Reprod Biomed Online. 2010 Oct;21(4):470-3. Epub 2010 May 24.

Follicular-fluid anti-Müllerian hormone concentration is similar in patients with endometriosis compared with non-endometriotic patients.

Campos CS, Vaamonde D, Andreoli C, Martins AC, Genro VK, Souza CA, Chapon R, Cunha-Filho JS.

Universidade Federal do Rio Grande do Sul. Porto Alegre, RS 90035-003, Brazil.

This cross-sectional prospective study assessed follicular-fluid anti-Müllerian hormone (AMH) concentrations in infertile patients with mild/minimal endometriosis during natural IVF. Thirty-two women participated in the study. Patients were divided into two groups: tubal obstruction without endometriosis (control group) and minimal/mild endometriosis (study group). All patients underwent laparoscopy for assessment of infertility; at the same time, any foci of endometriosis found were cauterized. AMH concentration was measured in the follicular fluid of a single follicle when it achieved pre-ovulatory maturation by ultrasensitive enzyme-linked immunosorbent assay. Likewise, AMH, FSH and inhibin B content in serum was also measured. Age (30 ± 1.3 and 32 ± 0.8 years) and body mass index (22 ± 0.6 and 22 ± 0.5 kg/m(2)), day-3 antral follicle count (11.3 ± 1.7 and 10.7 ± 1.5), serum FSH concentrations (5.4 ± 0.6 and 5.0 ± 0.3 IU/ml) and follicular-fluid AMH concentrations (1.8 ± 0.3 and 1.5 ± 0.1 ng/ml, study and control group, respectively; mean difference 0.33, 95% CI -0.21 to 0.88) were similar in both groups. This study shows that infertile patients with minimal/mild endometriosis have a similar concentration of AMH in the follicular fluid after natural IVF as compared with control subjects.

Copyright © 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Fertil Steril. 2010 Aug 25. [Epub ahead of print]

Increased plasma levels of phthalate esters in women with advanced-stage endometriosis: a prospective case-control study.

Kim SH, Chun S, Jang JY, Chae HD, Kim CH, Kang BM.

Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.

We performed the present prospective case-control study to evaluate whether the plasma concentrations of phthalate esters are elevated in women with advanced-stage endometriosis in a Korean population. Measuring plasma levels of monoethylhexyl phthalate and di-(2-ethylhexyl) phthalate in 97 women with advanced-stage endometriosis and 169 control women by liquid chromatography-tandem mass spectrometry, we found that the concentrations of monoethylhexyl phthalate, as well as di-(2-ethylhexyl) phthalate, are significantly higher in those with advanced-stage endometriosis, which supports the hypothesis that exposure to phthalate might play a role in the establishment of endometriosis.

Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Fertil Steril. 2010 Aug 24. [Epub ahead of print]

Endometriosis and autoimmune disease: association of susceptibility to moderate/severe endometriosis with CCL21 and HLA-DRB1.

Sundqvist J, Falconer H, Seddighzadeh M, Vodolazkaia A, Fassbender A, Kyama C, Bokor A, Stephansson O, Padyukov L, Gemzell-Danielsson K, D’Hooghe TM.

Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden.

This study investigates the association of rheumatoid arthritis-associated single nucleotide polymorphisms in endometriosis. We found an association of CCL21 (rs2812378) and HLA-DRB1 (rs660895) with moderate to severe endometriosis.

Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Fertil Steril. 2010 Aug 25. [Epub ahead of print]

Functional association of interleukin-18 gene -607 C/A promoter polymorphisms with endometriosis.

Ayaz L, Celik SK, Cayan F, Aras-Ateş N, Tamer L.

Department of Biochemistry, School of Medicine, Mersin University, Mersin, Turkey.

This study evaluated for the first time the relationship between interleukin-18 (IL-18) C607A genotypes and endometriosis in 135 women with endometriosis and 84 controls. In the study population, IL-18 -607 *A homozygote and A allele were positively correlated with the risk of developing endometriosis or the stage of endometriosis.

Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Reprod Fertil Dev. 2010;22(7):1118-30.

Immunohistochemical study of the ubiquitin-nuclear factor-kB pathway in the endometrium of the baboon (Papio anubis) with and without endometriosis.

Ilad RS, Fleming SD, Murphy CR, Fazleabas AT.

Department of Obstetrics and Gynaecology at Westmead Hospital, The University of Sydney, Westmead, NSW 2145, Australia.

