Springerplus. 2016 May 17;5:643.

A case of recto-sigmoid endometriosis mimicking carcinoma.

Rana R¹, Sharma S¹, Narula H¹, Madhok B¹.

 

Abstract

INTRODUCTION:

Although endometriosis with sigmoid serosal involvement is not uncommon in women of childbearing age, the mucosal and lymph node involvement is rare and differential diagnosis from colon cancer and diverticulitis may be difficult due to poor diagnostic accuracy of colonoscopy and colonic biopsies.

CASE PRESENTATION:

We present a case of a nulliparous woman presenting with large bowel obstruction. She underwent emergency sigmoid colectomy based on clinical and radiological findings. At operation, the pathology was thought to be primary sigmoid tumour. However, histopathological examination of the sigmoid colon led to the final diagnosis of large intestinal endometriosis.

CONCLUSION:

Rectosigmoid endometriosis is often difficult to diagnose but should be considered in differential diagnosis of child bearing aged women with lower gastrointestinal tract obstruction.

 

 

J Endometr Pelvic Pain Disord. 2015 Oct-Dec;7(4):129-135.

Characteristics of women with endometriosis from the USA and Puerto Rico.

Fourquet J¹, Sinaii N², Stratton P³, Khayel F², Alvarez-Garriga C¹, Bayona M¹, Ballweg ML⁴, Flores I⁵.

 

Abstract

PURPOSE:

To describe lifetime differences in clinical characteristics of women with endometriosis between the USA and Puerto Rico.

METHODS:

A descriptive study using self-administered demographic and clinical questionnaires was undertaken. Women with self-reported surgically diagnosed endometriosis who completed questionnaires from the Endometriosis Association (EA), Wisconsin, USA (n = 4358) and the Endometriosis Research Program (ERP) in Puerto Rico (n = 878), were included in this study. We compared demographic, gynecological and clinical history, frequency of endometriosis-associated symptoms and co-morbidities.

RESULTS:

Although both groups have similar symptomatology, EA respondents had significantly higher rates of chronic pelvic pain and incapacitating pain than ERP participants. EA respondents were significantly more likely to report a history of problems getting pregnant, heavy bleeding, and hysterectomy than ERP respondents. Miscarriages were more frequently reported by the ERP group. Co-morbidities such as allergies, chronic fatigue syndrome, and fibromyalgia were more prevalent in EA respondents, whereas asthma was significantly more frequent in participants from ERP.

CONCLUSIONS:

Overall, women with endometriosis from the USA and Puerto Rico reported high rates of pain and infertility and a similar spectrum of symptoms. Those from the EA reported longer time to diagnosis, and diagnostic delays than those from the ERP, which may explain the observed increased in rates of endometriosis-related symptoms and co-morbidities in EA as compared to ERP.

 

 

Gynecol Oncol Rep. 2016 Jan 26;16:1-4.

Ruptured clear cell carcinoma of the ovary presenting as acute abdomen.

Zhou ZN¹, Tierney C¹, Rodgers WH², Nguyen L³, Fishman D³.

 

Abstract

BACKGROUND:

Ovarian cancer remains one of the leading causes of cancer-related deaths among women. Clear cell ovarian carcinoma is a rare histologic subtype accounting for 5-10% of all epithelial ovarian cancers and is often associated with endometriosis. Patients generally present with vague abdominal and pelvic complaints. However, patients can present in the acute setting with pleural effusions, ascites, bowel obstructions, and deep vein thrombosis.

CASE:

A 54 year old woman presenting with an acute abdomen secondary to rupture of ovarian clear cell carcinoma.

CONCLUSION:

Ovarian clear cell carcinoma should remain in the differential diagnosis in a patient presenting with an acute abdomen and imaging suspicious for a gynecologic malignancy originating from the ovary.

 

 

 

Hum Reprod. 2016 Aug;31(8):1904-12.

Sexual and physical abuse and gynecologic disorders.

Schliep KC¹, Mumford SL², Johnstone EB³, Peterson CM³, Sharp HT³, Stanford JB⁴, Chen Z², Backonja U⁵, Wallace ME⁶, Buck Louis GM².

 

Abstract

STUDY QUESTION:

Is sexual and/or physical abuse history associated with incident endometriosis diagnosis or other gynecologic disorders among premenopausal women undergoing diagnostic and/or therapeutic laparoscopy or laparotomy regardless of clinical indication?

SUMMARY ANSWER:

No association was observed between either a history of sexual or physical abuse and risk of endometriosis, ovarian cysts or fibroids; however, a history of physical abuse was associated with a higher likelihood of adhesions after taking into account important confounding and mediating factors.

WHAT IS KNOWN ALREADY:

Sexual and physical abuse may alter neuroendocrine-immune processes leading to a higher risk for endometriosis and other noninfectious gynecologic disorders, but few studies have assessed abuse history prior to diagnosis.

STUDY DESIGN, SIZE, DURATION:

The study population for these analyses includes the ENDO Study (2007-2009) operative cohort: 473 women, ages 18-44 years, who underwent a diagnostic and/or therapeutic laparoscopy or laparotomy at 1 of the 14 surgical centers located in Salt Lake City, UT, USA or San Francisco, CA, USA. Women with a history of surgically confirmed endometriosis were excluded.

PARTICIPANTS/MATERIALS, SETTING AND METHODS:

Prior to surgery, women completed standardized abuse questionnaires. Relative risk (RR) of incident endometriosis, uterine fibroids, adhesions or ovarian cysts by abuse history were estimated, adjusting for age, race/ethnicity, education, marital status, smoking, gravidity and recruitment site. We assessed whether a history of chronic pelvic pain, depression, or STIs explained any relationships via mediation analyses.

MAIN RESULTS AND ROLE OF CHANCE:

43 and 39% of women reported experiencing sexual and physical abuse. No association was observed between either a history of sexual or physical abuse, versus no history, and risk of endometriosis (aRR: 1.00 [95% confidence interval (CI): 0.80-1.25]); aRR: 0.83 [95% CI: 0.65-1.06]), ovarian cysts (aRR: 0.67 [95% CI: 0.39-1.15]); aRR: 0.60 [95% CI: 0.34-1.09]) or fibroids (aRR: 1.25 [95% CI: 0.85-1.83]); aRR: 1.36 [95% CI: 0.92-2.01]). Conversely, a history of physical abuse, versus no history, was associated with higher risk of adhesions (aRR: 2.39 [95% CI: 1.18-4.85]). We found no indication that the effect of abuse on women’s adhesion risk could be explained by a history of chronic pelvic pain, depression or STIs.

LIMITATIONS, REASONS FOR CAUTION:

Limitations to our study include inquiries on childhood physical but not sexual abuse. Additionally, we did not inquire about childhood or adulthood emotional support systems, found to buffer the negative impact of stress on gynecologic health.

WIDER IMPLICATIONS OF THE FINDINGS:

Abuse may be associated with some but not all gynecologic disorders with neuroendocrine-inflammatory origin. High prevalence of abuse reporting supports the need for care providers to screen for abuse and initiate appropriate follow-up.

STUDY FUNDING/COMPETING INTERESTS:

Supported by the Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (contracts NO1-DK-6-3428, NO1-DK-6-3427, and 10001406-02). The authors have no potential competing interests.

 

 

Fertil Steril. 2016 Sep 1;106(3):692-703.

Severe spontaneous hemoperitoneum in pregnancy may be linked to in vitro fertilization in patients with endometriosis: a systematic review.

Brosens IA¹, Lier MC², Mijatovic V², Habiba M³, Benagiano G⁴.

 

Abstract

OBJECTIVE:

To evaluate existing evidence of a possible association in women with endometriosis between controlled ovarian hyperstimulation plus embryo transfer (COH-ET) and the occurrence of spontaneous hemoperitoneum in pregnancy (SHiP).

DESIGN:

Comprehensive review.

SETTING:

Not applicable.

PATIENT(S):

None.

INTERVENTION(S):

An electronic literature search up to February 2016 was conducted using Scopus and PubMed.

MAIN OUTCOME MEASURE(S):

The role of COH-ET in SHiP.

RESULT(S):

Controlled ovarian hyperstimulation plus embryo transfer may increase the severity or incidence of the rare condition known as SHiP. An analysis of published cases shows that bleeding often occurs from multiple or diffuse sites, mainly situated in the posterior pelvic cavity, making it difficult to control without interfering with the pregnancy itself. Spontaneous hemoperitoneum in pregnancy is linked to adverse perinatal outcomes, including stillbirth, neonatal mortality, and very low or low birth weight. In 14 cases a biopsy of the bleeding site was obtained, and in all cases, even in the absence of visible endometriosis, decidualization was documented. At present, the relatively small number of cases published prevents firm conclusions, although they are highly suggestive of a link between COH-ET in women with endometriosis and the occurrence and seriousness of SHiP.

CONCLUSION(S):

Spontaneous hemoperitoneum in pregnancy is a rare but potentially fatal complication for the pregnant woman and her unborn child. In vitro fertilization in women with severe endometriosis may be a risk factor for SHiP.

 

 

Zhonghua Yi Xue Za Zhi. 2015 Dec 15;95(47):3829-32.

Analysis of influence of inflammatory factor in patients with ovarian endometriosis follicular fluid on the outcome of in vitro fertilization.

Ning Y, Liu B, Han B, Guo J, Liu X, Fan G, Guo C, Wang F, Zhou J, Yin L.

 

Abstract

OBJECTIVE:

To observe the effect of follicular fluid IL-6, TNF-α on the clinical outcome of in vitro fertilization and embryo transfer (IVF-ET) in patients with ovarian endometriosis.

METHOD:

From June 2013 to June 2014, the data of 64 (from Tangshan Maternal and Child Health Hospital IVF center) ovarian endometriosis patients was analyzed retrospectively. 58 infertility cases caused by male side were used as control group. Oocyte retrieval rate, M II oocytes rate, fertilization rate, recovery-intracytoplasmic sperm injection (R-ICSI) rate, good quality embryo rate, biochemical pregnancy rate and clinical pregnancy rate were analyzed and compared between two groups. Changes in the expression of follicular fluid IL-6, TNF-α were detected.

RESULTS:

Oocyte retrieval rate, M II oocytes rate, fertilization rate, good quality embryo rate, biochemical pregnancy rate and clinical pregnancy rate in ovarian endometriosis group were significantly lower than those in the control group (all P < 0.05), while R-ICSI rate increased in ovarian endometriosis group compared with control group (P < 0.05). IL-6, TNF-α expressions of follicular fluid were higher in affected side of ovarian endometriosis patients than those in the unaffected side and those in control group.

CONCLUSION:

Inflammation microenvironment of the follicular fluid may influence IVF-ET outcomes in ovarian endometriosis patients.

 

 

Rev Med Liege. 2016 May;71(5):236-41.

