Fertil Steril. 2015 Jan;103(1):147-52.

Urinary tract endometriosis in patients with deep infiltrating endometriosis: prevalence, symptoms, management, and proposal for a new clinical classification.

Knabben L¹, Imboden S², Fellmann B², Nirgianakis K², Kuhn A², Mueller MD².

 

Abstract

OBJECTIVE:

To analyze the prevalence of urinary tract endometriosis (UTE) in patients with deep infiltrating endometriosis (DIE) and to define potential criteria for preoperative workup.

DESIGN:

Retrospective study.

SETTING:

University hospital.

PATIENT(S):

Six hundred ninety-seven patients with endometriosis.

INTERVENTION(S):

Excision of all endometriotic lesions.

MAIN OUTCOME MEASURE(S):

Correlation of preoperative features and intraoperative findings in patients with UTE.

RESULT(S):

Out of 213 patients presenting DIE, 52.6% suffered from UTE. In patients with ureteral endometriosis, symptoms were not specific. Among the patients with bladder endometriosis, 68.8% complained of urinary symptoms compared to 7.9% in the group of patients without UTE. In patients with rectovaginal endometriosis, the probability of ureterolysis showed a linear correlation with the size of the nodule. We found that 3 cm in diameter provided a specific cutoff value for the likelihood of ureteric involvement.

CONCLUSION(S):

The prevalence of UTE has often been underestimated. Preoperative questioning is important in the search for bladder endometriosis. The size of the nodule is one of the few reliable criteria in preoperative assessment that can suggest ureteric involvement. We propose a classification of ureteral endometriosis that will allow the standardization of terminology and help to compare the outcome of different surgical treatment in randomized studies.

 

 

Reprod Biol Endocrinol. 2014 Dec 1;12:120.

Ovarian reserve markers and assisted reproductive technique (ART) outcomes in women with advanced endometriosis.

Wahd SA¹, Alalaf SK, Al-Shawaf T, Al-Tawil NG.

 

Abstract

BACKGROUND:

The role of ovarian reserve markers as predictors of the controlled ovarian stimulation (COS) response in intracytoplasmic sperm injection (ICSI) cycles in women with endometriosis has been much debated. The aim of the present study is to assess the predictability of ovarian reserve markers for the number of mature oocytes (MII) retrieved and to assess the pregnancy rate and live birth rate in women with advanced endometriosis.

METHODS:

Two hundred eighty-five infertile women who had laparoscopy followed by a first ICSI cycle were recruited in this prospective study. One hundred ten patients were diagnosed with endometriosis stage III-IV (group 1), and 175 patients had no endometriosis (group II). Sixty-three patients in group 1 had no history of previous endometrioma surgery (group Ia), and 47 patients had a history of previous endometrioma surgery (group Ib).

RESULTS:

The number of mature oocytes retrieved was significantly lower in women with advanced endometriosis than in women with no endometriosis. The number of mature oocytes retrieved in women with and without endometriosis was best predicted by antral follicle count (AFC) and age, whereas only AFC was a predictor in women with previous endometrioma surgery (odds ratio: 0.49; 95% confidence interval: 0.13-0.60). Women with endometriosis had a lower rate of live births than the control group, but this difference was not statistically significant; the number of live births was significantly lower in those with previous endometrioma surgery.

CONCLUSIONS:

The best predictor of the COS response in ICSI was AFC, followed by age. Women receiving ICSI following surgery for ovarian endometrioma had a poorer clinical outcome and lower rate of live births compared with those with endometriosis but no previous surgery and the control group.

 

 

 

 

 

Gynecol Obstet Fertil. 2014 Nov;42(11):744-8.

Robotic-assisted laparoscopy for deep infiltrating endometriosis: the Register of the Society of European Robotic Gynaecological Surgery.

Hanssens S¹, Nisolle M², Leguevaque P³, Neme RM⁴, Cela V⁵, Barton-Smith P⁶, Hébert T⁷, Collinet P⁸.

 

Abstract

OBJECTIVES:

To assess the interest of robotic-assisted laparoscopy in the context of deep infiltrating endometriosis and to investigate perioperative results.

PATIENTS AND METHODS:

From November 2008 to April 2012, 164 women with stage IV endometriosis who underwent robotic-assisted laparoscopy (DA VINCI Intuitive Surgical System(®)) were included by eight international participating clinical centers. Patients were divided in 4 groups according to the localization of the nodule(s): rectum (n=88), bladder (n=23), ureter and uterosacral ligaments (n=115) et hysterectomy (n=28). We evaluated the procedures performed, the duration of intervention, the complications, the recurrence and the impact on fertility.

RESULTS:

In the rectum group, there was a laparotomy conversion, 2 sutured rectal injuries and a red cells blood transfusion. In the bladder group, there was a vesicovaginal hematoma and a prolongated intermittent self-catheterization. In the ureter and uterosacral ligaments group, there was 2 ureteral fistulas and there was no complication in the hysterectomy group.

DISCUSSION AND CONCLUSION:

This study is the largest series published in the literature on robotic-assisted laparoscopy for deep infiltrating endometriosis. The interest of robotic-assisted laparoscopy in deep infiltrating endometriosis seems to be promising while no increase in surgical time, blood loss, and intra- and postoperative complications were observed.

 

 

 

J Gynecol Obstet Biol Reprod (Paris). 2015 Feb;44(2):136-44.

Glutathione S-transferase M1 polymorphism and endometriosissusceptibility: a meta-analysis.

Li H¹, Zhang Y².

 

Abstract

BACKGROUND:

Many studies have investigated the association between glutathione S-transferase M1 (GSTM1) null genotype and the risk of endometriosis. However, the effect of the GSTM1 null genotype on endometriosis is still unclear because of apparent inconsistencies among those studies. A meta-analysis was performed to characterize the relationship more accurately. PubMed, Embase, and Web of Science were searched.

OBJECTIVE:

To derive a more precise estimation of the relationship, a meta-analysis was performed.

METHODS:

We estimated the summary odds ratio (OR) with a 95% confidence interval (95% CI) to assess the association. Up to 24 case-control studies with 2,684 endometriosis cases and 3,119 control cases were included into this meta-analysis.

RESULTS:

Meta-analysis of the 24 studies showed that GSTM1 null genotype was associated with the risk of endometriosis (random effects OR=1.66, 95% CI 1.23 to 2.24). In the subgroup analysis by ethnicity, increased risks were found for both Caucasians (OR=1.26, 95% CI 1.04-1.51) and Asians (OR=1.28, 95% CI 1.06-1.55). No evidence of publication bias was observed.

CONCLUSION:

In conclusion, this meta-analysis suggests that the GSTM1 null genotype increases the overall risk of endometriosis.

 

 

Reprod Biomed Online. 2014 Dec;29(6):761-70.

Knockdown of prohibitin expression promotes glucose metabolism in eutopic endometrial stromal cells from women with endometriosis.

Qi X¹, Zhang Y², Ji H³, Wu X⁴, Wang F⁵, Xie M⁶, Shu L⁴, Jiang S⁷, Mao Y⁸, Cui Y⁴, Liu J⁴.

 

Abstract

In this in-vitro study, the effect of prohibitin (PHB) on glucose metabolism in eutopic endometrial stromal cells from women with endometriosis was investigated. Endometrial stromal cells were isolated from endometrium in women with endometriosis, in women without endometriosis, or from endometrioma tissues. Glucose metabolic phenotype of stromal cells were examined in vitro. Quantitative polymerase chain reaction was used to measure the mRNA expression of glycolysis-related genes. Glucose consumption and lactate production were examined after knockdown of PHB expression in women with endometriosis with siRNA. In endometrioma tissue, significantly increased glucose consumption, lactate production and aberrant expression of glycolysis-related enzymes were found in women with endometriosis compared with women who do not have endometriosis (P < 0.05 versus P < 0.001). In women with endometriosis, PHB mRNA and protein were under-expressed in endometrioma tissue; in women without endometriosis, PHB mRNA and protein were over-expressed. Knockdown of PHB expression in women with endometriosis increased glucose consumption, although it had no effect on lactate production. This study suggests that aberrant expression of glycolysis-related enzymes in endometrioma tissue is associated with enhanced glycolytic metabolism. The malignant-like feature may be partially caused by low-expression of PHB gene in endometriotic stromal cells.

 

 

J Minim Invasive Gynecol. 2015 Feb;22(2):275-84.

Increased serum cancer antigen-125 is a marker for severity of deep endometriosis.

Santulli P¹, Streuli I², Melonio I³, Marcellin L⁴, M’Baye M³, Bititi A³, Borghese B⁴, Lafay Pillet MC³, Chapron C⁴.

 

Abstract

STUDY OBJECTIVE:

To determine whether cancer antigen-125 (CA-125) levels are increased in women with endometriosis, especially in those with endometriomas (OMAs), deep infiltrating lesions (DIE), and superficial endometriosis (SUP) compared with controls without endometriosis in a large cohort of operated women.

DESIGN:

Cross-sectional study (Canadian Task Force classification II-2).

SETTING:

Tertiary-care university hospital.

PATIENTS:

Four hundred six women with histologically proven endometriosis and 279 women without endometriosis.

