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Fertil Steril. 2007 Oct;88(4):986-7. Epub 2007 Apr 10.

Pelvic pain after gonadotropin administration as a potential sign of endometriosis.

Jun SH, Lathi RB.

Department of Reproductive Endocrinology and Infertility, Stanford University Medical Center, Stanford, California 94305, USA.

We describe five patients who developed significant pelvic pain, requiring narcotics, during a controlled ovarian hyperstimulation cycle and who were surgically diagnosed with significant endometriosis. Severe pain, especially if it requires narcotics, is unusual for patients undergoing controlled ovarian hyperstimulation and may be an indicator of endometriosis.

Zhonghua Yi Xue Za Zhi. 2007 Jan 16;87(3):179-83.

[Expression of cyclin B1 and cyclin-dependent kanasel in ectopic and eutopic endometrium tissues of patients with endometriosis]

[Article in Chinese]

Tang L, He RH, Zhou CY, Pan H, Huang HF.

Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Zhejiang 310006, China.

OBJECTIVE: To investigate the possible roles of cyclin B1 and cyclin-dependent kanase1 cyclin-dependent kanase1 play in the pathogenesis and development of endometriosis and their association with the ovarian hormones. METHODS: Twenty-nine specimens of ectopic endometrium tissues and 20 specimens of eutopic endometrium tissues were obtained from 29 patients with endometriosis, aged 24 approximately 46. Thirty specimens of endometrium form 30 women without endometriosis were used as controls. The intracellular location of cyclin B1 and Cdc2 was detected by microscopy. Western blotting, RT-PCR, and immunohistochemistry were employed to examine the mRNA expression and protein expression of cyclin B1 and Cdc2. Serum estrogen and progestogen were detected. RESULTS: The expression level of cyclin B1 in the ectopic endometrium from the women with endometriosis was significantly higher than that in the ectopic endometrium tissues from the women with and without endometriosis (both P < 0.05). No significant difference was found between the expression level of cyclin B1 in the ectopic endometrium tissues from the women with and without endometriosis (both P > 0.05). The Cdc2 expression levels were not significantly different among th3 3 groups and the proliferative and secretary stage of endometrium (all P > 0.05). Cyclin B1 expression level was positively correlated with the serum estrogen level, and negatively correlated with the serum progestogen level, and Cdc2 expression was not correlated with the serum sex hormone levels. CONCLUSION: The expression of cyclin B1 in the ectopic endometrium is higher than normal. Cyclin B1 may be involved in the proliferation of endometrium in endometriosis.

Acta Cytol. 2007 Mar-Apr;51(2):222-6.

Ectopic lesions as potential pitfalls in fine needle aspiration cytology: a report of 3 cases derived from the thyroid, endometrium and breast.

Paksoy N.

Cytopathology Laboratory, Izmit, Kocaeli, Turkey. citographica@superonline.com

BACKGROUND: Ectopic lesions are rarely encountered. Those that are derived from thyroid, breast, endometrium and salivary glands present with palpable masses that can mimic malignancy. Fine needle aspiration cytology (FNAC) is a practical procedure for the differential diagnosis of such lesions but can reveal surprising images for a cytopathologist. CASES: Three cases of discrete, ectopic lesions at different locations occurred. Case 1 was a 27-year-old woman. Upon diagnosis of a submandibular mass with a diameter of 1 cm, FNAC was performed. The smears showed crowded thyroid follicular cells comprising papillary clusters. A cytologic diagnosis of papillary thyroid lesion was rendered, Histopathology revealed that this lesion was ectopic thyroid tissue with focal chronic thyroiditis. Case 2 was a 38-year-old woman who presented with a painful mass with a diameter of 2.5 cm in the abdominal wall. The patient had undergone cesarean section 3 years earlier. The case was diagnosed on FNAC as low grade malignancy in which an adenocarcinoma/mesenchymal tumor distinction could not be made. The pathologic examination revealed endometriosis. Case 3 was a 31-year old woman who presented with a palpable nodule in the axillary region with a diameter of 1 cm. The patient had given birth 1 month earlier and was nursing. An FNAC diagnosis of lactation ectopic breast tissue was made. The mass disappeared by the end of lactation. CONCLUSION: FNAC of ectopic lesions may prove to be a diagnostic pitfall for cytopathologists. A cytopathologist who encounters a cellularpicturefrom a lesion that is outside the normal anatomic location must use a cautious diagnostic approach. Unless there are clear findings, the cytopathologist must refrain from a diagnosis of malignancy.

Abdom Imaging. 2007 Jul-Aug;32(4):451-6. Epub 2007 Apr 10.

Nodular endometriosis: dynamic MR imaging.

Onbas O, Kantarci M, Alper F, Kumtepe Y, Durur I, Ingec M, Gursan N, Okur A.