The aim of the present study was to conduct a semiquantitative immunohistochemical investigation into the levels of intermediary proteins within the nuclear factor (NF)-kappaB pathway throughout the menstrual cycle in a non-human primate, namely the baboon (Papio anubis), with and without endometriosis. Formalin-fixed eutopic (n = 2-4) and ectopic (n = 6-7) endometrial tissues from baboons at the mid-luteal phase were embedded in paraffin and examined for NF-kappaB pathway components (i.e. IkappaB kinase (IKK) alpha, IKKbeta, phosphorylated (phospho-) IkappaBalpha and phospho-NF-kappaB p65 subunit), ubiquitin, 19S proteasome and the NF-kappaB activator tumour necrosis factor (TNF)-alpha. Similarly, endometrial tissues from baboons at the late follicular, mid-luteal and menses phase (n = 2-4) were investigated to determine the levels of these proteins throughout the menstrual cycle. Cytoplasmic stromal IKKalpha and glandular 19S proteasome immunostaining was elevated in the ectopic endometrium, whereas levels of ubiquitin, phospho-p65, IKKbeta, TNF-alpha and nuclear 19S proteasome were similar in the eutopic and ectopic endometrium. A significant decrease in phospho-IkappaBalpha nuclear immunostaining was observed within glandular cells of the ectopic endometrium. In the eutopic endometrium, IKKalpha, ubiquitin and 19S proteasome immunostaining was elevated in different phases of the menstrual cycle, whereas levels of phospho-p65, IKKbeta, phospho-IkappaBalpha and TNF-alpha remained unchanged. We have demonstrated that, in the baboon endometriosis model, levels of IKKalpha immunostaining are elevated, whereas those of phospho-IkappaBalpha are reduced, consistent with the hypothesis that excessive NF-kappaB activity plays a role in reducing ectopic endometrial apoptosis, which contributes to the pathophysiology of endometriosis. Further studies are required to confirm a causal association between elevated IKKalpha levels and reduced endometrial apoptosis.

Case Rep Oncol. 2010 Jan 12;3(1):9-13.

Sarcoidosis Presenting as an Intraperitoneal Mass.

Brown JV, Epstein HD, Chang M, Goldstein BH.

Gynecologic Oncology Associates, Hoag Memorial Hospital Presbyterian, Newport Beach, Calif., USA.

BACKGROUND: Sarcoidosis is an idiopathic, inflammatory condition primarily encountered within the lungs but very rarely identified in the peritoneum. Case Study: A 34-year-old woman presented with pleural effusion, ascites and an adnexal mass, indicative of ovarian cancer.

RESULTS: A biopsy revealed granulomas and lymphocytic infiltrate, consistent with sarcoidosis. The patient’s symptoms were resolved with corticosteroids. However, 2 years later, she developed another pelvic mass and underwent a diagnostic laparoscopy. Final pathology revealed granulomas and endometriosis, consistent with sarcoidosis.

CONCLUSION: Since intraperitoneal sarcoidosis is extremely rare, the differential diagnosis is unlikely to include this condition in the context of presumptive ovarian cancer. However, in patients with a history of sarcoidosis, physicians should maintain a high index of suspicion to effectuate early detection and provide appropriate treatment.

Curr Opin Obstet Gynecol. 2010 Oct;22(5):393-8.

Myofascial pain in the adolescent.

Jarrell J.

Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada. [email protected]

PURPOSE OF REVIEW: Whereas in the recent past pain in the child and adolescent was directed to cancer management, there is increasing interest in pain in children and adolescents in relation to nonmalignant conditions. Additionally, there is an emerging literature related to disorders of myofascial function as a cause of pain.

RECENT FINDINGS: Pain associated with myofascial dysfunction is common in the adolescent female. Pain in this group of women has been shown to extend into adulthood. Although there has been attention directed to the management of endometriosis through laparoscopic surgical approaches, these are seen as limiting. Myofascial dysfunction is now regarded as an important factor in the evaluation of adolescent pain. One of the most important approaches to the reduction of severe pain in the adolescent is the complete menstrual suppression through use of continuous oral contraceptives or contraceptive rings. Operative laparoscopy has been heavily utilized but there are increasing concerns about the overutilization of this procedure

SUMMARY: Alternative approaches to myofascial pain include multidisciplinary care with a rehabilitative perspective.

J Clin Endocrinol Metab. 2010 Aug 25. [Epub ahead of print]

Overexpression and Functional Relevance of Somatostatin Receptor-1, -2, and -5 in Endometrium and Endometriotic Lesions.

Fasciani A, Quilici P, Biscaldi E, Flamini M, Fioravanti A, Orlandi P, Oliviero J, Repetti F, Bandelloni R, Danesi R, Simoncini T, Bocci G.

Divisions of Gynecology and Obstetrics (A.F., F.R.), Pathology (P.Q., J.O., R.B.), and Radiology (E.B.), “Ospedali Galliera,” 16128 Genova, Italy; and Division of Obstetrics and Gynecology, Department of Reproductive Medicine and Child Development (M.F., T.S.), and Division of Pharmacology, Department of Internal Medicine (A.F., P.O., R.D., G.B.), University of Pisa, 56126 Pisa, Italy.

