Fertil Steril. 2018 Jan;109(1):172-178.e1.

Postoperative complications after bowel endometriosis surgery by shaving, disc excision, or segmental resection: a three-arm comparative analysis of 364 consecutive cases.

Abo C¹, Moatassim S¹, Marty N¹, Saint Ghislain M¹, Huet E², Bridoux V², Tuech JJ², Roman H³.

 

Abstract

OBJECTIVE:

To assess the postoperative complications related to three surgical procedures used in colorectal endometriosis: rectal shaving, disc excision, and segmental resection.

DESIGN:

Retrospective comparative study using data prospectively recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis (CIRENDO) database.

SETTING:

University tertiary referral center.

PATIENT(S):

A total of 364 consecutive patients with deep endometriosis infiltrating the rectosigmoid, were stratified into three arms according to the technique used.

INTERVENTION(S):

All patients had a laparoscopic surgical procedure to treat bowel endometriosis: rectal shaving (145 patients), disc excision (80 patients), or segmental colorectal resection (139 patients).

MAIN OUTCOME MEASURE(S):

Postoperative complication rate was assessed using Clavien-Dindo classification.

RESULT(S):

Clavien 3b postoperative complications were recorded in 43 patients (11.8%), two thirds of whom were managed by segmental colorectal resection (P<.001). Fourteen cases of rectovaginal fistula (3.8%) were reported: three in the shaving arm (2.1%), three in the disc excision arm (3.7%), and eight in the segmental colorectal resection arm (5.8%) (P=.13). Twenty-four cases (6.6%) of pelvic abscess were recorded in patients free of fistula or leakage. One year after the surgery pregnancy rate (PRs) and delivery rate were comparable between patients with or without severe complications who intended to get pregnant. Three years postoperatively, the PR in infertile patients was 66.7%, with spontaneous conception in 50% of cases.

CONCLUSION(S):

Our data suggest that using a strategy prioritizing shaving, whenever it is possible, could be related to a reduction in severe complication rates. However, prudence is required before concluding that extensive disease should not be treated by segmental resection because of the risk of complications.

 

 

 

J Midlife Health. 2017 Oct-Dec;8(4):196-199.

Scar Endometriosis with Rudimentary Horn: An Unusual and Elucidative Report of a Case Diagnosed on Histopathology and Immunohistochemistry.

Chauhan V¹, Pujani M¹, Singh K¹, Chawla R², Ahuja R².

 

Abstract

Endometriosis is defined as the presence of functioning endometrial tissue outside the endometrial cavity. Scar endometriosis, also known as spontaneous abdominal wall endometriosis, is an unusual clinical presentation which often goes unnoticed. It usually develops after pelvic operations. The incidence has been estimated to be only 0.03%-0.15% of all cases of endometriosis. It can be either asymptomatic or present as abdominal wall pain at the site of surgical incision. It is most commonly diagnosed clinically or on ultrasonography. The treatment of choice predominantly remains surgical excision. We present a case of a 24-year-old female (known case of bicornuate uterus) who presented with chief complaints of abdominal pain for 1 month and 6 months after metroplasty. The patient was clinically diagnosed as a case of scar endometriosis with rudimentary horn and fistulous tract and taken up for surgery. Both the scar tissue and fistulous tract were removed and histopathology revealed only endometrial glands without stroma or hemosiderin-laden macrophages. Diagnosis of scar endometriosis was established on positive immunohistochemistry for estrogen and progesterone receptor in endometrial glands. Timely diagnosis and surgical excision of scar endometriosis along with close follow-up are necessary to prevent complications and recurrence.

 

 

 

Ger Med Sci. 2017 Dec 19;15:Doc19..

Risk factors for ectopic pregnancy in Germany: a retrospective study of 100,197 patients.

Jacob L¹, Kalder M², Kostev K³.

 

Abstract

in English, German

Aim: The goal of this study was to identify potential risk factors for ectopic pregnancy in women followed in German gynecological practices. Methods: The present study included pregnant women diagnosed with ectopic pregnancy and pregnant women without ectopic pregnancy followed in 262 gynecological practices between January 2012 and December 2016. The effects of demographic and clinical variables on the risk of developing ectopic pregnancy were estimated using a multivariate logistic regression model. Results:This study included 3,003 women with ectopic pregnancy and 97,194 women without ectopic pregnancy. The mean age was 31.4 years (SD=5.9 years) in ectopic pregnancy patients and 31.1 years (SD=5.6 years) in non-ectopic pregnancy patients. Women aged 36-40 (OR=1.12) and 41-45 years (OR=1.46) were at a higher risk of ectopic pregnancy than women aged 31-35 years. Prior ectopic pregnancy was strongly associated with a risk of recurring ectopic pregnancy (OR=8.17). Prior genital surgery (OR=2.67), endometriosis (OR=1.51), and eight other gynecological diseases were also positively associated with ectopic pregnancy (ORs ranging from 1.19 to 2.06). Finally, there was a 1.80-fold increase in women previously diagnosed with psychiatric disorders. Conclusions: Prior ectopic pregnancy and prior genital surgery were strongly associated with ectopic pregnancy in women followed in German gynecological practices. Psychiatric diseases had an additional impact on the risk of ectopic pregnancy.

 

 

 

Bull Exp Biol Med. 2018 Jan;164(3):386-389.

Immunohistochemical Features of O6-Methylguanine-DNA Methyltransferase Expression during Ovarian Endometriosis.

Shchegolev AI¹, Bykov AG², Faizullina NM², Adamyan LV².

 

Abstract

A comparative immunohistochemical study for the expression of O6-methylguanine-DNA methyltransferase (MGMT) was performed in tissues of the eutopic endometrium and ovarian endometriosis. The highest level of MGMT expression in eutopic endometrial tissue was observed in epitheliocyte nuclei during the proliferative phase. In regions of endometriosis the expression of MGMT in epitheliocyte nuclei was shown to increase during stages I and II, but decreased in stages III and IV. The progression of endometriosis was accompanied by a gradual increase of study parameters in the nuclei and cytoplasm of stromal cells. These changes reflect the impairment of DNA reparation, which probably serves as a stage in the development and progression of endometriosis.

 

 

 

Cell J. 2018 Apr;20(1):84-89. miR-31 and miR-145 as Potential Non-Invasive Regulatory Biomarkers in Patients with Endometriosis.

Bashti O¹, Noruzinia M², Garshasbi M¹, Abtahi M³.

 

Abstract

OBJECTIVES:

Endometriosis is a prevalent gynecologic disease affecting 10% of women in reproductive age. Endometriosis is diagnosed by laparoscopy that was followed by histologic confirmation. Early diagnosis will lead to a more effective treatment with much less morbidity. As miR-31 and miR-145 are shown to be directly or indirectly correlated to biological processes involved in endometriosis, the aim of this study was to examine the association of miR-31 and miR-145 expression in plasma with the presence of endometriosis.

MATERIALS AND METHODS:

In this case control study, the plasma samples of 55 patients with endometriosis and 23 women without endometriosis were collected, extracted and analyzed by real time quantitative polymerase chain reaction (qPCR) for the expression of miR-145 and miR-31.

RESULTS:

Our findings showed that miR-31 expression levels in stage 3 or 4 and stage 1 or 2 were significantly downregulated (less than 0.01-fold, P<0.05), while the expression level of miR-145 was significantly up-regulated in women with endometriosis in stage 1 or 2.

CONCLUSIONS:

Different cellular biological processes, such as differentiation, proliferation, mitochondrial function, reactive oxygen species (ROS) production, invasion and decidualization, are deregulated in endometriosis. miR-31 and miR-145 are microRNAs (miRNAs) with potential roles, as shown in pathologies like cancers. We found that miR- 31 was under-expressed in patients with endometriosis, while miR-145 was over-expressed in stage 1 or 2, indicating that they were relatively down-regulated in the more severe forms. Our findings suggested that these two miRNAs may be considered as potential biomarkers with probable implications in early diagnosis and even follow-up of patients with endometriosis.

 

 

Anticancer Agents Med Chem. 2018 Jan 7.

The clinical and experimental research on the treatment of endometriosiswith thiostrepton.

Jin P¹, Chen FX², Li YZ², Zhang QQ³, Zhang J³.

 

Abstract

BACKGROUND/OBJECTIVE:

Forkhead Box M1 (FOXM1) is frequently activated in tumors. We studied the expression and the possible mechanism of FOXM1 and evaluated the effects of thiostrepton in an endometriotic rat model.

