Ger Med Sci. 2010 Feb 10;8:Doc03.
Medical Center of Central Georgia, Macon, GA 31201, USA. [email protected]
Endometriosis may in severe cases lead to obliteration of the anterior and/or posterior cul-de-sacs in the female pelvis. The anterior cul-de-sac is generally less commonly affected. This type of cases usually presents a challenge for the operating surgeon, whether via open route or through laparoscopy. In this paper, we present an illustrative case and explain our technique for dealing with a scarred and totally obliterated anterior cul-de-sac because of endometriosis during total laparoscopic hysterectomy.
J Proteome Res. 2010 Mar 26. [Epub ahead of print]
Prince Henry’s Institute of Medical Research, Department of Obstetrics and Gynecology, Monash University, and Monash IVF, Clayton, Victoria, 3168, Australia.
Endometriosis is a chronic disorder affecting approximately 10% of women in whom endometrial tissue forms painful lesions outside the uterus. It has a major impact on their physical, mental and social well-being but has no known cure, and there is no nonsurgical means of diagnosis. We have used a proteomic approach to identify proteins with altered abundance in the eutopic endometrium of endometriosis patients in the midsecretory phase of the menstrual cycle. 2D-differential in gel electrophoresis (DIGE) and mass spectrometry identified 20 proteins that were present at different levels in endometriosis patients (p < 0.05), many of which have not previously been associated with endometriosis. Protein abundance changes did not correlate well with published gene array data, emphasizing the extensive post-translational modification that occurs in this tissue. Abundance or localization changes in endometrial tissue were validated by immunohistochemistry and Western blotting for three proteins, vimentin (VIM), peroxiredoxin 6 (PRDX6), and ribonuclease/angiogenin inhibitor 1 (RNH1), while observed changes could not be confirmed for coronin 1A (CORO1A) or transgelin (TAGLN2). In addition, multiple charge and size isoforms were observed for PDRX6 and vimentin (VIM), and an additional PDRX6 isoform was observed in endometriosis patients that was below the level of detection in healthy women. Biological pathway analysis identified that cytoskeletal remodeling via keratin intermediate filaments, processing of the cystic fibrosis transmembrane receptor (CFTR), the glucocorticoid receptor subunit alpha (GCR), and heat shock factor 1 (HSF1) were all significantly over-represented features in endometriosis patients. This study highlights the highly dynamic nature of endometrial tissue and suggests that considerable post-translational modification of proteins is a key factor in the pathology of endometriosis.
Tissue Antigens. 2010 Jan;75(1):65-7.
Department of Molecular Life Science, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, Japan.
Endometriosis is a female disorder characterized by the presence of uterine endometrial tissue in ectopic loci. Previous studies reported a higher prevalence of particular human leukocyte antigen (HLA) in endometriosis. In order to confirm the association between endometriosis and the HLA region, 15 polymorphic microsatellite markers distributed in the HLA class II to class III region were subjected to association analysis by polymerase chain reaction (PCR)-based DNA typing of 89 patients and 136 healthy controls. Statistical analysis of the allelic frequency at each microsatellite locus showed that there were no statistically significant differences in the allele frequency distributions between the cases and controls. This finding suggests that the etiology of endometriosis does not involve the HLA class II genomic region and a portion of class III genomic region in the Japanese population.
PLoS One. 2010 Feb 25;5(2):e9401.