Context: Somatostatin plays a role in physiological and pathological cell proliferation and angiogenesis. Five subtypes of somatostatin receptors have been identified, and the therapeutic use of somatostatin receptor-selective agonists has been reported in several diseases. Objectives: The aim was to describe the expression and the functional relevance of three human somatostatin receptors (sst1, sst2, and sst5) in tissues of women with and without endometriosis. Patients and Methods: This pilot study analyzed endometrium, ovarian endometriomata, and peritoneal lesions in 15 patients affected by endometriosis and the endometrium of five women without endometriosis. (111)In-pentetreotide scintigraphy was used to detect endometriotic lesions; real-time RT-PCR and immunohistochemistry for sst1, sst2, and sst5 were performed. Migration and proliferation assays were performed on human endometrial stromal cells (ESC) treated with somatostatin and octreotide for 48 h. Results: (111)In-pentetreotide scintigraphy was able to correctly identify and locate pelvic endometriotic lesions as confirmed by computed tomography scans. The endometrium of women with endometriosis expressed significantly more sst1, sst2, and sst5 in comparison to that of control women. Moreover, sst1, sst2, and sst5 were highly expressed in ovarian endometriomata and peritoneal lesions. The sst receptor ligand octreotide significantly inhibited ESC migration and proliferation with a maximum effect at 10(-6) M, whereas somatostatin was effective only on ESC growth. Conclusions: This is the first report characterizing the overexpression and functional relevance of somatostatin receptors in eutopic endometrium and lesions of patients affected by endometriosis. Thus, the use of these receptors may provide new strategies for the diagnosis and treatment of endometriosis.

Fertil Steril. 2010 Aug 24. [Epub ahead of print]

Long-term urinary retention after laparoscopic surgery for deep endometriosis.

Kovoor E, Nassif J, Miranda-Mendoza I, Lang-Avérous G, Wattiez A.

Institute for Research Against Cancer of the Digestive System, EITS Department and University Hospitals Strasbourg, Strasbourg, France.

OBJECTIVE: To report on chronic urinary retention after surgery for deep endometriosis and the possible risk factors for this complication.

DESIGN: Descriptive study.

SETTING: University hospital.

PATIENT(S): Four patients with deep endometriosis who developed this complication.

INTERVENTION(S): Laparoscopic surgery, intermittent self-catheterization (ISC).

MAIN OUTCOME MEASURE(S): To identify site(s) of lesion associated with this complication.

RESULT(S): Four patients developed this complication from damage to the inferior hypogastric plexus involving the sympathetic and/or parasympathetic afferents from the bladder. One patient regained complete bladder function 8 months after surgery, and the others required ISC at the time of writing (13, 24, and 3 months after surgery). Patients with lesions located laterally and deep in the uterosacral ligaments especially near the ischial spines were at high risk. All patients were, however, satisfied with the results of surgery.

CONCLUSION(S): Most such injuries are unpredictable, but in our experience, two of three patients with lesions near the ischial spine developed this complication. Chronic urinary retention after radical endometriosis surgery is rare and often under reported. Although most lesions are unilateral and have a potential for improvement, it is not known how long these effects will last. More data from other centers may help in providing additional information.

Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Int J Gynecol Pathol. 2010 Sep;29(5):405-10.

Expression of podoplanin in epithelial ovarian carcinomas and its potential as a marker for clear cell adenocarcinoma.

Oe S, Hasegawa K, Nagase S, Kato R, Torii Y, Udagawa Y.

Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan.

Podoplanin is a 43-kd mucin-type transmembrane glycoprotein that is a candidate marker for the pathologic diagnosis of mesothelioma and lymphatic endothelial cells and lymphangiogenesis. The aim of this study was to investigate podoplanin expression in epithelial ovarian carcinomas. Immunohistochemistry was performed on the paraffin-embedded tissues from 78 patients with epithelial ovarian carcinomas consisting of serous adenocarcinoma (SA), endometrioid adenocarcinoma (EM), mucinous adenocarcinoma (MA), and clear cell adenocarcinoma (CCC) cases. Only 36.8% (7/19) of SA, 33.3% (6/18) of EM, and 15.8% (3/19) of MA cases were positive for podoplanin expression, whereas 54.5% (12/22) of CCC samples were positive. Immunohistochemical scores (mean+/-SD) were 1.2+/-1.5, 1.9+/-2.6, 0.8+/-1.6 and, 3.6+/-4.0 in SA, EM, MA, and CCC, respectively. Podoplanin expression was significantly stronger in CCC than in other histologic types. However, no significant correlation was observed between its expression and FIGO stage, the presence of endometriosis, lymph node metastasis, or recurrence. There was also no correlation between podoplanin expression and overall survival. We confirmed the expression of podoplanin in epithelial ovarian carcinomas, particularly in CCC. Podoplanin might have utility as a marker for CCC in pathologic diagnosis. Further investigation is needed to clarify the relationship between podoplanin expression and the biologic characteristics of CCC.