STUDY DESIGN:

This was a randomized study in a rat model of endometriosis. Fifty female Wistar rats were surgically induced with endometriosis. After 4 weeks of observation, twenty and thirty rats were randomly allocated to an ovariectomized (OVX) group and a treatment group, respectively. The OVX group was ovariectomized and randomly divided into an OVX-estrogen group and a control (OVX -oil) group. All rats were allowed a resting period of 3 days prior to any operation. The rats in the estrogen group were given estradiol (20 µg/kg, 0.1 ml /d), while the control group was treated with an equivalent amount of sesame oil. Every group was injected with subcutaneous injection for 7 days. The treatment group was randomly divided into three groups to receive the following: TST at 150 mg/kg, ip.; TST at 250 mg/kg, ip.; or sterile normal saline, ip. The groups received these dosages every 2 days for 2 weeks. Lesion growth, histological examination, and protein expression were subsequently analyzed using caliper measurement, histology, immunostaining, and Western blot after each rat received an injection in its own group.

RESULTS:

Our results showed that FOXM1 is enrich in nucleus of an ectopic endometrium when compared with an eutopic uterus. Furthermore, we found that an ERK/FOXM1/matrix metalloproteinase-9 (MMP9) signaling pathway might result in the establishment and development of endometriosis. Finally, a thiostrepton concentration dependently reduced the expression of FOXM1, MMP9 and Bcl-2 in endometriotic lesions of the treated rats. Statistical significance was accepted for a value of P < 0.05 .

CONCLUSION:

We postulate that thiostrepton could inhibit the endometriotic lesions, at least in part, by decreasing the FOXM1 expression and exerting a pro-apoptotic effect. We reported for the first time that FOXM1 expresses in experimental endometriosis rat and thiostrepton may also be suitable for the administration of endometriosis by inhibiting the growth of endometriotic implants. More studies are needed to further evaluate thiostrepton’s effect.

 

 

 

Gynecol Endocrinol. 2018 Jan 8:1-6.

Expression of inflammatory cytokines in serum and peritoneal fluid from patients with different stages of endometriosis.

Fan YY¹, Chen HY², Chen W³, Liu YN⁴, Fu Y¹, Wang LN¹.

 

Abstract

OBJECTIVE:

To investigate the level of inflammatory cytokines in endometriosis patients, and explore the relationship between IL-37 concentration and endometriosis stages.

METHODS:

Inflammatory cytokine concentrations from 27 patients with different stages of endometriosisand 52 controls without endometriosis were examined by ELISA. Then, the specificity and sensitivity of cytokines for distinguishing from controls and the different stages of endometriosis were analyzed using the ROC curve.

RESULTS:

The difference in serum concentrations of IL-37, IL-17A, IL-10, and IL-2 between the endometriosis and control groups was statistically significant (p < .01). Compared with controls, significantly higher levels of serum IL-37 and IL-10, and significantly lower levels of serum IL-17A and IL-2 were detected in patients with endometriosis (p < .01). Furthermore, IL-2 concentration was significantly higher in peritoneal fluid (PF) in the endometriosis group (p = .0034), IL-10 concentrations in PF were significantly lower in the early-stages of endometriosis than in the more advanced groups (p = .0439), and IL-4 concentration in PF was significantly higher in more advanced endometriosis (p = .0228). The sensitivity and specificity of serum IL-37 for distinguishing endometriosis were 81.48% and 83.33%, respectively, and the cutoff concentration was 69.84 pg/ml. For IL-17A, the sensitivity and specificity were 96.30% and 100%, respectively, and the cutoff concentration was 57.54 pg/ml. For IL-10, the sensitivity and specificity was 92.59% and 100%, respectively, and the cutoff concentration was 3.301 pg/ml. For IL-2, the sensitivity and specificity were 74.07% and 93.75%, respectively, and the cutoff concentration was 1.813 pg/ml. For PF IL-2, the sensitivity and specificity were 29.73% and 100%, respectively, and the cutoff concentration was 1.06 pg/ml.

CONCLUSIONS:

IL-37, IL-17A, IL-10, and IL-2 may play a significant role in immune response in endometriosis. IL-37 levels may be used as a diagnostic marker for endometriosis.

 

 

 

Gene. 2018 Jan 5.

Matrix metalloproteinase and tissue inhibitors of metalloproteinases gene polymorphisms in disorders that influence fertility and pregnancy complications: A systematic review and meta-analysis.

Barišić A¹, Pavlić SD², Ostojić S³, Pereza N⁴.

 

Abstract

Matrix metalloproteinase (MMP) and tissue inhibitors of metalloproteinase (TIMP) gene polymorphisms have been extensively evaluated as predisposing factors to human reproductive disorders. However, the evidence available is inconsistent. Therefore, we performed a systematic review and meta-analysis to provide the first comprehensive synopsis of case-control studies that investigated the association of MMP and TIMP gene polymorphisms with disorders that influence fertility and pregnancy complications. Literature search was performed using PubMed and Scopus databases. We included 42 case-control studies in the systematic review for the following disorders: adenomyosis, endometriosis, hypertensive disorders of pregnancy, preterm birth and recurrent spontaneous abortion. Although a large number of MMP and TIMP gene polymorphisms were tested, no exclusive and unambiguous risk factors were identified for any of the disorders. The majority of statistically significant associations were confirmed in just one study. Additionally, we performed two meta-analyses for MMP9 rs3918242 polymorphism in endometriosis/adenomyosis and preeclampsia but found no association with either disorder. Considering the modest associations and conflicting results between individual case-control studies, new data is needed for further research of this subject.

 

 

 

Eur J Obstet Gynecol Reprod Biol. 2017 Dec 7;221:58-63.

Cutaneous endometriosis: Presentation of 33 cases and literature review.

Lopez-Soto A¹, Sanchez-Zapata MI², Martinez-Cendan JP³, Ortiz Reina S⁴, Bernal Mañas CM⁵, Remezal Solano M⁶.

 

Abstract

OBJECTIVE:

Cutaneous endometriosis is a rare condition that usually affects the abdominal wall in women with a history of open abdominal surgery. It has a characteristic clinical picture of a mass and pain associated with menstruation. The diagnosis is difficult on being an uncommon and little known condition. Once there is suspicion, a correct anamnesis and examination is usually sufficient. The treatment is normally surgery.

STUDY DESIGN:

The study included all women identified with a diagnosis of cutaneous endometriosis over a period of 20 years. The variables collected and analysed included, age, surgical history, gynaecology history, symptoms, time period between surgery and consultation, specialist consulted, location, size, tests performed, treatment, and recurrence.

RESULTS:

A total of 33 women were identified, with a mean age of 35.4 ± 2.33 years. A surgical history was found in 31 (93%) of 33 women. The main symptom was abdominal mass (96%), followed by period pain (51%), and non-period pain (42%). The initial diagnosis was correct in 15 (45%) of 33 women, and after performing further tests it was correct in 23 (69%) of 33 women. The main additional test was fine needle aspiration (FNA) in 24 (72%) of 33 patients. Surgery was performed on 30 (90%) of 33 women, with 8 (24%) women requiring a prosthesis. There was a recurrence of cutaneous endometriosis in 3 (9%) women.

CONCLUSION:

Although it is a rare disease, its association with gynaecological surgery, and in particular caesarean section, means that there should be more awareness of this condition. Its diagnosis may be complicated due to lack of knowledge, when a proper examination and anamnesis can give us the key.

 

 

 

Int Urogynecol J. 2018 Jan 8.

Urodynamic observations and lower urinary tract symptoms associated with endometriosis: a prospective cross-sectional observational study assessing women with deep infiltrating disease.

de Resende Júnior JAD^1,2,3, Crispi CP⁴, Cardeman L⁵, Buere RT⁶, Fonseca MF⁶.

 

Abstract

INTRODUCTION AND HYPOTHESIS:

The objective was to assess the association between lower urinary tract disease (LUTD) and the presence of endometriosis at different anatomical sites.

METHODS:

Our prospective cross-sectional observational study evaluated 138 women with deep infiltrating endometriosis who had undergone preoperative evaluation of urodynamics and detailed assessment of lower urinary tract symptoms between August 2013 and May 2016. After laparoscopy, the anatomical sites of histologically confirmed endometriosis lesions were mapped.

RESULTS:

The presence of endometriosis in the bladder demonstrated significant negative angular coefficients for bladder compliance (mL/cmH₂O) (P = 0.007; B = -54.65; 95%CI: -93.76 to -15.51) and for maximum cystometric capacity (mL; P = 0.001; B = -39.79; 95%CI: -62.51 to -17.06), whereas endometriosis in the parametrium showed significant positive coefficients for opening pressure (cmH₂O) (P = 0.016; B = 5.89; 95%CI: 1.10-10.69) and post-void residual (mL) (P = 0.015; B = 31.34; 95%CI: 6.14-56.55). The presence of endometriosis in the bladder was a statistically significant independent predictor of low bladder compliance (P < 0.001; OR = 30.10; 95%CI: 9.48-95.55), whereas endometriosis in the parametrium was a statistically significant independent predictor of both abnormal residual urine (P = 0.019; OR = 5.21; 95%CI: 1.32-20.64) and bladder outlet obstruction (P = 0.011; OR = 7.91; 95%CI: 1.61-38.86). Correspondence analysis suggested two possible independent ways through which endometriosis acts on the genesis of urinary dysfunctions.