INTERVENTIONS:

Surgical examination of the abdomino-pelvic cavity.

MEASUREMENTS AND MAIN RESULTS:

Preoperative serum CA-125 antigen levels were evaluated by electrochemoluminescence immunoassay in women with endometriosis and controls. Correlations between serum CA-125 levels and clinical and anatomical characteristics of disease severity were examined. Women with endometriosis displayed higher mean serum CA-125 levels compared with disease-free controls (50.1 ± 62.4 U/mL vs 22.5 ± 25.2 U/mL; p ≤ .001). CA-125 levels were significantly increased in women with OMA (60.8 ± 63.5 U/mL) and DIE (55.2 ± 68.7 U/mL) compared with women with SUP (23.2 ± 24.5 U/mL) and controls (22.5 ± 25.2 U/mL). There was no difference in CA-125 levels between patients with SUP and controls and between patients with OMA and DIE. CA-125 serum levels were correlated with DIE severity: the mean number of DIE lesions and worst DIE lesion.

CONCLUSION:

Serum CA-125 levels were significantly increased in women with severe forms of endometriosis, OMA, and DIE lesions. In addition, elevated serum Ca-125 levels were associated with more severe and extended DIE lesions. In women with superficial peritoneal lesions, CA-125 levels were not different from women without endometriosis.

 

 

Chem Biol Interact. 2015 Jun 5;234:320-31.

Expression of AKR1B1, AKR1C3 and other genes of prostaglandin F2α biosynthesis and action in ovarian endometriosis tissue and in model cell lines.

Sinreih M¹, Anko M¹, Kene NH¹, Kocbek V¹, Rižner TL².

 

Abstract

Endometriosis is a frequent benign gynecological disease characterized by endometrial tissue outside the uterine cavity. The estimated prevalence in the general population is 6-10%, but this reaches 30-50% in women with infertility and/or pain. As ectopic tissue within the pelvic cavity provokes inflammation, endometriosis is also considered a chronic inflammatory disease, and is characterized by increased peritoneal fluid levels of prostaglandin (PG)E2 and PGF2α. The AKR1B1 and AKR1C3 enzymes act as PG synthases and catalyze reduction of PGH2 to PGF2α, and PGD2 to 9α,11β-PGF2α, respectively. AKR1B1 and AKR1C3 may thus be associated with increased PGF2α production in endometriosis patients, as supported by our previous report of increased AKR1C1-AKR1C3 mRNA levels in endometriotic tissue, compared to control endometrium. Here, we initially evaluated PGF2α concentrations in peritoneal fluid from endometriosis patients and healthy women. We also examined expression of AKR1B1, AKR1C3 and other genes involved in PGF2α biosynthesis, metabolism, and action in ovarian endometriosis tissue versus healthy endometrium, and in peritoneal endometriosis and control endometrium model cell lines. Compared to controls, increased PGF2α concentrations in peritoneal fluid of patients were supported by endometriotic tissue showing increased AKR1B1 mRNA and protein levels, but unchanged AKR1C3 protein levels. Among genes involved in PGF2α biosynthesis, metabolism and action PLA2G2A, PTGS2/COX-2, ABCC4 and PTGFR were up-regulated, mRNA levels of SLCO2A, PTGDS and HPGDS were unchanged, and genes PLA2G4A and HPGD were down-regulated in diseased tissue. All of these PGF2α-associated genes were also expressed in control endometrial HIEEC epithelial and HIESC stromal cell lines, and in peritoneal endometriosis 12-Z epithelial and 22-B stromal cell lines. Higher expression of PLA2G2A, PTGS2, AKR1B1, AKR1C3 and ABCC4 was seen in 22-B endometriosis cells compared to HIESC control cells. These cell models characterized in this study will enable further investigations into the role of PGF2α in the pathophysiology of endometriosis and the involvement of AKR1B1 and AKR1C3.

 

 

 

J Proteomics. 2015 Jan 30;114:182-96.

Investigation of serum proteome alterations in human endometriosis.

Dutta M¹, Subramani E¹, Taunk K², Gajbhiye A², Seal S³, Pendharkar N², Dhali S², Ray CD⁴, Lodh I⁵, Chakravarty B⁵, Dasgupta S⁶, Rapole S², Chaudhury K⁷.

 

Abstract

Endometriosis is a common benign gynecological disease, characterized by proliferation of functional endometrial glands and stroma outside the uterine cavity. The present study involves investigation of alterations in the serum proteome of endometriosis patients compared to healthy controls using 2DE and 2D-DIGE combined with MALDI TOF/TOF-MS. Comparison of serum proteome of endometriosis patients and healthy subjects revealed 25 significant differentially expressed proteins. Gene ontology and network analysis, performed using PANTHER, DAVID, WebGestalt and STRING, revealed that the differentially expressed proteins are majorly involved in response to stimulus, immune system, metabolic, localization and cellular processes. For serum diagnostic marker identification, several robust statistical screening procedures were applied to identify the set of the most significant proteins responsible for successful diagnosis of different endometriosis stages. Partial least squares (PLS) based marker selection tool and orthogonal partial least squares-discriminant analysis (OPLS-DA) were used to identify the most significant proteins for disease prediction. Western blotting validation in a separate cohort of patients revealed that haptoglobin (HP), Ig kappa chain C region (IGKC), alpha-1B-glycoprotein (A1BG) can be considered effective serum protein markers for the diagnosis of Stage II, III and IV endometriosis. For diagnosis of Stage I, only IGKC and HP seemed promising.

BIOLOGICAL SIGNIFICANCE:

Globally, about 12 in 100 women of reproductive age are diagnosed with endometriosis. The pathogenesis of the disease still remains unclear, leading to non-specific therapeutic approaches for disease management. Moreover, there is a delay of 8-12years in correct diagnosis after the initial onset of symptoms leading to a considerable impact on the woman’s lifestyle. Also, the gold standard for diagnosis of endometriosis, laparoscopy, is an invasive procedure. The value of a noninvasive or semi-invasive diagnostic test for endometriosis with easily accessible fluids such as plasma, serum, urine, and saliva is, therefore, rightfully recognized. The present study is expected to considerably improve the understanding of the disease pathogenesis along with improved diagnostics and therapeutic approaches leading to better management of the disease.

 

 

Fertil Steril. 2015 Jan;103(1):160-2.

Fetal endometriosis: a case report.

Schuster M¹, Mackeen DA².

 

Abstract

OBJECTIVE:

To report a case of a large fetal pelvic mass diagnosed at 35 weeks’ gestation.

DESIGN:

Report of a unique case of a fetal abdominal mass, emphasizing the wide range of differential diagnoses. Although rare reports of fetal ovarian cysts exist, even fewer describe endometriosis or endometriomas in infants. As of 2014 there have not been any published reports of fetal endometriosis from the United States.

SETTING:

Large tertiary community hospital.

PATIENT(S):

An 18-year-old pregnant woman diagnosed with a large fetal pelvic mass at 35 weeks’ gestation.

INTERVENTION(S):

Diagnosis of a fetal abdominal mass at 35 weeks with documented enlargement at 37 weeks leading to delivery, with subsequent removal of the mass on day of life 2.

MAIN OUTCOME MEASURE(S):

On day of life 2, a pediatric surgeon performed an exploratory laparotomy and left salpingo-oophorectomy.

RESULT(S):

Final pathology showed a 7.0 × 4.5 cm cyst-like structure consistent with hemorrhagic ovarian cyst wall and focal endometriosis.

CONCLUSION(S):

It can be very difficult to counsel patients regarding an abdominal mass in their unborn child. These difficulties stem from the large list of differential diagnoses and the range of prognoses they portend. As more and more of these cases appear in the literature, we are able to gain a better understanding of how each of these diagnoses present and appear on imaging, allowing us to provide a more accurate diagnosis and counseling antenatally.

 

 

 

Arch Gynecol Obstet. 2015 May;291(5):961-8.

Decidualisation of ovarian endometriomas in pregnancy: a management dilemma. A case report and review of the literature.

Taylor LH¹, Madhuri TK, Walker W, Morton K, Tailor A, Butler-Manuel S.

 

Abstract

INTRODUCTION:

Increased progesterone levels during pregnancy may cause decidualisation of endometriomas mimicking malignancies on radiology and causing management dilemmas.

CASE:

An ovarian cyst was detected in a 33-year-old woman at her routine 12-week gestation ultrasound scan. By 18 weeks, the unilocular mass was increasing in size with features suggestive of early ovarian malignancy. The cyst was monitored throughout pregnancy and caesarean section at 38 weeks delivered a healthy male. Histology confirmed a decidualised endometrioma and benign dermoid cyst with no evidence of malignancy.

LITERATURE REVIEW:

The evidence for decidualised ovarian endometriomas in pregnancy was explored; 14 papers were identified, which reported 26 cases, excluding our index case. Of the 27 cases, 19 (70%) were managed surgically, 4 of which were delayed till caesarean section with concomitant cyst excision; 8 cases were managed conservatively through serial monitoring of the cyst, which spontaneously regressed following delivery.