Akush Ginekol (Sofiia). 2010;49(4):47-58.

Three-dimensional (3D) transvaginal ultrasound–clinical implementation in benign gynecological disorders.

[Article in Bulgarian]

Markov D, Markov P, Pavlova E, Atanaova D.

The implementation of three-dimensional (3D) transvaginal (TV) ultrasound (US) in gynecology increases progressively. The method is successfully used in the diagnosis and differential diagnosis of benign gynecological pathology–congenital anomalies of the female reproductive system, fibroids, endometriosis, adenomyosis, endometrial polyps, pelvic inflammatory disease, adnexal masses, ectopic pregnancy, etc. This review describes the current use of 3D TV US in gynecological practice.

J Mol Endocrinol. 2010 Nov;45(5):291-9. Epub 2010 Aug 23.

The high level of RANTES in the ectopic milieu recruits macrophages and induces their tolerance in progression of endometriosis.

Wang XQ, Yu J, Luo XZ, Shi YL, Wang Y, Wang L, Li DJ.

Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, IBS, Fudan University Shanghai Medical College, Shanghai 200011, People’s Republic of China Department of Obstetrics and Gynecology, Hainan Medical College Affiliated Hospital, Haikou 570102, People’s Republic of China.

RANTES (C-C chemokine, regulated on activation, normal T cell expressed and secreted) is involved in progression of endometriosis, but the precise mechanism is understood inadequately. This study is to elucidate the roles of RANTES in macrophage recruitment and tolerance in the endometriotic milieu. The expression of RANTES was analyzed by immunohistochemistry. The cell co-cultures were applied to simulate the endometriotic milieu to investigate the regulation of RANTES secretion and its receptor CCR1 expression. Transwell migration assay was used for chemotaxis of U937 cells (macrophage line) to endometrial stromal cells (ESCs) and/or human pelvic mesothelial cells. The expression of CCR1 was analyzed by RT-PCR and qPCR in transcription and by western blot in translation respectively. Concentrations of RANTES, IL10, and IL12p70 were determined by ELISA. The phenotype of U937 cells and apoptosis of ESCs were analyzed by flow cytometry. We have found that the expression of RANTES is significantly higher in the endometriotic tissue and eutopic endometrium than that of the normal endometrium without endometriosis. The combination of 17β-estradiol and dioxin 2,3,7,8-tetrachlorodibenzo-p-dioxin increases significantly RANTES secretion in the endometriosis-associated cell co-culture which can recruit more macrophages, upregulate CCR1 expression, and induce tolerant phenotype, which inhibits the apoptosis of ESC in the milieu. In conclusion, the higher levels of RANTES in the ectopic milieu facilitate the onset and progression of endometriosis by macrophage recruitment and tolerance that in turn inhibits apoptosis and enhances growth of ESC.

Diagn Cytopathol. 2010 Aug 20. [Epub ahead of print]

Fine-needle aspiration biopsy of endometriosis of the abdominal wall: A potential diagnostic pitfall.

Aziz Z, Wang D.

Department of Pathology, St. Joseph’s Health Care Centre, Toronto, Ontario, Canada.

Endometriosis is a relatively common disease in women, usually of reproductive age. In rare occasions, endometriosis may occur in unusual body sites, including extragonadal, extra-pelvic sites, or in the skin. We report a case of endometriosis of the abdominal wall diagnosed by fine-needle aspiration biopsy (FNAB). The patient was a 41-year-old woman with a clinical impression of “desmoid” tumor of the abdominal wall. FNAB showed groups of epithelial cells with mild nuclear atypia and rare mitoses. A few small clusters of slightly atypical spindle cells were also seen. The initial screening impression was adenocarcinoma due to the atypical cytological features. However, after review with the pathologist, the FNAB was signed out as “endometriosis.” Subsequent local excisional biopsy confirmed the diagnosis of endometriosis. In conclusion, endometriosis may present diagnostic challenges in FNAB and this possibility should be considered in differential diagnosis. A clinical cytopathological correlation is necessary to avoid a misdiagnosed as an adenocarcinoma. Diagn. Cytopathol. 2010. (c) 2010 Wiley-Liss, Inc.

Hum Reprod Update. 2010 Aug 21. [Epub ahead of print]

Implantation failure: molecular mechanisms and clinical treatment.

Cakmak H, Taylor HS.

Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA.

