J Minim Invasive Gynecol. 2011 Jan-Feb;18(1):128-30.

Resolution of catamenial epilepsy after goserelin therapy and oophorectomy: case report of presumed cerebral endometriosis.

Vilos GA, Hollett-Caines J, Abu-Rafea B, Ahmad R, Mazurek MF.

Department of Obstetrics and Gynecology, The University of Western Ontario, London, Ontario, Canada.


Endometriosis can develop in every organ and tissue in the female body except perhaps the spleen. The mechanism of distal metastasis is thought to be hematogenous or lymphatic spread from the uterus. Endometriotic lesions in the central nervous system are rare. Herein, we report the case of a woman with abnormal uterine bleeding who developed catamenial neurologic signs and symptoms. Computed tomography scans and magnetic resonance images demonstrated a circumscribed lesion in the left centrum semiovale of the brain. All neurologic symptoms resolved completely after treatment with gonadotropin-releasing hormone agonist for 3 months and subsequent laparoscopic bilateral oophorectomy. The patient was thought to have cerebral endometriosis, a rare phenomenon, although several cases have been reported in the literature. Temporal association of neurologic signs and symptoms with menstruation that resolves with medical or surgical menopause is highly suggestive of cerebral endometriosis.

Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

Reprod Sci. 2010 Dec 30. [Epub ahead of print]

Aberrant Expression of Apoptosis-Related Molecules in Endometriosis: A Possible Mechanism Underlying the Pathogenesis of Endometriosis.

Nasu K, Nishida M, Kawano Y, Tsuno A, Abe W, Yuge A, Takai N, Narahara H.

Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan.


Endometriosis, a disease affecting 3% to 10% of women of reproductive age, is characterized by the ectopic growth of endometrial tissue under the influence of estrogen. It is also becoming recognized as a condition in which ectopic endometrial cells exhibit abnormal proliferative and apoptotic regulation in response to appropriate stimuli. Apoptosis plays a critical role in maintaining tissue homeostasis and represents a normal function to eliminate excess or dysfunctional cells. Accumulated evidence suggests that, in healthy women, endometrial cells expelled during menstruation do not survive in ectopic locations because of programmed cell death, while decreased apoptosis may lead to the ectopic survival and implantation of these cells, resulting in the development of endometriosis. Both the inability of endometrial cells to transmit a “death” signal and the ability of endometrial cells to avoid cell death have been associated with increased expression of antiapoptotic factors and decreased expression of preapoptotic factors. Further investigations may elucidate the role of apoptosis-associated molecules in the pathogenesis of endometriosis. Medical treatment with apoptosis-inducing agents may be novel and promising therapeutic strategy for endometriosis.

J Steroid Biochem Mol Biol. 2010 Dec 28. [Epub ahead of print]

17β-Hydroxysteroid dehydrogenases (17β-HSDs) as therapeutic targets: Protein structures, functions, and recent progress in inhibitor development.

Marchais-Oberwinkler S, Henn C, Möller G, Klein T, Negri M, Oster A, Spadaro A, Werth R, Wetzel M, Xu K, Frotscher M, Hartmann RW, Adamski J.

Saarland University, Pharmaceutical and Medicinal Chemistry, PO Box 15 11 50, 66041 Saarbrücken, Germany.


17β-Hydroxysteroid dehydrogenases (17β-HSDs) are oxidoreductases, which play a key role in estrogen and androgen steroid metabolism by catalyzing final steps of the steroid biosynthesis. Up to now, 14 different subtypes have been identified in mammals, which catalyze NAD(P)H or NAD(P)(+) dependent reductions/oxidations at the 17-position of the steroid. Depending on their reductive or oxidative activities, they modulate the intracellular concentration of inactive and active steroids. As the genomic mechanism of steroid action involves binding to a steroid nuclear receptor, 17β-HSDs act like pre-receptor molecular switches. 17β-HSDs are thus key enzymes implicated in the different functions of the reproductive tissues in both males and females. The crucial role of estrogens and androgens in the genesis and development of hormone dependent diseases is well recognized. Considering the pivotal role of 17β-HSDs in steroid hormone modulation and their substrate specificity, these proteins are promising therapeutic targets for diseases like breast cancer, endometriosis, osteoporosis, and prostate cancer. The selective inhibition of the concerned enzymes might provide an effective treatment and a good alternative to the existing endocrine therapies. Herein, we give an overview of functional and structural aspects for the different 17β-HSDs. We focus on steroidal and non-steroidal inhibitors recently published for each subtype and report on existing animal models for the different 17β-HSDs and the respective diseases.

Odontostomatol Trop. 2010 Jun;33(130):15-20.

Immunological aspects of a case of extragenital endometriosis localized in the mouth.

[Article in French]

Akre DP, Konan KE, Seka SJ, Dasse SR, Koffi KA, Abauleth R.

Dpt Immunologie, UFR Sciences Médicales Bouaké, Côte d’Ivoire.


To appreciate the role of the immune system in transportation and development of endometer cells in mouth, authors reported the results of immunological parameters analysis in one patient suffering to a mouth localisation healed endometriosis out of hormonal therapy in experimental and analytic study. Immunoglobulin A, G, M and C3, C4 complement fractions were measured by Mancini radial immunodiffusion. The count of CD4+, CD8+and B Cell was performed by BD FASCalibur flow cytometer. Autoimmune diseases were searched after by measuring autoantibodies using agglutination and immunofluoresence methods. The results showed any antibodies detected and the count of CD4, CD8 and B cells was normal. However, IgG and IgA increased. But C3, C4 factions and IgM decreased. This seems an immunological disorder which could be more explored in NK cells and cytokines study.