CONCLUSION:

Surgical management of the cyst provides histological diagnosis but may introduce risks to mother and fetus; a conservative approach may cause anxiety but limits interventions. Elective caesarean section following monitoring throughout pregnancy may bridge the gap between surgical and purely conservative approaches if appropriate. Limited available evidence makes a definitive decision regarding management difficult. Decidualisation should be considered as a differential for suspicious ovarian lesions in pregnancy.

 

 

Fertil Steril. 2015 Jan;103(1):163-71.

Healthcare utilization and costs in women diagnosed with endometriosisbefore and after diagnosis: a longitudinal analysis of claims databases.

Fuldeore M¹, Yang H², Du EX², Soliman AM³, Wu EQ², Winkel C⁴.

 

Abstract

OBJECTIVE:

To assess healthcare resource utilization and costs during the 5 years before and 5 years after diagnosis among women with endometriosis, in comparison with women without endometriosis.

DESIGN:

Longitudinal, retrospective, case-control study.

SETTING:

None.

PATIENT(S):

A total of 37,570 matched pairs of women with and without (controls) endometriosis were identified from the Truven Health MarketScan claims database (2000-2010).

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Annual healthcare resource utilization and costs (in 2010 US dollars) were evaluated for the 5 years before and 5 years after diagnosis.

RESULT(S):

Mean patient age at index (first diagnosis) date was 36.4 years for endometriosis patients and controls. Endometriosis patients had a higher utilization of outpatient and emergency room services during each pre- and postindex year, and a higher utilization of inpatient services during the last preindex year and all 5 postindex years. Total costs were highest in the first postindex year for endometriosis patients, reaching $13,199, compared with $3,747 for controls. Annual costs were significantly higher for patients than controls during each pre- and postindex year; overall, the cost difference was $26,305 over 10 years: $7,028 in the 5 years before diagnosis and $19,277 in the 5 years after diagnosis.

CONCLUSION(S):

Endometriosis poses a significantly high economic burden, both before and after diagnosis. The highest resource utilization and costs experienced by endometriosis patients occur in the first year after diagnosis.

 

 

 

J Minim Invasive Gynecol. 2015 Feb;22(2):261-7.

Does the uterine cervix become abnormally reinnervated after subtotal hysterectomy and what is the association with future trachelectomy?

Yunker A¹, Curlin H², Banet N³, Fadare O², Steege J³.

 

Abstract

STUDY OBJECTIVE:

To compare nerve fiber density in the cervices removed by trachelectomy from women with pelvic pain with those cervices removed for nonpain indications.

DESIGN:

Retrospective cohort study (Canadian Task Force classification II-2).

SETTING:

Two university hospitals.

PATIENTS:

Subjects who underwent trachelectomy during a 10-year time frame were identified.

INTERVENTIONS:

Two tissue sections were obtained from each preserved cervix specimen and stained for S100 antibody. The numbers of S100-immunoreactive peripheral nerve fibers were assessed in 6 high-powered fields (HPFs) per tissue section (12 total HPFs per patient). Information collected included patient characteristics and surgical findings. We excluded any patients with dysplasia/cancer and those without an available adequate specimen.

MEASUREMENTS AND MAIN RESULTS:

We evaluated the cervix specimens from 35 patients who underwent trachelectomy for pain (n = 25, group 1) and nonpain (n = 10, group 2) indications in addition to control cervices (n = 15, group 3) from benign hysterectomies performed for nonpain indications. There were increased numbers of nerve fibers in trachelectomy patients with pain versus those without pain (group 1 vs group 2, p = .02). There were also increased numbers of nerve fibers in both trachelectomy groups compared with the control group (group 1 vs group 3, p < .01; group 2 vs group 3, p = .04). Adjusted average cervical nerve counts/HPF were 17.8 (95% confidence interval [CI], 13.2-22.3) for pain-indicated trachelectomies, 11.5 (95% CI, 4.8-18.2) for nonpain, and 6.3 (95% CI, 0.8-11.8) for controls. Regardless of trachelectomy indication, adjusted average nerve counts/HPF were 17.7 (95% CI, 13.4-22.0) for patients with endometriosis and 14.6 (95% CI, 12.2-17.1) for patients without endometriosis.

CONCLUSION:

Nerve fibers in the cervical stump after supracervical hysterectomy are significantly increased in women undergoing trachelectomy for pain indications compared with those who underwent trachelectomy for nonpain indications and controls. Although not statistically significant, endometriosis may be an independent risk factor for increased nerve fibers. These histopathologic observations may support the idea that the cervix should be removed in women undergoing hysterectomy for chronic pelvic pain or endometriosis.

 

 

 

J Minim Invasive Gynecol. 2015 Feb;22(2):245-9.

The efficacy of laparoscopic surgical treatment of ovarian remnant and ovarian retention syndromes.

Martinez A¹, Howard FM².

 

Abstract

STUDY OBJECTIVE:

To evaluate the degree of pain relief provided by laparoscopic surgical treatment of ovarian remnant and ovarian retention syndromes.

DESIGN:

Retrospective analysis (Canadian Task Force classification II-2).

SETTING:

Academic hospital and affiliated outpatient offices.

PATIENTS:

A total of 54 patients from 2004 to 2008 who underwent surgical treatment for suspected ovarian remnant syndrome or ovarian retention syndrome.

INTERVENTIONS:

Oophorectomy.

MEASUREMENTS AND MAIN RESULTS:

Preoperative and postoperative pain scores were recorded from patients who underwent surgical treatment for either ovarian remnant or ovarian retention syndrome. Data regarding comorbid diagnoses that would contribute to chronic abdominopelvic pain, previous surgical history, surgical complications, and pathology to confirm the preoperative diagnosis were also collected. Pathology confirmed that ovarian tissue was removed in 52 of the 54 patients. Forty percent and 41% of patients with ovarian remnant and ovarian retention, respectively, achieved a 50% reduction of their average pain levels; 50% and 56%, respectively, achieved a 30% reduction in average pain levels. There was not a statistically significant difference in postoperative pain relief between the 2 groups. Cases with ovarian remnant syndrome had more prior surgical procedures (4.8 vs 3.6, p = .049) and were more likely to have a surgical complication (25% vs 3%, p = .03) than cases with ovarian retention syndrome. Patients with a 30% or greater decrease in their pain levels postoperatively were likely to have fewer other diagnoses associated with chronic pain (1.4 ± 1.1 vs 2.1 ± 0.9, p = .009).

CONCLUSION:

Surgical treatment for ovarian remnant or ovarian retention syndrome is effective but is most effective in patients with no other pain-related diagnoses. Thus, it is important to thoroughly evaluate women with ovarian remnant or ovarian retention syndrome for other pelvic pain-related disorders. In almost all cases, surgery can be done laparoscopically in patients with these syndromes.

 

 

Int J Surg Case Rep. 2014;5(12):890-2.

Intussusception secondary to endometriosis of the cecum.

Katagiri H¹, Lefor AK², Nakata T³, Matsuo T³, Shimokawa I⁴.

 

Abstract

INTRODUCTION:

Intussusception in adults is a rare cause of bowel obstruction. Endometriosis of the bowel is also a rare entity that can be the cause of bowel obstruction. Here, we report a rare case of intussusception secondary to endometriosis of the cecum.

PRESENTATION OF CASE:

A 40-year-old woman presented to the hospital with a one-week history of intermittent epigastric pain. On physical examination, there was a soft, round non-tender palpable mass in the right flank and abdominal computed tomography scan revealed an intussusception. We made the diagnosis of ileo-colic intussusception and performed ileocecal resection. The surgical specimen revealed a round submucosal cystic mass in the cecum and the histology showed endometriosis of the cecum.

DISCUSSION:

Intussusception in adults is a rare entity present in just 1% of all patients with bowel obstruction, and 5% of all intussusceptions. In general, intussusception in adults has a pathologic lesion as the lead point and the lesion is a malignancy in 20-50% of the cases. Thus, the treatment of an intussusception in adults should be operative. Endometriosis of the bowel is a rare cause of intussusception. Small endometriosis lesions of the bowel are unlikely to cause symptoms; however, in patients presenting with bowel obstruction, urgent treatment is indicated.

CONCLUSION:

Intussusception in an adult is a rare cause of bowel obstruction and intussusception caused by endometriosis is also rare. Although rare, the diagnosis of endometriosis as a cause of intussusception must be considered as part of the differential diagnosis.

 

 

Int J Surg Case Rep. 2014;5(12):979-83.

A case of clear cell adenocarcinoma arising from endometriosis of the rectum treated by laparoscopic surgery.

Okazawa Y¹, Takahashi R², Mizukoshi K², Takehara K², Ishiyama S², Sugimoto K², Takahashi M², Kojima Y², Goto M², Okuzawa A², Tomiki Y², Yao T³, Sakamoto K².

 

Abstract

INTRODUCTION:

Malignant transformation of intestinal endometriosis occurring in the extraovarian sites is extremely rare. We report a very rare case of clear cell adenocarcinoma arising from endometriosis of the rectum.