BACKGROUND Implantation is a complex initial step in the establishment of a successful pregnancy. Although embryo quality is an important determinant of implantation, temporally coordinated differentiation of endometrial cells to attain uterine receptivity and a synchronized dialog between maternal and embryonic tissues are crucial. The exact mechanism of implantation failure is still poorly understood. METHODS This review summarizes the current knowledge about the proposed mechanisms of implantation failure in gynecological diseases, the evaluation of endometrial receptivity and the treatment methods to improve implantation. RESULTS The absence or suppression of molecules essential for endometrial receptivity results in decreased implantation rates in animal models and gynecological diseases, including endometriosis, hydrosalpinx, leiomyoma and polycystic ovarian syndrome. The mechanisms are diverse and include abnormal cytokine and hormonal signaling as well as epigenetic alterations. CONCLUSIONS Optimizing endometrial receptivity in fertility treatment will improve success rates. Evaluation of implantation markers may help to predict pregnancy outcome and detect occult implantation deficiency. Treating the underlying gynecological disease with medical or surgical interventions is the optimal current therapy. Manipulating the expression of key endometrial genes with gene or stem cell-based therapies may some day be used to further improve implantation rates.

Eur J Obstet Gynecol Reprod Biol. 2010 Aug 20. [Epub ahead of print]

Is acupuncture in addition to conventional medicine effective as pain treatment for endometriosis? A randomised controlled cross-over trial.

Rubi-Klein K, Kucera-Sliutz E, Nissel H, Bijak M, Stockenhuber D, Fink M, Wolkenstein E.

Johannes Bischko Institute of Acupuncture, Huglgasse 1-3, 1150 Vienna, Austria; Department of Internal Medicine, Kaiserin Elisabeth Hospital, Huglgasse 1-3, 1150 Vienna, Austria; Hannover Medical School, Department for Rehabilitation Medicine, Germany.

OBJECTIVE: The aim of the study was to examine whether acupuncture is an effective additional pain treatment for endometriosis.

STUDY DESIGN: One hundred and one women aged 20-40 years participated and were randomised into two groups, each receiving two units of 10 acupuncture treatments, twice a week over a period of five weeks. Group 1 (n=47) received verum-acupuncture during the first series, and group 2 (n=54) received non-specific acupuncture. After the first unit of 10 treatments, an observation period of at least two menstruation cycles was set, followed by a second unit, according to a cross-over design. Prior to the study (during a two-week run-in period) the patients’ actual pain intensity was surveyed. Throughout the study period, participants were asked to keep a ‘pain protocol’, in which they defined and recorded their pain according to the 10-point visual analogue scale (VAS).

RESULTS: Eighty-three out of a total of 101 patients finished the study. Group 1 showed a significant reduction of pain intensity after the first 10 treatments. In comparison, group 2 showed significant pain relief only after the cross-over.

CONCLUSION: Acupuncture treatment on specific acupuncture points appears to be an effective pain treatment for endometriosis, but this has to be confirmed in further study.

Copyright © 2010. Published by Elsevier Ireland Ltd.

J Minim Invasive Gynecol. 2010 Sep-Oct;17(5):646-50.

Laparoscopic management of peritoneal mesothelioma associated with pelvic endometriosis.

Nezhat FR, DeNoble SM, Brown DN, Shamshirsaz A, Hoehn D.

Columbia University Medical Center, New York, NY 10019, USA. [email protected]

OBJECTIVE: To describe 3 cases of peritoneal mesothelioma associated with endometriosis that were managed laparoscopically.

DESIGN: Case series.

SETTING: University and community hospitals.

PATIENTS: Three women with well-differentiated papillary mesothelioma of the peritoneum associated with endometriosis.

INTERVENTIONS: Laparoscopic excision and treatment of mesothelioma and endometriosis.

RESULTS: Three patients underwent laparoscopy for treatment of endometriosis and were found to have peritoneal mesothelioma. All 3 patients underwent total laparoscopic excision of the lesions and were followed up regularly for surveillance of possible recurrence.

CONCLUSIONS: In selected cases of well-differentiated papillary mesothelioma associated with pelvic endometriosis, operative laparoscopy can be used effectively to diagnose and treat this condition.

Copyright © 2010 AAGL. Published by Elsevier Inc. All rights reserved.

J Minim Invasive Gynecol. 2010 Sep-Oct;17(5):637-40.

The elephant in the room: quality control of endometriosis data.

Koninckx PR, Batt RE, Hummelshoj L, McVeigh E, Ussia A, Yeh J.

Katholieke Universiteit, Leuven, Belgium. [email protected]

With the steadily increasing volume of endometriosis articles, and titles and abstracts readily available online, there is a growing risk that references are cited without the full articles having been read by the author(s) or by referees. Too often the titles and statements in abstracts are not supported by data in the published articles. Therefore, the peer-review process should direct extra attention to titles and abstracts to ensure that they are supported by data in the manuscript. Moreover, it is suggested that authors explicitly indicate which references have been read in full. To support the secondary peer-review process, we urge open-access journals to welcome letters to the editor and publish them instead of quietly “burying” them on the Internet.

Copyright © 2010 AAGL. All rights reserved.

J Minim Invasive Gynecol. 2010 Sep-Oct;17(5):541-2.

Endometrial stromal sarcoma from endometriosis.

Sinha R, Sundaram M.

