger age<25 years (P<.001), nulliparity (P=.020), and lager cyst size>8 cm (P=.048). Recurrence of pain was influenced by previous surgery of endometrioma (P<.05). Laparoscopy had a higher percentage of symptom-free patients than laparotomy did (49.0% vs 33.3%). Additional postoperative hormonal treatment resulted in a higher spontaneous pregnancy rate (41.4% vs 12.6%; P<.001) but a lower recurrence-free interval rate (70.5% vs 82.6%; P=.050) when compared with surgery only.

CONCLUSIONS:

We identified preoperative and intraoperative findings associated with higher risk of recurrence of endometrioma, pain, and dysmenorrhea. Patients desiring pregnancy benefited from postoperative hormone treatment, but no favorable results from combined therapy were observed with regard to recurrence rate.

 

 

JSLS. 2014 Jul-Sep;18(3).

Advanced gynecologic laparoscopy in a fast-track ambulatory surgery center.

Nezhat C¹, Main J¹, Paka C¹, Soliemannjad R¹, Parsa MA¹.

Abstract

BACKGROUND/OBJECTIVES:

It has been shown that major gynecologic laparoscopy is safe in hospital ambulatory settings, but there is little data to suggest the same in freestanding ambulatory surgery centers. This study evaluates the safety and efficacy of advanced gynecologic laparoscopic surgery using a fast-track model in freestanding ambulatory surgery centers and discusses our institution protocols.

METHODS:

Retrospective, multicenter review was conducted of major gynecologic surgeries from August 1st 2010 to September 30th 2011 in 3 surgical centers with one primary surgeon. All patients were treated for symptomatic uterine leiomyomas and/or endometriosis. Primary outcome measures were unplanned admissions and discharge within 23 hours.

RESULTS:

One hundred and thirty-four patients underwent major laparoscopic gynecologic surgery with a total of 160 procedures: 77 stage IV endometriosis treatment including 7 disk excisions of endometriosis from the large bowel, 3 ureteroneocystostomies and 1 partial bladder resection, 38 myomectomies, and 34 hysterectomies including 12 modified radical hysterectomies. The overall unplanned admission rate was 4.5%. One hundred and thirty-one patients (97.7%) were discharged within 24 hours after surgery. Three patients (2.2%) were transferred to the hospital postoperatively: 1 patient for observation of postoperative anemia and 2 patients for postoperative fever. Three patients (2.2%) were admitted to the hospital after discharge: 1 patient for postoperative ileus, 1 patient for postoperative fever, and 1 patient with septic pelvic thrombophlebitis. These postoperative issues all resolved without complication, and all patients had an uneventful follow-up.

CONCLUSIONS:

With appropriate resources and an experienced surgeon, advanced laparoscopic surgery can be safely performed in a fast-track ambulatory surgery center with a high rate of discharge within 23 hours and low unplanned readmission rate.

 

 

JSLS. 2014 Jul-Sep;18(3).

Multidisciplinary treatment for thoracic and abdominopelvic endometriosis.

Nezhat C¹, Main J¹, Paka C¹, Nezhat A¹, Beygui RE².

Abstract

BACKGROUND AND OBJECTIVES:

Thoracic endometriosis is a rare form of extragenital endometriosis with important clinical ramifications. Up to 80% of women with thoracic endometriosis have concomitant abdominopelvic endometriosis, yet the surgical treatment is usually performed with separate procedures. This is the largest published series of the combination of video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of abdominopelvic and thoracic endometriosis. The objectives of this series are to further evaluate the manifestations of thoracic endometriosis, assess the multidisciplinary surgical approach, and discuss our institution’s protocols.

METHODS:

This is a retrospective, institutional review board-approved case series of 25 consecutive women who underwent combined video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of abdominopelvic, diaphragmatic, and thoracic endometriosis from January 1, 2008, to September 30, 2013. All surgeries were performed at a tertiary referral center by the same primary surgeons. Data were collected by chart review.

RESULTS:

Twenty-five patients were included, with a mean age of 37.7 years. Eighty percent of patients had catamenial chest pain, and in 40% this was their only chest complaint. Shoulder pain was noted in 40% of patients, catamenial pneumothorax in 24%, and hemoptysis in 12%. One hundred percent of patients were found to have endometriosis in the pelvis, 100% in the diaphragm, 64% in the chest wall, and 40% in the parenchyma. There were 2 major postoperative complications: 1 diaphragmatic hernia and 1 vaginal cuff hematoma.

CONCLUSION:

Clinical suspicion and preoperative assessment are crucial in the diagnosis of thoracic endometriosis and allow for a multidisciplinary approach. The combination of video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of endometriosis optimally addresses the pelvis, diaphragm, and thoracic cavity in a single operation.

 

 

JSLS. 2014 Jul-Sep;18(3).

Antimullerian hormone level and endometrioma ablation using plasma energy.

Roman H¹, Bubenheim M², Auber M¹, Marpeau L¹, Puscasiu L³.

Abstract

OBJECTIVE:

To investigate the impact of ovarian endometrioma vaporization using plasma energy on antimullerian hormone (AMH) level.

METHOD:

We report a prospective, noncomparative series (NCT01596985). Twenty-two patients with unilateral ovarian endometriomas≥30 mm, with no surgical antecedent and no ongoing pregnancy, underwent vaporization of ovarian endometriomas using plasma energy during the period of November 29, 2010 to November 28, 2012. We assessed AMH levels before surgery, 3 months postoperatively, and at the end of follow-up.

RESULTS:

The mean length of postoperative follow-up was 18.2±8 months. AMH level significantly varied through the 3 assessments performed in the study, as the mean values±SD were 3.9±2.6 ng/mL before the surgery, 2.3±1.1 ng/mL at 3 months, and 3.1±2.2 ng/mL at the end of the follow-up (P=.001). There was a significant increase from 3 months postoperatively to the end of follow-up (median change 0.7 ng/mL, P=.01). Seventy-one percent of patients had an AMH level>2 ng/mL at the end of the follow-up versus 76% before the surgery (P=1). During the postoperative follow-up, 11 patients tried to conceive, of whom 8 (73%) became pregnant.

CONCLUSIONS:

The ablation of unilateral endometriomas is followed in a majority of cases by a significant decrease in AMH level 3 months after surgery. In subsequent months, this level progressively increases, raising questions about the real factors that impact postoperative ovarian AMH production.

 

 

JSLS. 2014 Jul-Sep;18(3).

Comparison of ovulation induction protocols after endometrioma resection.

Bastu E¹, Yasa C¹, Dural O¹, Mutlu MF², Celik C¹, Ugurlucan FG¹, Buyru F¹.

Abstract

BACKGROUND AND OBJECTIVES:

The aim of this study was to compare the in vitro fertilization (IVF) outcomes of long gonadotropin-releasing hormone agonist (GnRH-a) and GnRH-antagonist (GnRH-ant) protocols in endometriosis patients who have undergone laparoscopic endometrioma resection surgery. To our knowledge, there is no study in the current literature that compares the effectiveness of long GnRH-a and GnRH-ant protocols in management of IVF cycles in endometriosis patients who underwent laparoscopic endometrioma resection surgery.