J Med Chem. 2011 Jan 27;54(2):534-47. Epub 2010 Dec 28.

New drug-like hydroxyphenylnaphthol steroidomimetics as potent and selective 17β-hydroxysteroid dehydrogenase type 1 inhibitors for the treatment of estrogen-dependent diseases.

Marchais-Oberwinkler S, Wetzel M, Ziegler E, Kruchten P, Werth R, Henn C, Hartmann RW, Frotscher M.

Pharmaceutical and Medicinal Chemistry, Saarland University, Campus C2 3, D-66123 Saarbrücken, Germany.


Inhibition of 17β-hydroxysteroid dehydrogenase type 1 (17β-HSD1) is a novel and attractive approach to reduce the local levels of the active estrogen 17β-estradiol in patients with estrogen-dependent diseases like breast cancer or endometriosis. With the aim of optimizing the biological profile of 17β-HSD1 inhibitors from the hydroxyphenylnaphthol class, structural optimizations were performed at the 1-position of the naphthalene by introduction of different heteroaromatic rings as well as substituted phenyl groups. In the latter class of compounds, which were synthesized applying Suzuki-cross coupling, the 3-methanesulfonamide 15 turned out to be a highly potent 17β-HSD1 inhibitor (IC(50) = 15 nM in a cell-free assay). It was also very active in the cellular assay (T47D cells, IC(50) = 71 nM) and selective toward 17β-HSD2 and the estrogen receptors α and β. It showed a good membrane permeation and metabolic stability and was orally available in the rat.

J Clin Endocrinol Metab. 2010 Dec;95(12):0.


[Article in English, Spanish]

Hormone Foundation.

J Cytol. 2010 Jul;27(3):106-8.

Scar endometriosis.

Pathan ZA, Dinesh U, Rao R.

Department of Pathology, SDM College of Medical Sciences Dharwad, Karnataka, India.


Endometriosis is the presence of functioning endometrium outside the uterus. Endometriosis rarely occurs in the abdominal wall. Majority of abdominal wall endometriosis occur in or adjacent to surgical scars, following caesarean section or hysterectomy. Laparotomy scar endometriosis following salpingectomy for ectopic pregnancy has rarely been reported. We report a case of scar endometriosis following laparotomy for chronic ectopic, and diagnosed by fine needle aspiration cytology (FNAC). Excision biopsy confirmed the FNAC diagnosis of scar endometriosis.

J Ethnopharmacol. 2010 Dec 25. [Epub ahead of print]

Combining rigour with relevance: A novel methodology for testing Chinese herbal medicine.

Flower A, Lewith G, Little P.

Department of Primary Care, Southampton Medical School, University of Southampton, UK.


BACKGROUND: There is a need to develop an evidence base for Chinese herbal medicine (CHM) that is both rigorous and reflective of good practice. This paper proposes a novel methodology to test individualised herbal decoctions using a randomised, double blinded, placebo controlled clinical trial.

METHOD: A feasibility study was conducted to explore the role of CHM in the treatment of endometriosis. Herbal formulae were pre-cooked and dispensed as individual doses in sealed plastic sachets. This permitted the development and testing of a plausible placebo decoction. Participants were randomised at a distant pharmacy to receive either an individualised herbal prescription or a placebo.

RESULTS: The trial met the predetermined criteria for good practice. Neither the participants nor the practitioner-researcher could reliably identify group allocation. Of the 28 women who completed the trial, in the placebo group (n=15) 3 women (20%) correctly guessed they were on placebo, 8 (53%) thought they were on herbs and 4 (27%) did not know which group they had been allocated to. In the active group (n=13) 2 (15%) though they were on placebo, 8 (62%) thought they were on herbs and 3 (23%) did not know. Randomisation, double blinding and allocation concealment were successful and the study model appeared to be feasible and effective.

CONCLUSION: It is now possible to subject CHM to rigorous scientific scrutiny without compromising model validity. Improvement in the design of the placebo using food colourings and flavourings instead of dried food will help guarantee the therapeutic inertia of the placebo decoction.

J Gynecol Obstet Biol Reprod (Paris). 2010 Dec;39(8 Suppl 2):S34-44.

Anatomic evaluation of the female of the infertile couple.

[Article in French]

Torre A, Pouly JL, Wainer B.

Faculté de médecine Paris-Ouest, Université de Versailles Saint-Quentin en Yvelines, 9 boulevard d’Alembert, 78280 Guyancourt, France. antoinetorre@voila.fr


One third of infertility cases are due to anatomical abnormalities of the female reproductive tract: endometrial polyps (33%), bilateral tubal blockage (12%), hydrosalpinx (7%), sub-mucosal fibroids (3%) and pelvic endometriosis. These may need surgical correction which could restore fertility. This review aim to determine which examinations should be performed first. Hysterosalpingography shows sensitivity of only 65% but it increases the achievement of spontaneous pregnancy by three times. Office hysteroscopy has an excellent sensitivity (>95%) for diagnosing intra-uterine lesions. Pelvic ultrasound, whose good sensitivity is improved by adding 3D imaging and hysterosonography, seems as efficient as office hysteroscopy in diagnosing uterine cavity abnormalities. Moreover, it also efficiently diagnoses pelvic diseases such as hydrosalpinx or endometrioma without laparoscopy. A first line laparoscopy is indicated in for woman suspected of endometriosis or tubal pathology (history of complicated appendicitis, previous pelvic surgery, pelvic inflammatory disease). For the others straight forward cases, the majority of patients, hysterosalpingography and pelvic ultrasound seem to be sufficient as primary diagnostic tool.