PRESENTATION OF CASE:

An 83-year-old woman was admitted with the complaint of hematochezia. Colonoscopy revealed a tumor around about half of the rectal circumference. Biopsy of the tumor revealed a well-differentiated adenocarcinoma. Low anterior resection was undergone laparoscopically under the diagnosis of rectal carcinoma. Histopathological examination revealed clear cell adenocarcinoma, invading the sub-serosa of the rectum, but no metastasis of the lymph nodes. Immunohistochemical staining showed strong positivity for cytokeratin 7, but no staining for cytokeratin 20 and CDX2. The tumor existed adjacent to the endometrial glands, which were stained positive for Estrogen receptor. Ultimately, the patient was diagnosed with clear cell adenocarcinoma arising from endometriosis. Eighteen months after surgery, there are no signs of tumor recurrence.

DISCUSSION:

Clear cell adenocarcinoma arising from intestinal endometriosis has been reported in 7 cases, including our case. Careful observation is required because the prognosis of endometriosis after malignant transformation remains poor.

CONCLUSION:

We report a very rare case of clear cell adenocarcinoma arising from endometriosis of the rectum treated by laparoscopic surgery.

 

 

 

J Minim Invasive Gynecol. 2015 Mar-Apr;22(3):415-20.

Effect on ovarian reserve of hemostasis by bipolar coagulation versus suture during laparoendoscopic single-site cystectomy for ovarian endometriomas.

Song T¹, Kim WY², Lee KW², Kim KH².

 

Abstract

STUDY OBJECTIVE:

To compare the postoperative decrease in ovarian reserve between hemostasis by bipolar coagulation and suture during laparoendoscopic single-site cystectomy (LESS-C) for ovarian endometriomas.

DESIGN:

Prospective comparative study (Canadian Task Force Classification II-1).

SETTING:

University hospital.

PATIENTS:

One hundred twenty-five patients with ovarian endometriomas.

INTERVENTIONS:

Patients with endometrioma were managed by hemostasis with either bipolar coagulation (n = 62) or suturing (n = 63) during LESS-C. We evaluated the impact of surgery on ovarian reserve using serum anti-Müllerian hormone (AMH) levels, which were measured before surgery and 3 months after surgery in all patients.

MEASUREMENT AND MAIN RESULTS:

Baseline characteristics such as age, bilaterality of endometriomas, and preoperative AMH levels were similar between the 2 study groups. There were also no differences between the 2 groups in surgical outcomes, such as operative time, operative blood loss, or operative complications. In both study groups, postoperative AMH levels were lower than preoperative AMH levels (p < .001). The decline rate of AMH levels was significantly greater in the bipolar coagulation group than in the suture group (42.2% [interquartile range, 16.5%-53.0%] and 24.6% [interquartile range, 11.6%-37.0%], respectively, p = .001).

CONCLUSION:

Hemostasis by bipolar coagulation after stripping of the endometrioma during LESS-C reduces ovarian reserve more than suturing does, as determined by serial AMH levels. Therefore, suturing may be a better hemostatic choice after stripping ovarian endometriomas.

 

 

J Minim Invasive Gynecol. 2015 Mar-Apr;22(3):403-9.

Three-dimensional ultrasound in the management of bladder endometriosis.

Thonnon C¹, Philip CA¹, Fassi-Fehri H², Bisch C¹, Coulon A³, de Saint-Hilaire P¹, Dubernard G⁴.

 

Abstract

STUDY OBJECTIVE:

To assess the performance of three-dimensional (3D) ultrasound with color Doppler in the diagnosis of bladder endometriosis compared with magnetic resonance imaging (MRI) and cystoscopy.

DESIGN:

Canadian Task Force classification II-3.

SETTING:

Department of gynecology and obstetrics of a university hospital.

PATIENTS:

Eight women who reported urinary tract symptoms suggestive of bladder endometriosis between May 2012 and November 2013.

INTERVENTIONS:

For all cases, we assessed the size of the endometriotic nodule, its location on the bladder wall, and the distance between the lesion and the ureteral meatus, with pelvic 3D ultrasound (full bladder), uro-MRI, and cystoscopy. The results were compared with the postoperative histopathologic findings.

MEASUREMENTS AND MAIN RESULTS:

The pathology results differed from those produced by imaging by a mean ± SD of -3.5 ± 6.4 mm on transvaginal ultrasound (TVUS) and -5.75 ± 11.9 mm) for MRI. There was no significant difference between imaging and pathology findings (p = .20) or between the 2 imaging findings (TVUS and MRI) (p = .73). Results showed a trend toward better accuracy for 3D ultrasound than MRI with smaller SDs (p = .08). Cystoscopy and ultrasound were compared; however, without any tools to assess the distance in cystoscopy, no statistical result was possible.

CONCLUSION:

Ultrasound seems to be superior to cystoscopy and is at least as effective as MRI in diagnosing and planning the surgery for bladder endometriosis.

 

 

Eur J Obstet Gynecol Reprod Biol. 2014 Dec;183:70-7

Pregnancy affects morphology of induced endometriotic lesions in a mouse model through alteration of proliferation and angiogenesis.

Cohen J¹, Naoura I², Castela M³, Von N’Guyen T³, Oster M³, Fontaine R³, Chabbert-Buffet N², Darai E², Aractingi S³.

 

Abstract

OBJECTIVE:

Pregnancy is known to alleviate the symptoms of endometriosis and is also known to be a pro-angiogenic condition affecting blood and lymphatic vessels. However, angiogenesis actively participates in the development of endometriosis. The objective of our study was to study the impact of pregnancy on endometriotic tissue. Study design We performed a cross-sectional, control versus treatment study in a mouse model of endometriosis. Thirty-one female C57Bl6 mice were mated and became pregnant and 31 females were not mated and served as control. Intraperitoneal endometriotic lesions were surgically induced in C57Bl6 mice which were subsequently mated or not (group P: pregnant, group NP: non-pregnant). P and NP mice were sacrificed on day E15.5 of the pregnancy of P mice and lesions were harvested. Lesions were weighed and analyzed by histology, immunohistology, flow cytometry and real-time quantitative RT-PCR (qRT-PCR).

RESULTS:

Pregnancy reduced lesion weight, decreased the proportion of cystic component (0.02 vs. 0.4; p<0.001) and modified the architecture of peritoneal endometriotic lesions. Pregnancy also increased cell proliferation in both stromal and glandular tissue as shown by the increase in Ki 67-positive cells in the P group (glandular: 19 vs. 3.9%, p<0.001; stromal: 8.7 vs. 3.3%, p<0.01). Finally, pregnancy increased angiogenesis in endometriotic lesions as indicated by an increased microvessel density (CD-31 and LYVE-1 stainings: respectively 2.2 vs. 5.1%, p<0.01 and 0.4 vs. 0.9%, p<0.001), an increased number of LYVE1 positive cells evaluated by flow cytometry (18.9 vs. 4.6%, p<0.05) and a rise in VEGF-A, -R2 and -R3 RNA expression shown by qRT-PCR (p<0.001; p<0.01; p<0.05).

CONCLUSION:

These challenging results provide insight in understanding the pathophysiology of endometriosisand evoke a correlation between lesion architecture and symptomatology.

 

 

Eur J Obstet Gynecol Reprod Biol. 2014 Dec;183:83-8.

Small RNA molecules in endometriosis: pathogenesis and therapeutic aspects.

Yang L¹, Liu HY².

Author information

Abstract

Endometriosis is one of the major female health burdens which affects the quality of life and reproductive potential of individuals. Although some treatment strategies are available, the complete cure of endometriosis is not yet possible. Investigation of new and alternative strategies for endometriosis treatment thus remains necessary. Identification of small RNA molecules and their roles in gene regulation and other cellular functions has revolutionized modern biomedical science. Several micro RNAs (miRNAs) and short interfering RNAs (siRNAs) have been found to be associated with endometriosis progression. Some of them are down-regulated, while some are up-regulated. Detail profiling of miRNAs and/or siRNAs may serve as an important tool for endometriosis diagnosis. Meanwhile, targeting the specific miRNAs/siRNAs which are up-regulated in endometriosisis, or using miRNAs/siRNAs precursors, which are down-regulated in endometriosisis, have produced some success stories in endometriosis theraputics. Extensive studies on miRNAs/siRNAs may aid potential therapeutic approaches in endometriosis treatment.

 

 

Eur J Obstet Gynecol Reprod Biol. 2014 Dec;183:104-8.

Leisure and occupational physical activity at different ages and risk of endometriosis.

Garavaglia E¹, Ricci E², Chiaffarino F³, Cipriani S³, Cioffi R¹, Viganò P⁴, Frigerio A³, Candiani M¹, Parazzini F³.

 

Abstract

OBJECTIVE:

Cohort and case-control studies have suggested that adult physical activity (PA) may lower endometriosis risk and improve symptoms, but evidence is still controversial. To add information on leisure and occupational PA impact, if any, on endometriosis risk, we have analyzed data from a small case-control study conducted in Milan (Italy).

STUDY DESIGN:

Ninety cases and 90 controls (median age 35 years, range 18-76) were compared. Endometriosis was laparoscopically diagnosed within the year before interview. Information on demographic variables, menstrual and reproductive history, occupational and recreational physical activity was collected.