METHODS:

Eighty-six patients with stage III to IV endometriosis who had undergone laparoscopic resection surgery for endometrioma were divided into 2 groups: those who had ovarian stimulation with a long GnRH-a protocol (n=44), and those who had ovarian stimulation with a GnRH-ant protocol (n=42).

RESULTS:

The number of follicles on human chorionic gonadotropin injection day, duration of hyperstimulation, number of retrieved metaphase II oocytes, and total number of grade 1 embryos were statically significantly higher in the long GnRH-a protocol. There were no significant differences in positive β-human chorionic gonadotropin pregnancy rates (25% vs 21.4%; P=.269) and ongoing pregnancy rates per patient (20.5% vs 19.1%; P=.302) between the 2 protocols.

CONCLUSIONS:

Long GnRH-a and GnRH-ant protocols both present similar IVF outcomes in patients with endometriosis who have undergone laparoscopic endometrioma resection surgery. A long GnRH-a protocol may lead to a higher number of embryos that can be cryopreserved, providing the possibility of additional embryo transfers without having to go through the process of ovarian stimulation again.

 

 

Reprod Sci. 2015 May;22(5):626-32.

Pelvic pain and quality of life of women with endometriosis during quadriphasic estradiol valerate/dienogest oral contraceptive: a patient-preference prospective 24-week pilot study.

Grandi G¹, Xholli A¹, Napolitano A¹, Palma F¹, Cagnacci A².

Abstract

OBJECTIVE:

The progestin dienogest (DNG) given alone effectively reduces pelvic pain of women with endometriosis. It is not clear whether the same occurs when DNG is associated with estradiol (E2).

DESIGN:

Patient preference prospective observational study.

SETTING:

Outpatient centre of university hospital.

PATIENTS:

40 patients with endometriosis and menstrual pain.

INTERVENTIONS:

24-week treatment with a quadriphasic association of E2 valerate (E2V) and DNG or a nonsteroidal anti-inflammatory drug (NSAID) to be used only in case of pain (ketoprofene 200-mg tablets).

MAIN OUTCOME MEASURES:

Menstrual pain and, when present, intermenstrual pain, and dyspareunia were investigated by means of a 10-cm visual analogue scale (VAS). Quality of life was investigated by the short form 36 (SF-36) of the health-related quality of life questionnaire.

RESULTS:

Final study group consists of 34 patients, 19 in the E2V/DNG group and 15 in the NSAID group. After 24 weeks, no significant modification of menstrual pain, intermenstrual pain, dyspareunia, or SF-36 score was observed in the NSAID group. Treatment with E2V/DNG reduced the VAS score of menstrual pain by 61% (P < .0001). In the subgroups of women with intermenstrual pain or dyspareunia, E2V/DNG reduced these complaints by 65% (P = .013) and 52% (P = .016), respectively. The reduction in menstrual (P = .0001) and intermenstrual pain (p = 0.03) was significantly greater during E2V/DNG than NSAID. Quality of life improved during E2V/DNG (P = .0002), both in physical (P = .0003) and mental domains (P = .0065). Only a few minor adverse effects were described during E2V/DNG, and none caused withdrawal from treatment.

CONCLUSION:

In patients with endometriosis and pelvic pain, the 24-week administration of the quadriphasic association of E2V/DNG decreases pelvic pain and improves quality of life.

 

 

J Hum Reprod Sci. 2014 Jul;7(3):170-4.

Gonadotropin-releasing hormone analogs: Understanding advantages and limitations.

Kumar P¹, Sharma A².

 

Abstract

Pituitary stimulation with pulsatile gonadotropin-releasing hormone (GnRH) analogs induces both follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Pituitary gonadotropin secretions are blocked upon desensitization when a continuous GnRH stimulus is provided by means of an agonist or when the pituitary receptors are occupied with a competitive antagonist. GnRH antagonists were not available originally; therefore, prolonged daily injections of agonist with its desensitizing effect were used. Today, single- and multiple-dose injectable antagonists are also available to block the LH surge and thus to cause desensitization. This review provides an overview of the use of GnRH analogs which is potent therapeutic agents that are considerably useful in a variety of clinical indications from the past to the future with some limitations. These indications include management of endometriosis, uterine leiomyomas, hirsutism, dysfunctional uterine bleeding, premenstrual syndrome, assisted reproduction, and some hormone-dependent tumours, other than ovulation induction.

 

 

Med Mol Morphol. 2015 Sep;48(3):146-54

Clinicopathological heterogeneity in ovarian clear cell adenocarcinoma: a study on individual therapy practice.

Matsuo Y¹, Tashiro H¹, Yanai H², Moriya T³, Katabuchi H⁴.

 

Abstract

Ovarian clear cell adenocarcinoma (CCA) has been believed to be a lethal histological subtype of an epithelial ovarian adenocarcinoma (EOA); its precursor has been assumed to be endometriosis. However, it has been reported that CCAs occasionally exhibit different clinical behaviors, suggesting that CCAs might not belong to a single category. We focused on CCAs combined with other histological types of EOAs; we re-evaluated the pathology of 46 CCAs and divided them into two subgroups: 35 CCAs alone (pure-type CCAs); and 11 CCAs with other histological types, endometrioid adenocarcinomas (EAs) or/and serous adenocarcinomas (SAs) (mixed-type CCAs). Immunohistochemical analysis for expression of ARID1A, p53, PTEN, Annexin 4, hepatocyte nuclear factor-1β (HNF-1β), and WT-1 was employed. We identified that patients with endometriosiswere younger than those without endometriosis in pure-type CCAs (P < 0.005). In mixed-type CCAs, the immunohistochemical-staining patterns revealed internal transition of each histological component. In pure-type CCAs, expressions of ARID1A and p53 were mutually altered, and altered expression of p53 was associated with worse prognosis than that of ARID1A (P < 0.001). Our results provide evidence that CCAs would have clinicopathological heterogeneity, determining the patient’s prognosis. Furthermore, immunohistochemical analysis may shed light on the selection of appropriate treatment, including chemotherapy.

 

 

J Assist Reprod Genet. 2015 Feb;32(2):263-70.

Effect of induced peritoneal endometriosis on oocyte and embryo quality in a mouse model.

Cohen J¹, Ziyyat A, Naoura I, Chabbert-Buffet N, Aractingi S, Darai E, Lefevre B.

Abstract

PURPOSE:

To assess the impact of peritoneal endometriosis on oocyte and embryo quality in a mouse model.

METHODS:

Peritoneal endometriosis was surgically induced in 33 B6CBA/F1 female mice (endometriosis group, N = 17) and sham-operated were used as control (sham group, N = 16). Mice were superovulated 4 weeks after surgery and mated or not, to collect E0.5-embryos or MII-oocytes. Evaluation of oocyte and zygote quality was done by immunofluorescence under spinning disk confocal microscopy.

RESULTS:

Endometriosis-like lesions were observed in all mice of endometriosis group. In both groups, a similar mean number of MII oocytes per mouse was observed in non-mated mice (30.2 vs 32.6), with a lower proportion of normal oocytes in the endometriosis group (61 vs 83 %, p < 0.0001). Abnormalities were incomplete extrusion or division of the first polar body and spindle abnormalities. The mean number of zygotes per mouse was lower in the endometriosis group (21 vs 35.5, p = 0.02) without difference in embryo quality.