CONCLUSIONS:

Our findings strongly suggest that endometriosis involving the bladder might disturb storage function, whereas endometriosis in the parametrium disturbs the voiding phase.

 

 

 

Hum Reprod. 2018 Jan 5.

Fertility outcomes in women experiencing severe complications after surgery for colorectal endometriosis.

Ferrier C¹, Roman H², Alzahrani Y¹, d’Argent EM¹, Bendifallah S^1,3, Marty N², Perez M⁴, Rubod C⁴, Collinet P⁴, Daraï E^1,3,5, Ballester M^1,3,5.

 

Abstract

STUDY QUESTION:

What are the fertility outcomes in women wishing to conceive after experiencing a severe complication from surgical removal of colorectal endometriosis?

SUMMARY ANSWER:

The pregnancy rate (PR) among women who wished to conceive after a severe complication of surgery for colorectal endometriosis was 41.2% (spontaneously for 80%, after ART procedure for 20%).

WHAT IS KNOWN ALREADY:

While the long-term benefit of surgery on pain and quality of life is well documented for women with colorectal endometriosis, it exposes women to the risk of severe complications. However, little is known about fertility outcomes in women experiencing such severe postoperative complications.

STUDY DESIGN, SIZE, DURATION:

This retrospective cohort study included women who experienced a severe complication after surgery for colorectal endometriosis between January 2004 and June 2014, and who wished to conceive. A total of 53 patients met the inclusion criteria. The fertility outcome was available for 48 women, who were therefore included in the analysis. The median follow-up was 5 years.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

All the women underwent complete removal of colorectal endometriosis. Postoperative severe complications were defined as grades III-IV of the Clavien-Dindo classification. Fertility outcomes, PR and cumulative pregnancy rate (CPR), were estimated.

MAIN RESULTS AND THE ROLE OF CHANCE:

Most women experienced a grade IIIb complication (83.3%). Of 48 women, 20 became pregnant (overall PR: 41.2%); spontaneously for 16 (80%) and after ART procedure for 4 (20%). The median interval between surgery and first pregnancy was 3 years. The live birth rate was 14/48 (29.2%). The 5-year CPR was 46%. A lower CPR was found for women who experienced anastomotic leakage (with or without rectovaginal fistula) (P = 0.02) or deep pelvic abscess (with or without anastomotic leakage) (P = 0.04).

LIMITATIONS REASONS FOR CAUTION:

Due to a lack of information, no sub-analysis was done to investigate other parameters potentially impacting fertility outcomes.

WIDER IMPLICATIONS OF THE FINDINGS:

The PR for our population was slightly lower to that observed in the literature for women who experience such surgery without consideration for the occurrence of complications. However, ‘severe complications’ covers a range of conditions which are likely to have a very different impacts on fertility. Even if the PR and CPR appear satisfactory, septic complications can negatively impact fertility outcomes. Rapid ART may be a good option for these patients.

STUDY FUNDING/COMPETING INTEREST(S):

No funding was required for the current study. Pr H. Roman reported personal fees from Plasma Surgical Inc. (Roswell, GA, USA) for participating in a symposium and a masterclass, in which he presented his experience in the use of PlasmaJet®. None of the other authors declared any conflict of interest.

 

 

J Obstet Gynaecol Res. 2018 Jan 5.

Bilateral tubo-ovarian abscesses presenting with huge pelvic mass after repeated intrauterine inseminations in a woman with severe endometriosis.

Vichinsartvichai P¹.

 

Abstract

A 32-year-old woman consulted for an evaluation of pelvic pain following intrauterine insemination (IUI). Vaginal and abdominal sonography, septic workup were performed and laparoscopic surgery was scheduled after failure to respond to a course of antibiotics. During laparoscopic surgery, bilateral tubo-ovarian abscesses arising on the endometriotic cysts of both ovaries were identified with a vast amount of brownish peritoneal fluid under the adhesion of the greater omentum. Bilateral ovarian cystectomy, right salpingectomy and lysis adhesion were performed. Pathologic organisms were not detected in any of the specimen cultures. Pelvic infection is an uncommon complication following IUI. Endometriosis might be a risk factor predisposing the pelvic organ to be susceptible to such infection. Performing IUI in a patient with endometriosis should be done with great vigilance.

 

 

 

J Obstet Gynaecol Res. 2018 Jan 5.

Involvement of immune cells in the pathogenesis of endometriosis.

Izumi G¹, Koga K¹, Takamura M¹, Makabe T¹, Satake E¹, Takeuchi A¹, Taguchi A¹, Urata Y¹, Fujii T¹, Osuga Y¹.

 

Abstract

Endometriosis is characterized by the implantation and growth of endometriotic tissues outside the uterus. It is widely accepted the theory that endometriosis is caused by the implantation of endometrial tissue from retrograde menstruation; however, retrograde menstruation occurs in almost all women and other factors are required for the establishment of endometriosis, such as cell survival, cell invasion, angiogenesis, and cell growth. Immune factors in the local environment may, therefore, contribute to the formation and progression of endometriosis. Current evidence supports the involvement of immune cells in the pathogenesis of endometriosis. Peritoneal neutrophils and macrophages secrete biochemical factors that help endometriotic cell growth and invasion, and angiogenesis. Peritoneal macrophages and NK cells in endometriosis have limited capability of eliminating endometrial cells in the peritoneal cavity. An imbalance of T cell subsets leads to aberrant cytokine secretions and inflammation that results in the growth of endometriosis lesions. It is still uncertain whether these immune cells have a role in the initial cause and/or stimulate actions that enhance disease; however, in either case, modulating the actions of these cells may prevent initiation or disease progression. Further studies are needed to deepen the understanding of the pathology of endometriosis and to develop novel management approaches of benefit to women suffering from this disease.

 

 

 

Diagn Cytopathol. 2018 Jan 8.

The role of peritoneal washings in the diagnosis of endometriosis.

Cantley RL¹, Yoxtheimer L¹, Molnar S¹.

 

Abstract

Endometriosis, the presence of endometrial tissue outside the uterine corpus, is a common finding in reproductive age women. It is classically diagnosed based on the presence of at least two of the following elements: endometrial glands, endometrial stroma, and hemosiderin-laden macrophages (HLMs). Although a common finding in surgical pathology specimens at the time of gynecologic surgery, there is little literature on the role of pelvic washings in diagnosing endometriosis. Our study aimed to examine the characteristics of endometriosis in pelvic washings at the time of gynecologic surgery. We report nine cases of endometriosis diagnosed on pelvic washing. Two had a reported history of endometriosis. Four had endometriosis on the concurrent surgical pathology specimen. Liquid-based cytology was diagnostic of endometriosis in seven patients, including five with glandular cells and HLMs and two with glandular cells, HLMs, and endometrial stromal cells. Cell block was diagnostic of endometriosis in eight patients, including four cases with intact fragments of endometrial glands and stroma. Three cases showed glandular cells and HLMs, while one showed separate fragments of glandular cells and stromal cells. Pelvic washings increased the diagnostic yield for endometriosis at the time of gynecologic surgery, as only four out of nine cases had endometriosis diagnosed on surgical pathology. Cell block in particular aids in the diagnosis, since intact glandular and stromal fragments frequently can be identified.

 

 

 

Med Hypotheses. 2018 Jan;110:80-82.

The origin of endometriosis-associated ovarian cancer from uterine neoplastic lesions.

Garavaglia E¹, Sigismondi C², Ferrari S³, Candiani M⁴.

 

Abstract

Endometriosis is a risk factor for type I epithelial ovarian cancer but an issue to be clarified is the site of origin of endometriosis associated ovarian cancer. Here we proposed that the uterus may be the organ of origin of ovarian endometrioid cancer associated with endometriosis. Thus, the first neoplastic transformation would characterize the uterine cells migrating in the pelvis via retrograde menstruation and they would implant secondarily on the ovary. Supporting this hypothesis, an higher incidence of synchronous precancerous and cancerous endometrial pathology in patients affected by ovarian endometrioid cancer associated with endometriosis was showed. Moreover, uterine endometrial type I carcinoma resembles endometriosis associated endometrioid ovarian cancer in behavior and prognosis. This hypothesis is also supported by epidemiologic evidence showing a protective effect for tubal ligation and oral contraceptive use for endometriosis associated endometrioid ovarian cancer. Endometriosis and endometrioid ovarian carcinoma might represent two distinct biological entities characterized by the same organ of origin (the uterus), the same pathogenetic mechanism (transtubal reflux) and the same target organ (the ovary). By shifting the early events of ovarian carcinogenesis to the endometrium, prevention approaches as salpingectomy/tubal ligation and intervention at uterine corpus level may play an important role.