RESULTS:

A consistent protective effect emerged between leisure PA and endometriosis risk. For <2-4 and ≥5h/week (reference no PA), the estimated odds ratios (ORs) were, respectively: 0.36 (95% CI 0.18-0.74) and 0.83 (95% CI 0.27-2.53) as regards PA in early adolescence; 0.31 (95% CI 0.15-0.63) and 0.78 (95% CI 0.25-2.38) as regards PA in teenage years; 0.34 (95% CI 0.12-0.94) and 0.33 (95% CI 0.08-1.28) for PA in adulthood. However, no significant trend was seen according to hours spent in leisure PA. Occupational PA did not show statistical significant differences among different types or across age classes.

CONCLUSIONS:

These results suggest that leisure PA in early adolescence, teenage years and adulthood may, to some extent, decrease the risk of endometriosis. In the interpretation of these results, however, the role of potential biases cannot be totally ruled out.

 

 

Eur J Obstet Gynecol Reprod Biol. 2014 Dec;183:114-20.

Polymorphisms of glutathione S-transferase M1 (GSTM1) and T1 (GSTT1) and endometriosis risk: a meta-analysis.

Ding B¹, Sun W², Han S², Cai Y³, Ren M³.

 

Abstract

Published data on the association between the glutathione S-transferases (GSTs) gene polymorphisms and endometriosis risk are inconclusive. We performed a meta-analysis to clarify the association of GSTM1 and GSTT1 polymorphisms and endometriosis risk. A comprehensive search was conducted to examine all the eligible studies of GSTM1 and GSTT1 polymorphisms and endometriosis risk. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of the association. A total of 18 case-control studies were included in the meta-analysis of GSTM1 (2593 cases and 2732 controls) and GSTT1 (2520 cases and 2508 controls) genotypes. The overall results showed that the GSTM1 null genotype was related to an increased risk of endometriosis (OR=1.55, 95% CI=1.38-1.73). Similarly, for GSTT1 null polymorphism, moderate significantly increased risk was found (OR=1.30, 95% CI=1.13-1.50). In the subgroup analysis by ethnicity, significantly increased risks were also found among Caucasians and Asians for null GSTM1 genotype, and Asians for null GSTT1 genotype, but no correlation was noted in Caucasian populations for GSTT1 polymorphism. This meta-analysis provides strong evidence that the GSTM1 and GSTT1 polymorphisms are associated with the development of endometriosis.

 

 

Eur J Obstet Gynecol Reprod Biol. 2014 Dec;183:164-8.

A randomized study comparing the side effects and hormonal status of triptorelin and leuprorelin following conservative laparoscopic surgery for ovarian endometriosis in Chinese women.

Li Z¹, Zhang HY², Zhu YJ¹, Hu YJ¹, Qu PP¹.

 

Abstract

OBJECTIVES:

Different gonadotropin-releasing-hormone agonist (GnRH-a) formulations with different potency and associated side effects, therefore, different compliance and persistence of therapy. This study was to evaluate the difference of hormonal profile and side effects due to hypoestrogenic status after treatment of leuprorelin and triptorelin in Chinese women with ovarian endometrioma after conservative surgical treatment.

STUDY DESIGN:

A total of 302 women underwent laparoscopic excision of ovarian endometriomas with rASRM III and IV were enrolled in the study.Subjects were randomized into two groups with use of a random table. Twenty two patients dropped out during the study. Thus 142 patients had three doses of i.m. leuprorelin (group A) and 138 patients had three doses of i.m. triptorelin(group B) at 4 weeks intervals after surgical treatment. Menopausal symptoms were evalutaed using a questionnaire and serum sex hormonal levels were also measured during the follow-up.

RESULTS:

At week 4 after the treatment, most of the patients in leuprorelin group have no obvious side effects. After 9 weeks, bone pain, hot flashes and sweating, and irregular bleeding were the main side effects and showed no difference between the groups. Anxiety, depression, vaginal dryness, headache, and acne rates were all significantly higher in triptorelin group than in leuprorelin group. A significant difference in FSH (p=0.003), LH (p=0.026) and E2 (p=0.002) levels between the groups were observed after 21 days of the GnRHa treatment. The FSH (p=0.021) and E2 (p=0.033) levels remained higher in the leuprorelin group than the triptorelin group after six weeks of treatment, but the difference of LH(p=0.917) level was no longer discernible.

CONCLUSION:

Leuprorelin in down-regulating the pituitary-ovarian function was more moderate, and the hormonal levels decrease progressively and gradually, therefore, with lower rate of menopausal symptoms. Leuprorelin acetate maybe better tolerated than triptorelin.

 

 

Eur J Obstet Gynecol Reprod Biol. 2014 Dec;183:188-92.

Dienogest in women with persistent endometriosis-related pelvic pain during norethisterone acetate treatment.

Morotti M¹, Sozzi F², Remorgida V², Venturini PL², Ferrero S².

 

Abstract

OBJECTIVE:

To evaluate patient satisfaction at 6-months dienogest (DNG) treatment in women with symptomatic rectovaginal endometriosis who had pain persistence and were unsatisfied after 6-months of norethisterone acetate (NETA) therapy.

STUDY DESIGN:

This 24-weeks pilot open-label prospective study enrolled 25 women. The main outcome was the degree of patient satisfaction measured by using a Likert scale. Secondary outcomes were to evaluate differences in endometriosis-related pain, quality of life, sexual function changes and volumetric nodules changes during DNG compared to NETA treatment.

RESULTS:

Patient satisfaction improved at 3- and 6-months (p<0.001, respectively) treatment with DNG compared with baseline treatment with NETA. Six months DNG treatment decreased the intensity of all the endometriosis-associated pain (chronic pelvic pain, dyspareunia, dyschezia) compared to baseline (p<0.001 for all comparisons). Quality of life and quality of sexual life evaluated with the EHP-30 and FSFI, respectively, increased after 6 months treatment. The volume of the endometriotic nodules did not significantly change during treatment.

CONCLUSIONS:

This study confirms the efficacy of DNG in treating symptomatic women with rectovaginal endometriosis even in a particular endometriotic subpopulation of NETA “resistant” patients. Further randomized clinical trials comparing these two progestins both in first than second line are warranted.

 

 

Eur J Obstet Gynecol Reprod Biol. 2014 Dec;183:193-200.

Association of neutrophil extracellular traps with endometriosis-related chronic inflammation.

Berkes E¹, Oehmke F², Tinneberg HR², Preissner KT³, Saffarzadeh M³.

 

Abstract

OBJECTIVE:

To study if neutrophil extracellular traps (NETs) are present in the peritoneal fluid of endometriosispatients. NETs play a crucial role in fighting against microorganisms. However, exaggerated NET production may lead to tissue damage in their vicinity in pathological conditions. Our study evaluates the presence of NETs in endometriosis peritoneal fluid.

STUDY DESIGN:

Peritoneal fluid (PF) was collected in a case-control study from 52 women, who underwent either diagnostic or operative laparoscopy. The control group consisted of 17 women with infertility, chronic pelvic pain, simple or functional cysts or irregular bleeding. The endometriosis group, altogether 35 patients, comprised 19 patients with stage I and II and 16 patients with stage III and IV endometriosis. First we tested whether the PF is able to stimulate NET production. Neutrophils from healthy volunteers were treated with the PF of endometriosis patients and controls and NETs were detected with Sytox orange extracellular DNA dye and immunofluorescence microscopy. Then we evaluated if NETs were already present in the collected PF using the specific myeloperoxidase (MPO)-DNA capture ELISA method, based on the MPO associated with the NET scaffold.

RESULTS:

The PF of endometriosis patients did not stimulate NET release from healthy granulocytes. However, pre-existent NETs could be detected in 17 endometriosis patients out of 35 (49%). In contrary, in the control group NETs were present in only 3 patients out of 17 (18%), (p=0.03, OR: 4.4). Moreover, the quantification of NETs showed a significantly higher amount of NETs in endometriosis compared to the controls (0.097 vs. 0.02, p=0.04).

CONCLUSION:

This is the first study, which evaluated and described the presence of NETs in the PF of endometriosis patients. Our study shows, that NETs may be involved in the complex pathophysiology of endometriosis.

 

 

Int J Surg Case Rep. 2014;5(11):845-8.

Rectal obstruction due to endometriosis: A case report and review of the Japanese literature.

Ono H¹, Honda S², Danjo Y³, Nakamura K³, Okabe M⁴, Kimura T⁴, Kawakami M⁴, Nagashima K⁵, Nishihara H⁶.

 

Abstract

INTRODUCTION:

Colorectal obstructive endometriosis is relatively rare in Japan and its differentiation from malignancy is often difficult. We report a case of rectal obstructive endometriosis.

PRESENTATION OF CASE:

A 37-year-old woman was referred to our hospital with a suspected ileus. Her chief symptoms were left lower abdominal pain and vomiting. Colonoscopy showed an intraluminal mass of redness in the upper rectum. A proctectomy was performed because of the bowel obstruction. The rectum was filled with an intraluminal mass measuring 5cm×4cm, and endometriosis was diagnosed pathologically.

DISCUSSION:

A preoperative diagnosis of colorectal obstructive endometriosis is often difficult because of the lack of definite diagnostic, clinical, sonographic, or radiological findings that are characteristic of this disease. Medical treatment is not always effective for colorectal obstructive endometriosis, and surgery is often performed.