MINIMAL AND MILD ENDOMETRIOSIS: WHICH IMPACT ON FERTILITY?.

Brichant G, Audebert A, Nisolle M.

 

Abstract

Minimal and mild endometriosis (stages I/II) is frequently identified in subfertile patients, especially in case of unexplained infertility. The impact of those lesions on fecundity is still debatted and they have been considered as paraphysiological by some experts. In addition, they are heterogenous with variable spread, biological activity, induced inflammation and, sometimes, the presence of associated mild adhesions. Stages I/II endometriosis are the most frequent endometriotic lesions encountered in subfertile women. Reduced oocyte quality, anti sperm effects and, possibly, endometrial disorders appear as the most pertinent mechanisms involved. Spontaneous fecundity of women with minimal or mild endometriosis is reduced when compared to fecundity of women whose infertility is unexplained. Intra-uterine insemination with controlled ovarian stimulation improves fecundity. Laparoscopic ablation of endometriotic lesions modestly improves fecundity. This procedure has thus been recommended in view of the very small increased surgical risk. IVF is the most efficient method allowing to obtain pregnancy, with slightly reduced or similar results when compared to the performances of IVF in case of tubal infertility.

 

 

Qual Life Res. 2017 Jan;26(1):213-220.

Development of a French version of the Endometriosis Health Profile 5 (EHP-5): cross-cultural adaptation and psychometric evaluation.

Fauconnier A^1,2, Huchon C^3,4, Chaillou L³, Aubry G⁴, Renouvel F⁵, Panel P⁵.

 

Abstract

PURPOSE:

The Endometriosis Health Profile 5 (EHP-5) is a short version of an endometriosis-specific quality of life questionnaire. The objective of the study was to assess the psychometric validity of its French version.

METHODS:

A total of 125 patients with histologically proven endometriosis who underwent surgery for painful symptoms and 80 asymptomatic controls completed the EHP-5. Principal components analysis was performed to determine the dimensions of the instrument. Internal consistency was assessed using Cronbach’s alpha. Construct validity was assessed by testing the relationship between the EHP-5 and the characteristics of endometriosis.

RESULTS:

For each item of EHP-5, endometriosis patients scored significantly higher than control women (p > 0.0001). Eleven items of the EHP-5 were unidimensional with excellent internal consistency (Cronbach’s alpha = 0.92), and a summary aggregated index was then constructed. The EHP-5 index was sensitive to the presence of endometriosis, the type, location, severity of the disease, and pain or infertility as the main complaint with effect sizes ranging from 0.48 (95 % CI 0.11-0.85) for superficial endometriosis to 2.56 (95 % CI 2.18-2.93) for deeply infiltrating endometriosis.

CONCLUSION:

The French version of EHP-5 is valid and can be used for reporting patient-orientated outcome in future studies of French-speaking patients with endometriosis.

 

 

Case Rep Surg. 2016;2016:5843179.

Abdominal Wall Endometrioma after Laparoscopic Operation of Uterine Endometriosis.

Vukšić T¹, Rastović P¹, Dragišić V¹.

 

Abstract

Endometriosis is presence of functional endometrium outside of uterine cavum. As a pluripotent tissue, endometrium has the possibility of implanting itself almost everywhere; even implantation in abdominal wall was described, but it is not common site. This case report presents implantation of functional endometrium in abdominal wall, inside scar tissue, and after insertion of a laparoscopic trocar port. Final diagnosis was confirmed by pathohistological examination.

 

 

Syst Biol Reprod Med. 2016 Aug;62(4):266-82.

Molecular signatures of ovarian diseases: Insights from network medicine perspective.

Kori M¹, Gov E¹, Arga KY¹.

 

Abstract

Dysfunctions and disorders in the ovary lead to a host of diseases including ovarian cancer, ovarian endometriosis, and polycystic ovarian syndrome (PCOS). Understanding the molecular mechanisms behind ovarian diseases is a great challenge. In the present study, we performed a meta-analysis of transcriptome data for ovarian cancer, ovarian endometriosis, and PCOS, and integrated the information gained from statistical analysis with genome-scale biological networks (protein-protein interaction, transcriptional regulatory, and metabolic). Comparative and integrative analyses yielded reporter biomolecules (genes, proteins, metabolites, transcription factors, and micro-RNAs), and unique or common signatures at protein, metabolism, and transcription regulation levels, which might be beneficial to uncovering the underlying biological mechanisms behind the diseases. These signatures were mostly associated with formation or initiation of cancer development, and pointed out the potential tendency of PCOS and endometriosis to tumorigenesis. Molecules and pathways related to MAPK signaling, cell cycle, and apoptosis were the mutual determinants in the pathogenesis of all three diseases. To our knowledge, this is the first report that screens these diseases from a network medicine perspective. This study provides signatures which could be considered as potential therapeutic targets and/or as medical prognostic biomarkers in further experimental and clinical studies. Abbreviations DAVID: Database for Annotation, Visualization and Integrated Discovery; DEGs: differentially expressed genes; GEO: Gene Expression Omnibus; KEGG: Kyoto Encyclopedia of Genes and Genomes; LIMMA: Linear Models for Microarray Data; MBRole: Metabolite Biological Role; miRNA: micro-RNA; PCOS: polycystic ovarian syndrome; PPI: protein-protein interaction; RMA: Robust Multi-Array Average; TF: transcription factor.

 

 

Reprod Sci. 2017 Feb;24(2):324-331

Effects of Hydrogen Gas Inhalation on Endometriosis in Rats.

He Y¹, Shi JZ², Zhang RJ³, Zhai DX⁴, Zhang D⁴, Yu CQ⁴, Liu YH¹.

 

Abstract

OBJECTIVE:

Oxidative stress is generated during the pathophysiology of endometriosis (EMT). Hydrogen (H₂) has been demonstrated as a gas antioxidant. The aim of the present study is to evaluate the protective effect of H₂ on EMT in rats.

STUDY DESIGN:

Sprague Dawley rats with surgically induced EMT were randomly received the inhalation of 67% H₂-33% oxygen (O₂) mixture (1 h/d, 4 weeks) immediately after the EMT surgery or 4 weeks after the operation. The mixture of 67% N₂-33% O₂ was also used to exclude the possible influence of the increased O₂. Eight weeks after the operation, the endometrial tissues were weighted and analyzed using histology, immunohistochemistry, and real-time polymerase chain reaction. Several antioxidant enzymes and malondialdehyde were also measured in serum and tissue. The estrous cycles were monitored for H₂ safety.

RESULTS:

The results showed that both profiles of high-dose H₂ breathing reduced the size of the endometrial explants, inhibited cell proliferation, improved superoxide dismutase, glutathione peroxidase, malondialdehyde, and catalase activities, and regulated the expression of matrix metalloproteinase 9 and cyclooxygenase 2. However, inhalation of the same dose of nitrogen failed to show the protection. High-dose H₂ breathing did not change the normal estrous cyclicity.

CONCLUSION:

These results suggest that 67% H₂-33% O₂ breathing has a beneficial effect on EMT model rats, and inhalation of a high dose of H₂ could be a potential method applied in clinical practice.

 

 

Eur J Obstet Gynecol Reprod Biol. 2017 Feb;209:46-49

Adolescent endometriosis.

Sarıdoğan E¹.

 

Abstract

Endometriosis is a common finding in adolescents who have a history of chronic pelvic pain or dysmenorrhoea resistant to medical treatment, however the exact prevalence is unknown. Both early/superficial and advanced forms of endometriosis are found in adolescents, including ovarian endometriomas and deep endometriotic lesions. Whilst spontaneous resolution is possible, recent reports suggest that adolescent endometriosis can be a progressive condition, at least in a significant proportion of cases. It is also claimed that deep endometriosis has its roots in adolescence. Optimum treatment is far from clear and long term recurrence is still a significant problem. The most frequently reported treatment approach in the published literature is a combination of surgery and postoperative hormonal treatment with the combined oral contraceptives, progestins, levonorgestrel intrauterine system or gonadotrophin releasing hormone analogues. Use of gonadotrophin releasing hormone analogues and long term progestins should be carefully considered due to concerns over continuing bone formation in this age group. There is currently no consensus as to whether surgery should be avoided as much as possible to prevent multiple operations in the long term, or surgical treatment should be considered at an early stage before more severe lesions develop. Further research is required to determine which approach would offer a better long term outcome.

 

 

Eur J Obstet Gynecol Reprod Biol. 2017 Feb;209:86-94

Colorectal endometriosis and fertility.

Daraï E¹, Cohen J², Ballester M².

 

Abstract

OBJECTIVE:

The goal of this review was to assess the impact of colorectal endometriosis on spontaneous fertility and the potential benefit of Medically Assisted Reproduction (MAR) (in vitro fertilization and intrauterine insemination) and surgery on fertility outcomes.

STUDY DESIGN:

MEDLINE search for articles on fertility in women with DIE published between 1990 and December 2015 using the following terms: “deep endometriosis”, “deep infiltrating endometriosis”, “bowel endometriosis”, “colorectal endometriosis”, “fertility”, “infertility”, “IVF-ICSI”, “Assisted Reproductive Techniques (ART)”, and “MAR”.

RESULTS:

Spontaneous pregnancy rate (PR) in patients undergoing resection of DIE but leaving in situ colorectal endometriosis was 26.5% (95% CI=14-39). PR after MAR was 27.4% (95% CI=19-35) and the overall PR was 37.9% (95% CI=29-37). After colorectal surgery, among the 855 patients with and without proved infertility, the spontaneous PR was 31.4% (95% CI=28-34) without difference between the groups. PR after MAR was 19.8% (95% CI=17-22). PR after MAR in patients with and without proved infertility was 21.4% (95% CI=18-25) and 15.5% (95% CI=11-20), respectively. The overall PR after colorectal surgery was 51.1% (95% CI=48-54).

CONCLUSION:

Our review supports a potential benefit of surgery on fertility outcomes for women with colorectal endometriosis. Further studies are required to determine whether surgical management should be first-intention or restricted to failure of MAR.

 

 

 

 

 

Adv Ther. 2016 Aug;33(8):1385-407.

Factors and Regional Differences Associated with Endometriosis: A Multi-Country, Case-Control Study.

Chapron C¹, Lang JH², Leng JH², Zhou Y³, Zhang X⁴, Xue M⁵, Popov A⁶, Romanov V⁷, Maisonobe P⁸, Cabri P⁸.

 

Abstract

INTRODUCTION:

The present study aimed to investigate clinical, lifestyle, and environmental factors associated with endometrioma (OMA) and/or deep infiltrating endometriosis (DIE) as determined by case-control comparison [women with superficial peritoneal endometriosis (SUP) or no endometriosis], and compare differences between factor associated with endometriosis at a national level.