Department of Radiology, School of Medicine, Ataturk University, Erzurum, Turkey. oonbas@hotmail.com

PURPOSE: In this study we aimed to investigate the value of contrast enhanced dynamic MR imaging (DMI) in the diagnosis of nodular abdominal endometriosis. SUBJECTS AND METHODS: Fourteen patients with surgically and pathologically proven endometriosis were examined with DMI. The patients were 22-54 years old (mean age 30.8 years). The dynamic MR studies of these patients were retrospectively reviewed by two radiologists who were aware of the clinical data. Nodular masses showing enhancement were evaluated for size, margins, and signal intensity on T1- and T2-weighted MR sequences. The protocol was tailored to selectively determine the diagnostic utility of signal intensity time course analysis for the behavior of nodular endometriosis and endometrial tissue, in DMI. Contrast-enhanced DMI was performed and the time-intensity curves of the lesions and the uterine endometrial tissue of each patient were compared. Mean enhancement values were calculated. Each DMI was evaluated for signal intensity value. RESULTS: In 8 (57%) of 14 patients, we found endometriosis in the abdominal wall. All patients with abdominal wall endometriosis had pelvic surgical operation history. Diameter of nodular endometriosis determined in the abdominus muscle ranged between 3 and 40 mm. Of eight cases, five had only one lesion and three had multiple lesions. Remaining 6 (43%) cases had deep pelvic endometriosis located in the uterosacral ligaments (n = 3), rectosigmoid (n = 2), and rectovaginal septum (n = 1). Diameter of pelvic endometriosis ranged between 9 and 53 mm. Noncontrast mean signal intensity of endometriosis and endometrial tissue were 280 +/- 73 and 216 +/- 20, respectively. The mean values of both endometriosis and normal endometrial tissue were calculated for each patient examined with five-slice DMI. All of the curves showed significant correlation. The lesion showed significant enhancement in the course of time similar to the endometrial tissue in all patients. CONCLUSION: Our study was inspired from the fact that endometriosis is the ectopic endometrial tissue and we thought that endometrial tissue and endometriomas should have similar vascularity. In this way imaging with MR, getting the time-intensity curves and experiencing the correlation between the endometriosis and endometrial tissue may support the diagnosis in the cases with suspected endometriosis. This first study shows that the ectopic nodular endometriosis can easily be identified with dynamic MRI. It may be used to differentiate nodular endometriosis from the other pathologic conditions of abdominal wall and pelvis.

G Chir. 2007 Mar;28(3):83-92.

[Is extrauterine endometriosis confined to the gynecological sphere? A critical review of the experience in a general surgery unit]

[Article in Italian]

De Falco M, Ragusa M, Oliva G, Miranda A, Parmeggiani D, Sperlongano P, Accardo M, Calzolari F, Misso C, Monacelli M, Avenia N.

Dipartimento di Scienze Anestesiologiche, Seonda Università degli Studi di Napoli.

Extrauterine or external endometriosis (e.e.) describes ectopic localization of functional endometrial tissue, a finding whose incidence is increasing due to the diffusion of laparoscopic procedures. The clinical presentation of such disease is often non-specific, even in those cases with a definite surgical indication, depending on the site and pathology of the lesions. Surgical planning is therefore difficult at times, specifically regarding the extent of resection in patients–as young women–willing to maintain fertility. The Authors report on 7 cases observed in their own experience (inguinal endometriosis–1 case, umbilical endometriosis–1 case, abdominal wall endometriosis–3 cases, intestinal endometriosis–1 case, diaphragmatic endometriosis associated with pneumothorax–1 case), representing the wide range of clinical settings related to e.e. Based on literature data, an analysis of clinical and diagnostic issues is carried out. Specifically, the problems related to extent of surgical resection in multifocal cases, possible malignant degeneration and localization on abdominal wall scars are discussed.

Rev Mal Respir. 2007 Mar;24(3 Pt 1):339-42.

[Catamenial hemoptysis during hormone replacement treatment]

[Article in French]

Chahine B, Malbranque G, Lelong J, Ramon P, Tillie-Leblond I.

Service de Pneumologie et d’Immuno-Allergologie, Centre Hospitalier Universitaire de Lille, France.

INTRODUCTION: Catamenial haemoptysis is a rare clinical entity resulting from the presence of ectopic intra pulmonary endometrial tissue, either parenchymatous or endobronchial. The main diagnostic criterion is the periodic character of the haemoptysis which is synchronous with menstruation. CASE REPORT: The authors report a case of catamenial haemoptysis due to endobronchial endometriosis in a 46 year old menopausal woman receiving hormone replacement treatment (HRT). She presented with 3 episodes of haemoptysis synchronous with the first days of her menstrual cycle. A thoracic CT scan showed ground glass lesions with micronodulation. Bronchoscopy showed violacious lesions bleeding on contact. The endobronchial and CT abnormalities had disappeared by day 5. After withdrawal of the HRT the haemoptysis did not recur during a follow-up of 2 years. CONCLUSION: Endobronchial endometrioisis remains a rare occurrence. This is the first case reported in a menopausal woman with artificial cycles receiving hormone replacement therapy.

