Chin Med J (Engl). 2017 Aug 20;130(16):1932-1937.

Endometriosis Fertility Index for Predicting Pregnancy after EndometriosisSurgery.

Li X¹, Zeng C¹, Zhou YF¹, Yang HX¹, Shang J¹, Zhu SN², Xue Q¹.

 

Abstract

BACKGROUND:

The endometriosis fertility index (EFI) has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer (IVF-ET) is a good treatment to infertility. This study aimed to provide external validation of EFI, assess the factors affecting the ability of EFI to predict cumulative spontaneous pregnancy rates (PRs), and propose reasonable advice for treatment by evaluating the effect of infertility management combining surgery and IVF-ET.

METHODS:

This retrospective study enrolled 345 endometriosis-related infertile women after laparoscopic surgery from January 2012 to January 2016. Among them, 234 patients tried to conceive naturally and were divided into six groups according to their different EFI scores. Of the 345 patients, 307 with an EFI score ≥5 were divided into non-IVF-ET group (n = 209) and IVE-ET group (n = 98) to compare the cumulative PRs. Cumulative PRs’ curves were calculated using the Kaplan-Meier product limit estimate and the differences were evaluated by log-rank test. Independent predictive factors for pregnancy were assessed using the Cox regression model.

RESULTS:

Significant differences in spontaneous PRs among different EFI scores were identified (χ2=29.945, P< 0.05). The least function score was proved to be the most important factor for EFI (χ2 = 6.931, P< 0.05) staging system. In patients with an EFI score ≥5 after 12 months from surgery, the cumulative PRs of those who received both surgery and IVF-ET were much higher than the spontaneous PRs of those who received surgery alone (χ2=4.160, P= 0.041).

CONCLUSIONS:

The EFI is a reliable staging system to predict the spontaneous PR of patients. The least function score was the most influential factor to predict the spontaneous PR. Patients with an EFI score ≥5 after 12 months from surgery are recommended to receive IVF-ET to achieve a higher PR.

 

 

Curr Opin Obstet Gynecol. 2017 Oct;29(5):306-309.

Endometriosis in adolescents.

Dowlut-McElroy T¹, Strickland JL.

 

Abstract

PURPOSE OF REVIEW:

The current article addresses recent literature regarding the diagnosis and management of endometriosis in adolescents.

RECENT FINDINGS:

An increasing body of literature suggests that advanced-stage endometriosis (revised scoring system of the American Society for Reproductive Medicine Stage III or IV) and deeply invasive endometriosis are relatively common in adolescents. There remains limited data on the efficacy of postoperative hormonal management of endometriosis in the adolescent population.

SUMMARY:

Strong consideration should be made for surgical diagnosis of endometriosis in adolescents with pelvic pain, including noncyclic pain, with a concurrent family history of endometriosis and personal history of atopic disease. More research is needed regarding the benefits of the routine use of hypoestrogenic and other hormonal agents in the prevention of disease progression and long-term sequela in adolescents with endometriosis.

 

 

Maturitas. 2017 Sep;103:45-53.

Estrogen-gut microbiome axis: Physiological and clinical implications.

Baker JM¹, Al-Nakkash L², Herbst-Kralovetz MM³.

 

Abstract

Low levels of gonadal circulating estrogen observed in post-menopausal women can adversely impact a diverse range of physiological factors, with clinical implications for brain cognition, gut health, the female reproductive tract and other aspects of women’s health. One of the principal regulators of circulating estrogens is the gut microbiome. This review aims to shed light on the role of the gut microbiota in estrogen-modulated disease. The gut microbiota regulates estrogens through secretion of β-glucuronidase, an enzyme that deconjugates estrogens into their active forms. When this process is impaired through dysbiosis of gut microbiota, characterized by lower microbial diversity, the decrease in deconjugation results in a reduction of circulating estrogens. The alteration in circulating estrogens may contribute to the development of conditions discussed herein: obesity, metabolic syndrome, cancer, endometrial hyperplasia, endometriosis, polycystic ovary syndrome, fertility, cardiovascular disease (CVD) and cognitive function. The bi-directional relationship between the metabolic profile (including estrogen levels) and gut microbiota in estrogen-driven disease will also be discussed. Promising therapeutic interventions manipulating the gut microbiome and the metabolic profile of estrogen-driven disease, such as bariatric surgery and metformin, will be detailed. Modulation of the microbiome composition subsequently impacts the metabolic profile, and vice versa, and has been shown to alleviate many of the estrogen-modulated disease states. Last, we highlight promising research interventions in the field, such as dietary therapeutics, and discuss areas that provide exciting unexplored topics of study.

 

 

Sex Med. 2017 Sep;5(3):e184-e195.

Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia.

Yong PJ¹, Williams C², Yosef A², Wong F², Bedaiwy MA², Lisonkova S², Allaire C².

 

Abstract

INTRODUCTION:

Deep dyspareunia negatively affects women’s sexual function. There is a known association between deep dyspareunia and endometriosis of the cul-de-sac or uterosacral ligaments in reproductive-age women; however, other factors are less clear in this population.

AIM:

To identify anatomic sites and associated clinical factors for deep dyspareunia in reproductive-age women at a referral center.

METHODS:

This study involved the analysis of cross-sectional baseline data from a prospective database of 548 women (87% consent rate) recruited from December 2013 through April 2015 at a tertiary referral center for endometriosis and/or pelvic pain. Exclusion criteria included menopausal status, age at least 50 years, previous hysterectomy or oophorectomy, and not sexually active. We performed a standardized endovaginal ultrasound-assisted pelvic examination to palpate anatomic structures for tenderness and reproduce deep dyspareunia. Multivariable regression was used to determine which tender anatomic structures were independently associated with deep dyspareunia severity and to identify clinical factors independently associated with each tender anatomic site.

MAIN OUTCOME MEASURE:

Severity of deep dyspareunia on a numeric pain rating scale of 0 to 10.

RESULTS:

Severity of deep dyspareunia (scale = 0-10) was independently associated with tenderness of the bladder (b = 0.88, P = .018), pelvic floor (levator ani) (b = 0.66, P = .038), cervix and uterus (b = 0.88, P = .008), and cul-de-sac or uterosacral ligaments (b = 1.39, P < .001), but not with the adnexa (b = -0.16, P = 0.87). The number of tender anatomic sites was significantly correlated with more severe deep dyspareunia (Spearman r = 0.34, P < .001). For associated clinical factors, greater depression symptom severity was specifically associated with tenderness of the bladder (b = 1.05, P = .008) and pelvic floor (b = 1.07, P < .001). A history of miscarriage was specifically associated with tenderness of the cervix and uterus (b = 2.24, P = .001). Endometriosis was specifically associated with tenderness of the cul-de-sac or uterosacral ligaments (b = 3.54, P < .001).

CONCLUSIONS:

In reproductive-age women at a tertiary referral center, deep dyspareunia was independently associated not only with tenderness of the cul-de-sac and uterosacral ligaments but also with tenderness of the bladder, pelvic floor, and cervix and uterus. Yong PJ, Williams C, Yosef A, et al. Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia. Sex Med 2017;5:e184-e195.