METHODS:

This was three countries (China, Russia, and France), case-control study in 1008 patients. Patients were identified and enrolled during their first routine appointment with their physician post-surgery for a benign gynecologic indication, excluding pregnancy. Retrospective information on symptoms and previous medical history was collected via face-to-face interviews; patients also completed a questionnaire to provide information on current habits. For every DIE patient recruited (n = 143), two women without endometriosis (n = 288), two SUP patients (n = 288), and two OMA patients (n = 288) were recruited.

RESULTS:

For the overall population, factors significantly associated (P ≤ 0.05) with DIE or OMA [Odds ratio (OR) >1] were: previous use of hormonal treatment for endometriosis [OR 6.66; 95% confidence interval (CI) 4.05-10.93]; previous surgery for endometriosis (OR 1.95; 95% CI 1.11-3.43); and living or working in a city or by a busy area (OR 1.66; 95% CI 1.09-2.52). Differences between regions with regard to the diagnosis, symptomatology, and treatment of endometriosis exist.

CONCLUSION:

The findings provide insight into potential risk factors for endometriosis and differences between regions in terms of endometriosis management and symptomatology. Further investigations are required to confirm the associations found in this study.

 

 

J Acupunct Meridian Stud. 2016 Jun;9(3):109-17.

Compounds of Natural Origin and Acupuncture for the Treatment of Diseases Caused by Estrogen Deficiency.

Thakur A¹, Mandal SC², Banerjee S³.

 

Abstract

A predominant number of diseases affecting women are related to female hormones. In most of the cases, these diseases are reported to be associated with menstrual problems. These diseases affect female reproductive organs such as the breast, uterus, and ovaries. Estrogen is the main hormone responsible for the menstrual cycle, so irregular menstruation is primarily due to a disturbance in estrogen levels. Estrogen imbalance leads to various pathological conditions in premenopausal women, such as endometriosis, breast cancer, colorectal cancer, prostate cancer, poly cysts, intrahepatic cholestasis of pregnancy, osteoporosis, cardiovascular diseases, obesity, etc. In this review, we discuss common drug targets and therapeutic strategies, including acupuncture and compounds of natural origin, for the treatment of diseases caused by estrogen deficiency.

 

 

 

Fertil Steril. 2016 Oct;106(5):1264-1269.

Fertility outcome of laparoscopic treatment in patients with severe endometriosis and repeated in vitro fertilization failures.

Soriano D¹, Adler I², Bouaziz J³, Zolti M³, Eisenberg VH³, Goldenberg M⁴, Seidman DS⁵, Elizur SE⁵.

 

Abstract

OBJECTIVE:

To evaluate fertility outcomes in infertile women with severe endometriosis (The revised American Fertility Society classification [AFS] 3-4) and repeated IVF failures, who underwent surgery due to exacerbation of endometriosis-related symptoms.

DESIGN:

Retrospective cohort study.

SETTING:

University hospital.

PATIENT(S):

All women who failed IVF treatment before surgery and who underwent laparoscopic surgery for severe endometriosis between January 2006 and December 2014.

INTERVENTION(S):

All patients were operated by highly skilled surgeons specializing in laparoscopic surgery for advanced endometriosis. Only patients with evidence of endometriosis in the pathology specimens were included in this study.

MAIN OUTCOME MEASURE(S):

Delivery rate after surgery.

RESULT(S):

Seventy-eight women were included in the present study. All women were diagnosed with severe endometriosis during surgery (AFS 3-4) and all women had experienced failed IVF treatments before surgery. All women were symptomatic before their surgery. After surgical treatment 33 women (42.3%) delivered. Three women (9%) conceived spontaneously and all other women conceived after IVF treatment. Women who delivered were younger (32.5 [±4.1] years vs. 35.5 [±3.8] years), were less often diagnosed with diminished ovarian reserve before surgery (6% vs. 28.8%), and were more often diagnosed with normal uterine anatomy (by preoperative transvaginal ultrasound and during operation). In addition, performing salpingectomy during surgery was associated with a trend of improvement in delivery rates after surgery (70% in women who delivered vs. 51% in women who failed to deliver).

CONCLUSION(S):

Symptomatic women with severe endometriosis and repeated IVF implantation failures may benefit from extensive laparoscopic surgery when performed by an experienced multidisciplinary surgical team to improve IVF outcome.

 

 

Zhongguo Zhen Jiu. 2016 Mar;36(3):237-42.

Clinical effect evaluation of acupuncture combined with medication for prevention of endometriosis recurrence after surgery.

Zhang C, Zhang X, Li L, Zhou Y.

 

Abstract

OBJECTIVE:

To evaluate the effect and safety of acupuncture combined with Jiawei Mojie tablet for the prevention of endometriosis recurrence after surgery.

METHODS:

One hundred and six patients after the conservative surgery against endometriosis were randomly divided into a western medication group and an acupuncture and medication group(a combination group), 53 cases in each one. In the western medication group, gestrinone was applied orally. In the combination group, acupuncture and Jiawei Mojie tablet with oral administration were adopted. Xuehai (SP 10), Sanyinjiao (SP 6) and Guanyuan (CV 4) were mainly used, and acupoints based on syndrome differentiation were combined. After the surgery and when the menstruation was end, 3 to 5 days later the preventive treatment was used successively for 6 months. Patients were followed up after treatment and in 3 months, 6 months, and 18 months (two years after surgery) after treatment. The recurrence [Abdominal/perineal ultrasonic examination, serum cancer antigen 125 (CA125) test], menstruation score, endometriosis health profile-5 (EHP-5) and the safety index of serum alanine aminotransferase (ALT) were compared between the two groups.

RESULTS:

Eight patients (five cases in the western medication group and three cases in the combination group) were rejected because of dropping, and six ones (two cases in the western medication group and four cases in the combination group) discontinued. When patients were followed up in 18 months after treatment, the suspected recurrence rate through ultrasonic examination was 2.0% (1/50), and the unusual rate of serum CA125 text was 4.0% (2/50) in the combination group, which were apparently lower than 18.8% (9/48) and 25.0% (12/48) in the western medication group (both P < 0.01). After treatment and 3-month, 6-month, and 18-month following up, the menstruation scores of the combination group were obviously lower than those of the western medication group (P < 0.01, P < 0.05). After 18 months, the positive rate of EHP-5 in the combination group was 0 (0/50), which was markedly lower than 18.8% (9/48) in the western medication group (P < 0.01). After treatment and 3-month, 6-month, and 18-month following up, the unusual rates of serum ALT text in the combination group were lower than those in the western medication group (P < 0.01, P < 0.05). After treatment, the unusual rate of serum ALT text was not significantly different in the combination group compared with that before treatment (P > 0.05), and after treatment and 3-month, 6-month following up, the unusual rates of serum ALT text in the western medication group were remarkablely higher than those before treatment (P < 0.01, P < 0.05). After 18-month following up, the unusual rate of serum ALT text in the western medication group was not statistically significant compared with that before treatment (P > 0.05).

CONCLUSION:

Acupuncture combined with Jiawei Mojie tablet can effectively prevent endometriosis recurrence after surgery, and improve menstruation condition and life quality, which are less injurious for liver than gestrinone.

 

 

Ann Thorac Surg. 2016 Oct;102(4):1125-30.

Primary Spontaneous Pneumothorax in Menstruating Women Has High Recurrence.

Mehta CK¹, Stanifer BP¹, Fore-Kosterski S¹, Gillespie C², Yeldandi A³, Meyerson S¹, Odell DD¹, DeCamp MM¹, Bharat A⁴.

 

Abstract

BACKGROUND:

Primary spontaneous pneumothorax (PSP) is treated on the basis of studies that have predominantly consisted of tall male subjects. Here, we determined recurrence of PSP in average-statured menstruating women and studied prevalence of catamenial pneumothorax (CP) in this population.

METHODS:

Men and menstruating women, aged 18 to 55 years, without underlying lung disease or substance abuse were retrospectively studied between 2009 and 2015. A chest pathologist reviewed all specimens for thoracic endometriosis. Kaplan-Meier curves were constructed to determine recurrence.

RESULTS:

The median age of women (n = 33) and men (n = 183) was 33.4 and 31.6 years, respectively. In women, 9 (27%) had left-sided and 24 (73%) had right-sided PSP, treated with tube thoracostomy. Recurrence occurred in 21 women (64%) with median follow-up of 14 months, and they were treated with thoracoscopic pleurodesis. Right PSP had higher recurrence (70%) than left PSP (56%, p = 0.02). Four women (12%) presented with recurrent tension pneumothorax within 6 months. Eight patients (24%) had PSP within 72 hours of menses, meeting clinical criteria of CP. All these were placed on hormonal suppression after initial episode but went on to experience recurrence that was treated with pleurodesis. Classical endometrial glands were not found in any biopsy specimens obtained during the thoracoscopy. In contrast to female subjects, only 8 average-statured men (4.4%) had recurrence (p < 0.001) with a median follow-up of 16 months.

CONCLUSIONS:

PSP in healthy average-statured menstruating women has high recurrence compared with male counterparts. CP is a clinical diagnosis and often recurs despite hormonal suppression therapy.

 

 

Int J Gynaecol Obstet. 2016 Sep;134(3):256-9

The efficacy of long-term maintenance therapy with a levonorgestrel-releasing intrauterine system for prevention of ovarian endometrioma recurrence.

Kim ML¹, Cho YJ², Kim MK¹, Jung YW¹, Yun BS¹, Seong SJ³.

 

Abstract

OBJECTIVE:

To evaluate the cumulative recurrence rates of ovarian endometrioma among patients using a levonorgestrel-releasing intrauterine system (LNG-IUS) after conservative laparoscopic surgery.

METHODS:

A retrospective review was conducted of premenopausal women who underwent conservative laparoscopic surgery for ovarian endometrioma and subsequent treatment with LNG-IUS at two gynecologic surgery centers in South Korea between January 1, 2007, and September 30, 2014. Eligible patients had no residual ovarian lesions before LNG-IUS insertion, underwent insertion within 12 months of primary surgery, and were followed up for at least 6 months afterwards. Recurrence was defined as a cystic mass (≥2 cm in diameter) detected by transvaginal ultrasonography.

RESULTS:

Overall, 61 patients were included. The mean duration of follow-up was 42.9 ± 22.0 months (range 8-98). Recurrence of ovarian endometrioma was detected among 7 (11%) of the patients. On Kaplan-Meier analysis, the cumulative recurrence rates were 4.0%, 6.3%, and 25.5% at 24, 36, and 60 months after surgery, respectively. In multivariate analysis, nulliparity at surgery was the only risk factor for recurrence (hazard ratio 5.892, 95% confidence interval 1.139-30.484; P=0.034).

CONCLUSION:

Long-term maintenance therapy with LNG-IUS after conservative surgery might be a treatment option to consider to prevent ovarian endometrioma recurrence among premenopausal women.