 

 

 

Neurourol Urodyn. 2018 Jan 10.

Endometriosis increased the risk of bladder pain syndrome/interstitial cystitis: A population-based study.

Wu CC^1,2, Chung SD^3,4, Lin HC⁵.

 

Abstract

OBJECTIVE:

Previous studies have suggested an association between bladder pain syndrome/interstitial cystitis (BPS/IC) and endometriosis. However, no nation-wide population study has yet reported an association between them. In this study, we examined the risk of BPS/IC among subjects with endometriosis during a 3-year follow-up in Taiwan using a population-based dataset.

STUDY DESIGN:

This study comprised 9191 subjects with endometriosis, and 27 573 subjects randomly selected as controls. We individually followed-up each subject (n = 36 764) for a 3-year period to identify subjects subsequently diagnosed with BPS/IC. A Cox proportional hazards regression model was employed to estimate the risk of subsequent BPS/IC following a diagnosis of endometriosis.

RESULTS:

Incidences of BPS/IC during the 3-year follow-up period was 0.2% and 0.05% for subjects with and without endometriosis, respectively. The hazard ratio for developing BPS/IC over a 3-year period for subjects with endometriosis compared to subjects without endometriosis was 4.43 (95% CI: 2.13-9.23). After adjusting for co-morbidities like diabetes, hypertension, coronary heart disease, obesity, hyperlipidemia, chronic pelvic pain, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, depression, panic disorder, migraines, sicca syndrome, allergies, endometriosis, asthma, tobacco use, and alcohol abuse, the Cox proportional hazards regressions revealed that the hazard ratio for BPS/IC among subjects with endometriosis was 3.74 (95% CI = 1.76-7.94, P < 0.001) compared to that in controls.

CONCLUSIONS:

This study provides epidemiological evidence of an association between endometriosisand a subsequent diagnosis of BPS/IC.

 

 

 

Gynecol Endocrinol. 2018 Jan 10:1-5.

Transplantation of cryopreserved ovarian tissue in a patient affected by metastatic struma ovarii and endometriosis.

Fabbri R¹, Vicenti R¹, Paradisi R¹, Rossi S¹, De Meis L¹, Seracchioli R¹, Macciocca M¹.

 

Abstract

In this case report, the outcomes of cryopreserved ovarian tissue transplantation performed in a patient affected by struma-ovarii associated with mature cystic teratoma, recurrent endometriotic cysts and diffuse peritoneal malignant struma-ovarii implants were described. Before cryopreservation, the patient underwent two left ovarian surgeries for enucleation cysts 8 years after righ salpingo-oophorectomy for struma-ovarii. Ovarian biopsy was collected in another hospital and transported to our laboratory for cryopreservation. The patient was submitted to radioiodine-therapy for metastases from malignant struma-ovarii. After treatment she experienced premature ovarian failure. Ten years after cryopreservation, a first orthotopic transplantation was performed in the left ovary and in a peritoneal pocket. Before transplantation, ovarian samples were analyzed to assess neoplastic contamination and tissue quality. Three years later, a second transplantation was heterotopically performed in abdominal subcutaneous sites. The analysis on thawed ovarian tissue did not reveal micrometastasis and they showed follicle and stroma damages. After transplantation few small follicles were observed at ultrasound examination and hormonal levels remained at menopausal values. To date no ovarian function recovery has been observed. The report highlights that ovarian tissue cryopreservation after multiple ovarian surgery may have some limitations. An accurate counseling should be offered to patients who wish to preserve fertility.

 

 

 

Radiographics. 2018 Jan-Feb;38(1):309-328.

Atypical Sites of Deeply Infiltrative Endometriosis: Clinical Characteristics and Imaging Findings.

Chamié LP¹, Ribeiro DMFR¹, Tiferes DA¹, Macedo Neto AC¹, Serafini PC¹.

 

Abstract

Endometriosis is defined as the presence of endometrial tissue that is located outside the uterine cavity and associated with fibrosis and inflammatory reaction. It is a polymorphic and multifocal disease with no known cure or preventive mechanisms. Patients may be asymptomatic or may experience chronic pelvic pain, dysmenorrhea, dyspareunia, or infertility. The pelvic cavity is the most common location for endometriotic implants, which usually affect the retrocervical space, ovaries, vagina, rectosigmoid colon, bladder dome, and round ligaments. Atypical endometriosis is rare and difficult to diagnose. The most common atypical locations are the gastrointestinal tract, urinary tract, lung, umbilicus, inguinal area, breast, and pelvic nerves, as well as abdominal surgical scars. Gastrointestinal lesions are the most common extragenital manifestation, and the diaphragm is the most frequent extrapelvic site. The catamenial nature of the symptoms (occurring between 24 hours before and 72 hours after the onset of menstruation) may help suggest the diagnosis, but imaging by specialists is fundamental to evaluation. Depending on the area affected, radiography, ultrasonography, thin-section computed tomography, or magnetic resonance imaging can be used to assess suspected lesions. Because isolated extragenital endometriosis is rare, concomitant evaluation of the pelvic cavity is mandatory. Surgical excision is the only therapeutic option for definitive treatment, and comprehensive disease mapping is necessary to avoid residual disease. The authors review atypical locations for endometriosis and emphasize the most appropriate imaging protocols for investigation of various clinical manifestations. Online supplemental material is available for this article. ^©RSNA, 2018.

 

 

 

Reprod Sci. 2018 Jan 1:1933719117750751.

Therapeutic Roles of Statins in Gynecology and Obstetrics: The Current Evidence.

Zeybek B¹, Costantine M¹, Kilic GS¹, Borahay MA².

 

Abstract

INTRODUCTION:

Statins are a class of drugs, which act by inhibiting the rate-limiting enzyme of cholesterol biosynthesis (3-hydroxy-3-methyl-glutaryl-CoA reductase). The inhibition of mevalonate synthesis leads to subsequent inhibition of downstream products of this pathway, which explains the pleiotropic effects of these agents in addition to their well-known lipid-lowering effects. Accumulating evidence suggests that statins might be beneficial in various obstetric and gynecologic conditions.

METHODS:

Literature searches were performed in PubMed and EMBASE for articles with content related to statins in obstetrics and gynecology. The findings are hereby reviewed and discussed.

RESULTS:

Inhibition of mevalonate pathway leads to subsequent inhibition of downstream products such as geranyl pyrophosphate, farnesyl pyrophosphate, and geranylgeranyl pyrophosphate. These products are required for proper intracellular localization of several proteins, which play important roles in signaling pathways by regulating membrane trafficking, motility, proliferation, differentiation, and cytoskeletal organization. The pleiotropic effects of statins can be summarized in 4 categories: antiproliferative, anti-invasive, anti-inflammatory, and antiangiogenic. The growing body of evidence is promising for these agents to be beneficial in endometriosis, polycystic ovary syndrome, adhesion prevention, ovarian cancer, preeclampsia, and antiphospholipid syndrome. Although in vivo studies showed varying degrees of benefit on fibroids and preterm birth, appropriately designed clinical trials are needed to make definitive conclusions.

CONCLUSION:

Statins might play a role in the treatment of endometriosis, polycystic ovary syndrome, adhesion prevention, ovarian cancer, preeclampsia, and antiphospholipid syndrome.

 

 

 

JBRA Assist Reprod. 2018 Jan 12.

Prognostic factors in intrauterine insemination cycles.

Sicchieri F¹, Silva AB¹, Silva ACJSRE¹, Navarro PAAS¹, Ferriani RA¹, Reis RMD¹.

 

Abstract

OBJECTIVE:

This study aimed to evaluate the clinical pregnancy rate of intrauterine insemination cycles in relation to patient age, cause of infertility, ovulation induction method, number of mature follicles and sperm with progressive motility.

METHODS:

This retrospective observational study included 237 intrauterine insemination cycles performed from 2011 to 2015 at the Assisted Reproduction Service of the Hospital das Clínicas of the Ribeirão Preto Medical School, University of São Paulo. Student’s t-test was used to compare quantitative variables and the chi-square test was used to compare qualitative variables.

RESULTS:

Patient age was inversely and significantly correlated with pregnancy rates (p=0.001) (Pregnant women = 32.56±5.64 years, non-pregnant women = 36.64±5.03 years). Cause of infertility, ovulation induction method, number of mature follicles and sperm with progressive motility were not associated with pregnancy rates. The overall clinical pregnancy rate was 7.59%. In the subgroup of patients (n=102 cycles) considered ideal for intrauterine insemination (age ≤35 years, unexplained infertility, ovarian factor infertility or minimal endometriosis, and a partner with sperm count ≥2.5×106 retrieved on the day of insemination) the pregnancy rate was 12.74%.