J Neurosurg Spine. 2010 Dec 24. [Epub ahead of print]

Cyclic sciatica from extrapelvic endometriosis affecting the sciatic nerve.

Floyd JR, Keeler ER, Euscher ED, McCutcheon IE.

Departments of Neurosurgery.


Sciatic (catamenial) radiculopathy, waxing and waning with the menstrual cycle, is an uncommon condition typically caused by pelvic endometriosis affecting the lumbosacral plexus or proximal sciatic nerve. The authors describe a woman with catamenial sciatica caused by endometriosis affecting the sciatic nerve trunk in the upper thigh. Symptomatic with leg pain for 5 years, this patient developed gluteal atrophy and sensory loss and decreased strength in the L-5 dermatomyotome, a distribution confirmed by electromyography. Magnetic resonance imaging suggested thickening of the sciatic nerve at and distal to the sciatic notch. At operation the nerve showed extrinsic and intrinsic abnormality, proven to be endometriosis. Her symptoms improved, and she began gonadotropin-releasing hormone agonist therapy for further suppression. This very unusual case shows that endometriosis can affect the sciatic nerve over a range of territory inside and outside the pelvis, and that surgery must be appropriately directed to avoid negative exploration. Surgical decompression achieves good relief of symptoms, and medical therapy also allows sustained suppression of this disease.

Gynecol Obstet Fertil. 2011 Jan;39(1):e20-e22. Epub 2010 Dec 22.

Perimenopausal discovery of endometriomas on ovarian abscess.

[Article in French]

Faure AC, Faure C, Messica O, Margossian H, Ory JP.

Service de biologie de la reproduction, centre hospitalier universitaire de Besançon, 2, place Saint-Jacques, 25000 Besançon, France; Service de gynécologie-obstétrique, centre hospitalier intercommunal de Haute-Saône, 2, avenue René-Heymes, 70014 Vesoul cedex, France.


Ovarian abscess is a rare gynaecological diagnosis. The case reported is the one of an unexplained fever with a strong physical alteration during more than 14 days occurring around the menopause, at the age of 54. It has been discovered an ovarian tumour which was, infact, an infected endometrioma. The patient never complained from endometriosis during her reproductive life. She had no other risk factor for ovarian abscess.

Gynecol Obstet Fertil. 2011 Jan;39(1):3-7. Epub 2010 Dec 22.

Endometriosis and fertility: Results after surgery and Assisted Reproductive Technology (ART).

[Article in French]

Dechanet C, Rihaoui S, Reyftmann L, Hedon B, Hamamah S, Dechaud H.

Département de médecine et biologie de la reproduction, pôle naissances et pathologies de la femme, hôpital universitaire A.-de-Villeneuve, 371, avenue du Doyen-G.-Giraud, 34295 Montpellier cedex 5, France.


OBJECTIVE: To evaluate fertility outcomes after laparoscopic and ART management of endometriosis in an infertile population.

PATIENTS AND METHODS: Retrospective analysis including 79 infertile patients treated by laparoscopic surgery. Fertility was studied in relation to pregnancy’s mode (spontaneous or ART) and to endometriosis stages (rAFS).

RESULTS: After laparoscopy, 8.9% of patients had a spontaneous pregnancy. IIU led to a cumulative rate of pregnant women of 21.5%. Then after laparoscopy, IIU and IVF, 68.4% of patients were pregnant. The average delay was 460 days between laparoscopy and spontaneous pregnancy, 271 days between surgery and IIU pregnancy and 600 days between surgery and IVF pregnancy. Among women with stages I-II endometriosis (62 cases), 11.3% patients obtained a spontaneous pregnancy, the cumulative rate of pregnant women after laparoscopy and IIU was 25,8%. After laparoscopy, IIU and IVF, 66.1% of patients were pregnant. The average post-surgical time to spontaneous pregnancy was 460 days. The average delay between surgery and IIU pregnancy was 279 days and 589 days between surgery and IVF pregnancy. In case of stages III-IV (17 patients), 76.4% of pregnancies were obtained. No spontaneous pregnancy was observed. 94.1% of patients were treated with IVF, leading to a global rate of pregnancy of 70.5%. The average delay between surgery and IVF pregnancy was 563 days.

CONCLUSIONS: With a combination of surgery and ART, two-third of patients were pregnant with an average time between surgery and pregnancy of less than two years. This combination (surgery and ART) increases the chances of becoming pregnant. At the moment, the delay between surgery and ART needs to be established.

Fertil Steril. 2010 Dec 21. [Epub ahead of print]

Cervical endometriosis associated with malignant pleural mesothelioma mimicking cervical cancer-Occam’s razor or the “third man”

Engel JB, Heuer S, Segerer S, Rauthe S, Dietl J, Hönig A.

Department of Obstetrics and Gynecology, Medical University of Würzburg, Würzburg, Germany.


OBJECTIVE: To illustrate pitfalls in the diagnosis of endometriosis and cervical cancer.

DESIGN: Case report.

SETTING: University hospital, department of obstetrics and gynecology.

PATIENT(S): A 45-year-old woman with menorrhagia, pelvic mass, right-sided hydronephrosis, and unexplained weight loss.

INTERVENTION(S): Cervical biopsies were suggestive of cervical endometriosis. Laparoscopy confirmed endometriosis. Associated pleural effusion, without cytologic signs of malignancy, was interpreted as caused by thoracic endometriosis. The patient had a transabdominal hysterectomy and unilateral salpingo-oophorectomy. Histopathologic examination confirmed endometriosis and revealed a residual tubo-ovarian abscess. After surgery, the patient developed spontaneous seropneumothorax. Pleural biopsies revealed a well-differentiated epithelial malignant pleural mesothelioma. The patient underwent hypofractionated radiation of drain sites. She is now observed in our outpatient clinic.