 

 

Exp Ther Med. 2016 Jul;12(1):101-106

Effect of rapamycin on endometriosis in mice.

Ren XU¹, Wang Y², Xu G³, Dai L⁴.

 

Abstract

The aims of the present study were to investigate the impact of rapamycin (RAPA) on the endometriosis (EMS) lesions in severe combined immunodeficiency (SCID) mice, and to examine the possible mechanism involved in a novel therapy in EMS. Following the successful establishment of an EMS-SCID mouse model, the mice were randomly assigned into the RAPA, control and saline treatment groups. Subsequent to treatment for 2 weeks, the serum hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) were detected using ELISA. The levels of HIF-1α and VEGF, as well as the size of EMS lesions, were compared among the three groups. In addition, the HIF-1α, VEGF and CD34 protein expression levels, and the microvessel density (MVD) of the lesions were determined by immunohistochemical analysis. Compared with the control and saline groups, the volume of EMS lesions in the RAPA-treated SCID mice was significantly reduced. Furthermore, the serum level and protein expression of VEGF, and the MVD in the lesions of the RAPA-treated group were significantly reduced when compared with the other two groups. These parameters were comparable in the control and saline groups. In conclusion, RAPA may inhibit the growth of endometriotic lesions, most possibly through the inhibition of the expression of VEGF in lesions, thereby inhibiting angiogenesis.

 

 

Am J Transl Res. 2016 May 15;8(5):2394-402.

PAI-1 secretion of endometrial and endometriotic cells is Smad2/3- and ERK1/2-dependent and influences cell adhesion.

Sui C¹, Mecha E², Omwandho CO³, Starzinski-Powitz A⁴, Stammler A⁵, Tinneberg HR⁵, Konrad L⁵.

 

Abstract

In the endometrium transforming growth factor-betas (TGF-βs) are involved mainly in menstruation and endometriosis. After binding of the ligands to the high-affinity receptors, TGF-β receptors (TBR1 and TBR2), TGF-βs activate Smad signaling to modulate gene expression and cellular functions. However, recently also Smad-independent pathways have been studied in more details. To evaluate both pathways, we have analyzed TGF-β signaling in human endometrial and endometriotic cells. Although endometrial and endometriotic cells secrete TGF-β1, secretion by stromal cells was higher compared to epithelial cells. In contrast, secretion of TGF-β2 was higher in endometriotic stromal and endometriotic epithelial cells compared to normal endometrial cells. Treatment of endometrial and endometriotic stromal and epithelial cells with TGF-β1 or TGF-β2 increased Smad-dependent secretion of plasminogen activator inhibitor-1 (PAI-1) dramatically in all three cell lines. Of note, endometriotic cells secreted clearly higher levels of PAI-1 compared to endometrial cells. Whereas a TBR1 kinase inhibitor completely blocked the TGF-β1 or TGF-β2-induced PAI-1 secretion, an ERK1/2 inhibitor only partially reduced PAI-1 secretion. This inhibition was not dependent on epidermal growth factor receptor (EGFR) activation by phosphorylation but on kinase activity of the TBR1. Finally, treatment of endometrial and endometriotic cell lines with recombinant PAI-1 showed reduced cell adhesion, especially of the endometrial cells. In summary, our results demonstrate that both Smad-dependent and TBR1-dependent ERK1/2 pathways are necessary for TGF-β-dependent high level secretion of PAI-1, which might increase cellular deadhesion.

 

 

Lab Invest. 2016 Sep;96(9):959-971.

Functional expression of aryl hydrocarbon receptor on mast cells populating human endometriotic tissues.

Mariuzzi L^#1, Domenis R^#1, Orsaria M¹, Marzinotto S¹, Londero AP², Bulfoni M¹, Candotti V¹, Zanello A¹, Ballico M³, Mimmi MC³, Calcagno A², Marchesoni D², Di Loreto C¹, Beltrami AP¹, Cesselli D¹, Gri G¹.

 

Abstract

Endometriosis is an inflammatory disease characterized by the presence of ectopic endometrial tissue outside the uterus. A diffuse infiltration of mast cells (MCs) is observed throughout endometriotic lesions, but little is known about how these cells contribute to the network of molecules that modulate the growth of ectopic endometrial implants and promote endometriosis-associated inflammation. The aryl hydrocarbon receptor (AhR), a transcription factor known to respond to environmental toxins and endogenous compounds, is present in MCs. In response to AhR activation, MCs produce IL-17 and reactive oxygen species, highlighting the potential impact of AhR ligands on inflammation via MCs. Here, we investigated the possibility that endometrial MCs promote an inflammatory microenvironment by sensing AhR ligands, thus sustaining endometriosis development. Using human endometriotic tissue (ET) samples, we performed the following experiments: (i) examined the cytokine expression profile; (ii) counted AhR-expressing MCs; (iii) verified the phenotype of AhR-expressing MCs to establish whether MCs have a tolerogenic (IL-10-positive) or inflammatory (IL-17-positive) phenotype; (iv) measured the presence of AhR ligands (tryptophan-derived kynurenine) and tryptophan-metabolizing enzymes (indoleamine 2,3-dioxygenase 1 (IDO1)); (v) treated ET organ cultures with an AhR antagonist in vitro to measure changes in the cytokine milieu; and (vi) measured the growth of endometrial stromal cells cultured with AhR-activated MC-conditioned medium. We found that ET tissue was conducive to cytokine production, orchestrating chronic inflammation and a population of AhR-expressing MCs that are both IL-17 and IL-10-positive. ET was rich in IDO1 and the AhR-ligand kynurenine compared with control tissue, possibly promoting MC activation through AhR. ET was susceptible to treatment with an AhR antagonist, and endometrial stromal cell growth was improved in the presence of soluble factors released by MCs on AhR activation. These results suggest a new mechanistic role of MCs in the pathogenesis of endometriosis.

 

 

Ultrasound Obstet Gynecol. 2016 Sep;48(3):318-32.

Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group.

Guerriero S¹, Condous G², van den Bosch T³, Valentin L⁴, Leone FP⁵, Van Schoubroeck D³, Exacoustos C⁶, Installé AJ⁷, Martins WP⁸, Abrao MS⁹, Hudelist G¹⁰, Bazot M¹¹, Alcazar JL¹², Gonçalves MO¹³, Pascual MA¹⁴, Ajossa S¹, Savelli L¹⁵, Dunham R¹⁶, Reid S¹⁷, Menakaya U¹⁸, Bourne T¹⁹, Ferrero S²⁰, Leon M²¹, Bignardi T²², Holland T²³, Jurkovic D²³, Benacerraf B²⁴, Osuga Y²⁵, Somigliana E²⁶, Timmerman D³.

 

Abstract

The IDEA (International Deep Endometriosis Analysis group) statement is a consensus opinion on terms, definitions and measurements that may be used to describe the sonographic features of the different phenotypes of endometriosis. Currently, it is difficult to compare results between published studies because authors use different terms when describing the same structures and anatomical locations. We hope that the terms and definitions suggested herein will be adopted in centers around the world. This would result in consistent use of nomenclature when describing the ultrasound location and extent of endometriosis. We believe that the standardization of terminology will allow meaningful comparisons between future studies in women with an ultrasound diagnosis of endometriosis and should facilitate multicenter research. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

 

 

Int J Reprod Biomed (Yazd). 2016 Apr;14(4):241-6.

Association study of Glutathione S-Transferase polymorphisms and risk of endometriosis in an Iranian population.

Hassani M¹, Saliminejad K², Heidarizadeh M¹, Kamali K², Memariani T³, Khorram Khorshid HR⁴.

 

Abstract

BACKGROUND:

Endometriosis influenced by both genetic and environmental factors. Associations of glutathione S-transferases (GSTs) genes polymorphisms in endometriosis have been investigated by various researchers; however, the results are not consistent.

OBJECTIVE:

We examined the associations of GSTM1 and GSTT1 null genotypes and GSTP1 313 A/G polymorphisms with endometriosis in an Iranian population.

MATERIALS AND METHODS:

In this case-control study, 151 women with diagnosis of endometriosis and 156 normal healthy women as control group were included. The genotyping was determined using multiplex PCR and PCR- RFLP methods.

RESULTS:

The GSTM1 null genotype was significantly higher (p=0.027) in the cases (7.3%) than the control group (1.3%). There was no significant difference between the frequency of GSTT1 genotypes between the cases and controls. The GSTP1 313 AG genotype was significantly lower (p=0.048) in the case (33.1%) than the control group (44.4%).

CONCLUSION:

Our results showed that GSTM1 and GSTP1 polymorphisms may be associated with susceptibility of endometriosis in Iranian women.

 

 

Br J Radiol. 2016 Sep;89(1065):20160173.

Usefulness of transabdominal real-time sonoelastography in the evaluation of ovarian lesions: preliminary results.

Herek D¹, Karabulut A², Agladioglu K¹.

 

Abstract

OBJECTIVE:

We aim to evaluate and describe the tissue elasticity characteristics of various ovarian lesions with sonoelastography.

METHODS:

35 patients (age range 16-85 years; mean age 40.8 years) underwent sonoelastography and later MRI. Histopathological confirmation of all lesions was carried out, except eight of endometriomas and six of septated cysts which were confirmed on MRI and follow-up ultrasonography. Strain ratios and elastogram patterns were recorded. Lesions were classified into three groups (Group 1: cystic lesions, Group 2: benign tumours and Group 3: malignant lesions) and findings were compared between groups for both observers. Interobserver agreement was analyzed. Optimal cut-off values for strain ratios were achieved with receiver operating characteristic curve analysis.

RESULTS:

Ovarian endometriomas and complex cystic lesions were observed hard on elastograms with high strain ratios, and malignant lesions were observed mostly soft with very small strain ratios. Benign tumours had average tissue stiffness, observed harder than the malignant lesions, and strain ratios ranged from 4 to 14. The differences in patterns and strain ratios between groups were statistically significant (p < 0.05 for both observers).

CONCLUSION:

Our study revealed that malignant ovarian lesions have softer tissue property than benign lesions and cystic lesions in terms of elastogram patterns and strain ratios.

ADVANCES IN KNOWLEDGE:

Most ovarian lesions contain solid and cystic parts which make the malignant and benign lesions look similar on imaging modalities. Using real-time sonoelastography as an adjunct to other imaging modalities may improve the differentiation of malignant ovarian lesions from benign lesions.

 

 

Eur J Gynaecol Oncol. 2016;37(3):348-52.

Serum lipid profile in gynecologic tumors: a retrospective clinical study of 1,550 patients.

Sun Y, Meng H, Jin Y, Shi X, Wu Y, Fan D, Wang X, Jia X, Dai H.

 

Abstract

BACKGROUND:

The study was performed to characterize and compare the serum lipid profile in gynecologic cancers and benign diseases.