 

 

Sex Med Rev. 2017 Oct;5(4):495-507.

Deep Dyspareunia in Endometriosis: A Proposed Framework Based on Pain Mechanisms and Genito-Pelvic Pain Penetration Disorder.

Yong PJ¹.

 

Abstract

INTRODUCTION:

Endometriosis is a common chronic disease affecting 1 in 10 women of reproductive age, with half of women with endometriosis experiencing deep dyspareunia. A review of research studies on endometriosisindicates a need for a validated question or questionnaire for deep dyspareunia. Moreover, placebo-controlled randomized trials have yet to demonstrate a clear benefit for traditional treatments of endometriosis for the outcome of deep dyspareunia. The reason some patients might not respond to traditional treatments is the multifactorial nature of deep dyspareunia in endometriosis, which can include comorbid conditions (eg, interstitial cystitis and bladder pain syndrome) and central sensitization underlying genito-pelvic pain penetration disorder. In general, there is a lack of a framework that integrates these multifactorial causes to provide a standardized approach to deep dyspareunia in endometriosis.

AIM:

To propose a clinical framework for deep dyspareunia based on a synthesis of pain mechanisms with genito-pelvic pain penetration disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

METHODS:

Narrative review after literature search with the terms (endometriosis AND dyspareunia) OR (dyspareunia AND deep) and after analysis of placebo-controlled randomized trials.

MAIN OUTCOME MEASURES:

Deep dyspareunia presence or absence or deep dyspareunia severity on a numeric rating scale or visual analog scale.

RESULTS:

Four types of deep dyspareunia are proposed in women with endometriosis: type I that is directly due to endometriosis; type II that is related to a comorbid condition; type III in which genito-pelvic pain penetration disorder is primary; and type IV that is secondary to a combination of types I to III.

CONCLUSION:

Four types of deep dyspareunia in endometriosis are proposed, which can be used as a framework in research studies and in clinical practice. Research trials could phenotype or stratify patients by each type. The framework also could give rise to more personalized care for patients by targeting appropriate treatments to each deep dyspareunia type. Yong PJ.

 

 

Med Sci Monit. 2017 Aug 5;23:3801-3807.

Role of Interleukin-6 and Its Receptor in Endometriosis.

Li S¹, Fu X¹, Wu T¹, Yang L¹, Hu C¹, Wu R¹.

 

Abstract

BACKGROUND Studies have shown that the concentration of interleukin (IL)-6 in peritoneal fluid is increased in patients with endometriosis; however, whether the disorders involving IL-6 contribute to the development of endometriosis is still unclear. In the present study, we evaluated the potential role of IL-6 and IL-6 receptor (IL-6R) in the pathogenesis of endometriosis. MATERIAL AND METHODS We examined activated macrophages and the expression of membrane-binding receptor (mIL-6R) in peritoneal fluid using flow cytometry. The levels of IL-6 and the IL-6 soluble receptor (sIL-6R) in peritoneal fluid and plasma in patients with endometriosis was measured by an enzyme-linked immunosorbent assay. RESULTS Activated macrophages and mIL-6R in peritoneal fluid were increased in patients with endometriosis. IL-6 and sIL-6R in peritoneal fluid were also increased in patients with endometriosis; however, there was an increase in plasma IL-6 and a decrease in plasma sIL-6R. The endometriosis group was categorized into 2 groups according to the retrospective American Fertility Society Score (r-AFS): group A and group B. Peritoneal fluid sIL-6R in endometriosis group B was significantly higher than in endometriosis group A and the control group. CONCLUSIONS Disorders involving IL-6 and IL-6R are correlated with the etiology of endometriosis. An increase in sIL-6R in peritoneal fluid promotes the development of endometriosis by enhancing the bioactivity of IL-6.

 

 

Basic Clin Neurosci. 2017 May-Jun;8(3):249-254.

Protective Effects of Cyperus Rotundus Extract on Amyloid β-Peptide (1-40)-Induced Memory Impairment in Male Rats: A Behavioral Study.

Mehdizadeh M¹, Hashem Dabaghian F¹, Shojaee A¹, Molavi N², Taslimi Z³, Shabani R⁴, Soleimani Asl S⁵.

 

Abstract

INTRODUCTION:

The Alzheimer Disease (AD) is the most common form of dementia that leads to memory impairment. As the oxidative stress plays an important role in AD pathogenesis, the current study aimed at examining the protective effects of Cyperus Rotundus as an antioxidant on amyloid β (Aβ)-induced memory impairment.

METHODS:

Twenty-eight Wistar male rats received intrahippocampal (IHP) injection of the Aβ (1-40) and C. rotundus (400 mg/kg, intraperitoneally). Spatial memory was assessed by the Morris water-maze (MWM) task.

RESULTS:

In the MWM, Aβ (1-40) significantly increased escape latency and traveled distance (P<0.001). The administration of C. rotundus attenuated the Aβ-induced memory impairment in the MWM task.

CONCLUSION:

The current study findings showed that C. Rotundus could improve the learning impairment, following the Aβ treatment, and it may lead to an improvement of AD-induced cognitive dysfunction.

 

 

J Clin Pharmacol. 2018 Jan;58(1):97-106.

Absence of Effect of Intravaginal Miconazole, Clindamycin, Nonoxynol-9, and Tampons on the Pharmacokinetics of an Anastrozole/Levonorgestrel Intravaginal Ring.

Nave R¹, Klein S¹, Müller A², Chang X¹, Höchel J¹.

 

Abstract

A study was performed to investigate the effect of an intravaginally administered antimycotic, an antibiotic, and a spermicide plus the co-usage of tampons on the pharmacokinetics (PK) of levonorgestrel (LNG) and anastrozole (ATZ) administered as an intravaginal ring (IVR) releasing 1050 μg ATZ per day and 40 μg LNG per day. In this parallel-group, randomized, open-label study, healthy premenopausal women received an IVR as the main treatment. Comedications were administered on 3 consecutive evenings during treatment with IVR on days 9-11 (group A, 400 mg miconazole; group B, 100 mg clindamycin; group C, 75 mg nonoxynol-9); tampon co-usage (group D) was performed on days 20-23. The primary PK parameter was the average plasma concentration (C_av,ss ) of ATZ and LNG at defined intervals, mainly prior to, during, and up to 7 days after the start of comedication. Fifty-two subjects were included, and at least 11 subjects per group completed the treatments. Overall, the medications and comedications were safe and well tolerated. Very similar ATZ and LNG plasma levels were observed across all groups. The calculated ratios of C_av,ss confirmed the absence of PK interactions because all relevant point estimates and 90% confidence intervals were within the range of 0.800-1.250, which is typically used in bioequivalence studies. These results demonstrate the absence of PK interactions between ATZ/LNG released from IVR and the tested antibiotic, antimycotic, spermicide, and tampons. Therefore, no restrictions for the use of the IVR are needed to continue the clinical program intended to treat endometriosissymptoms.

 

 

Asian J Endosc Surg. 2017 Aug 8.

Comparison of the impact of laparoscopic endometriotic cystectomy and vaporization on postoperative serum anti-Mullerian hormone levels.