Bombay Endoscopy Academy and Centre for Minimally Invasive Surgery, Beams Hospital, Khar (W), Mumbai, India.

Eur J Obstet Gynecol Reprod Biol. 2010 Aug 18. [Epub ahead of print]

Deep rectal and parametrial infiltrating endometriosis with monolateral pudendal nerve involvement: case report and laparoscopic nerve-sparing approach.

Ceccaroni M, Clarizia R, Roviglione G, Bruni F, Ruffo G, Peters I, De Placido G, Minelli L.

Gynecologic Oncology Division, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy; Department of Obstetrics and Gynecology, European Gynaecology Endoscopy School, Sacred Heart Hospital, Negrar, Verona, Italy.

Cytopathology. 2010 Aug 17. [Epub ahead of print]

Increased diagnostic accuracy of atypical glandular cells in cervical liquid-based cytology using cell blocks.

Risse EK, Holierhoek JP, Meijer-Marres EM, Ouwerkerk-Noordam E, Boon ME.

Leiden Cytology and Pathology Laboratory, Leiden, the Netherlands.

E. K. J. Risse, J. P. Holierhoek, E. M. Meijer-Marres, E. Ouwerkerk-Noordam and M. E. Boon Increased diagnostic accuracy of atypical glandular cells in cervical liquid-based cytology using cell blocks Objective: The purpose of this study was to reduce the number of diagnoses of atypical glandular cells (AGC). Residual material from the cervical ThinPrep(R) samples (Hologic, Marlboruogh, MA, USA) was used for cell blocks (CB) and immunohistochemistry (IHC). Methods: In 2007 there were 87 patients (0.12% of tests) with AGC on liquid-based cytology (LBC) in the Leiden Cytology and Pathology Laboratory (LCPL) using the Bethesda System 2001 (TBS). CB with IHC was used for 26 of these cases. The vials still containing the brush (Cervex-Brush((R)) Combi) were placed in a shaker for 10 minutes to dislodge the material trapped between the bristles. The residual sampling fluid was used to prepare paraffin sections (Shandon Cytoblock((R))) stained with Papanicolaou and immunostaining. Results: Four of five cases with AGC not otherwise specified (NOS) were diagnosed with CB/IHC as benign mimics (endometrium, tubal metaplasia, follicular cervicitis, microglandular hyperplasia) and one of four with AGC-favour neoplasia (FN) (endocervical polyp). In one of five cases with AGC-NOS and in two of seven with AGC-FN, CIN3 was found on subsequent histological biopsy. Of six cases diagnosed as adenocarcinoma in situ (AIS) on LBC with CB/IHC the diagnosis was confirmed in four; one was adenocarcinoma and one glandular atypia. Of eight cases diagnosed as adenocarcinoma on cytology and CB/IHC, the diagnosis was confirmed in three. The other five cases were found to be one each of AIS, squamous cell carcinoma, CIN3, CIN2 with glandular atypia, and cervical endometriosis. Conclusions: By reducing the number of benign mimics of AGC, we achieved a high proportion (16/26; 61.5%) of neoplastic or preneoplastic lesions (glandular or squamous) on histological outcome potentially avoiding colposcopy. Histological biopsy verification by the gynaecologist is needed for final diagnosis of AGC-FN, AIS and adenocarcinoma.

Am Surg. 2010 Aug;76(8):906-8.

Appendiceal intussusception resulting from endometriosis presenting as acute appendicitis.

Ruiz Marín M, Parra Baños PA, González Valverde FM, Rodenas Moncada J, Candel Arenas MF, Méndez Martínez M, Terol Garaulet E, Tamayo Rodríguez ME, Benavides Buleje JA, Escamilla Segade C, Oñate Celdrán J, Albarracín Marín-Blázquez A.

Am Surg. 2010 Aug;76(8):808-11.

The incidence of benign and malignant neoplasia presenting as acute appendicitis.

Sieren LM, Collins JN, Weireter LJ, Britt RC, Reed SF, Novosel TJ, Britt LD.

Eastern Virginia Medical School, Department of Surgery, Norfolk, Virginia, USA. [email protected]

Acute appendicitis remains the most common surgical emergency encountered by the general surgeon. It is most often secondary to lymphoid hyperplasia, however it can also result from obstruction of the appendiceal lumen by a mass. We sought to review our experience with neoplasia presenting as appendicitis. We retrospectively reviewed all patients admitted with the diagnosis of appendicitis to our Acute Care Surgery Service from July 1, 2007 to June 30, 2009. Patient demographics, duration of symptoms, lab findings, computed tomography findings, and pathology were all analyzed. Over the 2-year period, 141 patients underwent urgent appendectomy. Ten patients (7.1%) were diagnosed with neoplasia on final pathology, including four women and six men with a mean age of 46.9 years and mean duration of symptoms of 12.6 days. Final pathology revealed four colonic adenocarcinoma; three mucinous tumors; one carcinoid; one endometrioma; and one patient had a combination of a mucinous cystadenoma, a carcinoid tumor, and endometriosis of the appendix. Six patients had concurrent appendicitis. Colonic and appendiceal neoplasia are not unusual etiologies of appendicitis. These patients tend to present at an older age and with longer duration of symptoms.