Am J Surg Pathol. 2007 Apr;31(4):592-7.

Ovarian sertoli-leydig cell tumors with pseudoendometrioid tubules (pseudoendometrioid sertoli-leydig cell tumors).

McCluggage WG, Young RH.

Department of Pathology, Royal Group of Hospitals Trust, Belfast, Northern Ireland. glenn.mccluggage@bll.n-i.nhs.uk

The propensity for ovarian endometrioid adenocarcinomas to morphologically mimic Sertoli, Sertoli-Leydig, and granulosa cell tumors, is well known. The converse situation, mimicry of an endometrioid neoplasm by a sex cord-stromal tumor, has not been emphasized. In this report, we describe 9 ovarian Sertoli-Leydig cell tumors (5 well differentiated, 4 of intermediate differentiation) with areas containing hollow, sometimes dilated, tubules which resemble endometrioid glands; we refer to these as pseudoendometrioid tubules. The age of the patients ranged from 14 to 57. The tumors, all of which were unilateral except for one, ranged from 3.5 to 19 cm and were variously described as tan, pale, yellow, or gold. The proportion of the tumor made up of pseudoendometrioid tubules ranged from 10% to >90%. When widespread, their presence sometimes resulted in consideration of a borderline endometrioid adenofibroma or a well-differentiated endometrioid adenocarcinoma. However, all the neoplasms contained typical Sertoli tubules and one or more of the characteristic patterns of Sertoli-Leydig cell tumors as well as Leydig cells, although the latter cells were inconspicuous in some cases. Immunohistochemistry, performed in 4 cases, showed that the pseudoendometrioid tubules, as well as the more typical Sertoli cell elements, were either positive for alpha inhibin (3 of 4 cases) or calretinin (3 of 4 cases) or both, although sometimes focally so. These elements were negative with epithelial membrane antigen and cytokeratin 7. In all 4 cases, the pseudoendometrioid tubules were positive with the broad spectrum cytokeratin AE1/3. This report illustrates the potential for ovarian Sertoli-Leydig cell tumors to contain tubules with a pseudoendometrioid appearance which mimic a borderline or malignant endometrioid neoplasm. The presence of more typical Sertoli cell elements and Leydig cells, an absence of squamous elements, endometriosis or associated adenofibroma, and the characteristic immunophenotype assist in diagnosis.

Int J Gynecol Pathol. 2007 Apr;26(2):124-9.

Expression of estrogen and progesterone receptors in smooth muscle metaplasia of rectovaginal endometriosis.

Kitano T, Matsumoto T, Takeuchi H, Kikuchi I, Itoga T, Sasahara N, Kinoshita K.

Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan. t-kitano@med.juntendo.ac.jp

To investigate expression of estrogen receptors (ER) and progesterone receptors (PR) in smooth muscle metaplasia (SMM) outside the endometriotic foci of rectovaginal endometriosis (RVE). One hundred and ninety-five specimens were obtained from the rectovaginal areas of the 63 patients who were underwent laparoscopic surgery for RVE. The patients were divided into 3 groups: a gonadotropin-releasing hormone (GnRH) agonist group, a non-GnRH group, including a proliferative phase group, and a secretory phase group. Expression of ER and PR in the rectovaginal tissues of RVE were determined using immunohistochemical methods. Smooth muscle metaplasia occurred in 172 specimens (88.2%), and ER and PR expression were found in the smooth muscle cells in the SMM areas outside the endometriotic foci of RVE. The expression of ER and PR in the GnRH agonist group were significantly lower than those in the non-GnRH agonist group. This is the first report demonstrating ER and PR in the smooth muscle cells in SMM outside the endometriotic foci of RVE. The ER and PR were expressed in the SMM areas, but these receptors were not recognized in fibrotic areas. We could identify the expression ratio of these receptors during each menstrual phase, with or without administered GnRH agonist.

Fertil Steril. 2007 Nov;88(5):1468-9. Epub 2007 Apr 6.

Arg72Pro p53 polymorphism in Italian women: no association with endometriosis.

Vietri MT, Molinari AM, Iannella I, Cioffi M, Bontempo P, Ardovino M, Scaffa C, Colacurci N, Cobellis L.