Saito N¹, Yamashita Y^1,2, Okuda K¹, Kokunai K, Terai Y^1,3, Ohmichi M³.

 

Abstract

INTRODUCTION:

The aim of this study was to investigate the effect of laparoscopic endometriotic cystectomy and vaporization on ovarian reserve.

METHODS:

We prospectively analyzed the serum level of anti-Mullerian hormone (AMH) in 62 patients at four different time points- preoperatively and at 1 month, 6 months, and 1 year postoperatively. Among the 62 cases, a bilateral cystectomy was performed in 10, bilateral vaporization in 16, a unilateral cystectomy in 24, and unilateral vaporization in 12.

RESULTS:

The rate of AMH decline after unilateral cystectomy or bilateral cystectomy was higher than that after unilateral vaporization or bilateral vaporization. Age and bilaterality were associated with an AMH decline at 1 month, and age alone was associated with an AMH decline at 1 year. Moreover, being older than 38 years of age and having a revised American Society for Reproductive Medicine score >80 were independent risk factors for the non-recovery of AMH.

CONCLUSION:

The rate of AMH decline after laparoscopic endometriotic vaporization is significantly lower than that after cystectomy. Both methods, however, have the potential to lower ovarian reserve, especially in cases of severe endometriosis or in patients older than 38 years of age.

 

 

Obstet Gynecol Sci. 2017 Jul;60(4):396-400.

Diagnostic dilemma in cervical endocervicosis.

Lee SH¹, Park JW¹, Oh SR¹, Rha SH².

 

Abstract

Müllerianosis is an embryonic Müllerian disease, resulting in the formation of the benign diseases adenomyosis, endometriosis, endosalpingiosis, and endocervicosis. Endocervicosis primarily affects the bladder, and rarely the cervix. Cervical endocervicosis, which is also a pseudoneoplastic glandular lesion, could be misinterpreted as a premalignant or even a malignant lesion. Because the treatment of these diseases is very different, early clinical diagnosis is important. Unfortunately, however, this lesion is difficult to diagnose preoperatively using clinical and radiological information, and pathological confirmation is needed. Herein, we report a rare case of cervical endocervicosis that was difficult to diagnosis preoperatively.

 

 

Front Surg. 2017 Jul 25;4:40.

Fertility Preservation in Endometriosis Patients: Anti-Müllerian Hormone Is a Reliable Marker of the Ovarian Follicle Density.

Garavaglia E¹, Sala C², Taccagni G³, Traglia M², Barbieri C², Ferrari S¹, Candiani M¹, Panina-Bordignon P⁴, Toniolo D².

 

Abstract

OBJECTIVE:

To analyze the ovarian reserve via measurement of follicular density and anti-Müllerian hormone (AMH) in endometriosis patients participating to a clinical program of cortical ovarian cryopreservation.

DESIGN:

Retrospective analysis of serum AMH levels and prospective investigation of ovarian follicle number.

SETTING:

University Hospital.

PATIENTS:

Two hundred and two women with endometriosis and 400 controls.

INTERVENTIONS:

Blood samples and ovarian biopsies.

MAIN OUTCOME MEASURES:

Correlation of serum AMH levels and the number of non-growing follicles in the biopsied cortical tissues in endometriosis and control subjects, including age, type of AMH kit, and the laboratory performing the analysis as covariates.

RESULTS:

AMH levels were shown to decrease with age in untreated endometriosis patients (P < 1.0 × 10^-5) but they were significantly lower in endometriosis compared to controls only in patients over 36 years old (P = 2.7 × 10^-4). The AMH decrease was faster in endometriosis compared to controls (beta = 0.27, P = 4.0 × 10^-4). Primordial follicle number decreased with the reduction of AMH levels in both cases and controls (beta = 0.3; P = 0.04).

CONCLUSION:

AMH is a reliable marker of ovarian reserve in endometriosis patients, and it can predict follicular density in women undergoing ovarian tissue cryopreservation.

 

 

Adv Clin Exp Med. 2017 Mar-Apr;26(2):207-213.

In vivo effects of curcumin and deferoxamine in experimental endometriosis.

Kizilay G¹, Uz YH¹, Seren G², Ulucam E³, Yilmaz A³, Cukur Z⁴, Kayisli UA⁵.

 

Abstract

BACKGROUND:

Endometriosis is one of the most common chronic gynecological diseases.

OBJECTIVES:

The aim of the study was to examine the effects of curcumin and/or deferoxamine on cell proliferation in a rat model of endometriosis.

MATERIAL AND METHODS:

Thirty female 12-week-old albino Wistar rats, weighing 200-250 g, were used in this study. All the rats underwent ovariectomy and 0.1-mg β-estradiol 17-valerate pellets were placed intraperitoneally. An experimental model of endometriosis was created in all the animals. To create the experimental model, an approximately 1-cm long section of the uterus was taken, primarily from the right horn of the uterus. Autologous fragments were then placed between the peritoneum and muscle. The animals were divided into 3 groups: Group A, treated only with the vehicle used for curcumin and deferoxamine; group B, treated with curcumin (100 mg/kg body weight); and group C, treated with deferoxamine + curcumin (100 mg/kg body weight). After biopsy samples were obtained, the sections were stained with hematoxylin and eosin. Immunostaining for cytokeratin-7 and proliferating cell nuclear antigen (PCNA) was performed. Blood iron levels were measured using a Perkin Elmer AAnalyst 800 Atomic Absorption Spectrophotometer.

RESULTS:

The endometrial implant size increased in Group A, but treatment with curcumin (p = 0.01) and deferoxamine + curcumin (p = 0.007) reduced the implant size. In ectopic endometrial epithelial cells, there were significant decreases in PCNA immunoreactivity between groups A and B (p = 0.044) and between groups A and C (p = 0.033).

CONCLUSIONS:

Treatment with curcumin alone and/or in combination with deferoxamine contributed to a reduction in implant size and cell proliferation in a rat endometriosis model. Iron-chelating agents may act in the same manner when used in women with endometriosis; however, further studies from different perspectives are still needed.

 

 

Gynecol Oncol Rep. 2017 Jul 15;21:94-97.

Primary Pouch of Douglas malignancies: A case series and review of the literature.

Wong KY¹, Ng AX¹, Lim TYK².

 

Abstract

• POD lesions are often diagnosed as ovarian or uterine in origin on imaging.•POD malignancies with concomitant endometriosis, appear to be of lower grade.•There is no consensus on the optimal treatment for rare primary POD neoplasms.

 

 

Cancer Causes Control. 2017 Oct;28(10):1011-1019

Endometriosis and the risk of skin cancer: a prospective cohort study.

Farland LV^1,2, Lorrain S³, Missmer SA^1,4,5, Dartois L^6,7, Cervenka I^6,7, Savoye I^6,7, Mesrine S^6,7, Boutron-Ruault MC^6,7, Kvaskoff M^8,9.

 

Abstract

PURPOSE:

Endometriosis has been associated with an increased risk of skin melanoma. However, associations with other skin cancer types and how they compare with melanoma are unclear. Our objective was to prospectively investigate the relationships between endometriosis and risk of non-melanoma and melanoma skin cancers.