CONCLUSION:

In the studied group, female patient age was the only variable significantly correlated with intrauterine insemination success rates.

 

 

 

Georgian Med News. 2017 Dec;(273):7-11.

ENDOMETRIOSIS: A NEW APPROACH TO ETIOLOGY AND PATHOGENESIS (REVIEW).

 

Solopova A¹, Makacarya A¹, Chukanova E¹.

 

Abstract

Endometriosis is a dyshormonal immune-dependent genetically determined disease, which appears as an endometrioid tissue that grows outside the uterine. Endometriosis is one of the most urgent problems of medicine. To date, new concepts of the endometriosis etiology and pathogenesis have been developed, but, despite their abundance, there is no unified theory. Genetic and epigenetic factors result in changes in an expression of aromatase, steroidogenic factor 1, and estrogen receptors are suggested to be the main cause of endometriosis. These changes lead to an active synthesis of various pro-inflammatory agents and a nerve growth factor, that are important in the development of pain syndrome. Also, changes in the progesterone receptor functioning and the local progesterone resistance development decrease the antiproliferative activity, apoptosis, and the anti-inflammatory substances level, as well as increase the prostaglandin, metalloproteinase activity, and level of hypoxia factors. In addition, there are shreds of evidence that endometriosis is associated with the risk of malignant tumors development, so new concepts for understanding these mechanisms are actively developing. Some of these mechanisms are discussed in this review.

 

 

 

Int J Mol Med. 2018 Mar;41(3):1469-1476.

The role of IL‑16 gene polymorphisms in endometriosis.

Matalliotakis M¹, Zervou MI², Eliopoulos E³, Matalliotaki C¹, Rahmioglu N⁴, Kalogiannidis I⁵, Zondervan K⁴, Spandidos DA⁶, Matalliotakis I¹, Goulielmos GN².

 

Abstract

Endometriosis is one of the most common gynecological diseases affecting up to 10% of the female population of childbearing age and a major cause of pain and infertility. It is influenced by multiple genetic, epigenetic and environmental factors. Interleukin‑16 (IL‑16) is a proinflammatory cytokine playing a pivotal role in many inflammatory and autoimmune diseases as well as in the pathogenesis of endometriosis. The aim of the present study was to evaluate the association of two IL‑16 gene single nucleotide polymorphisms (SNPs), rs4072111 and rs11556218, with the risk of endometriosis in women from Greece as well as to gain insight about the structural consequences of these two exonic SNPs regarding development of the disease. A total of 159 women with endometriosis (stages I‑IV) hospitalized for endometriosis, diagnosed by laparoscopic intervention and histologically confirmed, and 146 normal controls were recruited and genotyped. Subjects were genotyped using a polymerase chain reaction restriction fragment length polymorphism (PCR‑RFLP) strategy. A significant association was detected regarding the GG and GT genotype as well as ‘G’ allele of rs11556218 in patients with endometriosis. The rs4072111 SNP of the IL‑16 gene was not found to be associated with an increased susceptibility to endometriosis either for all patients (stages I‑IV) or for stage III and IV of the disease only. Our results demonstrated that rs11556218 is associated with endometriosis in Greek women, probably by resulting in the aberrant expression of IL‑16, as suggested by the bioinformatics analysis conducted on the SNP‑derived protein sequences, which indicated a possible association between mutation and functional modification of Pro‑IL‑16.

 

 

 

J Mol Endocrinol. 2018 Jan 12.

Dysfunctional Signaling Underlying Endometriosis: Current State of Knowledge.

Cho YJ¹, Lee SH², Park JW³, Han M⁴, Park MJ⁵, Han SJ⁶.

 

Abstract

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It affects approximately 5-10% of women of reproductive age. Endometriosis is associated with dysmenorrhea, dyspareunia and, often, severe pelvic pain. In addition to pain, women with endometriosis often experience infertility. Defining the molecular etiology of endometriosis is a significant challenge for improving the quality of women’s lives. Unfortunately, the pathophysiology of endometriosis is not well understood. Here, we summarize the potential causative factors of endometriosis in the following three categories: 1) dysregulation of immune cells in the peritoneal fluid and endometriotic lesions; 2) alteration of apoptotic signaling in retrograde menstrual tissue and cytotoxic T cells involved in endometriosis progression; and 3) dysregulation of oxidative stress. Determining the molecular etiology of these dysregulated cellular signaling pathways should provide crucial clues for understanding initiation and progression of endometriosis. Moreover, improved understanding should suggest new molecular therapeutic targets that could improve the specificity of endometriosis treatments and reduce the side effects associated with current approaches.

 

 

 

Rev Esp Enferm Dig. 2018 Jan 15;110.

Bowel obstruction secondary to deep infiltrating endometriosis of the ileum.

Ávila Vergara MA¹, Sánchez Carrillo V², Peraza Garay F³.

 

Abstract

Deep infiltrating endometriosis (DIE) of the ileum is an uncommon lesion that may be severe in its clinical presentation. Its diagnosis is challenging in the absence of a gynecological history of endometriosis and because of its anatomical location. We read the article by Sánchez, Candel, and Albarracín, and now report an additional case that was managed urgently.

 

 

 

Curr Med Chem. 2018 Jan 10.

The delicate balance between the good and the bad IL-1 proinflammatory effects in endometriosis.

Sikora J¹, Ferrero S², Mielczarek-Palacz A¹, Kondera-Anasz Z¹.

 

Abstract

BACKGROUND:

Endometriosis is an inflammatory gynaecological disease with an associated chronic inflammation. Interleukin(IL)-1 is one of the most important immune and proinflammatory factors, produced mainly by monocytes and macrophages. Studies indicate the role of the cytokine from IL-1 family in endometrium-related disorders, particularly in endometriosis.

METHODS:

The information about the impact of cytokine from IL-1 cytokine family on the pathogenesis and development of endometriosis was obtained with an electronic literature search based on the PubMed and Medline databases, spanning the period of January 1950 to July 2017 and includes associated references in the published studies.

RESULTS:

The impairment of the IL-1 family cytokine-network may lead to changes in the activation of immune system in the peritoneal cavity of women with endometriosis. The aberrant ectopic endometrial cell properties of adhesion, implantation and proliferation may be the result of a reduced suppressive capacity controlling the IL-1. The imbalance between IL-1α, pro-IL-1β, mature IL-1β and sIL-1R2 and sIL-1RAcP in the peritoneal fluid and serum of women with endometriosis may be linked to the ability of transforming an acute inflammation into a chronic one. Despite the fact that peritoneal macrophages secrete more anti-inflammatory IL-1Ra and less proinflammatory IL-1 in the peritoneal cavity in affected women, the inflammation still develops.

CONCLUSIONS:

This observation clearly suggested a significant inadequacy in the specific regulatory mechanisms of IL-1 activity at the peritoneal cavity level. The imbalance between all studied cytokines in endometriosis may escalate peritoneal inflammation and, in consequence, develop endometriosis.

 

 

 

Evid Based Complement Alternat Med. 2017;2017:5416423.

Meta-Analysis of Chinese Traditional Medicine Bushen Huoxue Prescription for Endometriosis Treatment.

Shan J^1,2, Cheng W², Zhai DX², Zhang DY², Yao RP², Bai LL², Cai ZL³, Liu YH⁴, Yu CQ².

 

Abstract

OBJECTIVES:

To evaluate the efficacy and safety of Bushen Huoxue prescription (BSHXP) for endometriosis.

METHODS:

A meta-analysis was performed, and studies were searched from the seven databases from the date of database establishment to April 30, 2017. Randomized controlled trials (RCTs) that explored the efficacy and safety of BSHXP for patients with endometriosis were included. Two assessors independently reviewed each trial. The Cochrane Risk of Bias assessment tool was used for quality assessment.

RESULTS:

In the 13 included studies, the total effectiveness rates of BSHXP were higher than those of Western medicine (RR, 1.55; 95% CI, 1.03-2.32; P = 0.04), but the dysmenorrhea alleviation rates of the two treatments did not significantly differ (RR, 1.28; 95% CI, 0.70-2.34; P = 0.42). The pregnancy rates of BSHXP were also higher than those of hormone therapy (RR, 1.99; 95% CI, 1.17-3.39; P = 0.01). However, whether BSHXP is more effective than Western medicine in diminishing endometriotic cyst remains unknown.

CONCLUSIONS:

Our study provides evidence that BSHXP is effective and safe for endometriosis, but this evidence is inconclusive because of the low methodological quality of the included RCTs. Our findings suggest that BSHXP is an alternative drug for endometriosis, but it should be further examined in future clinical research.