CONCLUSIONS:

Our results support that induced peritoneal endometriosis in a mouse model is associated with a decrease in oocyte quality and embryo number. This experimental model allows further studies to understand mechanisms of endometriosis-associated infertility.

 

 

Saudi Med J. 2014 Nov;35(11):1390-2.

Malignant transformation of persistent endometriosis after hysterectomy.

Bawazeer NA¹, Al-Jifree HM, Gari AM.

 

Abstract

The malignant transformation of persistent endometriotic implants into endometrioid adenocarcinoma is rare, especially after remote hysterectomy and salpingo-oophorectomy (TAH-BSO), and there are few cases reported in the English language literature. Patients receiving estrogen replacement therapy are common among the reported cases. We present a case that demonstrates the possibility of malignant transformation in a 53-year-old female, known case of endometriosis, who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with no evidence of malignancy in the final pathology report. After 9 years, she presented with lower abdominal mass, and histopathological studies confirmed the diagnosis of well-differentiated endometrioid adenocarcinoma. The possibility of malignant transformation and possible risk factors are discussed with a brief literature review.

 

 

World J Gastroenterol. 2014 Nov 14;20(42):

Bowel endometriosis: colorectal surgeon’s perspective in a multidisciplinary surgical team.

Wolthuis AM¹, Meuleman C¹, Tomassetti C¹, D’Hooghe T¹, de Buck van Overstraeten A¹, D’Hoore A¹.

 

Abstract

Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Up to 15% of women in their reproductive period are affected by this condition. Deep endometriosis is defined as endometriosis located more than 5 mm beneath the peritoneal surface. This type of endometriosis is mostly found on the uterosacral ligaments, inside the rectovaginal septum or vagina, in the rectosigmoid area, ovarian fossa, pelvic peritoneum, ureters, and bladder, causing a distortion of the pelvic anatomy. The frequency of bowel endometriosis is unknown, but in cases of bowel infiltration, about 90% are localized on the sigmoid colon or the rectum. Colorectal involvement results in alterations of bowel habits such as constipation, diarrhea, tenesmus, dyschezia, and, rarely, rectal bleeding. Differential diagnosis must be made in case of irritable bowel syndrome, solitary rectal ulcer syndrome, and a rectal tumor. A precise diagnosis about the presence, location, and extent of endometriosis is necessary to plan surgical treatment. Multidisciplinary laparoscopic treatment has become the standard of care. Depending on the size of the lesion and site of involvement, full-thickness disc excision or bowel resection needs to be performed by an experienced colorectal surgeon. Long-term outcomes, following bowel resection for severe endometriosis, regarding pain and recurrence rate are good with a pregnancy rate of 50%.

 

 

World J Gastrointest Endosc. 2014 Nov 16;6(11):525-33.

Recto-sigmoid endoscopic-ultrasonography in the staging of deep infiltrating endometriosis.

Roseau G¹.

 

Abstract

Recto-sigmoid endoscopic ultrasonography (RS-EUS) has first been used in the staging of pelvic deep infiltrating endometriosis in the early 1990’s. Since then, although publications have been sparse, RS-EUS is routinely used for this indication in few centers. In this paper, we focus on technical aspects and operating method of rectal and sigmoid endo-sonography, and describe the most characteristic echographic presentations of endometriosis of the lower digestive tract. Through a literature review, results obtained with different types of endo-rectal probes, either flexible endoscopic, or blind rigid, are presented and compared with those of other close imaging techniques: magnetic resonance imaging and the more recent trans-vaginal sonography. As well as these two latter techniques, RS-EUS appears as an interesting method in the staging of pelvic deep infiltrating endometriosis particularly to evaluate rectal and sigmoid infiltrations. However, more prospective studies are required, to correctly define respective indications for each exam, in the light of recent advancements in treating this frequent disease.

J Assist Reprod Genet. 2015 Jan;32(1):91-4

CYP2C19 polymorphism increases the risk of endometriosis.

Christofolini DM¹, Amaro A, Mafra F, Sonnewend A, Bianco B, Barbosa CP.

Abstract

PURPOSE:

Estrogen metabolizing gene mutations can be associated with defective hormonal signaling leading to disease processes. Endometriosis is an estrogen dependent that can be influenced by defective signaling in the estrogen pathway.

OBJECTIVES:

To evaluate the association of A/G 85952 CYP2C19 and A/G 937 HSD17B1 gene polymorphisms with endometriosis through the investigation of a large Brazilian sample of women with endometriosis and a fertile control group.

METHODS:

Five hundred women with endometriosis and 500 women without endometriosis were tested for CYP2C19 and HSD17B1 polymorphisms, by TaqMan Real Time PCR. The results were statistically analyzed by chi-square, logistic regression and tested for Hardy-Weinberg equilibrium.

RESULTS:

The comparison of genotype and allelic frequency of CYP2C19 polymorphism (rs11592737) in patients with endometriosis and control group showed a statistically significant difference (p = 0.0203) and for the HSD17B1 polymorphism (rs605059) differences were not significant (p = 0.0687). Comparing the stages I/II and III/IV endometriosis with the control group for the CYP2C19 we observed p = 0.0133 and p = 0.0564, respectively, and for HSD17B1 the values for p = 0.4319 and p = 0.0667.

CONCLUSION:

We observed that CYP2C19 polymorphism is associated with endometrisis in Brazilian women and can be considered a potential biomarker of the disease.

 

 

BMC Cancer. 2014 Nov 18;14:831.

An increased risk of epithelial ovarian cancer in Taiwanese women with a new surgico-pathological diagnosis of endometriosis.

Wang KC, Chang WH, Lee WL, Huang N, Huang HY, Yen MS, Guo CY¹, Wang PH.

Abstract

BACKGROUND:

Epidemiological evidence of relationships between endometriosis and epithelial ovarian cancer (EOC) has been obtained mainly from Western countries. Our goal was to determine the risk of EOC due to endometriosis in Taiwanese women.

METHODS:

A retrospective cohort study was performed by linking to the National Health Insurance Research Database (NHIRD) of Taiwan. A total of 5,945 women with a new surgico-pathological diagnosis of endometriosis from 2000 to 2010 and 23,780 multivariable-matched controls (1:4) were selected. The Cox regression model adjusted for potential confounders was used to assess the risk of EOC due to endometriosis.

RESULTS:

The EOC incidence rate (IR) of the women with and without endometriosis was 11.64 and 2.66 per 10,000 person-years, contributing to a crude hazard ratio (HR) of 4.48 (95% confidence interval [CI] 2.84-7.06), and HR after adjustment for all confounders (adjusted HR) of 5.62 (95% CI 3.46-9.14); the risk was higher in clear-cell carcinoma subtypes (adjusted HR 7.36, 95% CI 1.91-28.33). The EOC IR of women with endometriosis consistently increased with increasing age, ranging from 4.99 (<30 years) to 35.81 (≥50 years) per 10,000 person-years, contributing to a progressively increased risk of EOC (crude HRs ranging from 2.80 to 6.74 and adjusted HRs ranging from 3.34 to 9.63) compared to age-matched women without endometriosis, whose EOC IR also increased with age. The older women (≥50 years) with endometriosis had a risk of EOC that was higher than both the age-matched women without endometriosis (adjusted HR 9.63, 95% CI 3.27-28.37) and the youngest women (<30 years) with endometriosis (adjusted HR 4.97, 95% CI 1.03-24.09).