MATERIALS AND METHODS:

A total of 1,550 age-matched females were included in this study: 760 patients with gynecologic cancers and 790 patients with benign diseases. Serum levels of triglycerides (TG), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c), total cholesterol (TC), and lipoprotein (a) were measured.

RESULTS:

Compared to gynecologic benign disease group, gynecologic cancer group was associated with higher level of TG (p = 0.0002), as well as lower level of HDL-c (p < 0.0001), LDL-c (p = 0.004) and TC (p = 0.003). Compared to benign ovarian tumor group, ovarian cancer group had significantly lower levels of HDL-c (p < 0.0001), LDL-c (p = 0.0009), and TC (p < 0.0001), as well as a trend of higher level of lipoprotein (a) (p = 0.10). Compared to endometriosis group, endometrial cancer group showed higher levels of TG (p < 0.0001) and lower levels of HDL-c (p = 0.002). There was no significant difference in any lipid parameters between cervical cancer group and uterine leiomyomas group.

CONCLUSION:

In conclusion, compared with benign diseases, gynecologic cancers are associated with a disordered lipid profile characterized by higher TG and lipoprotein (a) levels, and lower HDL-c, LDL-c, and TC levels. The association is most conspicuous in ovarian cancers. Endometrial cancer is accompanied by alterations only in TG and HDL-c levels, while cervical cancer does not appear to be associated with disordered lipid profile.

 

 

Int J Gynaecol Obstet. 2016 Sep;134(3):282-5.

Pregnancy after fertility-sparing surgery for borderline ovarian tumors.

Lian C¹, Chen X², Ni Y¹, Huang X¹, Lin Y¹.

 

Abstract

OBJECTIVE:

To investigate the ability to conceive and the factors affecting chances of pregnancy among patients with borderline ovarian tumors (BOTs) treated with fertility-sparing surgery.

METHODS:

A retrospective study included nulliparous patients aged 40years or younger who had undergone fertility-sparing surgery for BOTs between January 2005 and June 2012 at a center in Fuzhou, China. Identified patients were followed up by telephone or mail between March 15 and June 30, 2013. Patients who had already been pregnant and those who had not but had discontinued contraception for more than 1year were included in final analyses.

RESULTS:

Among 23 included patients, 17 (74%) had become pregnant within the mean follow-up period of 48.2months. The frequencies of previous infertility, sequelae of pelvic inflammatory disease, and endometriosis were all higher in the nonpregnant group than in the pregnant group (P≤0.021 for all). More women in the nonpregnant group that in the pregnant group had BOTs of stage II or worse, but the difference was nonsignificant (P=0.059).

CONCLUSION:

Fertility-sparing surgery in young patients with BOTs is associated with a good pregnancy rate. However, the tumor stage and coexisting infertility factors are important considerations in selecting the optimal surgical approach.

 

 

Anticancer Res. 2016 Jul;36(7):3445-9.

Endometriosis-associated Ovarian Cancer: A Distinct Clinical Entity?

Bounous VE¹, Ferrero A², Fuso L², Ravarino N³, Ceccaroni M⁴, Menato G², Biglia N².

 

Abstract

AIM:

The aim of the study was to evaluate the incidence of endometriosis-associated ovarian cancer (EAOC) and compare clinicopathological characteristics and overall survival (OS) between patients with EAOC and those with ovarian cancer not associated with endometriosis.

PATIENTS AND METHODS:

We identified EAOC among 203 patients with invasive epithelial ovarian cancer who underwent complete surgery at our Institution from January 2004 to March 2014.

RESULTS:

EAOC was present in 45 patients. EAOC was significantly more frequently diagnosed at an earlier stage of disease (p=0.038). At a median follow-up time of 32 months, OS among patients with EAOC was significantly longer (p=0.039). However, stratifying by stage, the OS advantage of EAOC was not significant. At multivariate analysis, only stage was an independent prognostic factor for OS (hazard ratio=5.7; 95% confidence interval=1.8-18.6; p=0.003).

CONCLUSION:

EAOC incidence was 22.2%. EAOC appears to be diagnosed at an earlier stage and confers a better OS. However, stratifying by stage, the advantage in survival of EAOC disappears.

 

 

Zhonghua Fu Chan Ke Za Zhi. 2016 Jun 25;51(6):436-41.

Differential expression of microRNA in eutopic endometrium tissue during implantation window for patients with endometriosis related infertility.

Wang Y¹, Ma CH, Qiao J.

 

Abstract

OBJECTIVE:

To predict the genes that affect endometrial receptivity through the differential expression of microRNA (miRNA) in eutopic endometrial tissues during implantation window in patients with endometriosis infertility.

METHODS:

Among infertile patients that received treatments at the Center for Reproductive Medicine, Peking University Third Hospital between May and December 2013, patients with endometriosis infertility were selected as endometriosis group (among the selected 17 cases, there were 6 cases with follicular phase endometrium and 11 cases with implantation window phase endometrium), and patients with tubal factor infertility were selected as control group (among the selected 19 cases, there were 7 cases with follicular phase endometrium and 12 cases with implantation window phase endometrium). (1)Implantation window phase endometrium was selected from 3 cases in each group. Using miRNA and mRNA joint gene sequencing and database for forecast results, as well as using the negative regulatory relationship between miRNA and mRNA, the intersection of target gene that negatively correlates with miRNA expression were obtained. The co-expression network of miRNA-mRNA wae constructed. Combined with the genes associated with endometrial receptivity found through bioinformatics method, the miRNA with core regulatory functionwas found. (2) Expand sample size to 14 cases for endometriosis group and 16 cases for control group.Reverse transcription (RT)-PCR technique was utilized to detect the expression of miR- 142- 5p, miR- 146a- 5p and miR- 543 in endometrial tissues, and verify miRNA microarray results.

RESULTS:

(1) miRNA and mRNA microarray screening results showed that, among the endometrial tissues of patients with endometriosis infertility and with implantation window phase, 6 differentially expressed miRNA were indentified, among which miR-142-5p, miR-146a-5p, miR-1281, miR-940, miR-4634 showed significantly enhanced expression and miR- 543 showed significantly inhibited expression. Sixty- three differentially expressed mRNA were indentified, among which 58 mRNA such as CADM1, IL-10RA, ITGAL and LPAR5 had significantly enhanced expression. Five mRNA such as HLA- DRB1,3,4,5 and SOHLH2 showed significantly inhibited expression. Thirty- six taget genes were found in consideration of negatively correlated miRNA expression with the genes, miRNA-mRNA co-expression network were constructed. The miR-543 was found at the core of the network. Targetscan and other database predicted that miR-142-5p, miR- 146a- 5p and miR- 543 could act on various types of endometrial receptivity molecular corresponding marker genes such as HOX10, ITGAV, ITGB3, OPN, LIF, ESR, PGR, CDH1 and MMP. (2) RT- PCR test showed that the average levels of expression of miR-142-5p and miR-146a-5p in implantation window phase endometrium in endometriosis group were 8.3±10.6 and 1.9±0.8 respectively; the average levels of that in control group were 1.1±0.6 and 0.9±0.4, respectively. The difference was statistically significant (P=0.027, P=0.015), and was consistent with results from miRNA microarray test. The expression of miR-543 in tissues of follicular phase endometrium in endometriosis group (2.3±1.0) was significantly higher than that in control group (1.0 ± 0.4), and the difference was statistically significant (P=0.008). However, when comparing the expression of miR-543 implantation window phase endometrium in endometriosis group (1.2±0.6) with that in control group (1.5±1.0), the difference was not statistical significant (P=0.890).

CONCLUSIONS:

There are multiple differential expressions of miRNA in the implantation window phase endometrium tissues of endometriosis infertility patients, among which miR-142-5p and miR-146a-5p show significantly enhanced expression and may affect embryo implantation by acting on a variety of endometrial receptivity marker molecules. The expression of miR- 543 in implantation window phase endometrium of endometriosis infertility patients is lower than that in the follicular phase, forewarned changes in the pattern of cyclic variation of miR-543, and may be the reason for affecting endometrial receptivity.

 

 

Hum Reprod. 2016 Oct;31(10):2377-83

Endometriomas and deep infiltrating endometriosis in adulthood are strongly associated with anogenital distance, a biomarker for prenatal hormonal environment.

Mendiola J¹, Sánchez-Ferrer ML², Jiménez-Velázquez R³, Cánovas-López L³, Hernández-Peñalver AI³, Corbalán-Biyang S³, Carmona-Barnosi A³, Prieto-Sánchez MT², Nieto A², Torres-Cantero AM⁴.

 

Abstract

STUDY QUESTION:

Is the length of the anogenital distance (AGD), a biomarker of the in-utero prenatal hormonal environment, associated with the presence of endometriomas and deep infiltrating endometriosis (DIE)?

SUMMARY ANSWER:

Shorter AGD is associated with presence of endometriomas and DIE.

WHAT IS KNOWN ALREADY:

It is debated whether hormonal exposure to estrogens in utero may be a risk factor for endometriosis in adulthood. AGD is a biomarker of prenatal hormonal environment and observational studies have shown an association between AGD and reproductive parameters in both sexes.

STUDY DESIGN, SIZE, DURATION:

This case-control study of 114 women with endometriosis (endometriomas and/or DIE) and 105 controls was conducted between September 2014 and May 2015.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Cases were attending the Endometriosis Unit of the Hospital. Prevalent as well as incident cases, diagnosed by transvaginal ultrasound (TVUS), were included. Controls were women without endometriosis attending the gynecological outpatient clinic for routine gynecological exams. Participants completed health questionnaires, followed physical and gynecological examinations, including TVUS. Measurements from the anterior clitoral surface to the upper verge of the anus (AGDAC), and from the posterior fourchette to the upper verge of the anus (AGDAF) were obtained in all subjects. Unconditional multiple logistic regression was used to estimate the association between AGD measurements and presence of endometriomas and/or DIE while accounting for important confounders and covariates, including age, body mass index, vaginal delivery or episiotomy.

MAIN RESULTS AND THE ROLE OF CHANCE:

AGDAF was related to presence of endometriomas and/or DIE. For all cases of endometriosis (endometriomas and DIE), women in the lowest tertile of the AGDAF distribution, compared with the upper tertile, were 7.6-times (95% CI 2.8-21.0; P-trend < 0.001) more likely to have endometriosis. With regard to DIE, women with AGDAF below the median, compared with those with AGDAF above the median, were 41.6-times (95% CI 3.9-438; P-value = 0.002) more likely to have endometriosis.

LIMITATIONS, REASONS FOR CAUTION:

In case-control studies, information and selection bias has to be ruled out. Physicians conducting the measurement were blind to the status of the patients. Controls came from the same population as the cases. We adjusted for known and suspected confounders and covariates, but the possibility of residual confounding or chance findings should always be considered. As with all observational studies, causal inference is limited.