METHODS:

E3N is a prospective cohort of 98,995 French women aged 40-65 years in 1990. Data on surgically confirmed endometriosis and skin cancer diagnoses were collected every 2-3 years through self-report, with skin cancer cases confirmed through pathology reports. Hazard Ratios (HR) and 95% confidence intervals (CIs) were calculated using Cox regression models.

RESULTS:

Between 1990 and 2008, 535 melanoma, 247 squamous-cell carcinoma (SCC), and 1,712 basal-cell carcinoma (BCC) cases were ascertained. Endometriosis was associated with an increased overall risk of skin cancer (HR 1.28, 95% CI 1.05-1.55). When considering skin cancer type, endometriosis was associated with melanoma risk (HR 1.64, 95% CI 1.15-2.35), but not with SCC (HR 1.21, 95% CI 0.62-2.36) or BCC (HR 1.16, 95% CI 0.91-1.48) (non-melanoma skin cancers combined: HR 1.17, 95% CI 0.93-1.46), although no heterogeneity was detected across skin cancer types (Phomogeneity = 0.13).

CONCLUSION:

These data support an association between a personal history of endometriosis and the risk of skin cancer and suggest that the association is strongest for melanoma.

 

 

Biochem Pharmacol. 2017 Nov 15;144:149-161.

Insight into the mode of action and selectivity of PBRM, a covalent steroidal inhibitor of 17β-hydroxysteroid dehydrogenase type 1.

Trottier A¹, Maltais R¹, Ayan D¹, Barbeau X², Roy J¹, Perreault M¹, Poulin R¹, Lagüe P³, Poirier D⁴.

 

Abstract

17β-Hydroxysteroid dehydrogenase type 1 (17β-HSD1) is involved in the biosynthesis of estradiol, the major bioactive endogenous estrogen in mammals, and constitutes an interesting therapeutic target for estrogen-dependent diseases. A steroidal derivative, 3-{[(16β,17β)-3-(2-bromoethyl)-17-hydroxyestra-1,3,5(10)-trien-16-yl]methyl} benzamide (PBRM), has recently been described as a non-estrogenic, irreversible inhibitor of 17β-HSD1. However, the mode of action of this inhibitor and its selectivity profile have not yet been elucidated. We assessed PBRM potency via in vitro kinetic measurements. The mechanism of enzyme inactivation was also investigated using interspecies (human, mouse, pig and monkey) comparisons via both in vitro assays and in silico analysis. Mouse and human plasma protein binding of PBRM was determined, whereas its selectivity of action was studied using a wide range of potential off-targets (e.g. GPCR, hERG, CYPs, etc.). The affinity constant (K_i = 368 nM) and the enzyme inactivation rate (k_inact = 0.087 min^-1) values for PBRM were determined with purified 17β-HSD1. PBRM was found to be covalently linked to the enzyme. A long delay period (i.e. 3-5 days) is required to recover 17β-HSD1 activity following a pretreatment of breast and placenta cell lines with PBRM. Mechanistic analyses showed important interspecies differences of 17β-HSD1 inhibition which support an inactivation by PBRM. Evidences of the potency and selectivity of action presented herein for this first non-estrogenic and steroidal covalent irreversible inhibitor of 17β-HSD1 warrants its further development as a potential drug candidate for estrogen-dependent disorders.

 

 

J Minim Invasive Gynecol. 2017 Nov – Dec;24(7):1218-1226.

Magnetic Resonance Imaging Compared with Rectal Endoscopic Sonography for the Prediction of Infiltration Depth in Colorectal Endometriosis.

Kim A¹, Fernandez P², Martin B³, Palazzo L⁴, Ribeiro-Parenti L⁵, Walker F⁶, Bucau M⁶, Luton D⁷, Chis C⁷, Koskas M⁸.

 

Abstract

STUDY OBJECTIVE:

To compare the accuracies of magnetic resonance imaging (MRI) and rectal endoscopic sonography (RES) in the prediction of the infiltration depth of colorectal endometriosis.

DESIGN:

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

SETTING:

University teaching hospital.

PATIENTS:

Forty patients with symptomatic deep infiltrating endometriosis (DIE) of the rectum who underwent colorectal resection were included.

INTERVENTIONS:

All patients underwent an abdominopelvic MRI and RES preoperatively to assess infiltration depth of colorectal endometriosis, and segmental resection of the rectosigmoid by laparoscopy was performed if RES showed bowel invasion. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (LRs), and intermethod agreement were calculated for DIE muscularis and submucosal/mucosal infiltration, confirmed by histopathological analysis.

MEASUREMENTS AND MAIN RESULTS:

For the MRI detection of DIE muscularis infiltration, the sensitivity, specificity, PPV, NPV, and negative LR were 68%, 100%, 100%, 20%, and 0.32, respectively. For the MRI detection of DIE submucosal/mucosal involvement, the sensitivity, specificity, PPV, NPV, and positive and negative LRs were 47%, 81%, 69%, 63%, 2.49 and 0.65, respectively. The PPV of RES detection of DIE muscularis infiltration was 93%. For the RES detection of DIE submucosal/mucosal layers, the sensitivity, specificity, PPV, NPV, and positive and negative LRs were 79%, 48%, 58%, 71%, 1.51 and 0.44, respectively.

CONCLUSION:

In the current study, MRI is valuable for detecting endometriosis of the rectum but is less accurate in detecting submucosal/mucosal involvement than RES. Magnetic resonance imaging was not successful for preoperative determination of segmental resection versus a more conservative approach. When bowel involvement is detected by MRI, RES is not essential. When symptoms suggest DIE in patients without intestinal lesions detected by MRI, RES is necessary to exclude bowel invasion.

 

 

J Womens Health (Larchmt). 2018 Jan;27(1):40-50.

Cyclic Perimenstrual Pain and Discomfort and Australian Women’s Associated Use of Complementary and Alternative Medicine: A Longitudinal Study.

Fisher C¹, Hickman L¹, Adams J¹, Sibbritt D¹.

 

Abstract

OBJECTIVE:

To examine the longitudinal change in Australian women’s prevalence of cyclic perimenstrual pain and discomfort and the association between their symptoms and use of complementary and alternative medicine (CAM).

METHOD:

Data on endometriosis, premenstrual syndrome (PMS), irregular periods, heavy periods, and severe period pain were collected over a 7-year period from the Australian Longitudinal Study on Women’s Health, for women aged 28 to 33 years in 2006, and at 3-year follow-ups. Changes in symptoms and patterns of CAM practitioner and therapy/product use associated with these symptoms were analyzed using longitudinal regression modeling.

RESULTS:

Over the 7-year period, prevalence rates of PMS and heavy periods increased, while prevalence rates of endometriosis, irregular periods, and severe period pain remained stable. The most common use of CAM longitudinally associated with the perimenstrual symptoms was use of vitamins/minerals, yoga/meditation, massage therapy, herbal medicine, and aromatherapy. Excluding consultation with a naturopath/herbalist, over the 7-year survey women’s use of all other CAM practitioners increased as did their use of vitamin/minerals, yoga/meditation, and Chinese medicines, while aromatherapy use declined.