CONCLUSIONS:

These significant findings corroborate the previously reported association between endometriosis and increased risk of EOC. Since the risk of EOC in women with a new surgico-pathological diagnosis of endometriosis constantly increased with age and this increased risk of EOC was more significant in women aged ≥50 years, active and intensive surgical intervention should be taken into consideration for older women with endometriosis.

 

Med J Islam Repub Iran. 2014 Jul 7;28:50

Evaluation of procalcitonin as a biomarker of diagnosis, severity and postoperative complications in adult patients with acute appendicitis.

Vaziri M¹, Ehsanipour F², Pazouki A³, Tamannaie Z⁴, Taghavi R⁵, Pishgahroudsari M⁶, Jesmi F⁷, Chaichian S⁸.

Abstract

BACKGROUND:

Delay in diagnosis and treatment of acute appendicitis (AA) results in an increased rate of perforation, postoperative morbidity, mortality and hospital length of stay. Several biochemical parameters including white blood cell (WBC) count, C-reactive protein (CRP), interleukin-6 (IL6) and Procalcitonin (PCT) have been used to further improve the clinical diagnosis of AA. The aim of this study was to assess the value of procalcitonin as a predictor of diagnosis and severity of appendicitis in order to improve the clinical decision making, since other studies have been unable to demonstrate a diagnostic value for PCT elevation in acute appendicitis.

METHODS:

One-hundred patients who underwent open appendectomy, including 75 men and 25 women with a mean age of 28 years were included in this study. Procalcitonin values were measured by an immunofluorescent method). Serum PCT>0.5 ng/ml was considered positive. The PCT serum values were measured in four different categories, including ˂0.5ng/ml, 0.5-2 ng/ml, 2-10ng/ml and more than 10ng/ml.

RESULTS:

The sensitivity and specificity of PCT level measurement for acute appendicitis diagnosis were 44% and 100% respectively. The value of PCT increased with the severity of appendicitis and also with the presence of peritonitis and infection, at the site of surgery.

CONCLUSIONS:

Procalcitonin measurement cannot be used as a diagnostic test for adult patients with acute appendicitis and its routine use in such patients is not cost effective and conclusive. Procalcitonin values can be used as a prognostic marker and predictor of infectious complications following surgery and it can help to carry out timely surgical intervention which is highly recommended in patients with PCT values more than 0.5ng/ml.

 

 

 

Int J Oncol. 2015 Feb;46(2):445-58

The characteristic ultrasound features of specific types of ovarian pathology (review).

Sayasneh A¹, Ekechi C², Ferrara L², Kaijser J³, Stalder C², Sur S², Timmerman D³, Bourne T¹.

Author information

Abstract

Characterizing ovarian masses enables patients with malignancy to be appropriately triaged for treatment by subspecialist gynecological oncologists, which has been shown to optimize care and improve survival. Furthermore, correctly classifying benign masses facilitates the selection of patients with ovarian pathology that may either not require intervention, or be suitable for minimal access surgery if intervention is required. However, predicting whether a mass is benign or malignant is not the only clinically relevant information that we need to know before deciding on appropriate treatment. Knowing the specific histology of a mass is becoming of increasing importance as management options become more tailored to the individual patient. For example predicting a mucinous borderline tumor gives the opportunity for fertility sparing surgery, and will highlight the need for further gastrointestinal assessment. For benign disease, predicting the presence of an endometrioma and possible deeply infiltrating endometriosis is important when considering both who should perform and the extent of surgery. An examiner’s subjective assessment of the morphological and vascular features of a mass using ultrasonography has been shown to be highly effective for predicting whether a mass is benign or malignant. Many masses also have features that enable a reliable diagnosis of the specific pathology of a particular mass to be made. In this narrative review we aim to describe the typical morphological features seen on ultrasound of different adnexal masses and illustrate these by showing representative ultrasound images.

 

 

Hum Reprod Update. 2015 Mar-Apr;21(2):155-73.

Role of nuclear progesterone receptor isoforms in uterine pathophysiology.

Patel B¹, Elguero S¹, Thakore S¹, Dahoud W¹, Bedaiwy M², Mesiano S³.

Abstract

BACKGROUND:

Progesterone is a key hormonal regulator of the female reproductive system. It plays a major role to prepare the uterus for implantation and in the establishment and maintenance of pregnancy. Actions of progesterone on the uterine tissues (endometrium, myometrium and cervix) are mediated by the combined effects of two progesterone receptor (PR) isoforms, designated PR-A and PR-B. Both receptors function primarily as ligand-activated transcription factors. Progesterone action on the uterine tissues is qualitatively and quantitatively determined by the relative levels and transcriptional activities of PR-A and PR-B. The transcriptional activity of the PR isoforms is affected by specific transcriptional coregulators and by PR post-translational modifications that affect gene promoter targeting. In this context, appropriate temporal and cell-specific expression and function of PR-A and PR-B are critical for normal uterine function.

METHODS:

Relevant studies describing the role of PRs in uterine physiology and pathology (endometriosis, uterine leiomyoma, endometrial cancer, cervical cancer and recurrent pregnancy loss) were comprehensively searched using PubMed, Cochrane Library, Web of Science, and Google Scholar and critically reviewed.

RESULTS:

Progesterone, acting through PR-A and PR-B, regulates the development and function of the endometrium and induces changes in cells essential for implantation and the establishment and maintenance of pregnancy. During pregnancy, progesterone via the PRs promotes myometrial relaxation and cervical closure. Withdrawal of PR-mediated progesterone signaling triggers menstruation and parturition. PR-mediated progesterone signaling is anti-mitogenic in endometrial epithelial cells, and as such, mitigates the tropic effects of estrogen on eutopic normal endometrium, and on ectopic implants in endometriosis. Similarly, ligand-activated PRs function as tumor suppressors in endometrial cancer cells through inhibition of key cellular signaling pathways required for growth. In contrast, progesterone via PR activation appears to increase leiomyoma growth. The exact role of PRs in cervical cancer is unclear. PRs regulate implantation and therefore aberrant PR function may be implicated in recurrent pregnancy loss (RPL). PRs likely regulate key immunogenic factors involved in RPL. However, the exact role of PRs in the pathophysiology of RPL and the use of progesterone for therapeutic benefit remains uncertain.

CONCLUSIONS:

PRs are key mediators of progesterone action in uterine tissues and are essential for normal uterine function. Aberrant PR function (due to abnormal expression and/or function) is a major cause of uterine pathophysiology. Further investigation of the underlying mechanisms of PR isoform action in the uterus is required, as this knowledge will afford the opportunity to create progestin/PR-based therapeutics to treat various uterine pathologies.

 

 

 

Arch Esp Urol. 2014 Nov;67(9):771-5

Müllerianosis of the urinary bladder: report of three new cases.

Casasayas-Carles P¹, Fuentes-Marquez I, Tarrasa-Sagristá F, Gutiérrez Sanz-Gadea C.