WIDER IMPLICATIONS OF THE FINDINGS:

This study suggests that endometriosis, especially the DIE, might have a prenatal origin that may be traced back to the hormonal milieu in which the fetus develops.

STUDY FUNDING/COMPETING INTEREST:

This work was supported by the Ministry of Economy and Competitiveness, ISCIII (AES), grant no. PI13/01237 and the Seneca Foundation, Murcia Regional Agency of Science and Technology, grant no. 19443/PI/14. The authors have no competing interests to declare.

 

 

J Obstet Gynaecol Res. 2016 Oct;42(10):1336-1342

Usefulness of T2 star-weighted imaging in ovarian cysts and tumors.

Takahashi N¹, Yoshino O², Maeda E³, Naganawa S³, Harada M¹, Koga K¹, Hiraike O¹, Nakamura M⁴, Tabuchi T⁴, Hori M⁵, Saito S⁶, Fujii T¹, Osuga Y¹.

 

Abstract

AIM:

The aim of this study was to investigate the prevalence of hypointensity on T2 star-weighted imaging (T2*WI), which is useful for detecting hemosiderin, in endometriomas and other ovarian tumors. The efficacy of detecting adhesions around ovarian tumors was also investigated.

METHODS:

Pelvic magnetic resonance (MR) examinations, including T2*WI, were carried out. The inclusion criteria were female patients with ovarian surgical treatments. One hundred seventeen patients with a total of 147 lesions were enrolled. Two radiologists retrospectively evaluated MR imaging (MRI) to predict ovarian pathology and the presence of adhesions. T2*WI hypointensity of the inside and outside along ovarian cysts/tumors was utilized to predict pathological diagnoses and the presence of adhesions, respectively. The kappa scores were calculated to measure interobserver agreement on MRI findings. The MRI interpretations were compared with the results of pathological investigation and surgical observations.

RESULTS:

Hypointensity inside along the cyst walls on T2*WI was observed in 100 out of 106 lesions of endometriomas (94.3%), and three out of 41 non-endometrial ovarian cysts/tumors (7.3%). Four different patterns of T2*WI were observed in ovarian cysts/tumors. The kappa score regarding T2*WI hypointensity inside along the cyst walls was 0.633. Using conventional routine pelvic MRI, the sensitivity for detecting adhesions around ovarian cysts was 84.5%. By adding T2*WI, the sensitivity improved to 91.4% (P < 0.01). With conventional methods to predict adhesions, the kappa score was 0.660. After adding T2*WI to the conventional methods, the kappa score was 0.767.

CONCLUSION:

Hypointensity on T2*WI was observed frequently in endometrioma. T2*WI also improved the sensitivity for detecting adhesions around ovarian cysts/tumors.

 

 

Arch Gynecol Obstet. 2016 Sep;294(3):657-64.

Characterization of endometriosis-associated immune cell infiltrates (EMaICI).

Scheerer C¹, Bauer P¹, Chiantera V¹, Sehouli J¹, Kaufmann A¹, Mechsner S².

 

Abstract

OBJECTIVE:

To identify and characterize endometriosis-associated immune cell infiltrates (EMaICI). Furthermore, to define occurrence and size of EMaICI in various types of endometriosis.

METHODS:

Immune cells were characterized in samples of 60 premenopausal women with histological proven endometriosis. Therefore, immunohistochemical staining with monoclonal antibodies for CD3, CD4, CD8, CD45RO, CD25, CD56, CD68, and CD20 on sections of paraffin-embedded endometriotic tissue was performed.

RESULTS:

EMaICI were observed in all the types of endometriosis, and characterized as T lymphocytes (CD3+), helper T lymphocytes (CD4+), cytotoxic T lymphocytes (CD8+), antigen-experienced T lymphocytes”memory cells” (CD45RO+), macrophages (CD68+), and B lymphocytes (CD20+). The maximum frequency of EMaICI and their distribution per endometriotic lesion (EML) was observed in peritoneal endometriosis (pEM) and in ovarian endometriosis (Ov. EM). In myometrium from adenomyosis (M/AM), EMaICI occurrence was lower and smaller in size in comparison with EMaICI seen in other forms of endometriosis. EMaICI were negative for regulatory T cells (CD25+ high, FoxP3+) and natural killer cells (NK cells, CD56+).

CONCLUSION:

Numerous and brisk EMaICI comprising several types of immune cells in all endometriosis forms suggest acute immunological reactions within the microenvironment of endometriosis lesions.

 

 

 

 

Clin Exp Reprod Med. 2016 Jun;43(2):90-6.

Dietary supplementation with astaxanthin may ameliorate sperm parameters and DNA integrity in streptozotocin-induced diabetic rats.

Bahmanzadeh M¹, Vahidinia A², Mehdinejadiani S³, Shokri S⁴, Alizadeh Z¹.

 

Abstract

OBJECTIVE:

Diabetes mellitus (DM) is known to cause many systemic complications as well as male infertility. Astaxanthin (ASTX) is a powerful antioxidant that is involved in a variety of biologically active processes, including those with anti-diabetes effects. The present study investigates the effect of ASTX on the spermatozoa function in streptozotocin (STZ)-induced diabetic rats.

METHODS:

We divided 30 adult rats into three groups (10 rats per group), with a control group that received corn oil mixed with chow. DM was induced by intra-peritoneal injection of STZ. Eight weeks after the STZ injection, half of the diabetic animals were used as diabetic controls, and the rest were treated with ASTX for 56 days. Then the parameters and chromatin integrity of the epididymal sperm were analyzed using chromomycin A3, toluidine blue (TB), and acridine orange (AO) staining.

RESULTS:

The count, viability, and motility of the epididymal sperm were decreased significantly in the STZ group in comparison with the control group (count and viability, p<0.001; motility, p<0.001;0.01). ASTX increased normal morphology and viable spermatozoa compared to the STZ group (morphology, p=0.001; viability, p<0.001;0.05). The percentage of abnormal chromatins in TB and AO staining was higher in the STZ group compared to the control group (p<0.001;0.001). The mean percentage of TB and AO positive spermatozoa in STZ rats was significantly lower in the STZ+ASTX group (TB, p=0.001; AO, p<0.001;0.05).

CONCLUSION:

This study observed that in vivo ASTX treatment partially attenuates some detrimental effect of diabetes. Conversely, ASTX improved sperm viability, normal morphology, and DNA integrity.

 

 

Curr Opin Obstet Gynecol. 2016 Aug;28(4):304-10.

Advantages of robotics in benign gynecologic surgery.

Truong M¹, Kim JH, Scheib S, Patzkowsky K.

 

Abstract

PURPOSE OF REVIEW:

The purpose of this article is to review the literature and discuss the advantages of robotics in benign gynecologic surgery.

RECENT FINDINGS:

Minimally invasive surgery has become the preferred route over abdominal surgery. The laparoscopic or robotic approach is recommended when vaginal surgery is not feasible. Thus far, robotic gynecologic surgery data have demonstrated feasibility, safety, and equivalent clinical outcomes in comparison with laparoscopy and better clinical outcomes compared with laparotomy. Robotics was developed to overcome challenges of laparoscopy and has led to technological advantages such as improved ergonomics, visualization with three-dimensional capabilities, dexterity and range of motion with instrument articulation, and tremor filtration. To date, applications of robotics in benign gynecology include hysterectomy, myomectomy, endometriosis surgery, sacrocolpopexy, adnexal surgery, tubal reanastomosis, and cerclage. Though further data are needed, robotics may provide additional benefits over other approaches in the obese patient population and in higher complexity cases. Challenges that arose in the earlier adoption stage such as the steep learning curve, costs, and operative times are becoming more optimized with greater experience, with implementation of robotics in high-volume centers and with improved training of surgeons and robotic teams. Robotic laparoendoscopic single-site surgery, albeit still in its infancy where technical advantages compared with laparoscopic single-site surgery are still unclear, may provide a cost-reducing option compared with multiport robotics. The cost may even approach that of laparoscopy while still conferring similar perioperative outcomes.

SUMMARY:

Advances in robotic technology such as the single-site platform and telesurgery, have the potential to revolutionize the field of minimally invasive gynecologic surgery. Higher quality evidence is needed to determine the advantages and disadvantages of robotic surgery in benign gynecologic surgery. Conclusions on the benefits and risks of robotic surgery should be made with caution given limited data, especially when compared with other routes. Route of surgery selection should take into consideration the surgeons’ skill and comfort level that allows for the highest level of safety and efficiency. Ultimately, the robotic device is an additional minimally invasive surgical tool that can further the goal of minimizing laparotomy in gynecology.

 

 

Int J Gynecol Pathol. 2017 Mar;36(2):195-199

A Case of Stage 4B Seromucinous Ovarian Borderline Tumor With Endometriosis and Review of the Literature.

Newton CL¹, Brockbank E, Singh N, Faruqi A.

 

Abstract

Ovarian mucinous borderline tumors are traditionally divided into 2 morphologic groups: endocervical type, also known as seromucinous, and intestinal type. We present a case of stage 4B seromucinous ovarian borderline tumor with endometriosis and review the literature. At the time of writing, this is believed to be the first case of a seromucinous borderline tumor reported at such an advanced stage.

 

 

J Pediatr Urol. 2016 Aug;12(4):207.e1-5.

Congenital renal anomalies in cloacal exstrophy: Is there a difference?

Suson KD¹, Inouye B², Carl A², Gearhart JP².

 

Abstract

INTRODUCTION:

Cloacal exstrophy (CE) is the most severe manifestation of the epispadias-exstrophy spectrum. Previous studies have indicated an increased rate of renal anomalies in children with classic bladder exstrophy (CBE). Given the increased severity of the CE defect, it was hypothesized that there would be an even greater incidence among these children.

OBJECTIVE:

The primary objective was to characterize renal anatomy in CE patients. Two secondary objectives were to compare these renal anatomic findings in male and female patients, and female patients with and without Müllerian anomalies.

STUDY DESIGN:

An Institutional Review Board-approved retrospective review of 75 patients from an institutional exstrophy database. Data points included: age at analysis, sex, and renal and Müllerian anatomy. Abnormal renal anatomy was defined as a solitary kidney, malrotation, renal ectopia, congenital cysts, duplication, and/or proven obstruction. Abnormal Müllerian anatomy was defined as uterine or vaginal duplication, obstruction, and/or absence.

RESULTS:

The Summary Table presents demographic data and renal anomalies. Males were more likely to have renal anomalies. Müllerian anomalies were present in 65.7% of female patients. Girls with abnormal Müllerian anatomy were 10 times more likely to have renal anomalies than those with normal Müllerian anatomy (95% CI 1.1-91.4, P = 0.027).