 

 

 

Int J Fertil Steril. 2018 Apr;12(1):88-90.

Conservative Management of Ovarian Fibroma in A Case of Gorlin-Goltz Syndrome Comorbid with Endometriosis.

Khodaverdi S¹, Nazari L², Mehdizadeh-Kashi A¹, Vahdat M¹, Rokhgireh S¹, Farbod A³, Tajbakhsh B¹.

 

Abstract

Ovarian fibromas are the most common benign solid ovarian tumors, which are often difficult to diagnose preoperatively. Ovarian fibromas, especially in bilateral cases, may be cases of Gorlin-Goltz syndrome (GGS), a rare autosomal dominant disorder with predisposition to basal cell carcinomas (BCCs) and other various benign and malignant tumors. This case report describes a 25 year-old female with GGS, bilateral ovarian fibroma, endometriosis and septated uterus, which was referred to the Gynecology Clinic of Rasoul-e-Akram Hospital in October 2016. This patient had facial asymmetry due to recurrent odontogenic keratocysts. In young cases of ovarian fibromas as reported here, conservative surgical management can preserve ovarian function and fertility. These patients must be followed up by a multidisciplinary team and submitted to periodic tests.

 

 

 

Epigenomics. 2018 Jan 16.

Circular RNA expression in ovarian endometriosis.

Shen L¹, Zhang Y¹, Zhou W¹, Peng Z¹, Hong X¹, Zhang Y¹.

 

Abstract

AIM:

Circular RNAs (circRNAs) with miRNA response elements (MREs) could function as competing endogenous RNA (ceRNA) in regulating gene expression. This study was carried out to identify the expression profile and role of circRNAs in endometriosis.

MATERIALS & METHODS:

Microarray assay was performed in four paired ovarian endometriomas and eutopic endometrium, followed by quantitative real-time RT-PCR in 24 paired samples. Bioinformatical algorithms were used to predict MREs, as well as ceRNA and KEGG pathway analysis.

RESULTS:

We identified 262 upregulated and 291 downregulated circRNAs, binding with 1225 MREs. The ceRNA network included 122 miRNAs and 137 mRNAs, which are involed in nine pathways.

CONCLUSION:

CircRNAs are differentially expressed in endometriosis, which might be related with pathogenesis of endometriosis.

 

 

 

Eur J Med Chem. 2018 Jan 2;145:413-424.

Synthesis and biological evaluation of 3-(2-aminoethyl) uracil derivatives as gonadotropin-releasing hormone (GnRH) receptor antagonists.

Kim SM¹, Lee M¹, Lee SY², Lee SM², Kim EJ², Kim JS³, Ann J⁴, Lee J⁵, Lee J⁶.

 

Abstract

We investigated a series of uracil analogues by introducing various substituents on the phenyl ring of the N-3 aminoethyl side chain and evaluated their antagonistic activity against human gonadotropin-releasing hormone (GnRH) receptors. Analogues with substituents at the ortho or meta position demonstrated potent in vitro antagonistic activity. Specifically, the introduction of a 2-OMe group enhanced nuclear factor of activated T-cells (NFAT) inhibition up to 6-fold compared to the unsubstituted analogue. We identified compound 12c as a highly potent GnRH antagonist with moderate CYP inhibition. Compound 12c showed potent and prolonged LH suppression after a single dose was orally administered in castrated monkeys compared to a known antagonist, Elagolix. We believe that our SAR study offers useful insights to design GnRH antagonists as a potential treatment option for endometriosis.

 

 

 

Aust N Z J Obstet Gynaecol. 2018 Jan 16.

Response to: Yazdani A. Surgery or in vitro fertilisation: The simplicity of this question belies its complexity. When all you have is a hammer, everything looks like a nail.

Abbott J¹.

 

Abstract

This is perhaps the most apt mantra of IVF (in vitro fertilisation) as a treatment in Australasia in this day and age. It is also important to note the truth in the identification of IVF being low skill-based, largely independent of the practitioner, but more importantly costly, and with few exceptions, only available in the private sector. Such revelations really require a rethink of the entire reproductive endocrinology and infertility (CREI) subspecialty. In fact, if there is only one solution to all fertility problems – that of the ‘effective IVF procedure’ – why not do away completely with the clinician and simply have nurse practitioners who oversee the identified issue of an individual or couple wanting a pregnancy? This in conjunction with the outstanding scientific advances that led to the initiation and promulgation of IVF really would reduce costs by cutting out the unnecessary clinician middle-person who is unimportant in the equation. It may be that such cost reduction, the disbandment of the irrelevant subspecialty and protocol-driven, high-quality fertility checklists would allow this to be a publically accessible service for all, not just those who can afford it.

 

 

 

Dis Colon Rectum. 2018 Feb;61(2):221-229.

Pelvic Pain and Quality of Life Before and After Laparoscopic Bowel Resection for Rectosigmoid Endometriosis: A Prospective, Observational Study.

Riiskjær M¹, Forman A¹, Kesmodel US², Andersen LM³, Ljungmann K⁴, Seyer-Hansen M¹.

 

Abstract

BACKGROUND:

Surgery for rectosigmoid endometriosis carries a substantial risk of short- and long-term complications, which has to be counterbalanced against the potential effect of the procedure. Prospective data are scarce in the field of deep infiltrating endometriosis surgery.

OBJECTIVE:

The study aimed to assess pelvic pain and quality of life before and after laparoscopic bowel resection for rectosigmoid endometriosis.

DESIGN:

The study involved prospectively collected data regarding pelvic pain and quality of life before and after surgery.

SETTINGS:

It was conducted at a tertiary endometriosis referral unit at Aarhus University Hospital.

PATIENTS:

A total of 175 women were included.

INTERVENTION:

Patients underwent laparoscopic bowel resection for endometriosis.

MAIN OUTCOME MEASURES:

Questionnaires for pain (Numerical Rating Scale) and quality of life (RAND Short Form-36) were answered before and 1 year after surgery. Data on analgesic and hormone treatment were collected. Preoperative and postoperative pelvic pain and quality-of-life scores were compared, and risk factors for improvement/worsening were identified.

RESULTS:

A total of 97.1% of the women completed the 1-year follow up. A significant decrease (p = 0.0001) was observed on all pelvic pain parameters. Most profound was the decrease in dyschezia. A significant improvement on all quality-of-life scores was observed (p = 0.0001). A surgical complication did not have a negative impact on outcome 1 year after surgery. The postoperative outcome was not related to the type of surgery.

LIMITATIONS:

This is an observational study without a control group. Risk factor data should be interpreted with caution, because the study was relatively underpowered for some of the rare outcomes.

CONCLUSIONS:

A significant and clinically relevant improvement in pelvic pain and quality of life 1 year after laparoscopic bowel resection for endometriosis was found. We strongly recommend surgery for rectosigmoid endometriosis that is unresponsive to conservative treatment. See Video Abstract at http://links.lww.com/DCR/A472.

 

 

Ann Ital Chir. 2017;88:519-525.

Unexpected findings in the routine histopathological examinations of appendectomy specimens A retrospective analysis of 1,970 patients.

Dincel O, Goksu M, Turk BA, Pehlivanoglu B, Isler S.

 

Abstract

INTRODUCTION:

Diseases and tumors of the appendix vermiformis are very rare, except for acute appendicitis. This study aimed to examine rare findings in the histopathologic examinations of specimens of patients undergoing appendectomy due to the diagnosis of acute appendicitis.

METHODS:

The files of 1,970 patients undergoing appendectomy due to the diagnosis of acute appendicitis between March 2012 and March 2016 were retrospectively investigated. Rare findings were found in 59 (3%) patients, and these were evaluated in detail. Patients’ age, gender, pathology reports, and post-operation follow-ups were recorded.

RESULTS:

The rare histopathological findings of 59 patients were examined. Of these, 31 were female (52.5%) and 28 were male (47.5%). The average age was 33.1±18.2 years. The unusual findings were as follows: 16 Fibrous obliteration, 11 Enterobius vermicularis, 2 Schistosomiasis, 3 Appendiceal neuroma, 2 Granulomatous appendicitis, 1 Crohn’s disease, 3 Chronic appendicitis, 1 Endometriosis, 2 Hyperplastic polyps, 9 Mucinous cystadenoma (+mucocele), 8 Carcinoid tumors and 1 Lymphoma. All of the malignant tumors were localized in the distal end of the appendix and all of the patients were treated with appendectomy. Patients with parasitic diseases also underwent anthelmintic treatment, while chemotherapy was administered to the patient with lymphoma. All of the patients diagnosed with malignancy were alive reported no problems at their follow-ups.

CONCLUSION:

Although all of the appendectomy samples were normal macroscopically, data from this study suggest that all specimens should be sent for routine investigation.