Abstract

OBJECTIVE:

We report three new cases of müllerianosis of the urinary bladder.

METHODS:

We present three cases of women in the third decade of life, two of them presenting hematuria and pelvic pain, and the third was referred to perform a recto-vaginal endometriosis surgical procedure. Diagnosis was made by ultrasound and cystoscopy in the first and second case, and by CT scan in the endometriosiscase.

RESULTS:

Müllerianosis of the urinary bladder is described as the presence of müllerian remnants (endometrial, endosalpinx and endocervix) in the bladder wall. Diagnosis is made as a result of a pathologic study of the resected lesions. Although a relapse of the disease is infrequent, it can happen, and close monitoring of the patients must be performed.

CONCLUSIONS:

Müllerianosis of the bladder is a rare condition and differential diagnosis must be done with benign and malignant bladder lesions because it can affect the muscularis propia. It mostly presents as lower urinary tract symptoms and hematuria that can be cyclic. Transurethral resection is the treatment of choice in superficial and focal lesions. In the case of infiltration of the bladder muscle, and depending on the extension of the disease, partial cystectomy may be necessary.

 

 

Iran J Reprod Med. 2014 Aug;12(8):555-60.

The differential expression of microRNA-143,145 in endometriosis.

Zheng B¹, Xue X², Zhao Y³, Chen J⁴, Xu CY⁵, Duan P⁵.

Abstract

BACKGROUND:

Recent studies showed that inappropriate expression of microRNAs (miRNAs) is strongly associated with tumor-related processes in humans (2-9,11-17).

OBJECTIVE:

To understand the changes of miRNAs in endometriosis.

MATERIALS AND METHODS:

With real-time RT-PCR, we investigated the miR-143 and miR-145 expression in eutopic (EU, n=2) and ectopic endometrium (EC, n=11) (from women with endometriosis) (as well as EU+EC, n=11), along with the normal endometrium (EN, n=22) (from women without endometriosis, but with leiomyoma).

RESULTS:

We did not find that the expression of miR-143 and/or miR-145 in EN or EC changed with menstrual cycle. But our results showed the miR-143 was up-regulated in EC (p=0.000) compared to EN. The miR-143 was also up-regulated in EU, but the difference did not reach statistically significance (p=0.053). Compared to EU, the expression of miR-143 in EC was up-regulated (p=0.016). MiR-145 had the similar characteristic to miR-143. The miR-145 was up-regulated in both EU (p=0.004) and EC (p=0.000) in compared to EN group. When compared with EU, the miR-145 in EC was up-regulated (p=0.008).

CONCLUSION:

In conclusion, the miR-143 and miR-145 may play a certain role in the development and progression of endometriosis.

 

 

J Med Life. 2014 Sep 15;7(3):349-57

Endometriosis still a challenge.

Mehedintu C¹, Plotogea MN¹, Ionescu S¹, Antonovici M¹.

 

Abstract

Endometriosis is a debilitating disease with features of chronic inflammation. Endometriosis appears to be one of the most common benign gynecological proliferations in premenopausal women since it is estimated that 10-15% of reproductive aged women suffer from pelvic endometriosis. The biology of endometriosis is unclear. Despite its prevalence, this disease remains poorly understood and current studies prove that there is no relationship between the extent of the disease and its symptomatology. There is no blood test available for the diagnosis of endometriosis. Up to this point, there is no single very successful option for the treatment of endometriosis. Due to the relatively poor efficacy of hormonal therapy for endometriosis, several other experimental therapies are currently undergoing clinical trial.

 

 

Bioinformatics. 2015 Apr 1;31(7):1034-43.

HyDRA: gene prioritization via hybrid distance-score rank aggregation.

Kim M¹, Farnoud F¹, Milenkovic O¹.

Abstract

Gene prioritization refers to a family of computational techniques for inferring disease genes through a set of training genes and carefully chosen similarity criteria. Test genes are scored based on their average similarity to the training set, and the rankings of genes under various similarity criteria are aggregated via statistical methods. The contributions of our work are threefold: (i) first, based on the realization that there is no unique way to define an optimal aggregate for rankings, we investigate the predictive quality of a number of new aggregation methods and known fusion techniques from machine learning and social choice theory. Within this context, we quantify the influence of the number of training genes and similarity criteria on the diagnostic quality of the aggregate and perform in-depth cross-validation studies; (ii) second, we propose a new approach to genomic data aggregation, termed HyDRA (Hybrid Distance-score Rank Aggregation), which combines the advantages of score-based and combinatorial aggregation techniques. We also propose incorporating a new top-versus-bottom (TvB) weighting feature into the hybrid schemes. The TvB feature ensures that aggregates are more reliable at the top of the list, rather than at the bottom, since only top candidates are tested experimentally; (iii) third, we propose an iterative procedure for gene discovery that operates via successful augmentation of the set of training genes by genes discovered in previous rounds, checked for consistency.

MOTIVATION:

Fundamental results from social choice theory, political and computer sciences, and statistics have shown that there exists no consistent, fair and unique way to aggregate rankings. Instead, one has to decide on an aggregation approach using predefined set of desirable properties for the aggregate. The aggregation methods fall into two categories, score- and distance-based approaches, each of which has its own drawbacks and advantages. This work is motivated by the observation that merging these two techniques in a computationally efficient manner, and by incorporating additional constraints, one can ensure that the predictive quality of the resulting aggregation algorithm is very high.

RESULTS:

We tested HyDRA on a number of gene sets, including autism, breast cancer, colorectal cancer, endometriosis, ischaemic stroke, leukemia, lymphoma and osteoarthritis. Furthermore, we performed iterative gene discovery for glioblastoma, meningioma and breast cancer, using a sequentially augmented list of training genes related to the Turcot syndrome, Li-Fraumeni condition and other diseases. The methods outperform state-of-the-art software tools such as ToppGene and Endeavour. Despite this finding, we recommend as best practice to take the union of top-ranked items produced by different methods for the final aggregated list.

 

 

Ginecol Obstet Mex. 2014 Sep;82(9):641-5.

Cornual ectopic pregnancy.

Montes-Hernández D, López-Franco A, Hernández-Valencia M.

 

Abstract

This paper reports the case of a 16-year old patient, with menstrual delay of 9 weeks, with positive pregnancy test, who went to the hospital due to expulsion of organized material, as well as pain colic type in hypogastrium. It was carried out laparotomy, finding ectopic pregnancy in right horn, being carried out miometrial incision and trophoblast aspiration, with presence of multiple endometriosic focuses in later face of uterus. In later pregnancies, there are not studies about the solidity of the scar after the horn resection and uterine breaks have been described in the second and third trimester.

 

 

Int Immunol. 2015 Apr;27(4):195-204.

Endometriotic mesenchymal stem cells exhibit a distinct immune phenotype.

Koippallil Gopalakrishnan Nair AR¹, Pandit H¹, Warty N², Madan T³.