MAIN OUTCOME MEASURE(S): Steps to the correct diagnosis.

RESULT(S): The patient had an association of cervical and pelvic endometriosis, residual tubo-ovarian abscess, and malignant pleural mesothelioma.

CONCLUSION(S): Usually, the simplest diagnosis explaining a complex of symptoms and clinical and diagnostic findings is the one most likely to be correct. This is an application of Occam’s razor to medicine. Our case illustrates that occasionally the simplest and therefore most probable diagnosis can be wrong, and on these occasions one should consider a “third man.”

Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Fertil Steril. 2010 Dec 21. [Epub ahead of print]

A subserosal uterus-like mass presenting after a sliding hernia of the ovary and endometriosis: a rare entity with a discussion of the histogenesis.

Seki A, Maeshima A, Nakagawa H, Shiraishi J, Murata Y, Arai H, Kubochi K, Kuramochi S.

Pathology Division, Clinical Laboratories, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.


OBJECTIVE: To report the first case of a subserosal uterus-like mass.

DESIGN: Case report.

SETTING: A community-based hospital.

PATIENT(S): A 44-year-old nulliparous woman who complained of a left inguinal mass had a medical history that was notable for two features. One was left oophorectomy for a sliding hernia at 10 months of age; the other was endometriosis at the oophorectomy site at 26 years of age.

INTERVENTION(S): Tumorectomy.

MAIN OUTCOME MEASURE(S): Not applicable.

RESULT(S): Pathologic examination demonstrated that this subserosal mass mimicked a miniature uterus with a leiomyomatous lesion.

CONCLUSION(S): As of September 2010, 23 cases of uterus-like mass had been reported. Three pathologic theories of uterus-like mass have been proposed: [1] congenital anomaly theory, [2] metaplasia theory, and [3] heterotopia. The pathogenesis of this rare entity is currently under debate. Most uterus-like masses have been connected to the genital organs (75.0%) and associated with endometriosis (50.0%). In the present case, the uterus-like mass developed at the surgical scar site of oophorectomy for a sliding hernia and a tumorectomy for endometriosis. We review the literature and discuss the theories regarding the histogenesis of uterus-like mass.

Chem Biol Interact. 2010 Dec 21. [Epub ahead of print]

Progestins as inhibitors of the human 20-ketosteroid reductases, AKR1C1 and AKR1C3.

Beranič N, Gobec S, Rižner TL.

Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia.


The human aldo-keto reductases 1C1 and 1C3 (AKR1C1 and AKR1C3) are important 20-ketosteroid reductases in pre-receptor regulation of progesterone action. Both AKR1C1 and AKR1C3 convert progesterone to the less potent metabolite 20α-hydroxyprogesterone, although AKR1C1 has a higher catalytic efficiency than AKR1C3. Recently, we reported significant up-regulation of AKR1C1 and AKR1C3 in ovarian endometriosis, a complex estrogen-dependent disease. The typical characteristics of endometriosis are increased formation of estradiol, which stimulates proliferation of endometriotic tissue, and disturbed action of the protective progesterone. Although progestins have been used for treatment of endometriosis since the 1960s, their detailed mechanisms of action are still not completely understood. In the present study, we evaluated the potential inhibitory effects of progestins on the pre-receptor regulatory enzymes AKR1C1 and AKR1C3. We examined the following progestins as inhibitors of progesterone reduction catalyzed by recombinant AKR1C1 and AKR1C3: progesterone derivatives (dydrogesterone, its metabolite, 20α-hydroxydydrogesterone; and medroxyprogesterone acetate), 19-nortestosterone derivatives (desogestrel, norethinodrone and levonorgestrel), and the androgen danazol. Dydrogesterone, medroxyprogesterone acetate, 20α-hydroxydydrogesterone and norethinodrone inhibited AKR1C1 and AKR1C3 with K(i) values of 1.9μM, 7.9μM, 20.8μM and 48.0μM, and of 0.5μM, 1.4μM, 18.2μM and 6.6μM, respectively. Levonorgestrel and desogestrel preferentially inhibited AKR1C3 with K(i) values of 5.6μM and 39.1μM, respectively. Our data thus show that dydrogesterone, medroxyprogesterone acetate, 20α-hydroxydydrogesterone and norethinodrone inhibit AKR1C1 and AKR1C3 in vitro, although their physiological inhibitory effects still need to be evaluated further. Additionally, we investigated whether progestin dydrogesterone can be metabolized to its active 20α-hydroxymetabolite by AKR1C1 and AKR1C3. AKR1C1 converted dydrogesterone with a high catalytic efficiency while AKR1C3 was less active, which suggests that in vivo dydrogesterone is metabolized mainly by AKR1C1. Docking simulations of dydrogesterone into AKR1C1 and AKR1C3 also support these experimental data.

Hum Reprod. 2010 Dec 21. [Epub ahead of print]

Dietary fat consumption and endometriosis risk.

Koninckx PR, Brosens IA.

UZ Gasthuisberg, KULeuven, B3000 Leuven, Belgium.

J Obstet Gynaecol Can. 2010 Dec;32(12):1172-5.

Laparoscopic internal iliac artery ligation for postpartum spontaneous hemoperitoneum.

Gao JL, Lortie K, Singh SS.

School of Medicine, Queen’s University, Kingston ON.