Department of Medicine, Université de Montréal, Montréal, Quebec, Canada. [email protected]
BACKGROUND: We have examined the genomic distribution of large rare autosomal deletions in a sample of 440 parent-parent-child trios from the Quebec founder population (QFP) which was recruited for a study of Attention Deficit Hyperactivity Disorder. METHODOLOGY/PRINCIPAL FINDINGS: DNA isolated from blood was genotyped on Illumina Hap300 arrays. PennCNV combined with visual evaluation of images generated by the Beadstudio program was used to determine deletion boundary definition of sufficient precision to discern independent events, with near-perfect concordance between parent and child in about 98% of the 399 events detected in the offspring; the remaining 7 deletions were considered de novo. We defined several genomic regions of very high deletion frequency (‘hotspots’), usually of 0.4-0.6 Mb in length where independent rare deletions were found at frequencies of up to 100 fold higher than the average for the genome as a whole. Five of the 7 de novo deletions were in these hotspots. The same hotspots were also observed in three other studies on members of the QFP, those with schizophrenia, with endometriosis and those from a longevity cohort. CONCLUSIONS/SIGNIFICANCE: Nine of the 13 hotspots carry one gene (7 of which are very long), while the rest contain no known genes. All nine genes have been implicated in disease. The patterns of exon deletions support the proposed roles for some of these genes in human disease, such as NRXN1 and PARKIN, and suggest limited roles or no role at all, for others, including MACROD2 and CTNNA3. Our results also offer an alternative interpretation for the observations of deletions in tumors which have been proposed as reflecting tumor-suppressive activity of genes in these hotspots.
Rev Med Chir Soc Med Nat Iasi. 2009 Jul-Sep;113(3):799-802.
Clinical and paraclinical diagnosis of pelvic endometriosis. Clinical study.[Article in Romanian]
Facultatea de Medicină, Departamentul de Obstetrică Ginecologie, Universitatea de Medicină si Farmacie “Gr.T. Popa” Iaşi.
Pelvic endometriosis is a difficult diagnosis in gynecological practice, due to different symptoms and advanced stages in which the patients arrive to us. MATERIAL AND METHOD: This study retrospectively analyses 73 cases of confirmed endometriosis admitted in our service during 5 years. We gathered information about their clinical data and diagnosis, and intraoperative laparoscopic or laparotomic findings. RESULTS: The majority of our cases were in the 3rd age decade (52%). The clinical symptoms were: infertility (34%), pelvic or abdominal pain (71%), vaginal bleeding (14%), or an accidental finding after laparotomy or laparoscopy for other reasons (7%). The intraoperative evaluation of the cases showed: endometrial genital foci in 59%, with half of them located at the ovary; extragenital sites in 30 cases (bladder–4 cases, Douglas pouch 19 cases, abdominal wall 5 cases, para-cervix 2 cases). Associated pathology included: adhesions in 46%, retroverted uterus in 15%, ovarian non endometriotic cysts (18%), polycystic ovaries (12%) and tubal pathology (6%). CONCLUSION: Our study confirm the difficulty of a clinical diagnostic of endometriosis, but the main symptoms remain infertility and pelvic-abdominal pain. The laparoscopy or laparotomy were the main tools for the diagnostic and management of our cases.
Nurs Stand. 2010 Jan 20-26;24(20):64.
J Clin Ultrasound. 2010 May;38(4):209-11.
Department of Gynaecology Perinatology and Human Reproduction, University of Florence, Viale Morgagni, 85, 50100 Florence, Italy.
We present a rare case of endometriosis of the cervix. Transvaginal sonography showed a 35-mm cyst in the cervix with diffuse, low-level internal echoes. Transvaginal sonography-guided aspiration with a 17-gauge needle was performed, yielding a very thick chocolate-colored fluid. Cytological examination of the fluid revealed the presence of endometrial cells. Symptoms resolved after aspiration and no recurrence has developed.
J Endocrinol Invest. 2010 Feb 24. [Epub ahead of print]
Department of Forensic Medicine, Zhongshan Medical College, Sun Yat-sen University, Guangzhou 510080, China.