 

Abstract

Endometriosis is a significant debilitating gynecological problem affecting women of the reproductive age group and post-menopause. Recent reports suggest a role for endometriotic mesenchymal stem cells (ectopic MSCs) in the pathogenesis of endometriosis. To investigate the plausible mechanisms leading to the pathogenic behavior of ectopic MSCs, we compared the immunomodulatory properties of eutopic (healthy) and ectopic MSCs. We analyzed MSC phenotypes, differentiation potential, differential gene expression for an array of pattern recognition receptors (PRRs) and pro-inflammatory cytokine release along with markers of migration and angiogenesis among eutopic and ectopic MSCs. Further, alterations in immunosuppressive functions of eutopic and ectopic MSCs were examined by co-culturing them with mitogen-activated allogeneic PBMCs. Transcripts of PRRs such as all Toll-like receptors (TLR1-10), except TLR8, collectins (CL-L1, CL-P1 and CL-K1), NOD-1 and NOD-2 receptors and secreted pro-inflammatory cytokines like IL-6, IFN-γ, vascular endothelial growth factor (VEGF), epidermal growth factor and MCP-1 were significantly up-regulated in ectopic MSCs. The anti-inflammatory cytokine transforming growth factor-β showed significant down-regulation, while IL-10 showed a significant increase in ectopic MSCs. Further, ectopic MSCs showed up-regulated expression for markers of migration and angiogenesis such as matrix metalloproteinase-2 (MMP-2), MMP-3 and MMP-9 and VEGF, respectively. We report here that proliferation of PBMCs was less inhibited upon co-culture with ectopic MSCs compared with eutopic MSCs. The findings suggest that ectopic MSCs with increased levels of TLRs, collectins, pro-inflammatory cytokines and markers of migration and angiogenesis exhibit a distinct immune phenotype compared to eutopic MSCs. This distinct phenotype may be responsible for the reduced immunosuppressive property of ectopic MSCs and may be associated with the pathogenesis of endometriosis.

 

 

 

 

 

Cancer Sci. 2015 Jan;106(1):43-50.

Inducing malignant transformation of endometriosis in rats by long-term sustaining hyperestrogenemia and type II diabetes.

Wang CT¹, Wang DB, Liu KR, Li Y, Sun CX, Guo CS, Ren F.

 

Abstract

This study aimed to induce malignant transformation of endometriosis in Sprague-Dawley rats by hyperestrogenemia and type II diabetes and evaluate its similarity with human disease in biological features. Rats with surgically induced endometriosis were randomized into two groups: those treated with estradiol (5 mg/kg three times/week after surgery), streptozotocin (25 mg/kg, 1 month after surgery), and high carbohydrate-and-fat feed (Es group); and those treated with placebo saline and standard feed (control group). All rats were randomly killed 2, 4, or 8 months after surgery. The endometriosis lesions and the corresponding eutopic endometria were subjected to morphological evaluation, TUNEL, and immunohistochemical analysis for the expressions of proliferating cell nuclear antigen, phosphatase and tensin homolog, phosphorylated protein kinase B, and phosphorylated mammalian target of rapamycin proteins. In the Es group, three cases (6.0%) of endometriosis showed atypical hyperplasia accompanied by simple hyperplastic eutopic endometria, and two cases (4.0%) of endometriosis showed endometrioid carcinoma accompanied by atypical hyperplastic eutopic endometria. In the Es group, the activity of organelles and the expressions of proliferating cell nuclear antigen, phosphorylated protein kinase B, and phosphorylated mammalian target of rapamycin increased, and the level of phosphatase and tensin homolog and TUNEL positivity decreased progressively in the order of endometriosis, atypical endometriosis, and malignant endometriosis. The same tendency was found in the corresponding eutopic endometria. The induced malignant endometriosis showed similarities with human disease in the pathological process and histomorphological and molecular biological features. The method is feasible. The malignant transformations of endometriosis and eutopic endometria may have correlations and similarities, but the former may suffer a higher risk of canceration.

 

Cancer Genomics Proteomics. 2014 Nov-Dec;11(6):295-301.

The role of apurinic/apyrimidinic endonuclease DNA repair gene in endometriosis.

Hsu CM¹, Chang WS², Hwang JJ³, Wang JY⁴, Hsiao YL⁵, Tsai CW¹, Liu JC⁵, Ying TH⁶, Bau DT².

Abstract

BACKGROUND/AIM:

The altered cellular repair capacity plays a critical role in genomic instability and carcinogenesis. We aimed at evaluating the contribution of the polymorphic variant in apurinic/apyriminidinic endonuclease (APEX1) gene to its mRNA and protein levels and the risk of endometriosis.

PATIENTS AND METHODS:

In the current case-control study, 153 endometriosis patients and 636 non-endometriosis controls were recruited. APEX1 Asp(148)Glu (rs1130409) genotyping was conducted by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). At the same time, twenty eight endometriosis tissue samples with different genotypes were examined regarding their expression levels of APEX1 mRNA and protein by quantitative reverse transcription-polymerase chain reaction (q-PCR) and western blotting, respectively.

RESULTS:

Compared with wild-type TT genotype, TG and GG genotypes of APEX1 Asp(148)Glu had a risk of endometriosis of 0.93- and 0.87-fold. The results from in vivo transcriptional (RNA) and translational (protein) level analysis revealed that the APEX1 mRNA and protein were of similar levels among the endometriosistissues of people carrying TT, TG, or GG genotypes. There was no joint effect of APEX1 Asp(148)Glu genotype with menarche, pregnancy, smoking or alcohol drinking lifestyles on endometriosis risk.

CONCLUSION:

The APEX1 Asp(148)Glu genotype correlates well with its mRNA and protein expression among endometriosis patients and may not serve as a sensitive marker for prediction of endometriosis risk in Taiwan.

 

 

Minerva Ginecol. 2015 Aug;67(4):353-63.

Review of the various laparoscopic techniques used in the treatment of bowel endometriosis.

Pergialiotis V¹, Vlachos D, Protopapas A, Chatzipapas I, Vlachos G.

 

Abstract

Colorectal infiltration by endometriotic implants accounts about 90% of all intestinal location and is difficult to be assessed preoperatively by means of history taking and clinical examination. During the last decade, a number of studies are trying to assess various minimally invasive procedures in order to establish a therapeutic plan that is efficacious and produces acceptable clinical outcomes, preventing the morbidity that results from open surgery. The study aims to review the efficacy of these procedures as therapeutic options of endometriosisinfiltrating the bowel. Thirty five observational studies were finally included in the present review involving 3490 women. Intraoperative complications were observed in 4.3% of women and postoperative complications in 7.8%. Quality of life was statistically significantly improved, wherever recorded. Postoperative pain reduction and fertility scores were also improved among cases that received either segmental resection or less radical operations. The various techniques described seem to be efficacious, with acceptable intraoperative and postoperative complication rates. Laparoscopic disc shaving or disc resection in cases of minimal bowel involvement seem to be sufficient alternatives to segmental bowel resection, resulting in high rates of fertilization.

 

 

J Ovarian Res. 2014 Nov 26;7:108.

The impact of endometrioma and laparoscopic cystectomy on ovarian reserve and the exploration of related factors assessed by serum anti-Mullerian hormone: a prospective cohort study.

Chen Y¹, Pei H^2,3, Chang Y⁴, Chen M⁵, Wang H⁶, Xie H⁷, Yao S⁸.

Abstract

BACKGROUND:

To evaluate the impact of the presence of endometrioma and laparoscopic cystectomy on ovarian reserve as assessed by serum anti-Müllerian hormone (AMH) level. In addition, factors related to the decline in ovarian reserve were analyzed.