Department of General Pathology, Second University of Naples, Naples, Italy.

p53 codon 72 polymorphism in Italian women have a minor role in determining genetic susceptibility to endometriosis. The racial differences, in association with other risk factors, might be underlined in endometriotic disease.

Fertil Steril. 2007 Dec;88(6):1548-53. Epub 2007 Apr 6.

Prognostic factors in oocyte donation: an analysis through egg-sharing recipient pairs showing a discordant outcome.

Bodri D, Colodron M, Vidal R, Galindo A, Durban M, Coll O.

Clínica EUGIN, Barcelona, Spain. dbodri@euvitro.com

OBJECTIVE: To analyze prognostic factors that are associated with a discordant outcome in egg recipients sharing oocytes from the same donor. DESIGN: Matched case-control single-center study. SETTING: Private infertility clinic. PATIENT(S): Four hundred forty-four recipients (222 pairs) sharing oocytes from the same donor and showing a discordant outcome. INTERVENTION(S): Controlled ovarian hyperstimulation of egg donors, oocyte donation, intracytoplasmic sperm injection, and ET in egg recipients. MAIN OUTCOME MEASURE(S): Recipient age, obstetric (gravidity, parity) and gynecologic variables (previous uterine surgery, uterine fibroids, uterine malformations, endometriosis, history of tubal infertility), previous oocyte donation cycles, duration of E(2) replacement, received cumulus-oocyte complexes, mature (MII) oocytes, fertilized oocytes, transferred embryos, mean embryo score, transfer difficulty, and semen parameters. RESULT(S): No significant differences were found in the above-mentioned prognostic factors between the study and control groups. CONCLUSION(S): Recipient- and cycle-related prognostic factors investigated in our study were not associated with a discordant outcome in recipient pairs sharing oocytes from the same donor. Other possible prognostic factors involving oocyte donor heterogeneity, embryo aneuploidy rates, male factor infertility, and endometrial receptivity should be further investigated.

Fertil Steril. 2007 Sep;88(3):581-7. Epub 2007 Apr 6.

Comment in:

Fertil Steril. 2008 Jun;89(6):1847.

Growth-associated protein 43-positive sensory nerve fibers accompanied by immature vessels are located in or near peritoneal endometriotic lesions.

Mechsner S, Schwarz J, Thode J, Loddenkemper C, Salomon DS, Ebert AD.

Endometriosis Research Center Berlin, Department of Gynecology, Berlin, Germany.

OBJECTIVE: To investigate the topographical relationship between nerve fibers and peritoneal endometriotic lesions and to determine the origin of endometriosis-associated nerve fibers. DESIGN: Retrospective nonrandomized study. SETTING: University hospital endometriosis research center. PATIENT(S): Premenopausal women with histologically confirmed endometriosis were selected (n = 73). Peritoneal endometriotic lesions (n = 106) and unaffected peritoneal biopsies from patients without endometriosis (n = 9) were obtained. INTERVENTION(S): Immunohistochemistry was used to study the expression of neurofilament, substance P, smooth muscle actin, von Willebrand factor, growth-associated protein 43, nerve growth factor, and neutrophin-3 in peritoneal endometriotic lesion samples from women with symptomatic endometriosis and in peritoneal samples from women without endometriosis. RESULT(S): Pain-conducting substance-P-positive nerve fibers were found to be directly colocalized with human peritoneal endometriotic lesions in 74.5% of all cases. The endometriosis-associated nerve fibers are accompanied by immature blood vessels within the stroma. Nerve growth factor and neutrophin-3 are expressed by endometriotic cells. Growth-associated protein 43, a marker of neural outgrowth and regeneration, is expressed in endometriosis-associated nerve fibers but not in existing peritoneal nerves. CONCLUSION(S): The data provide the first evidence of direct contact between sensory nerve fibers and peritoneal endometriotic lesions. This implies that the fibers play an important role in the etiology of endometriosis-associated pelvic pain. Moreover, emerging evidence suggests that peritoneal endometriotic cells exhibit neurotrophic properties.

J Manag Care Pharm. 2007 Apr;13(3):262-72.

Actuarial analysis of private payer administrative claims data for women with endometriosis.

Mirkin D, Murphy-Barron C, Iwasaki K.