Objective:To research the relationship between polymorphism of trinucleotide (CAG)n repeat alleles of the Exon 1 of androgen receptor gene and women with polycystic ovary syndrome (PCOS),or with endometriosis. Materials and Methods: The 141 control women and 74 women with PCOS and with endometriosis were recruited. The (CAG)n repeat alleles were genotyped with 3100 genetic analyser. The repeat number and frequency distributions of (CAG)n alleles were compared and analyed statistically. Results:The results showed that mean repeat number of the (CAG)n in women with PCOS was significantly lower than that in controls (P < 0.001). The mean repeat number was significantly difference between infertile women with endometriosis(p<0.05). However, the between infertile women with PCOS and the fertility women with PCOS was not significant (P > 0.05). Conclusions: These data indicated that (CAG)n repeat polymorphism have some influence, but have not a straight relationship in infertility women with PCOS and with endometriosis in this research population.
Fertil Steril. 2010 Feb 26. [Epub ahead of print]
Centre for Advanced Reproductive Endosurgery, St. Leonards, Australia.
This prospective study aimed to evaluate the suitability of the Endometriosis Health Profile-30 Questionnaire (EHP-30) as a self-report health status instrument. We compared our results with those from the U.K. and the U.S. and discovered relationships between the EHP-30 and patient characteristics. The results showed that the EHP 30 questionnaire is a user-friendly self-report tool suitable for use in endometriosis-related clinical research. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Clin Imaging. 2010 Mar-Apr;34(2):113-5.
Service d’Imagerie Médicale, Centre Hospitalier Princesse Grace, 1, Avenue Pasteur, 98012 Monaco Cedex, France. [email protected]
We present three cases of endometriosis developing in the abdominal wall following cesarean section. The patients were examined by Doppler ultrasonography (US) and magnetic resonance imaging (MRI). The object is to describe the US and MRI findings of the lesion and evaluate their role in the diagnosis and management. In our opinion, a single procedure is sufficient in evaluating the lesion and in reaching the diagnosis. Copyright 2010. Published by Elsevier Inc.
Eur J Obstet Gynecol Reprod Biol. 2010 May;150(1):84-7. Epub 2010 Feb 25.
Department of Obstetrics and Gynecology, School of Medicine, University of Ondokuz Mayis, Samsun, Turkey.
OBJECTIVE: To compare the efficacies of anastrozole and raloxifene on endometriosis. STUDY DESIGN: A randomized, placebo-controlled, single-blind, experimental study was performed on 45 adult Wistar female rats in the Experimental Surgery Laboratory at Ondokuz Mayis University in Turkey. Endometrial tissues were implanted on the abdominal peritoneum in 45 rats. Six weeks later, the implant volumes were measured (volume-1) by performing a second laparotomy. Rats were randomized to one of three equal study groups. Saline solution (0.1 cc/rat/week, subcutaneously) was administered to group 1 (control group), anastrozole (0.004 mg/rat/day, orally) to group 2 (anastrozole group), and raloxifene (0.24 mg/rat/day, orally) to group 3 (raloxifene group) for 8 weeks. At the end of administration, a third laparotomy was performed to remeasure implant volumes (volume-2), and implants were totally excised for histopathologic examination. Volume-1 and volume-2 within the groups, as well as stromal and glandular tissues between the groups, were compared. RESULT(S): In the anastrozole and raloxifene groups, volume-2 values were significantly lower than those of volume-1. When compared to the control group, in both anastrozole and raloxifene groups, while glandular tissue scores were found significantly lower, stromal tissue scores were not different than that of the control group. There was no significant difference between both the GT and ST scores of the anastrozole and raloxifene groups. CONCLUSION(S): Anastrozole and raloxifene were seen to have caused equally the regression of the experimental endometriosis statistically significantly. Published by Elsevier Ireland Ltd.