CONCLUSION:

Only the prevalence of PMS and heavy periods increased with aging in this sample of women. While overall use of CAM practitioner and self-prescribed products/therapies increased over time, CAM was chosen by women mainly to treat endometriosis and PMS. The extent to which this use reflects treatment efficacy is uncertain.

 

 

World J Surg Oncol. 2017 Aug 15;15(1):154.

Oncofertility in patients with stage I epithelial ovarian cancer: fertility-sparing surgery in young women of reproductive age.

Jiang X¹, Yang J², Yu M¹, Xie W¹, Cao D¹, Wu M¹, Pan L¹, Huang H¹, You Y³, Shen K¹.

 

Abstract

BACKGROUND:

Fertility-sparing surgery is indicated for patients with stage I epithelial ovarian cancers. We sought to evaluate the clinical outcomes and oncofertility in a cohort of patients of reproductive age with stage I epithelial ovarian cancer (EOC).

METHODS:

Overall, 108 patients of reproductive age (≤ 40 years) diagnosed with stage I EOC who were treated at Peking Union Medical College Hospital between 1999 and 2013 were included in the study. The Kaplan-Meier model and Cox regression analyses were used for the survival analysis.

RESULTS:

The type of surgery included fertility-sparing surgery (FSS) (48.1%) and radical surgery (RS) (51.9%). After a median follow-up of 83 months, we observed that grade 3 or clear-cell carcinoma was the only independent risk factor for disease-free survival and tumor-specific survival in the multivariate analysis. Patients with grade 3 or clear-cell carcinoma tended to be older than 30 years, have endometriosis, and undergo RS (p < 0.05). Fertility-sparing surgery did not affect disease-free survival or tumor-specific survival among patients of reproductive age with stage I EOC and among high-risk patients with stage IC2-3, grade 3, or clear-cell carcinoma. Thirty-four out of 52 (65.4%) FSS patients attempted to get pregnant. Twenty-eight (82.4%) achieved a successful pregnancy with a full-term delivery.

CONCLUSIONS:

Grade 3 or clear-cell carcinoma was the only independent risk factor for survival of patients of reproductive age with stage I EOC. FSS can be safely performed on patients of reproductive age with grade 1-2, stage I EOC. The safety of FSS for grade 3 and clear-cell carcinoma warrants further investigation.

 

 

Fertil Steril. 2017 Sep;108(3):525-531.

Colorectal endometriosis-associated infertility: should surgery precede ART?

Bendifallah S¹, Roman H², Mathieu d’Argent E³, Touleimat S², Cohen J³, Darai E⁴, Ballester M⁴.

 

Abstract

OBJECTIVE:

To compare the impact of first-line assisted reproductive technology (ART; intracytoplasmic sperm injection [ICSI]-IVF) and first-line colorectal surgery followed by ART on fertility outcomes in women with colorectal endometriosis-associated infertility.

DESIGN:

Retrospective matched cohort study using propensity score (PS) matching (PSM) analysis.

SETTING:

University referral centers.

PATIENT(S):

A total of 110 women were analyzed from January 2005 to June 2014. A PSM was generated using a logistic regression model based on the age, antimüllerian hormone (AMH) serum level, and presence of adenomyosis to compare the treatment strategy.

INTERVENTION(S):

First-line surgery group followed by ART versus exclusive ART with in situ colorectal endometriosis.

MAIN OUTCOME MEASURE(S):

After PSM, pregnancy rates (PRs), live-birth rates (LBRs), and cumulative rates (CRs) were estimated.

RESULT(S):

After PSM, in the whole population, the total LBR and PR were 35.4% (39/110) and 49% (54/110), respectively. The specific cumulative LBR at the first ICSI-IVF cycle in the first-line surgery group compared with the first-line ART was, respectively, 32.7% versus 13.0%; at the second cycle, 58.9% versus 24.8%; and at the third cycle, 70.6% versus 54.9%. The cumulative LBRs were significantly higher for women who underwent first-line surgery followed by ART compared with first-line ART in the subset of women with good prognosis (age ≤ 35 years and AMH ≥ 2 ng/mL and no adenomyosis) and women with AMH serum level < 2 ng/mL.

CONCLUSION(S):

First-line surgery may be a good option for women with colorectal endometriosis-associated infertility.

 

 

J Minim Invasive Gynecol. 2018 Jan;25(1):99-104.

In Vitro Fertilization (IVF) Success Rates after Surgically Treated Endometriosis and Effect of Time Interval between Surgery and IVF.

AlKudmani B¹, Gat I², Buell D³, Salman J⁴, Zohni K¹, Librach C⁵, Sharma P⁵.

 

Abstract

STUDY OBJECTIVE:

To evaluate the impact of endometriosis staging and endometriomas on IVF outcome and to assess the optimal time interval between laparoscopy and IVF.

DESIGN:

Retrospective clinical study.

DESIGN CLASSIFICATION:

II1 SETTING: University affiliated private infertility clinic PATIENTS: 216 infertile patients with endometriosis and 209 infertile patients without endometriosis.

INTERVENTIONS:

Laparoscopy, In Vitro Fertilization (IVF).

MEASUREMENTS AND MAIN RESULTS:

Patients with endometriosis were classified according to ASRM criteria: 58, 67, 63 and 28 patients had stages 1-4 disease, respectively. Patients with endometriosis had significantly lower E2 on trigger day (9986±6710 vs. 12220±9414 pg/ml, respectively) and number of retrieved oocytes (12.7±8.6 vs. 14.0±10, respectively) compared to controls. We found consistent decline in clinical and ongoing pregnancy rates with increasing stage of endometriosis. The presence of endometrioma in patients with stages 3 and 4 endometriosis did not alter IVF outcome. Patients with time interval of 7-12 and 13-25 months after surgery had favorable outcome.

CONCLUSIONS:

IVF pregnancy rate was negatively correlated with endometriosis severity. Presence of endometriomas had no impact on IVF clinical outcome. Optimal time to perform IVF appears to be between 7-25 months after endometriosis surgery.

 

 

J Minim Invasive Gynecol. 2017 Aug 12.

Paraureteral Endometriosis with Bilateral Gross Hydroureters and Left Renal Compromise.

Wattiez A¹, Nasir R².

 

Abstract

Deep endometriosis is usually defined as endometriosis infiltrating the peritoneum by >5 mm. It sometimes involves the ureter causing hydronephrosis in 5% of cases. The latter is associated with 18% ureteral lesions. Ureteral endometriosis is one of the rare causes of silent Kidney failure. The ureter obstruction can lead to urinary tract obstruction, hydronephrosis and hydroureters. The ureters are usually compressed externally by the endometriotic lesions surrounding it causing extrinsic ureteral endometriosis, and sometimes by pressure from the bulky adenomyotic uterus with paraureteral fibrosis. Renal Compromise is usually slow and progressive and its diagnoses might many times be missed because of the vague symptoms and late reporting. Imaging Ultrasound and Pelvis MRI is useful in detecting the ureteral obstruction and associated endometriosis in other organs. Renal Function tests and Renal Scyntigrahy are essential to assess the renal function. Management of these cases can be multidisciplinary by the gynecologist and the urologists team and involves Surgical excision of the ureteral endometriosis to relieve the obstruction. These surgeries are better performed by Laparoscopy. These surgeries are difficult, challenging and requires advanced training, hence, should be performed in specialised centres for endometriosis and by expert hands.