CONCLUSION:

Colorectal obstructive endometriosis should be considered as a differential diagnosis in cases of various gastrointestinal symptoms in women who are of reproductive age.

 

Eur J Obstet Gynecol Reprod Biol. 2015 Jan;184:1-6.

Is resveratrol a potential substitute for leuprolide acetate in experimental endometriosis?

Bayoglu Tekin Y¹, Guven S², Kirbas A³, Kalkan Y⁴, Tumkaya L⁴, Guvendag Guven ES⁵.

 

Abstract

OBJECTIVE:

Resveratrol, a phytoalexin polyphenol, has anti-angiogenic, antioxidant, anti-inflammatory properties. We aimed to compare the anti-inflammatory and anti-angiogenic effects of resveratrol and leuprolide acetate (LA) in an experimental endometriosis model.

STUDY DESIGN:

A prospective experimental study was conducted in a University Surgical Research Center. Thirty-three non-pregnant female Sprague-Dawley rats, in which experimental model of endometriosis were surgically induced were randomly divided into four groups. Group 1 was administered 30 mg/kg resveratrol i.m. for 14 days, group 2 was given 1mg/kg s.c. single dose LA, group 3 was administered both resveratrol and LA, and group 4 had no medication. After two weeks medication rats were sacrificed and size, histopathology and immunreactivity to matrix metalloproteinase (mmp)2, mmp9, vascular endothelial growth factor (VEGF) of the endometriotic implants were evaluated. Plasma and peritoneal fluid levels of interleukin (IL)-6, IL-8, and tumor necrosis factor-α (TNF-α) were analyzed.

RESULTS:

The endometriotic implant volumes, histopathological grade and immunreactivity to mmp2, mmp9 and VEGF were significantly reduced (p<0.001), and plasma and peritoneal fluid levels of IL-6, IL-8 and TNF-α were significantly decreased in group 1 and group 2 in comparison to group 3 and group 4 (p < 0.001).

CONCLUSION:

Resveratrol alone is a potential agent for the treatment of endometriosis and may be an alternative to LA. In contrast, the combination of LA and resveratrol decreased the anti-inflammatory and anti-angiogenic effects of each agent. Since resveratrol is widely used as an alternative therapy for a variety of conditions, it can undermine the effectiveness of LA. Therefore, caution should be exercised when used in combination with other agents.

 

 

 

 

Eur J Obstet Gynecol Reprod Biol. 2015 Jan;184:7-12.

Is montelukast effective in regression of endometrial implants in an experimentally induced endometriosis model in rats?

Kiykac Altinbas S¹, Tapisiz OL², Cavkaytar S³, Simsek G⁴, Oguztuzun S⁵, Goktolga U².

 

Abstract

OBJECTIVE:

Montelukast, a selective antagonist of Type 1 cysteinyl leukotriene receptors (CysLT1Rs), antagonizes the proinflammatory and proasthmatic activities of CysLT1Rs. We investigated the effect of montelukast on a surgically induced endometriosis rat model.

STUDY DESIGN:

Thirty-two sexually mature, cycling, female Wistar-Albino rats, in which endometriotic implants were surgically induced, were randomly divided into three groups. Group I [Montelukast (M), 10 rats)] was given 1.6 mg/kg/day of oral montelukast sodium. Group II [Leuprolide acetate (L), 11 rats] was given 1 mg/kg single dose of s.c.leuprolide acetate. Group III [Control (C), 11 rats] received saline solution through an orogastric tube and served as controls. After a 3-weeks medication, the rats were sacrificed to investigate the endometriotic implants for size and morphological and histological characteristics, including immunoreactivity of MMP-2 and VEGF.

RESULTS:

The mean area of implants decreased from 48.2 ± 24.7 to 29.3 ± 15.8mm(2) in Group I (M) (P = 0.008) and from 62 ± 32.1 to 39.9 ± 18.1mm(2) in Group II (L) (P=0.003). In Group III (C), the mean area increased from 41.1 ± 31.1 to 60.4 ± 37.1mm(2) (P = 0.025). Histopathological analysis showed statistically significant lower scores in rats treated with montelukast compared to leuprolide and controls. MMP H scores were not different between the groups in both epithelial and stromal MMP-2 immunostaining. VEGF H scores were statistically lower in Group 1 (M) in epithelial VEGF immunostaining when compared to Group II (L) and Group III (C) (P=0.006).

CONCLUSION(S):

Montelukast may effectively cause a significant decrease in the area of endometriotic implants.

 

 

 

Trends Endocrinol Metab. 2015 Jan;26(1):1-10.

Inflammation and nerve fiber interaction in endometriotic pain.

McKinnon BD¹, Bertschi D², Bersinger NA³, Mueller MD³.

 

Abstract

Endometriosis is an extremely prevalent estrogen-dependent condition characterized by the growth of ectopic endometrial tissue outside the uterine cavity, and is often presented with severe pain. Although the relationship between lesion and pain remains unclear, nerve fibers found in close proximity to endometriotic lesions may be related to pain. Also, women with endometriosis pain develop central sensitization. Endometriosis creates an inflammatory environment and recent research is beginning to elucidate the role of inflammation in stimulating peripheral nerve sensitization. In this review, we discuss endometriosis-associated inflammation, peripheral nerve fibers, and assess their potential mechanism of interaction. We propose that an interaction between lesions and nerve fibers, mediated by inflammation, may be important in endometriosis-associated pain.

 

 

Iran J Reprod Med. 2014 Sep;12(9):649-52.

The effects of endometrial injury on intrauterine insemination outcome: A randomized clinical trial.

Zarei A¹, Alborzi S¹, Dadras N¹, Azadi G¹.

 

Abstract

BACKGROUND:

Implantation is considered as the rate-limiting step in success of assisted reproduction techniques, and intrauterine insemination cycles. It might be affected by ovarian superovulation and endometrial local scratching.

OBJECTIVE:

This study aims to investigate the effect of local endometrial injury on the outcome of IUI cycles.

MATERIALS AND METHODS:

In this randomized clinical trial 144 women with unexplained infertility, mild male factor, and mild endometriosis randomly divided into two study groups through block randomization. The patients were randomly assigned to undergo endometrial biopsy between days 6-8 of the previous menstrual cycle before IUI (n=72, IUI cycles =126) or receive no interventions (n=72, IUI cycles=105).

RESULTS:

The pregnancy rate per patient was 17 (23.6%) and 14 (19.4%) in endometrial biopsy and control groups, respectively (p=0.686). The pregnancy rate per cycle was 17/126 (13.5%) and 14/105 (13.3%) in endometrial biopsy and control groups, respectively (p=0.389). The abortion rate was comparable between the two groups (6.9% vs. 9.7%; p=0.764). The ongoing pregnancy rate was found to be comparable between the two study groups, as well (16.7% vs. 9.7%; p=0.325). Endometrial thickness (p=0.609) was comparable between the groups; however E2 was significantly lower in the endometrial biopsy group (p<0.001).

CONCLUSION:

Application of local endometrial injury in the cycle before the IUI cycles is not associated with increased pregnancy rate per patient and per cycle, decreased abortion, and increased endometrial thickness.

 

 

Obstet Gynecol Sci. 2014 Nov;57(6):553-6.

Rectouterine fistula after laparoscopic ultrasound-guided radiofrequency ablation of a uterine fibroid.

Jeong HJ¹, Kwon BS¹, Choi YJ¹, Huh CY¹.

 

Abstract

In the conservative management of uterine fibroids is radiofrequency ablation (RFA) considered to be one of the safe, effective and minimal invasive approaches in selected women who desire to retain their uterus. Few studies were conducted on its adverse outcomes and most of the reported complications were minor events such as pain, discharge, adhesion which didn’t require any intervention. However, although safe and effective, the RFA of a uterine myoma can be the cause for severe complications such as penetration and burn injuries of pelvic organs. In general, a rectouterine fistula is one of the rarest complications but can lead to serious adverse outcomes. Herein, to our knowledge, we report the first case involving a rectouterine fistula after laparoscopic ultrasound-guided RFA of a uterine myoma with pelvic endometriosis. In addition, we provide a brief review of the relevant literature.

 

 

 

 

Obstet Gynecol Sci. 2014 Nov;57(6):557-9.

Laparoscopic repair of indirect inguinal hernia containing endometriosis, ovary, and fallopian tube in adult woman without genital anomalies.

Kim JH¹, Chong GO¹, Lee JY¹, Lee YH¹, Hong DG¹, Park SY², Park JY³.

 

Abstract

Indirect inguinal hernia containing an ovary is a rare condition, especially in adult women who do not have any other genital tract anomalies. In addition, inguinal hernia containing an ovary and endometriosis is exceedingly rare. In the present report, we describe a case of indirect inguinal hernia containing an ovary, fallopian tube, and endometriosis. Laparoscopic repair was performed successfully using polypropylene mesh for the treatment of the inguinal hernia.

 

 

Br Med Bull. 2014 Dec;112(1):57-69.

The molecular genetics of hereditary and sporadic ovarian cancer: implications for the future.

Al Bakir M¹, Gabra H².