DISCUSSION:

Patients with CE had a much higher rate of renal anomalies than that reported for CBE. Males and females with Müllerian anomalies were at greater risk than females with normal uterine structures. Mesonephric and Müllerian duct interaction is required for uterine structures to develop normally. It has been proposed that women with both Müllerian and renal anomalies be classified separately from other uterine malformations on an embryonic basis. In these patients, an absent or dysfunctional mesonephric duct has been implicated as potentially causal. This provided an embryonic explanation for uterine anomalies in female CE patients. There were also clinical implications. Women with renal agenesis and uterine anomalies were more likely to have endometriosis than those with isolated uterine anomalies, but were also more likely to have successful pregnancies. Males may have had an analogous condition with renal agenesis and seminal vesicle cysts. Future research into long-term kidney function in this population, uterine function, and possible male sexual duct malformation is warranted.

CONCLUSION:

Congenital renal anomalies occurred frequently in children with CE. They were more common in boys than in girls. Girls with abnormal Müllerian anatomy were more likely to have anomalous renal development. Mesonephric duct dysfunction may be embyologically responsible for both renal and Müllerian maldevelopment.

 

 

Gynecol Obstet Fertil. 2016 Jul-Aug;44(7-8):377-84.

Current surgical practice of prophylactic and opportunistic salpingectomy in France.

Chene G¹, de Rochambeau B², Le Bail-Carval K³, Beaufils E³, Chabert P³, Mellier G³, Lamblin G³.

 

Abstract

OBJECTIVES:

Since the recent evidence of a tubal origin of most ovarian cancers, opportunistic salpingectomy could be discussed as a prophylactic strategy in the general population and with hereditary predisposition. We aimed to survey French gynecological surgeons about their current surgical practice of prophylactic salpingectomy.

METHODS:

An anonymous online survey was sent to French obstetrician-gynaecologists and gynecological surgeons. There were 13 questions about their current clinical practice and techniques of salpingectomy during a benign hysterectomy or as a tubal sterilization method, salpingectomy versus salpingo-oophorectomy in the population with genetic risk, salpingectomy in relationship with endometriosis and questions including histopathological considerations.

RESULTS:

Among the 569 respondents, opportunistic salpingectomy was always performed between 42.48% and 43.44% during laparoscopic, laparoscopic-assisted vaginal or laparotomic hysterectomy and only 12.26% in case of vaginal route. In the genetic population, salpingo-oophorectomy was mainly performed. Tubal sterilization was often practiced by the hysteroscopic route. More than 90% of respondents didn’t perform salpingectomy in case of endometriosis. There was not any specific tubal histopathological protocol in 71.54% of cases.

CONCLUSIONS:

Salpingectomy may be a preventing strategy in the low- and high-risk population. The survey’s responses show that salpingectomy seems to be a current practice during benign hysterectomy for more than 40% doctors. However, there is not any change with no more salpingectomy in the population with genetic risk, or in case of endometriosis or tubal sterilization.

 

 

Reprod Sci. 2017 Mar;24(3):342-354.

The Role of Relaxin in Normal and Abnormal Uterine Function During the Menstrual Cycle and Early Pregnancy.

Marshall SA¹, Senadheera SN¹, Parry LJ¹, Girling JE².

 

Abstract

The hormone relaxin is a 6-kDa peptide with high structural similarity to insulin. It is primarily produced by the corpus luteum during pregnancy but is also synthesized by other reproductive organs such as the uterus, decidua, and placenta. Relaxin binds to its receptor RXFP1, which has been localized to a wide variety of reproductive and nonreproductive tissues. The peptide’s many uterotropic effects include stimulating uterine growth and vascularization, remodeling extracellular matrix components, and regulating vascular endothelial growth factor in preparation for implantation. Evidence also supports a role for relaxin in the systemic maternal vascular adaptations required for a healthy pregnancy. Diminished relaxin levels in early pregnancy are linked with increased risks of miscarriage and the development of preeclampsia. In addition to pregnancy, relaxin may also play a functional role in the uterus during the menstrual cycle, and modified relaxin activity may contribute to gynecological disorders such as uterine fibrosis and endometriosis. Despite over 75 years of research, we still have a limited understanding of relaxin’s broad roles in the uterus, particularly as there are significant species differences in its synthesis and activity, which restricts the use of animal models for human-centric questions. Here, we review current knowledge regarding relaxin actions in the human uterus during the menstrual cycle and in early pregnancy, with a focus on its potential roles in various gynecological disorders, as well as the pregnancy disorders such as preeclampsia, recurrent miscarriage, and early pregnancy loss.

 

 

Reprod Sci. 2017 Feb;24(2):202-226.

Research Priorities for Endometriosis.

Rogers PA¹, Adamson GD^2,3, Al-Jefout M⁴, Becker CM⁵, D’Hooghe TM⁶, Dunselman GA⁷, Fazleabas A⁸, Giudice LC^3,9,10, Horne AW¹¹, Hull ML¹², Hummelshoj L^3,10, Missmer SA^3,13, Montgomery GW¹⁴, Stratton P¹⁵, Taylor RN^10,16, Rombauts L^3,10,17, Saunders PT¹⁸, Vincent K⁵, Zondervan KT^5,19; WES/WERF Consortium for Research Priorities in Endometriosis.

 

Abstract

The 3rd International Consensus Workshop on Research Priorities in Endometriosis was held in São Paulo on May 4, 2014, following the 12th World Congress on Endometriosis. The workshop was attended by 60 participants from 19 countries and was divided into 5 main sessions covering pathogenesis/pathophysiology, symptoms, diagnosis/classification/prognosis, disease/symptom management, and research policy. This research priorities consensus statement builds on earlier efforts to develop research directions for endometriosis. Of the 56 research recommendations from the 2011 meeting in Montpellier, a total of 41 remained unchanged, 13 were updated, and 2 were deemed to be completed. Fifty-three new research recommendations were made at the 2014 meeting in Sao Paulo, which in addition to the 13 updated recommendations resulted in a total of 66 new recommendations for research. The research recommendations published herein, as well as those from the 2 previous papers from international consensus workshops, are an attempt to promote high-quality research in endometriosis by identifying and agreeing on key issues that require investigation. New areas included in the 2014 recommendations include infertility, patient stratification, and research in emerging nations, in addition to an increased focus on translational research. A revised and updated set of research priorities that builds on this document will be developed at the 13th World Congress on Endometriosis to be held on May 17-20, 2017, in Vancouver, British Columbia, Canada.

 

 

Hum Reprod. 2016 Sep;31(9):2017-23.

RCT to evaluate the influence of adjuvant medical treatment of peritoneal endometriosis on the outcome of IVF.

Decleer W¹, Osmanagaoglu K², Verschueren K³, Comhaire F⁴, Devroey P⁵.

 

Abstract

STUDY QUESTION:

Does a 3-month adjuvant hormonal treatment of mild peritoneal endometriosis after laparoscopic surgery influence the outcome of IVF stimulation in terms of number of mature oocytes obtained per cycle?

SUMMARY ANSWER:

Complementary medical treatment of mild peritoneal endometriosis does not influence the number of oocytes per treatment cycle.

WHAT IS KNOWN ALREADY:

Endometriosis is a disease known to be related to infertility. However, the influence of superficial endometriosis-and its treatment-is still a matter of debate.

STUDY DESIGN, SIZE, DURATION:

A prospective controlled, randomized, open label trial was performed between February 2012 and March 2014 and embryological and clinical outcomes were measured. Patients with laparoscopically diagnosed peritoneal endometriosis (n= 120) were treated by laser surgery after which they were sequentially randomized by computer-generated allocation to one of the two groups. The primary outcome of the trial was the number of Metaphase II (MII) oocytes. Sample size was chosen to detect a difference of two MII oocytes with a power of 80%. The control group (Group B) received the classical long protocol IVF stimulation, whereas the research group (Group A) had an additional pituitary suppression, of 3 months using a long-acting GnRH agonist, prior to IVF.

PARTICIPANTS/ MATERIALS, SETTING, METHODS:

A total of 120 patients were included in the study, 61 of them in the study group and 59 patients in the control group. One patient of the control group was lost to follow up leading to 58 evaluable patients.

MAIN RESULTS AND THE ROLE OF CHANCE:

There was no difference in terms of the number of MII oocytes obtained per cycle: 8.2 in both groups (difference in MII between A and B: 0.07 [-1.89; 2.04] 95% confidence interval (CI)). Pregnancy rate did not differ, being 39.3% for Group A (24 out of 61 patients) versus 39.7% for Group B (23 out of 58 patients) (95% CI around difference in pregnancy rate between A and B: -0.31% [-17.96%; 17.86%]). However, a significantly (P = 0.025) lower dose of FSH (2561 IU for Group A and 2303 IU for Group B, 95% CI around difference in FSH between B and A: -258.6 IU [-483.4 IU; -33.8 IU]) and a significantly (P = 0.004) shorter stimulation period (Group A 12.3 days and Group B 11.3 days, 95% CI around difference in stimulation period between B and A: -1.03 days [-1.73 days; -0.33 days]) were needed to reach adequate follicle maturation in the control group.

LIMITATIONS, REASON FOR CAUTION:

The validity of this study is limited to mild peritoneal endometriosis, and does not apply to ovarian endometriosis, which is also commonly seen in infertility patients.

WIDER IMPLICATIONS OF THE FINDINGS:

There is no indication for complementary medical treatment of peritoneal endometriosis in terms of IVF outcome. On the contrary, stimulation takes longer and requires a higher amount of medication.

STUDY FUNDING/COMPETING INTERESTS:

There was no external funding for this clinical trial in the IVF Center, AZ Jan Palfijn, Ghent. There are no competing interests to declare.

 

 

J Reprod Immunol. 2016 Sep;117:30-8.

Inflammation influences steroid hormone receptors targeted by progestins in endometrial stromal cells from women with endometriosis.

Grandi G¹, Mueller MD², Papadia A³, Kocbek V⁴, Bersinger NA², Petraglia F⁵, Cagnacci A¹, McKinnon B⁶.

 

Abstract

Endometriosis is an estrogen-dependent disease characterised by the growth of endometrial epithelial and stromal cells outside the uterus creating a chronic inflammatory environment that further contributes to disease progression. The first choice treatment for endometriosis is currently progestin mediated hormone modulation. In addition to their progestogenic activity however, progestins also have the potential to bind to other nuclear receptors influencing their local activity on endometriotic cells. This local activity will be dependent on the steroid hormone receptor expression that occurs in endometrial cells in a chronic inflammatory environment. We therefore aimed to quantify receptors targeted by progestins in endometrial stromal cells after exposure to inflammation. Using primary endometrial stromal cells isolated from women with endometriosis we examined the mRNA and protein expression of the progesterone receptors A and B, membrane progesterone receptors 1 and 2, androgen receptors, mineralocorticoid receptors and glucocorticoid receptors after exposure to the inflammatory cytokines tumor necrosis factor α (TNFα) and interleukin 1β (IL-1β). The results indicate that both cytokines reduced the expression of progesterone receptors and increased the expression of the glucocorticoid receptors in the endometrial stromal cells. The change in expression of progestin targets in endometrial stromal cells in an inflammatory environment could contribute to the progesterone resistance observed in endometriotic cells and ultimately influence the design of hormonal therapies aimed at treating this disease.