Milliman, Inc, New York, NY 10119, USA. david.mirkin@milliman.com

BACKGROUND: Endometriosis is a painful, chronic disease affecting 5.5 million women and girls in the United States and Canada and millions more worldwide. The usual age range of women diagnosed with endometriosis is 20 to 45 years. Endometriosis has an estimated prevalence of 10% among women of reproductive age, although estimates of prevalence vary greatly. Endometriosis is the most common gynecological cause of chronic pelvic pain, but published information on its associated medical care costs is scarce. OBJECTIVE: The aim of this study was to determine (1) the prevalence of endometriosis in the United States, (2) the amount of health care services used by women coded with endometriosis in a commercial medical claims database during 1999 to 2003, and (3) the endometriosis-related costs for 2003, the most recent data available at the time the study was performed. METHODS: This study was a retrospective review of administrative data for commercial payers, which included enrollment, eligibility, and claims payment data contained in the Medstat Marketscan database for approximately 4 million commercial insurance members. All claims and membership data were extracted for each woman aged 18 to 55 years who had at least 1 medical or hospital claim with a diagnosis code for endometriosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 617.00-617.99) for 1999 through 2003. Claims data from 1999 through 2003 were used to determine prevalence and health care resource utilization (i.e., annual admission rate, annual surgical rate, distribution of endometriosis-related surgeries, and prevalence of comorbid conditions). The cost analysis was based on claims from 2003 only. Cost was defined as the payer-allowed charge, which equals the net payer cost plus member cost share. RESULTS: The prevalence of women with medical claims (inpatient and/or outpatient) containing ICD-9-CM codes for endometriosis was 1.1% for the age band of 30 to 39 years and 0.7% over the entire age span of 18 to 55 years. The medical costs per patient per month (PPPM) for women with endometriosis were 63% greater ($706 PPPM) than those of the average woman per member per month ($433) in 2003; inpatient hospital costs accounted for 32% of total direct medical costs. Between 1999 and 2003, these women with endometriosis who were identified by either inpatient and/or outpatient claims had high rates of hospital admission (53% for any reason; 38% for an endometriosis-related reason) and a high annual surgical procedure rate (64%). Additionally, women with endometriosis frequently suffered from comorbid conditions, and these conditions were associated with greater PPPM costs of 15% to 50% for women with an endometriosis diagnosis code, depending on the condition. Interstitial cystitis was associated with 50% greater cost ($1,061 PPPM); depression, 41% ($997 PPPM); migraine, 40% ($988 PPPM); irritable bowel syndrome, 34% ($943 PPPM); chronic fatigue syndrome, 29% ($913 PPPM); abdominal pain, 20% ($846 PPPM); and infertility, 15% ($813 PPPM). CONCLUSIONS: Women with endometriosis have a high hospital admission rate and surgical procedure rate and a high incidence of comorbid conditions. Consequently, these women incur total medical costs that are, on average, 63% higher than medical costs for the average woman in a commercially insured group.

Am J Obstet Gynecol. 2007 Apr;196(4):391.e1-7; discussion 391.e7-8.

Stromal cells of endometriosis fail to produce paracrine factors that induce epithelial 17beta-hydroxysteroid dehydrogenase type 2 gene and its transcriptional regulator Sp1: a mechanism for defective estradiol metabolism.

Cheng YH, Imir A, Fenkci V, Yilmaz MB, Bulun SE.

Division of Reproductive Biology Research, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-3095, USA.

OBJECTIVE: In endometrium, stromal progesterone receptors mediate production of paracrine factors, which enhance binding of the transcription factor specific protein-1 to the promoter of the gene encoding the 17beta-hydroxysteroid dehydrogenase type 2 enzyme responsible for converting biologically active estradiol to estrone in epithelium. The objective of this study is to define the cellular defect responsible for the disruption of this stromal-epithelial interaction in endometriosis. STUDY DESIGN: We determined the effects of conditioned media generated from primary human eutopic endometrial stromal cells vs endometriotic stromal cells on Ishikawa malignant endometrial epithelial cells. RESULTS: Conditioned media from progestin-pretreated eutopic endometrial stromal cells but not endometriotic stromal cells significantly stimulated specific protein-1 protein levels, 17beta-hydroxysteroid dehydrogenase type 2 messenger RNA levels and promoter activity, and binding activity of specific protein-1 to the 17beta-hydroxysteroid dehydrogenase type 2 promoter region in Ishikawa cells. CONCLUSION: A stromal cell defect in endometriosis blocks formation of progesterone-dependent production of factors leading to 17beta-hydroxysteroid dehydrogenase type 2 deficiency and defective conversion of estradiol to estrone in epithelium.

Cir Esp. 2007 Apr;81(4):170-6.

[Intestinal endometriosis. Current status]

[Article in Spanish]

Bianchi A, Pulido L, Espín F, Hidalgo LA, Heredia A, Fantova MJ, Muns R, Suñol J.

Servicio de Cirugía General, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, España. abianchi@csdm.es

Endometriosis affects a wide spectrum of premenopausal women. Intestinal involvement, affecting mainly the large bowel and sometimes the small bowel, is much less frequent. Diagnosis is relatively straightforward in women with long standing pelvic endometriosis but is difficult in acute intestinal obstruction, since a diagnosis of endometriosis is not often considered in this entity. We performed an exhaustive review of the medical literature, including the option of medical treatment, which is rarely effective in intestinal endometriosis. In most patients with intestinal symptoms, the disease is so severe that surgical treatment is required. Recent studies indicate that the most effective approach is laparoscopic. We analyze the most important classical and recent series of patients and discuss treatment results.