METHODS:

From June 2013 to January 2014, we prospectively included 40 women with endometriomas as the study group (group A), 36 women with tubal factor infertilities as control group 1 (group B) and 22 women with the other benign ovarian cysts as control group 2 (group C). The women with ovarian cysts underwent laparoscopic cystectomy. Serum AMH levels were determined preoperatively and at 1 month after surgery.

RESULTS:

The endometrioma group had lower AMH levels (1.53 ± 1.37 ng/ml) compared with the other benign ovarian cyst group (2.20 ± 1.23 ng/ml) and the tubal factor infertility group (2.82 ± 1.74 ng/ml). The rate of serum AMH decline 1 month after surgery in the endometrioma group (0.62 ± 0.35) was larger than the decline in the other benign ovarian cyst group (0.32 ± 0.30). The preoperative AMH level showed a significant correlation with patient age (group A, r = -0.32; group B, r = -0.54; group C, r = -0.71); there was a statistically significant correlation between the rate of serum AMH decline and endometrioma diameter as well as with the preoperative serum AMH level. In addition, the rate of serum AMH decline was larger for bilateral endometriomas than for unilateral endometriomas, but there was no similar correlation in the other benign ovarian cyst group. The rate of AMH decline after surgery in the subgroup of >7 cm was significantly higher than in the subgroup of ≤7 cm.

CONCLUSIONS:

Ovarian endometriomas per se may damage ovarian reserve, and cystectomy of endometriomas may cause greater damage to ovarian reserve compared with other benign ovarian cysts. The operation-related damage to the ovarian reserve was positively related to whether the endometriomas were bilateral, as well as cyst size (especially for cysts >7 cm), but was negatively related to the preoperative serum AMH level. Age was a negative factor that affected the ovarian reserve.

 

 

Gynecol Oncol Case Rep. 2014 May 5;9:18-20.

Umbilical endometriosis with giant degenerated uterine leiomyomas: A case report.

Omori M¹, Ogawa T¹, Nara M¹, Hashi A¹, Hirata S¹.

 

Abstract

• We present an unusual case of umbilical endometriosisand huge uterine leiomyomas with marked hydropic and cystic degeneration.•Although umbilical tumors are uncommon, the differential diagnosis should include umbilical endometriosis, particularly in reproductive-age women.•Umbilical endometriosiscan be suspected from the clinical presentation, but the diagnosis should be confirmed with histological examination.

 

 

Iran J Med Sci. 2014 Nov;39(6):580-3.

Adenoid Cystic Carcinoma of Bartholin’s Gland Clinically Mimics Endometriosis, A Case Report.

Akbarzadeh-Jahromi M¹, Sari Aslani F¹, Omidifar N¹, Amooee S².

 

Abstract

Adenoid cystic carcinoma of Bartholin’s gland is a rare malignant tumor of female genital tract. We report a case of a 42-year-old woman, presenting a palpable painful mass and burning sensation on the left side of vulva during the preceding two months. Based on examination, a solid fixed painful nodule with intact mucosa was palpated on the left side of the vagina. Histological features were compatible with adenoid cystic carcinoma. Often, such lesion is clinically misdiagnosed as a cyst or inflammation. The present case was carried out with an impression of endometriosis. The possibility of cancer should be considered in any female older than 40 years of age with a lesion near the Bartholin’s glands.

 

 

Ugeskr Laeger. 2014 Nov 17;176(47).

Severe intraabdominal bleeding in a pregnant woman with a history of endometriosis.

Berlac JF¹, Langhoff-Roos J, Lidegaard O, Hartwell D.

 

Abstract

Spontaneous haemoperitoneum in pregnancy has been associated with endometriosis. More women with endometriosis get pregnant due to improved fertility treatment and little is known of their risk of obstetrical complications. We report a case of a pregnant woman with a history of endometriosis who was admitted in gestational week 28 with spontaneous haemoperitoneum. We performed an emergency caesarean section and found multiple varicosities on the surface of uterus with active bleeding. Further knowledge on complications in pregnant women with endometriosis is needed.

 

 

Hum Reprod. 2015 Feb;30(2):308-14.

Characterization of anastrozole effects, delivered by an intravaginal ring in cynomolgus monkeys.

Rotgeri A¹, Korolainen H², Sundholm O², Schmitz H³, Fuhrmann U⁴, Prelle K⁵, Sacher F⁶.

Abstract

STUDY QUESTION:

Is it feasible to deliver anastrozole (ATZ), an aromatase inhibitor (AI), by a vaginal polymer-based drug delivery system in the cynomolgus monkey (Macaca fascicularis) to describe the pharmacokinetic profile?

SUMMARY ANSWER:

The present study showed the effective release of ATZ into the systemic circulation from intravaginal rings in cynomolgus monkeys.

WHAT IS KNOWN ALREADY:

ATZ is a marketed drug with well documented pharmacological and safety profiles for oral administration. Aromatase is the key enzyme catalyzing estrogen biosynthesis and is overexpressed in endometriotic lesions. AIs show therapeutic efficacy in endometriosis in exploratory clinical trials.

STUDY DESIGN, SIZE, DURATION:

The pharmacokinetics of the in vivo release and the pharmacodynamic activity of ATZ released by intravaginal rings (IVR) were investigated in healthy cycling female cynomolgus monkeys in three different dose groups (n = 5) for one menstrual cycle.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

IVRs for the cynomolgus monkey, releasing three different doses of ATZ were designed and tested for in vitro/in vivo release for up to 42 days. For pharmacokinetic and pharmacodynamic evaluation, plasma samples were taken once daily from Day 1 to 3 and then every third day until menses occurred (17-42 days).

MAIN RESULTS AND THE ROLE OF CHANCE:

ATZ was shown to be compatible with the IVR drug delivery system. An average in vivo release of 277 µg/day/animal of ATZ for one menstrual cycle was effective in causing a decrease of systemic estradiol (E₂) levels by ∼30% without inducing counter regulation such as the elevation of FSH or the formation of ovarian cysts.

LIMITATIONS, REASONS FOR CAUTION:

The study was limited to three dose groups in which only the highest dose decreased the E₂ level. Hence, additional research with IVRs releasing higher amounts of ATZ is required to define the threshold for an ATZ-dependent ovarian stimulation in cynomolgus monkeys.

WIDER IMPLICATIONS OF THE FINDINGS:

The release rate administered from IVRs is sufficient and in a range that supports feasibility of IVR administration of ATZ as a new approach for long-term therapy of estrogen-dependent diseases such as endometriosis in human.

 

 

Hum Reprod. 2015 Feb;30(2):392-405.

Endometriosis also affects the decidua in contact with the fetal membranes during pregnancy.

Marcellin L¹, Santulli P², Gogusev J³, Lesaffre C⁴, Jacques S⁴, Chapron C², Goffinet F⁵, Vaiman D³, Méhats C³.

Abstract

STUDY QUESTION:

Are the fetal membranes of women affected with endometriosis similar to those from disease-free women?

SUMMARY ANSWER:

Decidua of women with endometriosis is able to generate endometriotic-like lesions in contact with the fetal membranes.