Background: Spontaneous hemoperitoneum in pregnancy or the postpartum period is an uncommon but potentially life-threatening complication. Case: A 29-year-old woman presented with severe abdominal pain, decreased consciousness, and a reduced hemoglobin level three days after an uneventful spontaneous vaginal delivery. Initial ultrasound and CT imaging showed significant hemoperitoneum with no identifiable cause. Laparoscopic surgery was performed, during which bleeding from the left uterine artery was identified and resolved with laparoscopic internal iliac artery ligation. Concomitant cul-de-sac obliteration and adhesions secondary to decidualized endometriosis were found. Conclusion: Decidualized endometriosis is a possible etiologic factor in spontaneous hemoperitoneum. Prompt diagnosis and treatment are critical for improving outcomes. When surgical intervention is indicated, a laparoscopic approach should be considered because of its minimally invasive nature and shorter recovery time.

BJU Int. 2011 Feb;107(3):370-5. doi: 10.1111/j.1464-410X.2010.09843.x. Epub 2010 Dec 22.

The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain.

Parsons CL.

UC San Diego Medical Center, Department of Surgery/Urology, La Jolla, CA, USA.


What’s known on the subject? and What does the study add? This article reviews entirely new concepts concerning the etiology, presentation and diagnosis of interstitial cystitis. It pulls the information together in a concise fashion that emphasizes there is a radical change taking place in the concepts of what generates bladder symptoms. Primarily this emphasizes that the paradigm for interstitial cysititis and the generation of bladder symptoms is going to change dramatically. The data reviewed shows that the symptoms are caused by a leaky epithelium and subsequent diffusion of potassium into the tissues causing frequency, urgency, pain and incontinence. This is totally different from current concepts. The traditional diagnosis of interstitial cystitis (IC) only recognizes the severe form of the disease. The far more common early and intermittent phases of the disease are not perceived to be part of IC but rather are misdiagnosed as urinary tract infection, urethral syndrome, overactive bladder, chronic prostatitis, urethritis, or a type of gynecologic pelvic pain (such as endometriosis, vulvodynia, or some type of vaginitis). All of these patient groups actually suffer from the same bladder disease. This disease results from a leaky bladder epithelium and subsequent potassium leakage into the bladder interstitium that generates the symptoms of frequency, urgency, pain or incontinence in any combination. Robust scientific data now support this important concept. These data will be reviewed herein. The conclusions derived from these data substantially alter the paradigms for urology and gynecology in the generation of frequency, urgency and pelvic pain. All the above-mentioned syndromes unite into one primary disease process, lower urinary dysfunction epithelium, or LUDE disease, and not the 10 plus syndromes traditionally recognized.

Womens Health (Lond Engl). 2011 Jan;7(1):51-70.

Use of mifepristone to treat endometriosis: a review of clinical trials and trial-like studies conducted in China.

Guo SW, Liu M, Shen F, Liu X.

Obstetrics & Gynecology Hospital, Fudan University Shanghai College of Medicine, 419 Fangxie Road, Shanghai 200011, China. hoxa10@gmail.com


China was the first country in the world that approved mifepristone (RU-486) for abortion. A total of 6 years after the report published in the Western world indicated that mifepristone may also be effective in treating endometriosis, the first paper on the same topic was published in China in 1997. Since then, over 160 studies on this topic have been published in China. We retrieved 104 papers on clinical trials and trial-like studies conducted in China evaluating the use of mifepristone to treat endometriosis that were published in the last 11 years. We found that the quality of these studies is well below an acceptable level, making it difficult to judge whether mifepristone is truly efficacious. There are intriguing signs that these studies, as a whole, have serious anomalies. The areas that are glaringly deficient are informed consent, choice of outcome measures, the evaluation of outcome measures, data analysis and randomization. The uniformly low quality is disquieting, given the large quantity of studies, the enormous amount of resource and energy put into these studies and, above all, the weighty issue of treatment efficacy that concerns each and every patient with endometriosis. Equally disquieting are the low-quality repetition, the absence of a critical, systematic review on the subject, the lack of suggestions for multicenter clinical trials and the seemingly unnecessary duplication of clinical trials without due informed consent. In view of this, it may be time to institute changes in attitude and practice, and to change education and training programs in the methodology of clinical trials in obstetrics and gynecology research in China.

Kyobu Geka. 2010 Dec;63(13):1181-3.

Catamenial pneumothorax; report of a case.

[Article in Japanese]

Hokka D, Yoshikawa K, Morimoto M, Kamimura R, Tane K, Hoshida Y.

Department of Thoracic Surgery, Sumitomo Hospital, Osaka, Japan.


A 39-year-old woman was referred to our hospital because of pneumothorax related to menstruation. Chest X-ray showed right pneumothorax. Right thoracoscopy revealed 3 fenestrations on the diaphragm. Partial resection of the diaphragm including these lesions were performed. Intrathoracic minocycline was applied expecting pleural adhesion after surgery. Histopathological examination confirmed the presence of endometriosis on the resected diaphragm.

Arch Gynecol Obstet. 2010 Dec 19. [Epub ahead of print]

Interstitial cystitis and endometriosis in a 12-year-old girl.

Walid MS, Heaton RL.

Heart of Georgia Women’s Center, 207 Green Street, Warner Robins, GA, 31093-2727, USA, mswalid@yahoo.com.


INTRODUCTION: Interstitial cystitis (IC) is a common cause of pelvic pain in the general female population and is thought to be understated in young female patients.

CASE: A 12-year-old girl with IC and endometriosis.

METHOD: A single case report.