Braz J Med Biol Res. 2010 Aug;43(8):799-805. Epub 2010 Jul 30.

Genomic alterations detected by comparative genomic hybridization in ovarian endometriomas.

Veiga-Castelli LC, Silva JC, Meola J, Ferriani RA, Yoshimoto M, Santos SA, Squire JA, Martelli L.

Departamento de Genética, Universidade de São Paulo. [email protected]

Endometriosis is a complex and multifactorial disease. Chromosomal imbalance screening in endometriotic tissue can be used to detect hot-spot regions in the search for a possible genetic marker for endometriosis. The objective of the present study was to detect chromosomal imbalances by comparative genomic hybridization (CGH) in ectopic tissue samples from ovarian endometriomas and eutopic tissue from the same patients. We evaluated 10 ovarian endometriotic tissues and 10 eutopic endometrial tissues by metaphase CGH. CGH was prepared with normal and test DNA enzymatically digested, ligated to adaptors and amplified by PCR. A second PCR was performed for DNA labeling. Equal amounts of both normal and test-labeled DNA were hybridized in human normal metaphases. The Isis FISH Imaging System V 5.0 software was used for chromosome analysis. In both eutopic and ectopic groups, 4/10 samples presented chromosomal alterations, mainly chromosomal gains. CGH identified 11q12.3-q13.1, 17p11.1-p12, 17q25.3-qter, and 19p as critical regions. Genomic imbalances in 11q, 17p, 17q, and 19p were detected in normal eutopic and/or ectopic endometrium from women with ovarian endometriosis. These regions contain genes such as POLR2G, MXRA7 and UBA52 involved in biological processes that may lead to the establishment and maintenance of endometriotic implants. This genomic imbalance may affect genes in which dysregulation impacts both eutopic and ectopic endometrium.

Mol Cell Endocrinol. 2010 Aug 17. [Epub ahead of print]

Inflammatory pathways in endometrial disorders.

Maybin JA, Critchley HO, Jabbour HN.

University of Edinburgh Centre for Reproductive Biology, The Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.

Complex interactions between the endocrine and immune systems govern the key endometrial events of implantation and menstruation. In contrast to other tissue sites, cyclical endometrial inflammation is physiological. However, dysregulation of this inflammatory response can lead to endometrial disorders. This review examines the inflammatory processes occurring in the normal endometrium during menstruation and implantation, highlighting recent advances in our understanding and gaps in current knowledge. Subsequently, the role of inflammatory pathways in the pathology of various common endometrial conditions is discussed, including heavy menstrual bleeding, dysmenorrhoea (painful periods), uterine fibroids, endometriosis and recurrent miscarriage.

Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

J Sex Med. 2010 Aug 16. [Epub ahead of print]

Evaluation of Quality of Life and Sexual Satisfaction in Women Suffering from Chronic Pelvic Pain With or Without Endometriosis.

Tripoli TM, Sato H, Sartori MG, Fernando de Araujo F, Girão MJ, Schor E.

Federal University of São Paulo-Pelvic Pain and Endometriosis Unit-Department of Gynecology, São Paulo, Brazil.

Introduction. Chronic pelvic pain (CPP) is one of the most frequent symptoms in women of reproductive age. This is an enigmatic clinical condition that results from the complex interactions of physiological and psychological factors with direct impact on the social, marital, and professional lives of women. Aim. To evaluate the quality of life and sexual satisfaction of women who suffer from CPP with or without endometriosis. Method. Forty-nine patients who had been diagnosed with endometriosis and 35 patients with CPP diagnosed with another gynecological condition, all 84 of whom were treated at the Chronic Pelvic Pain and Endometriosis Clinic at Universidade Federal de São Paulo (UNIFESP) from January to July of 2008. The controls were 50 healthy women from the Family Planning Clinic at UNIFESP. Main Outcome Measures. World Health Organization Quality of Life Assessment-Bref (WHOQOL-BREF) quality of life questionnaire and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Results. No statistically significant differences were observed between the groups with CPP symptoms, in either the results from the WHOQOL-BREF or in the GRISS questionnaire. In both questionnaires, differences were observed when the two groups of symptomatic women were compared with the group of healthy women. Conclusion. CPP caused by endometriosis or other gynecological conditions leads to a significant reduction of quality of life and sexual satisfaction. Tripoli TM, Sato H, Sartori MG, de Araujo FF, Girão MJBC, and Schor E. Evaluation of quality of life and sexual satisfaction in women suffering from chronic pelvic pain with or without endometriosis. J Sex Med.