 

 

Hawaii J Med Public Health. 2017 Aug;76(8):220-224.

Red Snappers and Red Herrings: Pelvic Tuberculosis Causing Elevated CA 125 and Mimicking Advanced Ovarian Cancer. A Case Report and Literature Review.

Yates JA¹, Collis OA¹, Sueblinvong T¹, Collis TK¹.

 

Abstract

Female genital tuberculosis (FGTB) is a form of extra-pulmonary tuberculosis that has been primarily described in developing countries, where it is an important cause of infertility, ectopic pregnancy, and miscarriage. FGTB is rare in the United States and because its clinical presentation is non-specific and often insidious, FGTB may be misdiagnosed as a gynecologic malignancy or endometriosis. The tendency of tuberculosis to dramatically increase serum CA 125 levels contributes to the potential for FGTB to be mistaken for ovarian cancer in particular. We describe the case of a young woman who presented with what was initially thought to be advanced ovarian cancer but who had tuberculosis of the peritoneum, uterus, and ovaries discovered at laparotomy. This case emphasizes the importance of considering tuberculosis in the differential of any patient presenting with an abdomino-pelvic mass and an elevated CA 125 level.

 

 

J Health Psychol. 2017 Jan 1

“Free butterflies will come out of these deep wounds”: A grounded theory of how endometriosis affects women’s psychological health.

Facchin F¹, Saita E¹, Barbara G², Dridi D², Vercellini P².

 

Abstract

This study aimed to develop a grounded theory of how endometriosis affects psychological health. Open interviews were conducted with 74 patients. The Hospital Anxiety and Depression Scale was administered to all women, who were divided into distressed versus non-distressed. At the core of our grounded theory was the notion of disruption due to the common features of living with endometriosis. Experiencing disruption (vs restoring continuity) involved higher distress and was associated with a long pathway to diagnosis, bad doctor-patient relationships, poor physical health, lack of support, negative sense of female identity, and identification of life with endometriosis.

 

 

S D Med. 2017 Aug;70(8):359-361.

A Case of Incisional Endometrioma that Presented as an Abdominal Mass.

Landeen K¹, Wempe K^2,1, Miller R^3,4.

 

Abstract

Although endometriosis is a common condition in women of reproductive age, the incidence of endometrioma in prior surgical incision sites is rare.We present a case of an abdominal wall mass in a female patient with a history of obstetrical surgery. The mass was visualized with ultrasound and computerized tomography, removed by wide excision, and identified via frozen section. This case demonstrates the importance of a thorough surgical and obstetrical history in any woman who presents with an abdominal wall mass.

 

 

F1000Res. 2017 Aug 1;6:1295.

Advances on minimally invasive approach for benign total hysterectomy: a systematic review.

Andres MP¹, Borrelli GM¹, Abrão MS¹.

 

Abstract

Hysterectomy is one of the most commonly performed gynecologic surgeries, mainly for uterine myomas, abnormal uterine bleeding, and prolapses. It can be performed through several routes, each of which has its advantages and disadvantages. We conducted this systematic review to evaluate recent advances in surgical outcomes of benign total hysterectomies by any route: vaginal (VH), laparoscopic (LH), laparoscopically assisted vaginal (LAVH), single-port (SP), and robotic-assisted laparoscopy (RH). The search was applied to the PubMed electronic database by using keywords “hysterectomy” and “uterine benign disease”, “adenomyosis”, and “myoma”. Prospective and randomized trials of the last 3 years were included. Nine studies were selected and showed that VH was superior to LH, LAVH, and RH in terms of hospital stay and operation time and had the same complication rate and lower costs. SP hysterectomy had no clear advantages over VH or conventional LH.

 

 

Pan Afr Med J. 2017 Jun 14;27:112.

Catamenial pneumothorax revealing diaphragmatic endometriosis: a case report and revue of literature.

Aissa S¹, Benzarti W¹, Alimi F², Gargouri I¹, Salem HB¹, Aissa A³, Fathallah K⁴, Abdelkade AB⁵, Alouini R³, Garrouche A¹, Hayoun A¹, Abdelghani A¹, Benzarti M¹.

 

Abstract

Catamenial pneumothorax (CP) is a rare entity of spontaneous, recurring pneumothorax in women. We aim to discuss the etiology, clinical course, and surgical treatment of a 42-year-old woman with CP. This patient had a right-sided spontaneous pneumothoraces occurred one week after menses. She had under-gone video-assisted thoracoscopic surgery (VATS) because of a persistent air leak under chest tube. VATS revealed multiple diaphragmatic fenestrations with an upper right nodule. Defects were removed and a large part of the diaphragm was resected. Pleural abrasion was then performed over the diaphragm. Diaphragmatic endometriosis was confirmed by microscopic examination. Medical treatment with GnRH agonists was prescribed, and after recovery, the patient has been symptoms free for 20 months.

 

 

Magn Reson Med Sci. 2017 Aug 21.

Factors that Differentiate between Endometriosis-associated Ovarian Cancer and Benign Ovarian Endometriosis with Mural Nodules.

Tanase Y¹, Kawaguchi R¹, Takahama J², Kobayashi H¹.

 

Abstract

PURPOSE:

Mural nodules and papillary projections can be seen in benign ovarian endometriosis (OE) and malignant transformation of OE (endometriosis-associated ovarian cancer [EAOC]), which can pose a challenging diagnostic dilemma to clinicians. We identify the preoperative imaging characteristics helpful to the differential diagnosis between benign OE with mural nodules and EAOC.

MATERIALS AND METHODS:

This was a retrospective study of 82 patients who were diagnosed pathologically to have OE with mural nodules (n = 42) and malignant transformations of these tumors (n = 40) at the Nara Medical University Hospital from January 2008 to January 2015. All patients were assessed with contrast-enhanced magnetic resonance imaging (MRI) before surgery. Patient demographics, and clinical and pathologic features were analyzed to detect the significant differences between the two groups.

RESULTS:

Histological examinations of resected OE tissue specimens revealed that a majority (78.6%) of the mural nodular lesions were retracted blood clots. We found that the patients with malignant mural nodules, when compared to those with benign nodules, were older, had larger cyst diameters and larger mural nodule sizes, and were more likely to exhibit a taller than wider lesion. They were also more likely to present with various signal intensities on T₁-weighted images (T₁WI), high-signal intensity on T₂-weighted images (T₂WI), a lower proportion of shading on T₂WI, and were more likely to show an anterior location of the cyst. In the multivariate logistic regression analysis, “Height” (>1.5 cm) and “Height-Width ratio (HWR)” (>0.9) of mural nodules, maximum diameter of the cyst (>7.9 cm), and age at diagnosis (>43 years) were independent predictors to distinguish EAOC from OE with mural nodules.