WHAT IS KNOWN ALREADY:

Eutopic endometrium of women affected with endometriosis presents compromised properties. Endometrium undergoes decidualisation to accept and to further control the conceptus development during pregnancy. Decidualized endometrium is in close contact with the chorionic membrane and forms the choriodecidual layer, a major maternal-fetal interface.

STUDY DESIGN, SIZE, DURATION:

This is a laboratory case-control study involving diseased versus control samples. Eleven case samples and 11 control samples were collected from women in a tertiary care/research center between November 2011 and December 2013.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Participants were consecutive pregnant women affected with confirmed endometriosis and disease free women, who underwent Cesarean section before labor for obstetrical indication. The choriodecidual tissues were characterized using histology, immunohistochemistry, transcriptomic and whole genome CpG methylation analyses.

MAIN RESULTS AND THE ROLE OF CHANCE:

We demonstrate for the first time the presence of endometriotic-like lesions within the decidual side of the choriodecidua of the fetal membranes from women affected with severe endometriosis. Fetal membranes from women affected with endometriosis exhibited glandular components in the choriodecidual layer surrounded by enlarged decidualized cells disseminated along the entire membrane surface. Significant deregulation (variation of expression ≥2, P-value ≤0.05) was observed for 2773 genes known to be enriched in processes involved in glandular function, endocrine and nervous system, neoangiogenesis, and autoimmune disease. CpG methylation analysis revealed 5999 differentially methylated regions with a P-value ≤0.05.

LIMITATIONS, REASONS FOR CAUTION:

We studied women who delivered at term by Cesarean section before labor, following an uneventful pregnancy. Notwithstanding this, one cannot exclude that the presence of disseminated endometriotic lesions within the choriodecidual layer of the fetal membranes may disturb the anatomical integrity and/or the function of the membranes in some women with endometriosis.

WIDER IMPLICATIONS OF THE FINDINGS:

Our results shed new light on the capability of the diseased decidua to develop lesions not only at ectopic autologous locations, but also on the semi-allogenous fetal membranes, a particularly immunotolerant environment.

 

 

 

Hum Reprod. 2015 Feb;30(2):299-307.

Endometriotic ovarian cysts do not negatively affect the rate of spontaneous ovulation.

Leone Roberti Maggiore U¹, Scala C², Venturini PL², Remorgida V², Ferrero S².

Abstract

STUDY QUESTION:

Do endometriotic ovarian cysts influence the rate of spontaneous ovulation?

SUMMARY ANSWER:

Endometriotic cysts, no matter what their volume, do not influence the rate of spontaneous ovulation in the affected ovary.

WHAT IS KNOWN ALREADY:

Endometriotic ovarian cysts may negatively affect spontaneous ovulation in the affected ovary.

STUDY DESIGN, SIZE, DURATION:

This was a prospective observational study performed between September 2009 and June 2013.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

This study included women of reproductive age with regular menstrual cycles and unilateral ovarian endometriomas (diameter ≥20 mm) desiring to conceive. Exclusion criteria were: hormonal therapies in the 3 months prior to study entry and previous adnexal surgery. Patients underwent serial transvaginal ultrasound to assess the side of ovulation (for up to six cycles).

MAIN RESULTS AND THE ROLE OF CHANCE:

Ovulation was monitored in 1199 cycles in 244 women (age, mean ± SD, 34.3 ± 4.9 years). 55.3% of the patients had left endometriomas and 44.7% had right endometriomas (P = 0.024). The mean (±SD) diameter of the endometriomas was 5.3 cm (±1.7 cm). Ultrasonographically documented ovulation occurred in 596 cycles in the healthy ovary (49.7%; 95% CI, 46.8-52.6%) and in 603 cycles in the affected ovary (50.3%; 95% CI, 47.1-53.2%; P = 0.919). This observation was confirmed in patients with diameter of the cyst ≥4 cm (n = 166) and in those with diameter of the cyst ≥6 cm (n = 45). One hundred and five patients spontaneously conceived (43.0%; 95% CI, 36.7-49.5%).

LIMITATIONS, REASON FOR CAUTION:

The high pregnancy rate reported in this study was observed in a selected population of women with endometriomas and cannot be extrapolated to all patients with endometriosis.

WIDER IMPLICATIONS OF THE FINDINGS:

Since ovarian endometriomas do not impair spontaneous ovulation, the impact on fertility of surgical excision of ovarian endometriomas should be further investigated.

 

 

Oncol Lett. 2015 Jan;9(1):321-323.

Pure primary ovarian squamous cell carcinoma: A case report and review of the literature.

Park JW¹, Bae JW¹.

 

Abstract

Pure primary ovarian squamous cell carcinoma (SCC) is a rare lesion that usually arises from the malignant transformation of an existing ovarian dermoid cyst. The de novo occurrence of an ovarian SCC in the absence of a prior ovarian dermoid cyst, Brenner tumor or endometriosis is extremely rare. At present, no effective therapy exists for treating pure primary ovarian SCC. The present case study describes a patient that presented with progressive coughing, who was diagnosed with an International Federation of Gynecology and Obstetrics stage IV pure primary ovarian SCC with lung metastases. The patient received postoperative chemotherapy, however, the patient succumbed to the disease. The current study also presents a review of the literature.

 

 

Fertil Steril. 2015 Jan;103(1):153-9.e3.

Macrophage migration inhibitory factor as a potential biomarker of endometriosis.

Mahdian S¹, Aflatoonian R², Yazdi RS³, Yaghmaei P⁴, Ramazanali F², Afsharian P⁵, Shahhoseini M⁶.

Abstract

OBJECTIVE:

To evaluate the expression of MIF, CD74, and COX-2 in normal, ectopic, and eutopic endometrium during the menstrual cycle and to assess MIF level in peripheral blood.

DESIGN:

The expressions of MIF, CD74, and COX-2 in normal, ectopic, and eutopic endometrium were evaluated with the use of real-time polymerase chain reaction. MIF protein in peripheral blood samples was checked with the use of ELISA.

SETTING:

Reproductive biomedicine research center.

PATIENT(S):

Sixteen normal women and 20 women with endometriosis.

INTERVENTION(S):

Ectopic biopsies were obtained with the use of laparoscopic procedure, and eutopic and control biopsies were obtained with the use of Pipelle. Peripheral blood samples were collected before laparoscopy.

MAIN OUTCOME MEASURE(S):

The expression of MIF, CD74, and COX-2 in normal, ectopic and eutopic endometrium during the menstrual cycle and the expression level of MIF in peripheral blood samples.

RESULT(S):

Relative mRNA expression of MIF, CD74, and COX-2 were significantly higher in ectopic endometrium than in eutopic and control endometrium. Also, there were significant differences in expression of these genes in normal, ectopic, and eutopic endometrium during the menstrual cycle. Moreover, women with endometriosis had significantly higher circulating levels of MIF compared with control subjects.

CONCLUSION(S):

Dynamic expression of MIF, CD74, and COX-2 during the menstrual cycle could play an essential role in reproduction, inflammation, and endometrium reconstruction. A higher expression of these genes in ectopic endometrium can be considered as a molecular biomarker for endometriosis development and pathophysiology. Also, a high level of MIF in blood serum can act as a biomarker in the diagnosis of endometriosis.