Beijing Da Xue Xue Bao. 2010 Aug 18;42(4):461-4.

Diagnose and therapy for urinary tract endometriosis: A report of 22 cases.

[Article in Chinese]

Rong JH, Zhang Y, Li XS, He ZS, Zhou LQ.

Department of Urology,Peking University First Hospital; Institute of Urology,Peking University,Beijing 100034,China.

OBJECTIVE: To describe our diagnostic and therapeutic experience of patients with urinary tract endometriosis.

METHODS: We performed a retrospective analysis of 22 cases of urinary tract endometriosis with histopathological results from 2001 to 2007.

RESULTS: The mean patient age was 36.0 years. Of the 22 patients, 4 had bladder involvement and 18 ureteral involvement. In those with bladder endometriosis, the diagnosis was made by cystoscopy and biopsy in 4 patients. The treatments consisted of partial cystectomy in 3 patients and transurethral resection of the bladder in 1 patient. One of the patients who underwent transurethral resection of the bladder experienced 1 relapse. The relapse was treated with partial cystectomy. In the patients with ureteral endometriosis, the diagnosis was mainly established by ultrasound (18 cases), intravenous urography (11 cases), retrograde pyelography(7 cases), CT(14 cases) and MRI(5 cases). The treatments consisted of ureterolysis in 1 patient,ureteroneocystostomy in 4, and ureteral resection and end-to-end anastomosis in 13 of them. All the patients pathologic results were of endome-triosis.

CONCLUSION: Urinary tract endometriosis is an uncommon disease. Partial cystectomy should be considered as the therapeutic option for bladder endometriosis . For cases of ureteral endometriosis, the first technique depends on the location, extent and depth of the lesion.

J Stem Cells. 2009;4(4):217-27. doi: jsc.2010.4.4.217.

Neurotrophin in obstetrics and gynaecology.

Bose CK.

Institut für Reproduktionsmedizin, 48149 Münster, Germany. [email protected]

Since Rita Levi Montalcini and Stanley Cohen received Nobel Prize for their pioneering work on nerve growth factor (NGF), its role in female reproductive system has been reinforced in last two decades. The neurotrophins (NT) including nerve growth factor (NGF) are a family of related growth factors and their respective receptor tyrosine kinases that are of major importance in the regulation of neuronal survival and differentiation. While role of NGF in mast cell-mediated egg implantation and inhibition of rejection were primary concern at their time, in the ovary NGF can help in the differentiation process by which ovarian follicles become responsive to gonadotrophins. They help in follicular maturation, steroid secretion and ovulation in the ovary, by inducing the FSH receptor (FSHR). Due to the pleiotropism, NGF is mandatory for the success of pregnancy, while progesterone helping to maintain local levels of NGF in utero. In endometriosisi and polycystic ovarian disease it has major role to play. An autocrine role of NGF in breast cancer and epithelial ovarian cancer (EOC) is evident now. Thus its study will infuse new insight in diseases of both obstetrics and gynaecology.

Reprod Sci. 2010 Oct;17(10):894-903. Epub 2010 Aug 18.

Basal and steroid hormone-regulated expression of CXCR4 in human endometrium and endometriosis.

Ruiz A, Salvo VA, Ruiz LA, Báez P, García M, Flores I.

Department of Microbiology, Ponce School of Medicine, Ponce, PR 00731, USA.

Endometriosis is associated with activation of local and systemic inflammatory mechanisms, including increased levels of chemokines and other proinflammatory cytokines. We have previously reported increased gene expression of chemokine receptor 4 (CXCR4), the receptor for CXCL12, in lesions of the rat model of endometriosis. The CXCR4-CXCL12 axis has been shown to have both immune (HIV infection, lymphocyte chemotaxis) and nonimmune functions, including roles in tissue repair, angiogenesis, invasion, and migration. There is evidence indicating that these mechanisms are also at play in endometriosis; therefore, we hypothesized that activation of the CXCR4-CXCL12 axis could be responsible, at least in part, for the survival and establishment of endometrial cells ectopically. Immunohistochemistry (IHC) showed that CXCR4 protein levels were significantly higher in endometriotic lesions compared to the endometrium of controls. Next, we determined basal gene and protein expression of CXCR4 and CXCL12 and regulation by estradiol (E2) and/or progesterone (P4) in endometrial cell lines using quantitative polymerase chain reaction (qPCR), and Western blots. Basal CXCR4 gene expression levels were higher in epithelial versus stromal cells; conversely, CXCL12 was expressed at higher levels in stromal vs epithelial cells. CXCR4 gene expression was significantly downregulated by ovarian steroid hormones in endometrial epithelial. These data suggest that steroid modulation of CXCR4 is defective in endometriosis, although the specific mechanism involved remains to be elucidated. These findings have implications for future therapeutic strategies specifically targeting the inflammatory component in endometriosis.

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