Fertil Steril. 2010 Feb 24. [Epub ahead of print]
Instituto de Investigaciones Materno Infantil, Departamento de Obstetricia y Ginecología, Hospital Clínico San Borja-Arriarán, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
OBJECTIVE: To evaluate the role of nuclear factor-kappaB (NF-kappaB) in the pathogenesis of endometriosis. DESIGN: A literature search was conducted in PubMed to identify all relevant citations. RESULT(S): Our findings highlight the important role of NF-kappaB in the pathophysiology of endometriosis. In vitro and in vivo studies show that NF-kappaB-mediated gene transcription promotes inflammation, invasion, angiogenesis, and cell proliferation and inhibits apoptosis of endometriotic cells. Constitutive activation of NF-kappaB has been demonstrated in endometriotic lesions and peritoneal macrophages of endometriosis patients. Agents blocking NF-kappaB are effective inhibitors of endometriosis development and some drugs with known NF-kappaB inhibitory properties have proved efficient at reducing endometriosis-associated symptoms in women. Iron overload activates NF-kappaB in macrophages. NF-kappaB activation in macrophages and ectopic endometrial cells stimulates synthesis of proinflammatory cytokines, generating a positive feedback loop in the NF-kappaB pathway and promoting endometriotic lesion establishment, maintenance and development. CONCLUSION(S): NF-kappaB transcriptional activity modulates key cell processes contributing to the initiation and progression of endometriosis. Because endometriosis is a multifactorial disease, inhibiting NF-kappaB appears to be a promising strategy for future therapies targeting different cell functions involved in endometriosis development, such as cell adhesion, invasion, angiogenesis, inflammation, proliferation, and apoptosis. Upcoming research will elucidate these hypotheses. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Minerva Ginecol. 2010 Feb;62(1):17-31.
Departments of Obstetrics and Gynecology and Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA – [email protected]
Endometriosis is an enigmatic, debilitating disease which affects as many as 15% of all women of reproductive age and is characterized by pelvic pain and infertility. Current treatment regimes used to manage the disease do so by inducing a hypoestrogenic state. While the absence of circulating estrogen levels lead to a regression of the disease, this hypoestrogenism also induces many unpleasant and unwanted side-effects. As such, these and other shortcomings of current drug therapies emphasize their limitations and the necessity for the development of novel endometriosis treatments. In this review, current therapies for medical management of endometriosis are discussed as are their shortcomings. Potential target areas which may be attractive alternatives to current therapies are also reviewed and include aromatase inhibitors, angiogenesis disruptors and anti-tumor necrosis factor-alpha inhibitors.
Gynecol Obstet Invest. 2010 Feb 25;70(1):55-59. [Epub ahead of print]
Department of Surgery, Division of Urology, Oulu University Hospital, Oulu, Finland.
Objective: Urinary bladder endometriosis is a severe form of endometriosis often requiring surgery. The several cases treated at our hospital in recent years has led us to evaluate the incidence of urinary bladder endometriosis in Finland. Methods: We performed a register-based analysis of incidence of urinary bladder endometriosis. The patients were identified according to registered diagnosis and operation codes. Results: Six urinary bladder endometriosis cases were diagnosed at Oulu University Hospital during 1991-2007. These cases have been presented. The annual incidence, as evaluated from The Finnish Care Register HILMO, increased from 3.6 to 9.4 cases/1,000,000 females aged 15-49 years per year during 1996-1999 and 2004-2007, respectively, in Finland. Conclusion: There is an apparent increase in incidence of urinary bladder endometriosis in Finland. The low number of cases detected at Oulu University Hospital, and the limitations of the incidence evaluation based on the HILMO register, exclude the presentation of an accurate incidence. The results presented warrant further and careful evaluation of potential increases in urinary bladder endometriosis elsewhere. Copyright © 2010 S. Karger AG, Basel.
Environ Health Perspect. 2010 Feb 25. [Epub ahead of print]
Rush University Medical Center.