 

 

J Reprod Immunol. 2016 Sep;117:39-44.

Increased percentage of Th17 cells in peritoneal fluid is associated with severity of endometriosis.

Gogacz M¹, Winkler I², Bojarska-Junak A³, Tabarkiewicz J⁴, Semczuk A⁵, Rechberger T⁶, Adamiak A⁷.

 

Abstract

AIM:

Th17 cells are a newly discovered T helper lymphocyte subpopulation, producing interleukin IL-17. Th17 cells are present in blood and peritoneal fluid (PF) at different stages of endometriosis. We aim to establish their potential importance in the pathogenesis and clinical features of the disease.

METHODS:

The percentage of Th17 cells among T helper lymphocytes was determined in the PF and peripheral blood (PB) of patients with endometriosis and in the control group by flow cytometry using monoclonal antibodies: anti-CD-4-FITC, anti-CD-3-PE/Cy5, and anti-IL-17A-PE.

RESULTS:

Th17 percentage is increased in PF in comparison with PB in both endometriotic patients and in the control group. In severe endometriosis, the percentage of Th17 cells in PF was higher than with early (I/II stage) endometriosis. A positive correlation between the percentage of Th17 cells in PF and the white blood cell count in PB was found in patients with endometriosis.

CONCLUSION:

Targeting the activity of PF Th17 cells may have an influence on the proliferation of ectopic tissue and clinical manifestations of the disease.

 

 

Reprod Biomed Online. 2016 Sep;33(3):335-49.

Association between oestrogen receptor alpha (ESR1) gene polymorphisms and endometriosis: a meta-analysis of 24 case-control studies.

Zhao L¹, Gu C², Huang K¹, Fan W¹, Li L¹, Ye M¹, Han W³, Meng Y⁴.

 

Abstract

The PvuII (C > T), XbaI (A > G) and (TA)n polymorphisms of ESR1 gene are potentially associated with susceptibility to endometriosis. A meta-analysis was conducted to evaluate comprehensively the associations between endometriosis and ESR1 polymorphisms. Twenty-four studies, including 2740 cases and 3208 controls, were retrieved through searches of PubMed, EMBASE, Web of Science, CBM and CNKI. Meta-analyses showed that PvuII was associated with endometriosis only for stage I-III, only under a recessive model (OR = 1.53, 95% CI 1.05 to 2.21; P = 0.025). The short allele and TA13 of (TA)n were associated with a higher risk of endometriosis(ORS = 1.71, 95% CI 1.01 to 2.81, P = 0.046; ORTA13 = 1.45, 95% CI 1.06 to 1.97, PTA13 = 0.019); TA20 repeats was associated with a lower risk (OR = 0.36, 95% CI 0.16 to 0.80; P = 0.012). No statistically significant association was found in the XbaI polymorphism. This meta-analysis indicated that the PvuII and XbaI polymorphisms were not associated with the risk of endometriosis, whereas stage classification of endometriosiswas likely to influence the association of PvuII polymorphism. The (TA)n polymorphisms might play roles in the susceptibility to, or protection against, the pathogenesis of endometriosis.

 

 

Urology. 2016 Nov;97:66-72.

Occurrence of and Risk Factors for Urological Intervention During Benign Hysterectomy: Analysis of the National Surgical Quality Improvement Program Database.

Wallis CJ¹, Cheung DC¹, Garbens A¹, Kroft J², Carr L¹, Nathens AB³, Po L², Nam RK¹, Liu G², Gien L⁴, Satkunasivam R⁵.

 

Abstract

OBJECTIVE:

To determine the occurrence of lower genitourinary tract (LGUT) injury during hysterectomy for benign disease and identify risk factors for LGUT injury, with a specific focus on the effect of hysterectomy modality.

METHODS:

We performed a retrospective cohort study of patients undergoing hysterectomy for benign disease from 2010 t o 2014 using the American College of Surgeons National Surgical Quality Improvement Program, a multi-institutional prospective registry that captures perioperative surgical outcomes. We identified the occurrence of concomitant cystoscopy and therapeutic urologic interventions including endoscopic ureteric stenting, ureteric repair, bladder repair, cystectomy, and urinary diversion as a proxy for LGUT injuries. Adjusted odds ratios and 95% confidence intervals were calculated using multivariate logistic regression.

RESULTS:

We identified 101,021 patients treated with hysterectomy for benign disease: 18,610 (18.4%), 27,427 (27.2%), and 54,984 (54.4%) underwent vaginal, open, and laparoscopic hysterectomy, respectively. Cystoscopy was performed in 16,493 cases (16.3%). There were 2427 patients (2.4%) who underwent concomitant urologic intervention. Patients undergoing laparoscopic hysterectomy had increased occurrence of urologic intervention, excluding cystoscopy (adjusted odds ratio 1.47, 95% confidence interval 1.29-1.69), compared to vaginal hysterectomy; no differences were found between open and vaginal hysterectomy or laparoscopic and open hysterectomy. Larger uteri, a postoperative diagnosis of endometriosis, increasing comorbidity, and African American race were associated with an increased odd of urologic intervention whereas concomitant cystoscopy was associated with a decreased chance.

CONCLUSION:

The incidence of lower genitourinary tract intervention in benign hysterectomy is significant and may be higher than previously reported. Predisposing patient factors and operative technique are key risk factors.

 

 

Eur J Obstet Gynecol Reprod Biol. 2017 Feb;209:44-45.

Primary umbilical endometriosis (PUE).

Boesgaard-Kjer D¹, Boesgaard-Kjer D¹, Kjer JJ².

 

Abstract

Primary endometriosis of the umbilicus, Villars nodule, rarely occurs. It is characterized by a discolored change in the umbilicus which manifests itself with cyclic menstrual-related symptoms such as pain, swelling and bleeding. Often the diagnosis is based on objective findings, but imaging and histology predicts and verify the diagnosis. Radical excision is performed with good results. We present ten cases with primary umbilical endometriosis and present the referral pattern dominated by primary referral to the gastro-surgeon reflecting difficulties in finding the right diagnosis.

 

 

Pak J Med Sci. 2016 May-Jun;32(3):789-92.

Diagnosis and surgical treatment of isolated rectal endometriosis: long term complication of incomplete treatment for pelvic endometriosis.

Kwack JY¹, You SK², Kwon YS³.

 

Abstract

A 40-year-old woman visited our hospital with cyclic hematochezia for four months. The patient had the history of laparoscopic-assisted vaginal hysterectomy because of severe dysmenorrhea two years ago at another tertiary hospital. According to the medical records, the past surgical treatment was incomplete excision of pelvic endometriotic lesions, especially in rectal serosal lesions. A colonoscopy and abdominopelvic computed tomography showed an isolated tumor mimicking neoplasm, in which a biopsy under colonoscopy was performed and the lesion was endometriosis pathologically. Laparoscopic anterior resection (LAR) was performed. There were no complications during intraoperative and postoperative period and the patient was discharged 7 days after the LAR. It is important for reducing of long-term complication like rectal endometriosis that complete and safe excision of pelvic endometriosis with expert surgical strategy.

 

 

Gynecol Endocrinol. 2016 Sep;32(9):696-700.

Adenomyosis: a systematic review of medical treatment.

Pontis A¹, D’Alterio MN², Pirarba S², de Angelis C³, Tinelli R⁴, Angioni S².

 

Abstract

Adenomyosis is a heterogeneous gynaecologic condition with a range of clinical presentations, the most common being heavy menstrual bleeding and dysmenorrhoea; however, patients can also be asymptomatic. Several studies support the theory that adenomyosis results from invasion of the endometrium into the myometrium, causing alterations in the junctional zone. These changes are commonly seen on imaging studies, such as transvaginal ultrasound and magnetic resonance imaging. The aim of this review is to discuss the medical approach to the management of adenomyosis symptoms, including pain and abnormal uterine bleeding. The standard treatment of adenomyosis is hysterectomy, but there is no medical therapy to treat the symptoms of adenomyosis while still allowing patients to conceive. Medical therapies using suppressive hormonal treatments, such as continuous use of oral contraceptive pills, high-dose progestins, selective oestrogen receptor modulators, selective progesterone receptor modulators, the levonorgestrel-releasing intrauterine device, aromatase inhibitors, danazol, and gonadotrophin receptor hormone agonists can temporarily induce regression of adenomyosis and improve the symptoms.

 

 

Int J Clin Oncol. 2016 Dec;21(6):1136-1141.

Analysis of positron emission tomography/computed tomography in patients to differentiate between malignant transformation of endometrioma and endometrioma.

Kusunoki S¹, Ota T², Kaneda H², Kimura M², Terao Y², Takeda S².

 

Abstract

PURPOSE:

Of those patients who undergo open surgery for a suspicion of malignant transformation of endometrioma (MTOE) due to solid nodule enhancement identified by contrast-enhanced magnetic resonance imaging (MRI), some benign endometrioma cases are included. The aim of this retrospective study was to determine the value and diagnostic accuracy of positron emission tomography/computed tomography (PET/CT) using 18-fluoro-2-deoxy-D-glucose (FDG) to differentiate between MTOE and endometrioma.

PATIENTS AND METHODS:

We retrospectively analyzed 1599 consecutive patients who underwent laparoscopic surgery for the diagnosis of endometrioma preoperatively and 31 patients who underwent open surgery for a suspicion of MTOE preoperatively from January 2003 to December 2011. We analyzed the age, serum CA125 levels, and MRI findings of the patients and calculated the optimal cut-off value for PET/CT using receiver operating characteristic curve analysis.

RESULTS:

Of the 1,599 patients who underwent laparoscopic surgery for a suspicion of endometrioma preoperatively, malignancy was identified in one (0.062 %) patient. Of the 31 patients who underwent open surgery for a suspicion of MTOE preoperatively, 11 were diagnosed with endometrioma (false positive group) and 20 with MTOE stage I (positive group). Age, tumor size, presence of shading on MRI and maximum standardized uptake values (SUV_max) on PET/CT were significantly different between the two groups. A SUV_max cut-off >4.0 is capable of excluding endometrioma cases, with 75 % sensitivity and 100 % specificity (area under the curve 90 %).

CONCLUSION:

PET/CT is a good diagnostic tool for MTOE using the optimal SUV_max cut-off of 4.0 (75 % sensitivity and 100 % specificity).