CONCLUSION: It is important to screen for IC in young patients with endometriosis and vice versa.

Histochem Cell Biol. 2011 Jan;135(1):83-91. Epub 2010 Dec 18.

Increased c-Jun N-terminal kinase activation in human endometriotic endothelial cells.

Uz YH, Murk W, Bozkurt I, Kizilay G, Arici A, Kayisli UA.

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, 06520-8063, USA.


Endometriosis is a common inflammatory gynecological disease characterized by the presence of endometrial tissue outside of the uterine cavity. The c-Jun N-terminal kinase (JNK) is a subfamily of the mitogen-activated protein kinases (MAPKs) involved in cellular processes ranging from cytokine expression to apoptosis, and is activated in response to inflammation and cellular stress. We hypothesized that inflammatory cytokines in the peritoneal microenvironment increase JNK MAPK activity in endometriotic endothelial cells, and that human endometrial endothelial cells (HEECs) may be involved in inflammatory pathogenesis of endometriosis. Thus, we evaluated the expression of the total- and phosphorylated-(phospho)-JNK in endometrial and endometriotic endothelial cells in vivo, and in HEECs treated with normal peritoneal fluid (NPF), endometriotic peritoneal fluid (EPF), and the inflammatory cytokines interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) in vitro. Phospho-JNK immunoreactivity in HEECs in normal endometrium was significantly higher in the early proliferative and late secretory phases compared to other phases. Both eutopic and ectopic HEECs from the early secretory phase also revealed higher phospho-JNK immunoreactivity, compared to their respective cycle-matched normal HEECs. Moreover, HEECs treated with EPF showed significantly higher phospho-JNK levels compared to that in HEECs treated with NPF. In conclusion, our in vivo and in vitro findings suggest that increased phosphorylation of JNK in HEECs from women with endometriosis is likely due to high level of IL-1β and TNF-α in peritoneal fluid; this in turn may up-regulate inflammatory cytokine expression and thus play a role in the pathogenesis of endometriosis.

Arch Gynecol Obstet. 2010 Dec 18. [Epub ahead of print]

Primary umbilical endometriosis: a rare entity.

Dadhwal V, Gupta B, Dasgupta C, Shende U, Deka D.

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.


Primary umbilical endometriosis accounts for 0.5-1% of extragenital endometriosis. Clinical presentation is typical and treatment involves complete excision. It is important to consider it in differential diagnosis of an umbilical nodule.

Fertil Steril. 2011 Jan;95(1):46-9. Epub 2010 Jun 18.

Discovery of a novel biomarker in the urine in women with endometriosis.

Tokushige N, Markham R, Crossett B, Ahn SB, Nelaturi VL, Khan A, Fraser IS.

Department of Obstetrics and Gynaecology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, Sydney, New South Wales, Australia. ntokushige@med.usyd.edu.au


OBJECTIVE: To investigate whether proteins secreted in urine differ between women with and without endometriosis.

DESIGN: Laboratory study using human urine.

SETTING: University-based laboratory.

PATIENT(S): Women with and without endometriosis undergoing laparoscopy, hysteroscopy and curettage.

INTERVENTION(S): Urine collection from women with and without endometriosis.

MAIN OUTCOME MEASURE(S): Proteomic techniques and mass spectrometry to identify proteins secreted in the urine of women with and without endometriosis.

RESULT(S): On average, 133 proteins were significantly different between women with and without endometriosis. Cytokeratin-19 was highly up-regulated in the urine of women with endometriosis.

CONCLUSION(S): Cytokeratin-19 may be a valuable urinary biomarker for endometriosis.

Eur J Obstet Gynecol Reprod Biol. 2010 Dec 16. [Epub ahead of print]

Efficacy of transient abdominal ovariopexy in patients with severe endometriosis.

Carbonnel M, Ducarme G, Dessapt AL, Yazbeck C, Hugues JN, Madelenat P, Poncelet C.

Services de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Paris, France.


OBJECTIVE: To assess adhesion formation and fertility outcome after transient abdominal ovariopexy performed in patients with severe endometriosis.

STUDY DESIGN: Retrospective study including 218 patients who underwent surgery for severe endometriosis from 1997 to 2009. One hundred and thirty-nine (64%) patients were infertile. The initial ASRM stage was IV in 139 cases, III in 43 cases and II in 36 cases. Adnexal adhesions were scored by using the Operative Laparoscopy Study Group (OLSG) and modified AFS scoring systems. Unilateral or bilateral transient abdominal ovariopexy of 336 ovaries was performed to prevent adhesion formation or reformation for extensive surgery. In patients who underwent a second operation, adnexal adhesion scores were reported. Fertility outcome was evaluated by a questionnaire.

RESULTS: Second-look surgery was performed after 11.7±2.4 months in 24 patients (11%) who had undergone 38 ovariopexies. Transient abdominal ovariopexy significantly decreased adnexal adhesion scores (p<0.05). Regarding fertility outcome, the median follow up was 19.6±1.5 months. Fifty-eight patients, out of 105 infertile women who actively tried to conceive after surgery, conceived, 21 (36%) spontaneously and 37 (64%) after ART. The median time interval for conception was 8.6±1 months.

CONCLUSION: In patients with severe endometriosis, transient abdominal ovariopexy is an effective technique in preventing postoperative adhesion formation and in improving fertility outcome. CONDENSATION: In 218 patients with severe endometriosis, transient abdominal ovariopexy was an effective technique in preventing adhesion formation and improving fertility outcome.

Hum Immunol. 2010 Dec 15. [Epub ahead of print]

New insights into pattern recognition receptors and their ligands in gynecologic pathologies.