J Laryngol Otol. 2007 Jul;121(7):676-9. Epub 2007 Apr 3.

Brushing cytology in cutaneous lesions of the head and neck.

Tamiolakis D, Proimos E, Perogamvrakis GE, Skoulakis CE, Georgiou GC, Papadakis CE.

Department of Cytopathology, Chania General Hospital, Chania, Crete, Greece.

BACKGROUND: Brushing cytology is a well established diagnostic procedure used by gynaecologists, physicians and surgeons to obtain representative samples from lesions. Our aim was to evaluate its reliability in ulcerative and tumour-like conditions arising in the skin of the head and neck. METHODS: Over 28 months, 86 patients with suspected cutaneous malignant lesions underwent a cytological examination with a cytobrush within the otolaryngology department. RESULTS: Cytological analysis identified 63 out of 64 histologically documented malignant tumours (60 primary basal cell and squamous cell carcinomas and three metastatic adenocarcinomas), and 21 out of 22 benign lesions. There was one false positive and one false negative result. CONCLUSIONS: Brushing cytology of suspected cutaneous malignant lesions is a rapid and reliable diagnostic method which helps the clinician to decide on appropriate planning and treatment. The technique can be performed as an out-patient procedure, and smear preparation can be done in the laboratory, even at a peripheral hospital.

J Gynecol Obstet Biol Reprod (Paris). 2007 Jun;36(4):354-9. Epub 2007 Mar 30.

[Reproductive outcome after laparoscopic treatment of endometriosis in an infertile population]

[Article in French]

Fuchs F, Raynal P, Salama S, Guillot E, Le Tohic A, Chis C, Panel P.

Service de gynécologie obstétrique, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le-Chesnay, France. florentfuchs@yahoo.fr

OBJECTIVES: To evaluate fertility outcome after laparoscopic management of endometriosis in an infertile population. MATERIALS AND METHODS: A retrospective analysis of 64 patients presenting more than one year infertility and a pregnancy-wish associated with minimal to severe endometriotic lesions (stage I to IV according to the revised American Fertility Society (rAFS) classification), treated using laparoscopic surgery in order to remove the entire lesions. We excluded women under 20 years and over 40, as well as those with other infertility factors (tubal non endometriosis-related, hormonal or sperm). Fertility of the remaining 34 patients was studied in relation to endometriosis stage and to pregnancy’s mode (spontaneous or induced). RESULTS: Pregnant women percentage was 65% (22 patients) within a 8.5 months (quartiles: 3; 15.5) [range: 1; 52] post-surgical time, and 86.5% pregnancies issued with a delivery. The rate of pregnant women depended on stage of endometriosis (89% for stages I-II, and 56% for stages III-IV). Sixty percent pregnancies were spontaneous within a 5 months (3; 9) [1; 52] post-surgical time to pregnancy average. When pregnancies were obtained with assisted reproductive techniques, the median post-surgical time to pregnancy was 12 months (9; 22) [2; 31]. Among women with stages I-II endometriosis, the median post-surgical time to pregnancy was 2 months when spontaneous and 20.5 months when induced (P=0.007). In case of stages III-IV endometriosis, pregnancy’s delay was 8 and 12 months respectively (P=0.79). Among the 21% women who had had an induced pregnancy failure before surgery, 71% became pregnant and 80% spontaneously. Eighteen patients (53%) had an ovarian endometrioma and 50% of them became pregnant. Among the 4 patients who had colorectal endometriosis requiring colorectal resection, 1 pregnancy was obtained. CONCLUSIONS: These findings suggest that in a context of more than one year infertility only related to endometriosis, it is reasonable to offer these patients a complete operative laparoscopic treatment of their lesions, which enables 65% of them to be pregnant within a 8.5 months post-surgical median time to pregnancy and spontaneously in 60%. In case of stages I-II endometriosis we suggest a spontaneous pregnancy try during 8 to 12 months before starting induced pregnancy therapeutics instead of stages III-IV endometriosis where induced methods should be used after only 6 or 8 months.

Am Fam Physician. 2007 Mar 15;75(6):849-56.

Comment in:

Am Fam Physician. 2007 Oct 15;76(8):1111.

Infertility.

Jose-Miller AB, Boyden JW, Frey KA.

Department of Family and Community Medicine, University of Arizona, Tucson 85711, USA.