CONCLUSION:

The “Height” and “HWR” of the mural nodules in the cyst may yield a novel potential diagnostic factor for differentiating EAOC from benign OE with mural nodules.

 

 

J Laparoendosc Adv Surg Tech A. 2018 Jan;28(1):25-32.

Managing Mid and Lower Ureteral Benign Strictures: The Laparoscopic Way.

Ghosh B¹, Jain P¹, Pal DK¹.

 

Abstract

OBJECTIVE:

The aim of this study is to assess etiopathogenesis of ureteral mid/lower benign strictures and outcomes of various methods of laparoscopic reconstruction and repair.

MATERIALS AND METHODS:

We retrospectively reviewed the data of patients who underwent laparoscopic repair for mid and lower ureteral benign strictures at our department from January 2013 to February 2016. The demographic, operative, complication, and outcome data were analyzed.

RESULTS:

Twenty-two patients were treated by various methods of laparoscopic reconstruction in the department of urology for benign ureteral strictures. Ureteroneocystostomy was done by psoas hitch in 15 and Boari flap in 2. Ureteral tapering, followed by ureteral reimplantation, was done in 2 and ureteroureterostomy in 3 cases. The most common predisposing factor that leads to ureteral stricture was prior pelvic gynecological surgery. Other causes included endometriosis, tuberculosis, impacted ureteral calculus, and ureteroscopic removal of calculus. Seventeen patients had lower, 3 had mid, and 2 had mid/lower ureteral strictures. Ureteral patency was successfully reestablished in all 22 patients without significant complications during a mean follow-up of 25 months (range 12-48 months).

CONCLUSION:

Laparoscopic treatment of benign ureteral strictures imparted excellent outcomes without major complications with the advantage of the minimally invasive technique.

 

 

J Obstet Gynaecol Can. 2017 Aug 17.

Rate of Appendiceal Metastasis with Non-Serous Epithelial Ovarian Cancer in Manitoba.

Altman AD¹, Lefas G², Power L², Lambert P³, Lotocki R⁴, Dean E⁴, Nachtigal MW⁵.

 

Abstract

OBJECTIVE:

This study sought to evaluate the rate of appendiceal involvement in non-serous mucinous and endometrioid-associated epithelial ovarian cancers.

METHODS:

The Manitoba Cancer Registry and CancerCare database were used to find all women with non-serous epithelial ovarian, fallopian tube, or primary peritoneal cancer between 1995 and 2011. All patients with an appendectomy were then identified, and their final pathology findings were reviewed. Women who did not receive treatment or lacked follow-up were excluded.

RESULTS:

We identified 338 patients from 1995-2011 with no prior appendectomy. Of these, 16.6% received an appendectomy, and 22.8% were clinically evaluated. Most cases within this cohort were mucinous (62%) and stage 1 (63%). Four appendiceal metastases were identified (7.2%), and one half appeared clinically normal at the time of surgery (3.6%). Within the mucinous histologic type, 32.7% of patients received an appendectomy, with a metastatic rate of 5.7%. Of the 127 endometrioid cases, only 10 patients received an appendectomy, and 2 were found to have metastases. No metastases were found in the 85 patients in the clear cell cohort, only 5 of whom received an appendectomy.

CONCLUSION:

Routine appendectomy or clinical assessment of the appendix is valuable for all non-serous ovarian cancers. The rate of involvement for endometriosis-associated ovarian cancers may be significantly higher than expected, and further studies need to be conducted.

 

 

EXCLI J. 2017 Jun 14;16:852-867.

MicroRNA expression analysis in endometriotic serum treated mesenchymal stem cells.

Abdel-Rasheed M^1,2, Nour Eldeen G^3,2, Mahmoud M^4,2, ElHefnawi M⁵, Abu-Shahba N^4,2, Reda M^1,2, Elsetohy K⁶, Nabil M⁷, Elnoury A⁸, Taha T¹, Azmy O^1,2.

 

Abstract

Endometriosis is defined by presence of endometrial-like-tissue outside the uterus. Recently, ectopic endometriotic lesions have been suggested to originate by abnormal differentiation of endometrial mesenchymal stem cells (eMSCs). MicroRNAs (miRNAs) play an important role in the pathophysiology of endometriosis. Through a PCR array approach, we aimed to assess the differential expression of microRNAs in human eMSC treated in culture with sera derived from women with severe endometriosis. Sera were collected from five patients with severe endometriosis and three control women and added individually in the culture medium to conduct experimental and control eMSC sets, respectively. Regular microscopic follow-up for cell morphology was performed. SYBR Green based real-time PCR array was used to assess the expression of 84 miRNAs. Bioinformatics analysis was done to predict the target genes of the significantly dysregulated miRNAs and their enriched biological processes and pathways. Thirty-two miRNAs were found significantly dysregulated in experimental cultures. Functional enrichment analysis revealed several endometriosis associated biological processes and pathways were enriched by target genes of these miRNAs. In conclusion, treatment of human eMSCs with sera of severe endometriosis cases affects the expression of certain miRNAs and their target genes. This may result in altering cell functions and consequently, endometriosis development.

 

 

Drug Deliv Transl Res. 2017 Dec;7(6):829-839.

Drug delivery for the treatment of endometriosis and uterine fibroids.

Friend DR¹.

 

Abstract

Endometriosis and uterine fibroids (also known as uterine leiomyomas) are serious medical conditions affecting large numbers of women worldwide. Many women are asymptomatic but those with symptoms require medical intervention to relieve chronic pain and dysmenorrhea and to address infertility. Drug delivery has played a role in reducing some of the symptoms associated with endometriosis and uterine fibroids. Use of drug delivery systems for both conditions can roughly be divided into two categories: (1) existing systems designed for other indications such as contraception for symptomatic relief and (2) development of novel systems aimed at addressing some of the underlying biochemical changes associated with endometriosis and uterine fibroids such as oxidative stress, angiogenesis, and matrix degradation. The latter drug delivery approaches rely heavily on nanotechnology. Existing systems that deliver estrogens and/or progestins include vaginal rings, transdermal patches, and intrauterine systems. Long-acting implantable contraceptives such as Implanon® and injectables such as Depo-Provera® have found use in treating endometriosis. Similarly, long-acting GnRH products (e.g., Lupron Depot®) are used to treat endometriosis. Other drugs formulated in long-acting formulations include intravaginal rings capable of delivering selective progesterone receptor modulators, androgens such as danazol, and aromatase inhibitors (e.g., anastrozole). Nanoparticles composed of silica, poly(lactic-co-glycolic acid), cerium oxide, dendrimers, and chitosan/polyethyleneamine have all been investigated to improve treatment of endometriosisand to a lesser extent, uterine fibroids.

 

 

Comp Med. 2017 Aug 1;67(4):376-380.

Uterus-like Masses in a Rhesus Macaque (Macaca mulatta).

Dickerson MF¹, Martin LD², Lewis AD².