Background: Phthalates are ubiquitous chemicals used in consumer products. Some phthalates are reproductive toxicants in experimental animals, but human data are limited. Objective: We conducted a cross-sectional study of urinary phthalate metabolite concentrations in relation to self-reported history of endometriosis and uterine leiomyomata among 1,227 women aged 20-54 from three cycles of the National Health and Nutrition Examination Survey (NHANES), 1999-2004. Methods: We examined four phthalate metabolites: mono(2-ethylhexyl) phthalate (MEHP), monobutyl phthalate (MBP), monoethyl phthalate (MEP), and monobenzyl phthalate (MBzP). From the last two NHANES cycles, we also examined mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP). We used logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential confounders. Results: Eighty-seven (7%) and 151 (12%) women reported diagnoses of endometriosis and leiomyomata, respectively. The ORs comparing the highest versus lowest three quartiles of urinary MBP were 1.36 (95% CI, 0.77-2.41) for endometriosis, 1.56 (95% CI, 0.93-2.61) for leiomyomata, and 1.71 (95% CI, 1.07-2.75) for both conditions combined. The corresponding ORs for MEHP were 0.44 (95% CI, 0.19-1.02) for endometriosis, 0.63 (95% CI, 0.35-1.12) for leiomyomata, and 0.59 (95% CI, 0.37-0.95) for both conditions combined. Findings for MEHHP and MEOHP agreed with findings for MEHP with respect to endometriosis only. We observed null associations for MEP and MBzP. Associations were similar when we excluded women diagnosed >7 years before their NHANES evaluation. Conclusion: The positive associations for MBP and inverse associations for MEHP in relation to endometriosis and leiomyomata warrant investigation in prospective studies.
BMC Res Notes. 2010 Feb 25;3:45.
Department of Urology, Liverpool and Campbelltown Hospitals, NSW, Australia. [email protected]
ABSTRACT: BACKGROUND: Hydronephrosis is a rare but serious manifestation of ureteric endometriosis. FINDINGS: One hundred and twenty-six women underwent ureterolysis for ureteric endometriosis betweeen and October 1996 and June 2009. Thirteen of the 126 women were identified as having ureteric obstruction at the time of their procedure and were included in the case series. The median age was 39.5 (30 – 63). Chronic pelvic pain was the most common presenting symptom (53.8%). The point of ureteric obstruction was noted to occur most commonly at a small segment of distal left ureter, where it is crossed by the uterine artery (54%). Seven of the 13 women (53.8%) were successfully managed with ureterolysis only. Three of the 13 women (21.3%) underwent ureterolysis and placement of a double J ureteric stent. Three of the 13 (21.3%) required a segmental ureteric resection. There was one incidence of inadvertent thermal ureteric injury which was managed with a ureteric stent. In all cases the hydronephrosis had resolved at six months follow up. CONCLUSIONS: Our findings support the growing body of literature supporting ureterolysis as the optimal treatment for ureteric endometriosis causing moderate to severe ureteric obstruction.
Cases J. 2009 Aug 4;2:6661.
ABSTRACT : The author reports two cases of adenosquamous carcinoma arising from endometriosis of ovaries. The tumor patients were 38-year-old and 53-year-old women. Both patients underwent hysterectomy and bilateral salpingo-oophorectomy for ovarian carcinomas. Grossly, both ovarian tumors were located in the left ovaries, and were cystic tumors with mural tumors. Histologically, the cystic areas consisted of endometrial glandular epithelium. Both mural tumors were composed of grade I endometroid adenocarcinoma and squamous cell carcinoma. These two elements were admixed in some areas. A differentiation of endometrioid adenocarcinoma from the endometriosis were present in a few areas. Likewise, a differentiation of squamous cell carcinoma from the endometriosis were recognized in several areas. The pathologic diagnosis was adenosquamous carcinoma arising from endometriosis of the ovary in both cases, rather than endometrioid adenocarcinoma with malignant squamous differentiation. No tumors were present in other organs.
Acta Chir Belg. 2009 Nov-Dec;109(6):778-81.