Infertility is defined as failure to achieve pregnancy during one year of frequent, unprotected intercourse. Evaluation generally begins after 12 months, but it can be initiated earlier if infertility is suspected based on history or if the female partner is older than 35 years. Major causes of infertility include male factors, ovarian dysfunction, tubal disease, endometriosis, and uterine or cervical factors. A careful history and physical examination of each partner can suggest a single or multifactorial etiology and can direct further investigation. Ovulation can be documented with a home urinary luteinizing hormone kit. Hysterosalpingography and pelvic ultrasonography can be used to screen for uterine and fallopian tube disease. Hysteroscopy and/or laparoscopy can be used if no abnormalities are found on initial screening. Women older than 35 years also may benefit from ovarian reserve testing of follicle-stimulating hormone and estradiol levels on day 3 of the menstrual cycle, the clomiphene citrate challenge test, or pelvic ultrasonography for antral follicle count to determine treatment options and the likelihood of success. Options for the treatment of male factor infertility include gonadotropin therapy, intrauterine insemination, or in vitro fertilization. Infertility attributed to ovulatory dysfunction often can be treated with oral ovulation-inducing agents in a primary care setting. Women with poor ovarian reserve have more success with oocyte donation. In certain cases, tubal disease may be treatable by surgical repair or by in vitro fertilization. Infertility attributed to endometriosis may be amenable to surgery, induction of ovulation with intrauterine insemination, or in vitro fertilization. Unexplained infertility may be managed with ovulation induction, intrauterine insemination, or both. The overall likelihood of successful pregnancy with treatment is nearly 50 percent.

Ultrasound Obstet Gynecol. 2007 Apr;29(4):460-2.

Alcohol sclerotherapy for successful treatment of focal adenomyosis: a case report.

Furman B, Appelman Z, Hagay Z, Caspi B.

Ultrasound Unit, Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel.

Adenomyosis is characterized by the presence of ectopic endometrial tissue within the myometrium. Treatment options range from use of non-steroidal anti-inflammatory drugs and hormonal suppression for symptomatic relief, to endometrial ablation or even hysterectomy. We report a case of successful ultrasound-guided aspiration of focal adenomyosis with intracavitary alcohol instillation in a patient with a recurrent intramural uterine lesion. This is the first report of the treatment of sclerotherapy by alcohol instillation, which may be considered as a reasonable alternative modality in treating rare cases of symptomatic adenomyosis. Published by John Wiley & Sons, Ltd. Copyright (c) 2007 ISUOG.

J Gastrointest Surg. 2007 Feb;11(2):229-32.

An ileal endometrioma: of carcinoids and cadherin.

Pannala R, Gafni-Kane A, Kidd M, Modlin IM.

Bridgeport Hospital/Yale University, Bridgeport, CT 06520, USA.

A 38-year-old woman with history of prior adrenalectomy for Cushing’s syndrome presented with intermittent right lower quadrant (RLQ) abdominal pain, nausea, bloating, and non-bloody diarrhea for 2 months. Symptoms were not related to her menstrual periods. Examination revealed only an ill-defined mass in the RLQ. Investigations for infectious causes, inflammatory bowel disease, and carcinoid tumor were negative. Computed tomography (CT) demonstrated a terminal ileal mass with mesenteric stranding and dilatation of the proximal bowel. At laparotomy, a fibrotic, terminal ileal mass with matted adhesions involving the mesentery and retroperitoneum was resected. Histopathological examination identified multiple foci of endometriosis extending from the serosal surface into the mucosa of the terminal ileum. Immunostaining revealed E- and P-cadherin, but not N-cadherin immuno-positivity. Mucosal involvement without cyclical menstrual symptoms and intestinal obstruction is an unusual presentation of intestinal endometriosis. Although the mechanism of endometriosis is not clear, the role of cell adhesion molecules such as cadherins has received attention. Increased expression of E- and P-cadherin and decreased N-cadherin expression in our patient demonstrates differential expression of these cadherins in endometriotic tissue. Future studies may investigate patterns of differential expression of these cadherins in a series of cases to elucidate the mechanisms of migration of endometriotic tissue.

J Gynecol Obstet Biol Reprod (Paris). 2007 Apr;36(2):91.

[Endometriosis: a consensus]

[Article in French]

Fernandez H.

Community Genet. 2007;10(2):61-71.

Why do they do it? A pilot study towards understanding participant motivation and experience in a large genetic epidemiological study of endometriosis.

Treloar SA, Morley KI, Taylor SD, Hall WD.