 

Abstract

INTRODUCTION:

Epithelial ovarian cancer (EOC) is a heterogeneous condition with poor survival outcomes. The genetics of hereditary and sporadic ovarian cancers will be covered and its implications to management and future research are discussed.

SOURCES OF DATA:

Key recent published literature.

AREAS OF AGREEMENT:

Both genetic and environmental factors play a role in the development of EOC. Most EOCs develop sporadically and are divided into low-grade/genetically stable type I tumours and high-grade/genetically unstable type II tumours. The commonest hereditary syndromes are hereditary breast ovarian cancer syndrome (HBOC-BRCA mutations) and Lynch syndrome (DNA mismatch repair mutations).

AREAS OF CONTROVERSY:

The different histological types of EOC may not solely originate from the ovary but from the fallopian tube and endometriosis deposits; there is increasing evidence to support this.

GROWING POINTS:

Our understanding of the genetics and frequencies of mutations in ovarian cancer is expanding. The proportion of heritable EOC is larger than previously estimated and not all patients have a clear family history for this. Mutations in genes involving the downstream BRCA signalling pathway have recently been implicated in HBOC. TP53 mutations are the single most commonly identified mutations in aggressive sporadic high-grade serous carcinomas, affecting essentially 100% of such tumours. Furthermore, there is increasing recognition that the different histological sub-types need to be treated as separate entities.

AREAS FOR TIMELY RESEARCH:

Given how heterogeneous ‘ovarian’ cancer is, trials into new drugs should report responses for the different histo-/geno-types rather than simply using staging. Although the effect of new drugs such as poly(ADP-ribose) polymerase inhibitors are being investigated in ovarian cancer, there is still a need to develop targeted therapies-especially to tackle mutations in PI3 K pathway, RAS pathway and TP53.

 

 

Mol Cancer Biol. 2013 Dec 20;1(1).

Women with endometriosis have a higher DNA repair capacity and diminished breast cancer risk.

Matta JL¹, Flores I², Morales LM³, Monteiro J⁴, Alvarez-Garriga C⁵, Bayona M⁵.

 

Abstract

INTRODUCTION:

Breast cancer (BC) and endometriosis are important reproductive health diseases for women. Although endometriosis is not a malignant condition, some of its characteristics mimic that of a malignancy. Endometriosis is associated with increased risk of certain cancers; however, whether it alters BC risk is unclear. This study evaluates the association of endometriosis and BC and explores whether DNA repair capacity (DRC) plays a role in such a relationship.

MATERIALS AND METHODS:

A case-control study of 991 women (385 with BC and 606 controls, all recruited over 5 years) was undertaken in Puerto Rico. Eighty participants with self-reported surgically diagnosed endometriosis were identified, 20 of whom also had a diagnosis of BC. Data from a structured questionnaire and DRC measurements were assessed to determine the association between BC, DRC, and endometriosis.

RESULTS:

Participants with BC cases were 50% less likely to have history of endometriosis (OR = 0.5 95%CI: 0.3, 0.9, p = 0.038) than women without BC controls. Findings that did not reach statistical significance included the following: women with history of endometriosis had a slightly higher DRC level than those without it; BC cases and history of endometriosis were less likely to have had endometriosis diagnosis before age 38 as compared to controls with endometriosis.

DISCUSSION:

Here we report an inverse association between endometriosis and BC, the former possibly conferring a protective effect on the latter. Although the mechanisms involved are unknown they may include protection provided by higher DRC and or hormonal treatments for endometriosis. A larger sample of endometriosis cases is necessary to confirm these results and answer the question of whether a higher DRC capacity may contribute to this potential protection, and to identify other factors at play.

 

J Reprod Infertil. 2014 Oct;15(4):184-9.

Accurate diagnosis as a prognostic factor in intrauterine insemination treatment of infertile saudi patients.

Isa AM¹, Abu-Rafea B¹, Alasiri SA¹, Al-Mutawa J¹, Binsaleh S², Al-Saif S¹, Al-Saqer A¹.

 

Abstract

BACKGROUND:

The study meant to define the prognostic factors that help in prescribing intrauterine insemination (IUI) for infertility treatment which remains an area of continuous improvements.

METHODS:

The diagnostic indications of a cohort of IUI-treated patients and their corresponding pregnancy rates (PRs) were randomly and prospectively studied among Saudi cohort of 303 patients for a period of 20 months. The indications of IUI cases were statistically analyzed for those eligible patients over a period of twenty months (January 2010 till August 2011), and the PR that corresponded to each group was investigated as well. P-value less than 0.05 was considered significant.

RESULTS:

The highest PR, 18.87%, of the polycystic ovarian syndrome (PCOS)-only diagnosed patients, was significantly higher than the average PR of all other indications combined, 7.22%, (p = 0.011, compared to all other groups combined). The second highest PR, 14.0%, of the tubal factor (TF)-only indication, was double the PR average of all other indications combined, though it did not reach significance. However, PCOS and TF accompanied by other indications caused the PR to drop to 5.88% and 5.56%, respectively. However, a group of some hormonal-imbalance based indications had the least PR (0.0% to 2.70%). Those indications were elevated serum FSH, hyperprolactinemia, hypogonadotrophy, hypothyroidism and endometriosis. The rest of the indications had an average PR (8.33% to 11.11%).

CONCLUSION:

There is a reasonable chance of conception after IUI treatment for female factor infertility except in cases with sever hormonal imbalance. The PCOS cases having the best success chances.

 

 

J Reprod Infertil. 2014 Oct;15(4):199-204

Vasopressin Effect on Operation Time and Frequency of Electrocauterization during Laparoscopic Stripping of Ovarian Endometriomas: A Randomized Controlled Clinical Trial.

Ghafarnejad M¹, Akrami M¹, Davari-Tanha F¹, Adabi K¹, Nekuie S².

 

Abstract

BACKGROUND:

The purpose of this study was to assess the vasopressin effect on operation time and the need for electrocauterization frequency and ovarian reserve during laparoscopic stripping of ovarian endometriomas.

METHODS:

This was a randomized prospective clinical trial, in which twenty patients between 18-35 years with unilateral endometriomas were randomly divided in two groups of cases and controls. Laparoscopic cystectomy was performed by hydrodissection and stripping method in both groups with diluted vasopressin injected in cases, in comparison to only saline injection in controls. Ovarian hemostasis was achieved by bipolar electrocoagulation. The operation time and frequency of electrocoagulation were compared between two groups. The ovarian reserve was determined by ultrasound examination and laboratory assessment one month before and two months after surgery in two groups. Non parametric data was analyzed by Mann-Whitney test. The p-value less than 0.05 was considered statistically significant.

RESULTS:

The operation time was less in cases than control group, but the difference was not statistically significant (p=0.065). The frequency of electrocoagulation for hemostasis was less in cases than controls but this difference was not statistically significant (p=0.132). The antral follicle count decreased in both groups two months later, while no significant difference was found between two groups.

CONCLUSION:

This study shows that diluted vasopressin decreases operation time and electrocauterization frequency during laparoscopic stripping of ovarian endometriomas; however, the difference between case and control group is not statistically significant.

 

 

 

Int J Gynecol Pathol. 2015 Jan;34(1):85-9.

VCAM-1 on peritoneum and α4β1 integrin in endometrium and their implications in endometriosis.

Schutt AK¹, Atkins KA, Slack-Davis JK, Stovall DW.

 

Abstract

The objective of the study is to investigate vascular cellular adhesion molecule-1 (VCAM-1) expression on peritoneal mesothelial cells and α4β1 integrin on eutopic endometrium as possible mechanisms in the pathogenesis of endometriosis. It is a case-control study carried out at an academic medical center. Participants are patients with (n=9) and without (n=15) endometriosis. The main outcome measures included VCAM-1 expression on peritoneal mesothelial cells and α4β1 expression on eutopic endometrium using immunohistochemistry and flow cytometry, respectively. Patients with endometriosis were more likely to express VCAM-1 on peritoneal mesothelial cells, both in areas with and without macroscopic disease, compared with patients without endometriosis (9/9 vs. 3/15, P<0.001). No differences were found between cases and controls in regards to eutopic endometrial expression of α4β1 integrin. The presence of VCAM-1 on peritoneal mesothelial cells is associated with endometriosis. This field effect, in addition to the similarity found with regards to the expression of α4β1 integrin in eutopic endometrium between cases and controls, may implicate the expression of VCAM-1 in the peritoneum, and not changes in the eutopic endometrium, as a contributor to the pathogenesis of endometriosis.

 

 

PLoS One. 2014 Dec 4;9

Galectin-1 overexpression in endometriosis and its regulation by neuropeptides (CRH, UCN) indicating its important role in reproduction and inflammation.

Vergetaki A¹, Jeschke U², Vrekoussis T³, Taliouri E¹, Sabatini L⁴, Papakonstanti EA⁵, Makrigiannakis A¹.