 

 

 

 

Ann Surg Oncol. 2018 Jan 16.

Prospective Comparative Study of Laparoscopic Narrow Band Imaging (NBI) Versus Standard Imaging in Gynecologic Oncology.

Aloisi A¹, Sonoda Y¹, Gardner GJ¹, Park KJ², Elliott SL³, Zhou QC⁴, Iasonos A⁴, Abu-Rustum NR⁵.

 

Abstract

BACKGROUND:

Narrow band imaging (NBI) is an optic filtration enhancement for endoscopy that uses two wavelengths of light (415 and 540 nm) to highlight superficial microvascular patterns. It has been successfully utilized to improve identification of lesions with abnormal vasculature, which is associated with endometriosis and endometrial cancer. Case studies suggest it may also facilitate surgical staging of gynecologic cancer, which is critical in determining appropriate adjuvant therapies. A technology that enhances the ability to identify metastatic disease during minimally invasive surgery (MIS) could make an important difference in patient outcomes.

METHODS:

A prospective comparative study was conducted to evaluate patients with clinical indication for diagnostic or operative laparoscopy. All received white light imaging followed by NBI during the same procedure. Suspicious lesions were examined and photographed, using both modalities, before excision. The two techniques were compared. Positive predictive value, negative predictive value, and diagnostic accuracy in identifying histologically confirmed metastatic lesions were assessed, using appropriate statistical methods.

RESULTS:

Of 124 patients enrolled in the study, 94 were evaluable; 30 did not undergo MIS and were therefore excluded. A significantly higher number of peritoneal abnormalities were identified with NBI versus white light imaging (P = 0.0239). However, no statistically significant difference (P = 0.18, patient level) was observed in identification of histologically confirmed metastatic disease.

CONCLUSIONS:

NBI imaging provides a unique contrast between peritoneal surface and microvascular patterns. However, the results of this study suggest that NBI-enhanced laparoscopy does not provide superior detection of peritoneal surface malignancy compared with standard white light high-definition laparoscopy.

 

 

 

 

Arch Gynecol Obstet. 2018 Jan 17.

The effect of surgical management of endometrioma on the IVF/ICSI outcomes when compared with no treatment? A systematic review and meta-analysis.

Nickkho-Amiry M¹, Savant R², Majumder K², Edi-O’sagie E², Akhtar M².

 

Abstract

OBJECTIVE:

To assess the impact of surgical management of endometrioma on the outcome of assisted reproduction treatment (ART).

DESIGN:

A systematic review and meta-analysis.

SETTING:

Department of reproductive medicine at teaching university hospital, UK.

PATIENTS:

Subfertile women with endometrioma undergoing ART.

INTERVENTIONS:

Surgical removal of endometrioma or expectant management.

MAIN OUTCOME MEASURES:

Clinical pregnancy rate, pregnancy rate, live birth rate, number of oocytes retrieved and number of embryos available and ovarian response to gonadotrophins.

RESULTS:

An extensive search of electronic databases for articles published from inception to September 2016 yielded 11 eligible studies for meta-analysis. Meta-analysis was conducted comparing surgery versus no treatment of endometrioma. There were no significant differences in pregnancy rate per cycle, clinical pregnancy rate and live birth rate between women who underwent surgery for endometrioma and those who did not.

CONCLUSION:

Current evidence suggests that women with endometriosis-related infertility have similar cycle outcomes to other patients going through ART. It is pertinent for clinicians to assess the risks of surgical intervention on ovarian reserve prior to initiating therapy.

 

 

 

 

BMJ Case Rep. 2018 Jan 17;2018.

Early intrauterine pregnancy during major surgery: the importance of preoperative assessment and advice.

Pontré JC¹, McElhinney B^1,2.

 

Abstract

We present a case of a live birth occurring post radical laparoscopic excision of endometriosis, hysteroscopy, curettage and test of tubal patency in the presence of an early intrauterine gestation.

 

 

 

Biomed Res Int. 2017;2017:1514029.

From Clinical Symptoms to MR Imaging: Diagnostic Steps in Adenomyosis.

Krentel H¹, Cezar C², Becker S³, Di Spiezio Sardo A⁴, Tanos V⁵, Wallwiener M⁶, De Wilde RL².

 

Abstract

Adenomyosis or endometriosis genitalis interna is a frequent benign disease of women in fertile age. It causes symptoms like bleeding disorders and dysmenorrhea and seems to have a negative effect on fertility. Adenomyosis can be part of a complex genital and extragenital endometriosis but also can be found as a solitary uterine disease. While peritoneal endometriosis can be easily diagnosed by laparoscopy with subsequent biopsy, the determination of adenomyosis is difficult. In the following literature review, the diagnostic methods clinical history and symptoms, gynecological examination, 2D and 3D transvaginal ultrasound, MRI, hysteroscopy, and laparoscopy will be discussed step by step in order to evaluate their predictive value in the diagnosis of adenomyosis.

 

 

 

J Minim Invasive Gynecol. 2018 Jan 15.

The Isolated Ovarian Endometrioma: a History between Myth and Reality.

Exacoustos C¹, Giovanna F², Pizzo A², Morosetti G¹, Lazzeri L³, Centini G², Piccione E¹, Zupi E¹.

 

Abstract

STUDY OBJECTIVE:

To assess the association between ovarian endometriomas detectable at transvaginal ultrasound (TVS) and other specific extra-ovarian lesions including adhesions, deep infiltrating endometriosis, and adenomyosis.

DESIGN:

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

SETTING:

Two university hospitals.

PATIENTS:

255 symptomatic women with at least one ovarian endometrioma found on ultrasound after presentation with pain or irregular menstruation.

INTERVENTIONS:

Patients underwent TVS followed by either medical or surgical treatment.

MEASUREMENTS AND MAIN RESULTS:

Two hundred and fifty-five women, aged 20 to 40 years, underwent TVS and were found to have at least one endometrioma with a diameter > 20 mm. Associated sonographic signs of pelvic endometriosis (adhesions, deep infiltrating endometriosis, and adenomyosis) were recorded, and a subgroup of patients (n = 50) underwent laparoscopic surgery within 3 months of TVS. Mean endometrioma diameter was 40.0 ± 18.1 mm, and bilateral endometriomas were observed in 65 patients (25.5%). Transvaginal ultrasound showed posterior rectal deep infiltrating endometriosis in 55 patients (21.5%) and a thickening of at least one uterosacral ligament in 93 patients (36.4%). One hundred eighty-six patients (73%) had adhesions, and 134 patients (53%) showed signs of myometrial adenomyosis on TVS. Thirty-eight patients (15%) exhibited only a single isolated endometrioma with a mobile ovary and no other signs of pelvic endometriosis/adenomyosis at TVS.

CONCLUSION:

Ovarian endometriomas are indicators for pelvic endometriosis and are rarely isolated. Particularly, left endometriomas were found to be associated with rectal deep infiltrating endometriosis and left uterosacral ligament localization, and bilateral endometriomas correlated with adhesions and pouch of Douglas obliteration while no correlation was found between endometrioma size and deep infiltrating endometriosis. Determining appropriate management, whether clinical or surgical, is critical for ovarian endometriomas and concomitant adhesions, endometriosis, and adenomyosis in patients desiring future fertility.

 

 

 

 

J Nepal Health Res Counc. 2018 Jan 1;15(3):292-294.

Caesarean Scar Endometriosis.

Sedhain N¹, Dangal G¹, Karki A¹, Pradhan HK¹, Shrestha R¹, Bhattachan K¹, Poudel R¹, Bajracharya N¹.

 

Abstract

Endometriosis is a common benign gynecologic disorder defined as the presence of endometrial glands and stroma outside of the normal location. The overall prevalence is 8-15% in women of reproductive age group. Scar endometriosis is a rare disease, and is difficult to diagnose. It is commonly seen following obstetrical and gynecological surgeries. The symptoms are non-specific, typically involving abdominal wall pain at the incision site at the time of menstruation and palpable tender mass in the incision site. The diagnosis is frequently made only after excision of the diseased tissue and its histological analysis. We present here a case of abdominal wall scar endometriosis in a woman who had undergone a caesarean section four years ago. Surgical excision led to the diagnosis of scar endometriosis. The pathogenesis, diagnosis and treatment of this rare condition are discussed.

 

 

 

J Minim Invasive Gynecol. 2018 Jan 18.

Recurrence in Deep Infiltrating Endometriosis: a Systematic Review of the Literature.

Ianieri MM¹, Mautone D², Ceccaroni M².