Yamada Y, Shigetomi H, Onogi A, Haruta S, Kawaguchi R, Yoshida S, Furukawa N, Nagai A, Tanase Y, Tsunemi T, Oi H, Kobayashi H.

Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan.


In the ovary, clear cell carcinoma (CCC) and endometrioid adenocarcinoma occur in the setting of endometriosis. In this review, we discuss the role of innate immune responses, specifically endogenous ligands (also known as “alarmins”), their pattern recognition receptors (PRRs) and their signaling pathways, in the pathogenesis of ovarian cancer, in particular, endometriosis-associated ovarian cancer. This article reviews the English-language literature for pathogenesis and pathophysiological studies on endometriosis and ovarian cancer. Here, we show that iron functions as an endogenous ligand and can induce chromosomal instability through production of reactive oxygen intermediates-induced oxidative stress. Several important CCC-related genes overlap with those known to be associated with hepatocyte nuclear factor-1β-dependent oxidative stress. Aberrant expression of PRRs and HNF-1β in endometriosis has been reported in the setting of chronic inflammation and oxidative stress pathways, which lie downstream of these genes. A concerted overexpression of alarmins, their receptors and HNF-1β might be required for endometriosis carcinogenesis. Recent advances in innate immunity illuminate the molecular mechanism underlying inflammation-induced carcinogenesis. Upregulation of PRRs expression may synergize with activation of HNF-1β signaling to accelerate endometriosis proliferation and cause carcinogenesis.

Arch Gynecol Obstet. 2010 Dec 17. [Epub ahead of print]

Diagnosis of endometrial nerve fibers in women with endometriosis.

Aghaey Meibody F, Mehdizadeh Kashi A, Zare Mirzaie A, Ghajarie Bani Amam M, Shariati Behbahani A, Zolali B, Najafi L.

Minimally Invasive Surgery Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.


PURPOSE: Recent studies indicated that there is a high density of small nerve fibers in the functional layer of the endometrium in women with endometriosis and that it can be used as a marker to detect endometriosis. In this study, the efficacy assessment of small nerve fibers’ density as a diagnostic marker was compared in patients with and without endometriosis.

METHODS: In this study, women with history of pelvic pain and/or infertility who were candidates for laparoscopy or laparotomy in Rassoul hospital (2007-2009) were enrolled. Histological sections of endometrial tissue were prepared from endometrial biopsy from women with endometriosis (n = 12) (1) and without endometriosis (n = 15) (2). Protein gene product 9.5 and neurofilament were evaluated as marker from endometrial biopsies by immunohistochemical methods.

RESULTS: There was no statistically significant difference between two groups according to age, body mass index. Nerve fibers were detected in all endometrial biopsies from all women with endometriosis but detected only in three women without endometriosis. The mean density of nerve fibers was 2.2 ± 4.7 mm(-2) in group without endometriosis and) 13.1 ± 3.3 (in group with endometriosis (p < 0.001). Women with endometriosis had significantly higher nerve fiber density in comparison with women without endometriosis.

CONCLUSIONS: Our findings indicated that endometrial biopsy for detecting density of nerve fibers by usage of protein gene product 9.5, provided a reliable marker for diagnosis of endometriosis.

Gynecol Obstet Invest. 2010 Dec 14. [Epub ahead of print]

Appendectomy in the Gynecological Setting: Intraoperative Findings and Corresponding Histopathology.

Shavell VI, Mahdi HM, Awonuga AO, Edelman DA, Webber JD, Gidwani RM, Husain M, Berman JM.

Department of Gynecology, Wayne State University School of Medicine and the Detroit Medical Center, Detroit, Mich., USA.


Background/Aims: To evaluate the intraoperative findings and corresponding histopathology associated with appendectomies performed during benign gynecological surgery. Methods: Retrospective case series. Results: Twenty-two appendectomies were performed from 2002 through 2008 at Hutzel Women’s Hospital due to intraoperative findings of inflammation or erythema (n = 8), periappendiceal adhesions (n = 5), injury to the appendix or mesoappendix (n = 2), fecalith (n = 2), dilation of the appendix (n = 1), adnexal mass involving the appendix (n = 1), and suspected lipoma (n = 1). Final pathology was consistent with significant findings such as acute inflammation, periappendicitis, and adhesions or endometriosis involving the appendix in 68.2% of cases. Conclusion: In the benign gynecological setting, appendectomies were primarily performed due to inflammation or erythema. In the majority of cases, significant appendiceal pathology was confirmed.

Gynecol Obstet Invest. 2010 Dec 14. [Epub ahead of print]

Endometriosis Cost Assessment (the EndoCost Study): A Cost-of-Illness Study Protocol.

Simoens S, Hummelshoj L, Dunselman G, Brandes I, Dirksen C, D’Hooghe T.

Research Centre for Pharmaceutical Care and Pharmaco-Economics, Katholieke Universiteit Leuven, Leuven, Belgium.


Aims: The EndoCost study aims to calculate the costs of endometriosis from a societal perspective. Methods: This multicentre, prevalence-based cost-of-illness analysis aggregates data on endometriosis costs and quality of life from a prospective hospital questionnaire and from both retrospective and prospective patient questionnaires. The EndoCost study comprises 12 representative tertiary care centres involved in the care of women with endometriosis in 10 countries. The sample includes patients with a laparoscopic and/or histological diagnosis of endometriosis and with at least 1 patient contact related to endometriosis during 2008. The EndoCost study measures direct healthcare costs (e.g. costs of medication, physician visits), direct non-healthcare costs (e.g. transportation costs), and indirect costs of productivity loss. Cost questions are developed specifically for the purpose of the EndoCost study. Quality of life is measured using the EuroQol-5D and relevant parts of the Global Study of Women’s Health instruments. Both aggregate analyses and country-specific analyses are planned for total costs per patient. Costs are broken down into cost drivers and into the various payers that incur costs. Conclusions: The cost estimates provided by the EndoCost cost-of-illness analysis may be used to justify the prioritisation of future research in endometriosis.