 

Abstract

Endometriosis is an inflammatory disease of women of reproductive age featured by the presence of ectopic endometrium and is strongly related to infertility. Galectins, carbonhydrate-binding proteins, have been found to have pro- or anti-inflammatory roles in the reproductive tract and in pathological conditions concerning infertility. Galectin-1, which is expressed at endometrium and decidua, plays a major role in implantation and trophoblast invasion. Also, the neuropeptides, corticotropin releasing hormone (CRH) and urocortin (UCN) and their receptors are expressed in eutopic and ectopic endometrium showing a differential expression pattern in endometriotic women compared to healthy ones. The aim of this study was to examine the galectin-1 expression in endometriotic lesions and compare its expression in eutopic endometrium of endometriotic and healthy women. Furthermore, we examined the effect of CRH and UCN in galectin-1 expression in Ishikawa cell line and macrophages and investigated the implication of CRHR1 in these responses. Eutopic and ectopic endometrium specimens, Ishikawa cell line and mice macrophages were used. Immunohistochemistry and western blot analysis were performed in order to identify galectin-1 expression in ectopic and eutopic endometrium of women with and without endometriosis and the regulatory effect of CRH and UCN on galectin-1 expression. This study presents for the first time that galectin-1 is overexpressed in endometriotic lesions compared to eutopic endometrium of endometriotic women and is more abundantly expressed in eutopic endometrium of disease women compared to healthy ones. Furthermore, it is shown that CRH and UCN upregulate galectin-1 expression in Ishikawa cell line and macrophages and this effect is mediated through CRHR1. These results suggest that galectin-1 might play an important role in endometriosis pathology and infertility profile of women suffering from endometriosis by being at the same time regulated by CRH and UCN interfering in the immune disequilibrium which characterizes this pathological condition.

 

 

BMC Womens Health. 2014 Dec 5;14:151.

5-Year data analysis of patients following abdominal wall endometrioma surgery.

Khamechian T¹, Alizargar J², Mazoochi T³.

 

Abstract

BACKGROUND:

Endometriosis is a disorder in which an ectopic endometrial tissue grows outside the uterine cavity. The ectopic endometrium embedded in the subcutaneous fatty layer and the muscles of abdominal wall is called as abdominal wall endometriosis (AWE). AWE is a rare condition; however, it is usually known to develop along with previous surgical scars. Caesarean section and hysterectomy are considered to be commonly associated with the development of AWE.

METHODS:

We evaluated the data of the patients who underwent AWE surgery between March 2009 and March 2014.

RESULTS:

The mean age of the patients was 32.5 years. We found a previous history of caesarean section in all of the patients. The most frequent symptoms of the patients were abdominal mass sensation and abdominal pain. Invasion of endometriosis to fat layer, fascia, muscular layer, and peritoneum was recorded. Three masses were located within the scar regions.

CONCLUSIONS:

We can conclude that there is a high prevalence of caesarean sections among the women with AWE.

 

 

BMJ Case Rep. 2014 Dec 4;2014.

Endometriosis-induced intussusception of the caecal appendix.

Costa M¹, Bento A², Batista H², Oliveira F².

 

Abstract

Appendicular intussusception is an uncommon entity, with a reported incidence of 0.01%. The diagnosis is difficult and often only performed at the time of surgery. Intussusception has multiple causes including tumours, foreign bodies and polyps. The definitive treatment is surgical, and the extent of resection is determined by the underlying pathology and degree of invagination. Endometriosis is a rare cause of appendicular intussusception, with 194 cases described in the English literature. We report a case of a 42-year-old woman who presented with chronic abdominal pain in the lower right quadrant. A mass at the caecum was identified during investigations for renal stones by CT. Colonoscopy showed a polypoid lesion, with presumed origin in the appendix. Ileocaecal resection was performed because an appendicular tumour was suspected. Pathological examination identified endometriosis of the appendix and associated peritoneum with invagination of the caecum. The patient was discharged 7 days after surgery and is currently asymptomatic.

 

 

J Clin Diagn Res. 2014 Oct;8(10):

Bleeding ureter: endometriosis mascarading as a ureteral malignancy – a case report.

Babu SM¹, Sandeep P², Pathade A², Nagaraj HK³.

 

Abstract

Ureteral endometriosis is a serious localization of disease burden that can lead to urinary tract obstruction, with subsequent hydroureter, hydronephrosis, and potential kidney loss. As the diagnosis is elusive, a heavy clinical suspicion is necessary. Surgical technique to treatment varies, but the goal is to salvage renal function and decrease disease burden. Here, we are presenting a rare case of bleeding ureter in a young lady who had endometriosis of the ureter.

 

 

J Clin Diagn Res. 2014 Oct;8(10):OC01-2.

Laparoscopy:as a first line diagnostic tool for infertility evaluation.

Jain G¹, Khatuja R², Juneja A³, Mehta S⁴.

 

Abstract

INTRODUCTION:

The role of diagnostic and therapeutic hystero-laparoscopy in women with infertility is well established. It is helpful not only in the identification of the cause but also in the management of the same at that time.

MATERIALS AND METHODS:

In this study, the aim was to analyse the results of 203 women on whom laparoscopy for the evaluation of infertility was done. This study was carried out at a tertiary level hospital from 2005 to 2012. The study group included 121 women with primary infertility and 82 women with secondary infertility. Women with incomplete medical records and isolated male factor infertility were excluded from the study.

RESULTS:

It was observed that tubal disease was the responsible factor in 62.8% women with primary infertility and 54.8% women with secondary infertility followed by pelvic adhesions in 33% and 31.5%, ovarian factor in 14% and 8.5%, pelvic endometriosis in 9.9% and 6.1% women respectively. Thus tubal factor infertility is still a major cause of infertility in developing countries and its management at an early stage is important to prevent an irreversible damage. At the same time, it also directs which couples would be benefited from assisted reproductive technologies (ART).

 

 

J Clin Diagn Res. 2014 Oct;8(10):OD04-5

Skin to serosa: scar endometrioma.

Menon M¹, T A S², P N C³, Selvakumar A S⁴.

 

Abstract

Extra pelvic endometriosis, an underappreciated and misdiagnosed gynaecological problem has been reported here for its rare location. Patient presented with swelling and cyclical pain over vertical scar (caesarean). Diagnosis was made on high index of clinical suspicion which was complimented by Magnetic Resonance Imaging (MRI). Scar endometrioma extended from the skin upto the uterine serosa which is extremely rare. Wide excision of endometrioma followed by mesh repair was done. Histopathology confirmed the diagnosis.

 

ScientificWorldJournal. 2014;2014:270120.

Factors associated with placenta praevia in primigravidas and its pregnancy outcome.

Nur Azurah AG¹, Wan Zainol Z¹, Lim PS¹, Shafiee MN¹, Kampan N¹, Mohsin WS¹, Mokhtar NM², Muhammad Yassin MA¹.

 

Abstract

AIM:

To examine the factors associated with placenta praevia in primigravidas and also compare the pregnancy outcomes between primigravidas and nonprimigravidas.

METHOD:

A retrospective cohort study was conducted in women who underwent caesarean section for major placenta praevia in a tertiary university hospital from January 2007 till December 2013. Medical records were reviewed.

RESULT:

Among 243 with major placenta praevia, 56 (23.0%) were primigravidas and 187 (77.0%) were nonprimigravidas. Factors associated with placenta praevia in the primigravidas were history of assisted conception (P = 0.02) and history of endometriosis (P = 0.01). For maternal outcomes, the nonprimigravidas required earlier delivery than primigravidas (35.76 ± 2.54 weeks versus 36.52 ± 1.95 weeks, P = 0.03) and had greater blood loss (P = 0.04). A vast majority of the primigravidas had either posterior type II or type III placenta praevia. As for neonatal outcomes, the Apgar score at 1 minute was significantly lower for the nonprimigravidas (7.89 ± 1.72 versus 8.39 ± 1.288.39 ± 1.28, P = 0.02).

CONCLUSION:

This study highlighted that endometriosis and assisted conception were highly associated with placenta praevia in primigravida. Understanding the pregnancy outcomes of women with placenta praevia can assist clinicians in identifying patients who are at higher risk of mortality and morbidity. Identifying potential risk factors in primigravida may assist in counseling and management of such patients.

 

 

Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi. 2014 Dec;30(12):1258-61.

DNA demethylation at the promoter region enhances the expression of MMP-9 in ectopic endometrial stromal cells of endometriosis.

Yuan C¹, Zhang L¹, Gao Y¹, Peng D¹, Liu J², Cai Y¹.

 

Abstract

OBJECTIVE:

To investigate the role of DNA methylation in the regulation of matrix metalloproteinase 9 (MMP-9) gene expression in endometriosis.

METHODS:

MMP-9 gene methylation status in eutopic and ectopic endometria were analyzed by methylation specific PCR. The expression of MMP-9 protein in eutopic and ectopic endometria were detected by immunohistochemistry. We prepared the primary cultured ectopic endometrial stromal cells, and then examined the gene expression and methylation status of MMP-9 after the culture cells were treated with 5-Aza-2-deoxycytidine.

RESULTS:

The expression of MMP-9 in ectopic endometrial stromal cells was significantly higher than that in eutopic endometrium. MMP-9 methylation level was lower in ectopic endometrium. After treated with 5-Aza-dC, endometriosis cells showed elevated MMP-9 gene expression and methylation level.

CONCLUSION:

DNA methylation at the promoter region of MMP-9 gene can enhance the expression of MMP-9 in ectopic endometrial stromal cells of endometriosis.