 

Abstract

Endometriosis is a relatively common condition in women and some populations of adult female rhesus macaques. However, endometriosis with extensive smooth muscle proliferation, as occurs in endomyometrioma and uterus-like mass (ULM), is rare in women. This report describes a case of endometriosis with extensive smooth muscle metaplasia resembling multiple ULM in a 20-y-old female rhesus macaque. During a protocol-related procedure, a large, smooth, globoid, freely moveable mass was palpated in the midabdomen. Ultrasonography revealed a cystic structure from which dark brown fluid was aspirated. During exploratory laparotomy, an 8-cm spherical mass in the greater omentum and 3 additional masses (diameter, 2 to 5 cm) attached to the omentum were excised. Microscopic examination of the masses revealed numerous foci of ectopic endometrial glands and stroma frequently surrounded by bundles of smooth muscle and fibrous connective tissue. The gross and histologic lesions in this macaque bore many similarities to ULM in women. To our knowledge, this case represents the first report of endometriosis resembling a uteruslike mass in a NHP.

 

 

Gynecol Oncol Rep. 2017 Aug 8;21:119-121

Primary low-grade endometrial stromal sarcoma of the omentum.

Clair K¹, Wolford J¹, Veran-Taguibao S², Kim G², Eskander RN³.

 

Abstract

• Extra-uterine endometrial stromal sarcoma may arise in endometriosis.•Abdominal exploration for extra pelvic endometriosisis warranted.•Representative endometriotic implants should be resected and/or biopsied if clinically suspicious.

 

 

J Assist Reprod Genet. 2017 Dec;34(12):1667-1672.

Endometriosis-associated infertility: GDF-9, AMH, and AMHR2 genes polymorphisms.

De Conto E^1,2, Matte Ú³, Bilibio JP⁴, Genro VK³, Souza CA³, Leão DP⁴, Cunha-Filho JS⁴.

 

Abstract

PURPOSE:

The purpose of this paper is to determine whether there is a correlation between polymorphisms in the growth differentiation factor-9 (GDF-9) gene and anti-Müllerian hormone (AMH) gene and its receptor, AMHR2, and endometriosis-associated infertility.

METHODS:

This is a case-control study to evaluate whether there is a correlation between polymorphisms in the GDF-9 gene (SNPs determined by direct sequencing), AMH gene, AMHR2 (both SNPs determined by genotyping using TaqMan Allelic Discrimination), and endometriosis-associated infertility. The study included 74 infertile women with endometriosis and 70 fertile women (tubal ligation) as a control group.

RESULTS:

Patient age and the mean FSH levels were similar between the infertile with endometriosis and fertile without endometriosis groups. The frequency of genotypes between the groups for GDF-9 gene polymorphisms did not show statistical significance, nor did the AMHR2 gene polymorphism. However, the AMH gene polymorphism did show statistical significance, relating the polymorphic allele with infertility in endometriosis.

CONCLUSIONS:

We demonstrate that an SNP in the AMH gene is associated with infertility in endometriosis, whereas several SNPs in the GDF-9 gene and the – 482A G SNP in the AMHR2 gene were found to be unrelated.

 

 

Int J Cancer. 2018 Feb 1;142(3):460-469.

Menstrual pain and risk of epithelial ovarian cancer: results from the Ovarian Cancer Association Consortium.

Babic A¹, Harris HR², Vitonis AF³, Titus LJ⁴, Jordan SJ⁵, Webb PM⁵; Australian Ovarian Cancer Study Group, Risch HA⁶, Rossing MA^2,7, Doherty JA⁸, Wicklund K², Goodman MT^9,10, Modugno F^11,12,13, Moysich KB¹⁴, Ness R¹⁵, Kjaer SK^16,17, Schildkraut J¹⁸, Berchuck A¹⁹, Pearce CL^20,21, Wu AH²¹, Cramer DW^3,22, Terry KL^3,22.

 

Abstract

Menstrual pain, a common gynecological condition, has been associated with increased risk of ovarian cancer in some, but not all studies. Furthermore, potential variations in the association between menstrual pain and ovarian cancer by histologic subtype have not been adequately evaluated due to lack of power. We assessed menstrual pain using either direct questions about having experienced menstrual pain, or indirect questions about menstrual pain as indication for use of hormones or medications. We used multivariate logistic regression to calculate the odds ratio (OR) for the association between severe menstrual pain and ovarian cancer, adjusting for potential confounders, and multinomial logistic regression to calculate odds ratios for specific histologic subtypes. We observed no association between ovarian cancer and menstrual pain assessed by indirect questions. Among studies using direct question, severe pain was associated with a small but significant increase in overall risk of ovarian cancer (OR=1.07, 95% CI: 1.01-1.13), after adjusting for endometriosis and other potential confounders. The association appeared to be more relevant for clear cell (OR=1.48, 95% CI: 1.10-1.99) and serous borderline (OR=1.31, 95% CI: 1.05-1.63) subtypes. In this large international pooled analysis of case-control studies, we observed a small increase in risk of ovarian cancer for women reporting severe menstrual pain. While we observed an increased ovarian cancer risk with severe menstrual pain, the possibility of recall bias and undiagnosed endometriosis cannot be excluded. Future validation in prospective studies with detailed information on endometriosis is needed. This article is protected by copyright. All rights reserved.

 

 

JBRA Assist Reprod. 2017 Sep 1;21(3):196-202.

Expression of PGR, HBEGF, ITGAV, ITGB3 and SPP1 genes in eutopic endometrium of infertile women with endometriosis during the implantation window: a pilot study.

Broi MGD¹, Rocha CV Junior¹, Meola J¹, Martins WP¹, Carvalho FM², Ferriani RA¹, Navarro PA^1,3.

 

Abstract

OBJECTIVE:

Alterations in endometrial receptivity may be involved in the etiopathogenesis of endometriosis-related infertility. The literature has suggested that patients with endometriosis present progestin resistance, which could affect embryo implantation. We question the presence of alterations in the expression of the progesterone receptor gene (PGR) and the genes related to endometrium-embryo interaction regulated by progesterone. This pilot study compared the expression of PGR, HBEGF, ITGAV, ITGB3, and SPP1 genes in eutopic endometrium during the implantation window (IW) in infertile women with endometriosis with that observed in the endometrium of fertile and infertile controls.

METHODS:

In this prospective case-control study, endometrial biopsies were performed during the IW in patients aged between 18 and 45 years old, with regular cycles and without endocrine/systemic dysfunctions, divided into endometriosis (END), infertile control (IC) and fertile control (FC) groups. Total RNA extraction, cDNA synthesis, and gene expression analysis by Real-Time PCR were performed. We assessed the size of the difference that our series was powered to detect.

RESULTS:

From the 687 patients who underwent diagnostic videolaparoscopy or tubal ligation at the University Hospital, 130 were eligible. Of these, 32 had endometrial samples collected, with 17 confirmed in the IW. Fifteen samples (5 END, 5 IC and 5 FC) were analyzed. There was no significant difference in the expression of any studied gene. Our sample size allowed us to identify or discard large differences (two standard deviations) among the groups.

CONCLUSION:

Endometriosis doesn’t cause large changes in the endometrial expression of PGR, HBEGF, ITGAV, ITGB3 and SPP1 during the IW.