Reprod Sci. 2010 Dec 15. [Epub ahead of print]

TRPV1 Expression on Peritoneal Endometriosis Foci is Associated With Chronic Pelvic Pain.

Rocha MG, Silva JC, Ribeiro da Silva A, Candido Dos Reis FJ, Nogueira AA, Poli-Neto OB.

Department of Obstetrics and Gynecology, Ribeiraõ Preto Medical School, University of Saõ Paulo, Ribeiraõ Preto, Saõ Paulo, Brazil.


Objective: To investigate the expression of capsaicin receptor (transient receptor potential vanilloid type 1 [TRPV1]) in the peritoneal endometriosis foci of women with and without chronic pelvic pain (CPP). Methods: A case-control study was conducted on 49 women with endometriosis who underwent laparoscopy, 28 of whom had CPP and 21 without CPP. Samples from peritoneum of the rectouterine excavation (2 cm(2)) were obtained by laparoscopy, fixed in 4% formaldehyde, and underwent immunohistochemistry analysis using rabbit anti-TRPV1 (1:400) polyclonal antibody. Results: Image analysis revealed that the immunoreactivity for TRPV1 was more frequent in specimens (endometriosis foci) from women with CPP (n = 15 of 28, 53.6%), compared to samples from the endometriosis foci of women without CPP (n = 6 of 21, 28.6%; P = .04). There was no correlation with duration, intensity of pain, or stage of the disease (endometriosis). Discussion: The present study shows that TRPV1 expression in peritoneal endometriosis foci is related to CPP in women. However, this association is not related to the endometriosis stage. In view of the immunoreactivity for TRPV1 observed here, we believe that some endometriotic lesions may provide a scenario for TRPV1 to be tonically active and this activity may contribute to the underlying pathology of CPP.

J Obstet Gynaecol Res. 2010 Dec 15. doi: 10.1111/j.1447-0756.2010.01413.x. [Epub ahead of print]

Endoscopic rectal ultrasound and elastosonography are useful in flow chart for the diagnosis of deep pelvic endometriosis with rectal involvement.

Mezzi G, Ferrari S, Arcidiacono PG, Di Puppo F, Candiani M, Testoni PA.

Departments of Gastroenterology and Gastrointestinal Endoscopy and Obstetrics and Gynecology, IRCCS Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.


 Endometriosis is defined by the presence of endometrial glands and Aim: stroma outside the uterus. The disease causes pelvic pain, dysmenorrhea, dyspareunia, dyschezia and urinary symptoms. The aim of this study was to assess the usefulness of endoscopic ultrasound (EUS) and elastosonography for detecting rectosigmoid endometriosis and to compare the findings, in selected and symptomatic patients, with surgical specimens in order to select the best surgical strategy. Material &  Sixty-three consecutive patients Methods: years) with diagnosis of endometriosis were referred (mean age 34.2; range 25-50 for rectal endosonography to evaluate the rectal involvement. Patients complained of abdominal pain, rectal bleeding, constipation and dysmenorrhea. Sub-stenosis of the rectosigmoid lumen was found endoscopically in one patient (1.5%), bulging in 21 (33.3%), mucosal hyperemia or edema in one (1.5%), and no lesions in 39 patients (61.9%); no abdominal masses or obstruction were reported. Each woman completed a self-administered 100-point questionnaire to absent, = evaluate endometriosis-related pain (intensity of symptoms: 0 unbearable). After clinical imaging evaluation, 10 symptomatic patients = 100  EUS years) were evaluated for surgery. Results: (mean age 32.2; range 26-45 detected endometriotic lesions in all patients as a hypoechoic mass, poorly vascularized with irregular, undefined margins. In cases where the rectosigmoid wall was involved, there was invasion of the fourth layer. All patients who were operated had histologic findings of endometriotic lesions involving the rectal  EUS and elastosonography offers a wall, as indicated by EUS. Conclusion: non-invasive and sensitive technique to better define the endometriotic infiltration in the rectosigmoid wall.

Gynecol Endocrinol. 2010 Dec 15. [Epub ahead of print]

Dienogest, a new conservative strategy for extragenital endometriosis: a pilot study.

Harada M, Osuga Y, Izumi G, Takamura M, Takemura Y, Hirata T, Yoshino O, Koga K, Yano T, Taketani Y.

Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan.


Extragenital endometriosis severely impairs the quality of life for affected women but its standard management has not yet been well established because of its relatively low incidence. As extragenital organs, intestine, followed by urinary tract, is the most common place affected by endometriosis, for which surgical treatment is sometimes difficult and accompanied by severe complications. Recently, dienogest, a novel progestin, has emerged as a new alternative for endometriosis, especially for endometriosis-associated pain. In this report, we presented four cases with rectosigmoidal and one with bladder endometriosis, treated with oral 2 mg/day dienogest for over 6 months. For all cases, the measurable extragenital lesions exhibited the reduction in their size after 10 to 11 months of use, accompanied with immediate relief of subjective symptoms related with extragenital lesions. This report suggests that dienogest can be a novel conservative alternative for extragenital endometriosis.

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