3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. [email protected]
Endometriosis is the presence of endometrial glands and stroma outside the uterus. Spontaneous abdominal wall endometriosis (AWE) is any ectopic endometrium found superficial to the peritoneum without the presence of any previous scar. Rarely, endometriosis represents a disease of specific interest to the general surgeon, on account of its extrapelvic localisations. We describe a case with spontaneous AWE presenting as a painful mass with cyclic symptoms. A 28-year-old woman presented to the day-surgery division of our department, suffering from a painful mass in the left lower abdominal quadrant. A mobile mass of 5 x 4 cm was identified. The initial diagnosis was lipoma and excision was planned. During the operation two masses were spotted, very close to one another, and were excised within healthy limits. Pathology revealed endometrial glands surrounded by a disintegrating mantle of endometrial stroma and fibrous scar tissue in which there was a scattering of leucocytes. The woman had no scars. She was discharged from hospital after 2 hours. Two years after the excision she is free of disease and no recurrence has been observed. Spontaneous AWE is rare, accounting for 20% of all AWEs. The triad ; mass, pain and cyclic symptomatology helps in the diagnosis, but unfortunately it is not present in all cases. Spontaneous endometriomas are usually diagnosed by pathology and the treatment of choice is surgical excision.
Cases J. 2009 Sep 17;2:7195.
ABSTRACT : Vaginal endometriosis is characterized by the presence of endometrial tissue in the vagina. In this paper the authors present an unusual case of post-hysterectomy vaginal cuff endometriosis.
Cases J. 2009 Mar 10;2:6458.
ABSTRACT : Skin necrosis is a rare but serious complication of subcutaneously administered low-molecular-weight heparin. We report a case of a 53-year-old female patient with skin necrosis induced by subcutaneous administration of nadroparine. The patient suffered from essential thrombocythaemia on a background of chronic myeloproliferative disease. She was admitted to our clinic with a subacute ileus due to endometriosis of the rectosigmoid junction. She underwent a high anterior resection and she received pre- and postoperative antithrombotic prophylaxis with subcutaneous nadroparine on a daily basis. On the 6th and 7th postoperative days, two skin necroses occurred at two injection sites.
J Ovarian Res. 2010 Jan 28;3:3.
Department of Obstetrics and Gynecology, Sherbrooke University Hospital Centre, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada. [email protected]
ABSTRACT: OBJECTIVES: Endometrioid carcinoma of the ovary is one of the most types of epithelial ovarian cancer associated to endometrioisis. Endometrioid tumors as well as endometriotic implants are characterized by the presence of epithelial cells, stromal cells, or a combination of booth, that resemble the endometrial cells, suggesting a possible endometrial origin of these tumors. Pro-inflammatory cytokines, including interleukin-1 (IL-1) have been reported to be involved in both endometriosis and ovarian carcinogenesis. The major objective of this study was to determine the level expression of IL-1 ligands system (IL-1alpha, IL-1beta and IL-1RA) in the most common subtypes of ovarian cancer cells compared to endometrial cells. METHODS: We used primary endometrial cells, endometrial cell line RL-952 and different subtypes of epithelial ovarian cancer cell lines including TOV-112D (endometrioid), TOV-21G (clear cell) and OV-90 (serous). Immunofluorescence and real-time PCR analysis were used respectively for detecting IL-1 ligands at the levels of cell-associated protein and mRNA. Soluble IL-1 ligands were analyzed by ELISA. RESULTS: We demonstrated that IL-1 ligands were expressed by all endometriosis-associated ovarian cancer subtypes and endometrial cells. In contrast to other cancer ovarian cells, endometrioid cells exhibit a specific decrease of cell-associated IL-1RA expression and its soluble secretion. CONCLUSION: Endometrioid ovarian cancer exhibits an alteration in the expression of IL-1RA, a key protector against tumorogenic effects of IL-1. This alteration evokes the same alteration observed in endometriotic cells in previous studies. This suggests a possible link between the endometrium, the tissue ectopic endometriosis and endometrioid ovarian cancer.