 

Abstract

Deep infiltrative endometriosis (DIE) is an enigmatic disease that typically impacts the rectovaginal septum, uterosacral ligaments, pararectal space, and vesicouterine fold but can involve the rectum, sigma, ileum, ureters, diaphragm, and other less common sites. Surgery is the treatment of choice as medical management alone commonly fails in controlling the symptoms, although recurrence is very high following surgical treatment. The goal of the current study was to review recurrence rates and identify risk factors related to recurrence following surgery for DIE. The review involved searching the Cochrane Library, PubMed, and Google Scholar for relevant articles in accordance with the study’s inclusion criteria; 45 studies were considered suitable. The results showed a wide heterogenity regarding DIE recurrence, owing to inconsistent recurrence definitions and follow-up length. Younger age and high body mass index were found to be risk factors for DIE recurrence. Lack of complete surgical excision was another independent risk factor for recurrence of disease. In conclusion, there is a need for prospective studies and a more homogeneous standard for surgical treatment of DIE.

 

 

 

J Endometr Pelvic Pain Disord. 2014 Apr-Jun;6(2):67-119.

Peripheral and endometrial dendritic cell populations during the normal cycle and in the presence of endometriosis.

Maridas DE¹, Hey-Cunningham AJ¹, Ng CHM¹, Markham R¹, Fraser IS¹, Berbic M¹.

 

Abstract

BACKGROUND:

Dysfunctional immune response may be implicated in endometriosis pathogenesis, and dendritic cells (DC) may play greater roles in this response than previously recognized. This study set out to evaluate peripheral blood and endometrial DC population changes in the presence and absence of endometriosis pathology.

METHODS:

Endometrial (n = 83) and peripheral blood samples (n = 30) were subjected to immunohistochemical techniques and flow cytometry, respectively, to assess DC populations in women with and without endometriosis. Three circulating DC subsets (MDC1, MDC2 and PDC, expressing CD1c, CD303 and CD141), and late-stage mature endometrial DCs (using DC-LAMP antibody) were investigated.

RESULTS:

A highly significant reduction in CD1c intensity on MDC1 populations in peripheral blood was observed between normal cycle proliferative and menstrual phases (p = 0.025), but not in women with endometriosis, in whom CD1c intensity was markedly increased at the time of menstruation (p = 0.05). A significant reduction in peripheral blood MDC2 (p = 0.016) and apparent reduction in endometrial DC-LAMP+ DC (trend, p = 0.062) were observed in women with endometriosis compared with controls, consistent with our preliminary DC data.

CONCLUSIONS:

Cyclical variation in endometrial and circulating DC populations appears to be crucial during normal menstrual cycles and in the establishment of pregnancy. In endometriosis, circulating and endometrial DC populations are significantly dysregulated at a number of levels, and are likely to contribute to inefficient immunological targeting of endometrial fragments shed at menstruation, facilitating their survival and establishment of endometriosis.

 

 

 

Reprod Biol Endocrinol. 2018 Jan 22;16(1):4.

Integration analysis of microRNA and mRNA paired expression profiling identifies deregulated microRNA-transcription factor-gene regulatory networks in ovarian endometriosis.

Zhao L^1,2, Gu C^1,3, Ye M¹, Zhang Z¹, Li L¹, Fan W⁴, Meng Y⁵.

 

Abstract

BACKGROUND:

The etiology and pathophysiology of endometriosis remain unclear. Accumulating evidence suggests that aberrant microRNA (miRNA) and transcription factor (TF) expression may be involved in the pathogenesis and development of endometriosis. This study therefore aims to survey the key miRNAs, TFs and genes and further understand the mechanism of endometriosis.

METHODS:

Paired expression profiling of miRNA and mRNA in ectopic endometria compared with eutopic endometria were determined by high-throughput sequencing techniques in eight patients with ovarian endometriosis. Binary interactions and circuits among the miRNAs, TFs, and corresponding genes were identified by the Pearson correlation coefficients. miRNA-TF-gene regulatory networks were constructed using bioinformatic methods. Eleven selected miRNAs and TFs were validated by quantitative reverse transcription-polymerase chain reaction in 22 patients.

RESULTS:

Overall, 107 differentially expressed miRNAs and 6112 differentially expressed mRNAs were identified by comparing the sequencing of the ectopic endometrium group and the eutopic endometrium group. The miRNA-TF-gene regulatory network consists of 22 miRNAs, 12 TFs and 430 corresponding genes. Specifically, some key regulators from the miR-449 and miR-34b/c cluster, miR-200 family, miR-106a-363 cluster, miR-182/183, FOX family, GATA family, and E2F family as well as CEBPA, SOX9 and HNF4A were suggested to play vital regulatory roles in the pathogenesis of endometriosis.

CONCLUSION:

Integration analysis of the miRNA and mRNA expression profiles presents a unique insight into the regulatory network of this enigmatic disorder and possibly provides clues regarding replacement therapy for endometriosis.

 

 

 

 

 

Aust N Z J Obstet Gynaecol. 2018 Jan 23.

The levonorgestrel-releasing intrauterine system is associated with a reduction in dysmenorrhoea and dyspareunia, a decrease in CA 125 levels, and an increase in quality of life in women with suspected endometriosis.

Yucel N¹, Baskent E¹, Karamustafaoglu Balci B¹, Goynumer G².

 

Abstract

BACKGROUND AND AIMS:

The aim of this study was to investigate the effectiveness of a levonorgestrel-releasing intrauterine device (LNG-IUS) in the symptomatic relief of pain in women with endometriosis and additionally, to assess the changes in women’s life quality and serum cancer antigen (CA) 125 levels.

MATERIALS AND METHODS:

All women who had an LNG-IUS inserted for the treatment of dysmenorrhea, chronic pelvic pain or both for more than six months over a two-year period were included in the study. Each woman was asked to complete questionnaires of the Short Form-36 and visual analogue scales (VAS) in the first visit and the third, sixth, ninth and twelfth months after the LNG-IUS insertion. CA 125 levels were measured at each visit.

RESULTS:

Forty-five women were included in the study. At the end of 12 months, mean dysmenorrhoea VAS score decreased from 6.13 to 2.88, mean dsyspareunia VAS score from 6.04 to 2.61 and CA 125 level from 50.67 to 22.45. Endometriomas reduced in size in six women (mean size decreased from 31 to 20 mm) and disappeared in three.

CONCLUSIONS:

Several favourable outcomes were found following LNG-IUS insertion: (i) dyspareunia and dysmenorrhoea were clearly reduced; (ii) the size of endometriomas were decreased; (iii) CA 125 levels significantly decreased; (iv) a few women experienced the typical systemic adverse effects of progestogens; however, LNG-IUS-related adverse events were generally tolerable and the discontinuation rate was as low as 6.66% (3/45).

 

 

 

J Obstet Gynaecol Res. 2018 Jan 23.

Treatment of premenstrual mood changes in a patient with schizophrenia using dienogest: A case report.

Kamada Y¹, Sakamoto A^1,2, Kotani S^1,2, Masuyama H^1,2.

 

Abstract

Dienogest is a fourth-generation progestin that is used for the treatment of endometriosis. We report a case of premenstrual mood changes in a patient with schizophrenia who was unresponsive to conventional treatment but successfully managed with dienogest. A 37-year-old Japanese woman with schizophrenia was referred to our hospital and diagnosed with premenstrual exacerbation of schizophrenia or coexisting premenstrual dysphoric disorder with schizophrenia. She had already taken maximal doses of selective serotonin reuptake inhibitors and combined oral contraceptives produced intolerable side effects. Gonadotropin-releasing hormone agonist treatment was effective but was not suitable for long-term use. Dienogest was initiated to treat pelvic endometriosis and produced subsequent improvements in mental status. The patient was able to return to work and did not indicate any adverse effects. This case suggests that dienogest may be useful for managing premenstrual mood changes in patients with schizophrenia, that it can be safely administered over long periods of time.

 

 

 

Ann R Coll Surg Engl. 2018 Jan 24:e1-e2.

Ileocecal intussusception extending to left colon due to endometriosis.

Rodriguez-Lopez M¹, Bailon-Cuadrado M¹, Tejero-Pintor FJ¹, Choolani E¹, Fernandez-Perez G², Tapia-Herrero A³.

 

Abstract

Bowel involvement in endometriosis is uncommon and is most frequently located in the sigmoid colon and the rectum. We present a case in a 37-year-old woman of a cecal endometrioid mass complicated with an ileocolic intussusception which extended beyond the splenic colon flexure. Careful manual extraction allowed a reduction of the intussusceptum, followed by an oncological right hemicolectomy. The patient suffered postoperative ileus, which was spontaneously solved. Intussusception is infrequent in the adult population and usually involves the small bowel. The great majority of ileocolic intussusceptions have a malignant origin (cecal adenocarcinoma). An endometriotic mass located at the cecum as the lead point for ileocolic intussusception is an extremely rare presentation. On reviewing the literature, we found only 13 reports with no other cases extending beyond the splenic flexure, as occurred in our patient.