Genetic Epidemiology Laboratory, Queensland Institute of Medical Research, Brisbane, Australia. Susan.Treloar@qimr.edu.au

OBJECTIVE: This exploratory, pilot study aimed to investigate motivations and reflections of participants who had provided epidemiological information, blood samples and access to clinical records and data in a large genetic epidemiological study of endometriosis, a common multifactorial disorder affecting women. We also aimed to explore understanding of complex genetic or multifactorial conditions in general. METHODS: In-depth interviews were conducted with 16 endometriosis study participants with diverse characteristics. RESULTS: Interviewees generally described their participation in the genetic study using altruistic frameworks of reference. Themes that emerged included unquestioning willingness and consent to participate, little concern about privacy issues, desire for more information from the researchers about the condition rather than scientific progress, the benefits of research participation to family communication, and differing ideas about genetic influences on endometriosis. Specific features of endometriosis also influenced reflections on research participation experience. CONCLUSIONS: As increasing numbers of individuals and families in the community become involved in genetic epidemiological studies of common diseases, more extensive research will be needed to better understand their expectations with a view to improving researchers’ communications with study participants. Copyright 2007 S. Karger AG, Basel.

Am Surg. 2007 Mar;73(3):299-301.

Asymptomatic intussusception of the appendix secondary to endometriosis.

Offodile A 2nd, Hodgin JB, Arnell T.

Department of Surgery, New York Presbyterian Hospital-Columbia Campus, New York, New York, USA.

This is a report of a 47-year-old woman with an asymptomatic clinical presentation of appendiceal intussusception secondary to endometriosis. Initially discovered during routine colonoscopy as a submucosal mass, it was ultimately diagnosed after surgical resection by pathology findings. The theories regarding the pathogenesis of appendiceal intussusception are reviewed and discussed here.

Arch Gynecol Obstet. 2007 Oct;276(4):311-4. Epub 2007 Mar 20.

Laparoscopic hysterectomy with retroperitoneal uterine artery sealing using LigaSure: Gazi hospital experience.

Gol M, Kizilyar A, Eminoglu M.

Department of Obstetrics and Gynecology, Gazi Hospital, 1421 str, Kahramanlar, Izmir, Turkey. drgyno@hotmail.com

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of laparoscopic hysterectomy by retroperitoneal sealing of the uterine arteries with LigaSure. METHODS: Laparoscopic hysterectomy by retroperitoneal uterine artery sealing with LigaSure was performed by four-puncture laparoscopy in 50 women with various indications for hysterectomy. The mean operation time, amount of intraoperative bleeding, drop in hemoglobin concentration, weight of removed uterus, major and minor per-post operative complications, and the rate of conversion to classical abdominal approach were analyzed prospectively. RESULTS: The mean operation time was 85 min (range 60-125 min). The mean weight of removed uterus was 180 g (range 60-650 g). There was one major complication; one patient had cystotomy due to difficulty in dissecting severe adhesions because of two previous cesarean sections that were repaired laparoscopically. Only one patient converted to laparotomy because of severe bowel adhesions due to rectovaginal endometriosis. All patients were discharged on the first postoperative day. No minor complications occurred. Hemoglobin decreased a mean of 0.4 g/dl (range 0.2-1.4 g/dl) by postoperative day 1. CONCLUSION: Laparoscopic hysterectomy by retroperitoneal uterine artery sealing with LigaSure is an effective, safe, and fast procedure with less intra operative bleeding, short operation time and hospital stay.

J Chir (Paris). 2007 Jan-Feb;144(1):5-10; discussion 11.

[Surgical treatment of rectal endometriosis]

[Article in French]

Leconte M, Chapron C, Dousset B.

Service de Chirurgie Digestive, Hôpital Cochin – Paris. mahaut.leconte@cch.ap-hop-paris.fr

Intestinal endometriosis accounts for 8-12% of all endometriosis and rectal involvement is most often encountered in the context of deep pelvic infiltration. Intestinal symptoms, often nonspecific, are most typically seen as painful defecation or constipation worsening in the premenstrual period associated with pelvic pain, dysmenorrheal, dyspareunia, and infertility. Physical examination should include a pelvic exam under anesthesia. Endorectal ultrasound best evaluates rectal muscle invasion, while pelvic MRI and CT will evaluate the full extent of pelvic involvement and other GI sites of implantation. Only radical extirpative surgery of all intestinal, urologic, deep pelvic, and adnexal sites of endometriosis will permit relief of pain, prevent recurrence, and hopefully preserve fertility. In view of the frequency of extra-intestinal sites of involvement and technical difficulties augmented by previous surgical interventions, open laparotomy remains the preferred approach. A laparascopic approach would be reserved only for well-selected patients presenting with isolated colorectal involvement.

J Minim Invasive Gynecol. 2007 Mar-Apr;14(2):256-9.

Combined laparoscopic and vaginal approach for nephrectomy, ureterectomy, and removal of a large rectovaginal endometriotic nodule causing loss of renal function.

Jadoul P, Feyaerts A, Squifflet J, Donnez J.

Department of Gynecology, Université Catholique de Louvain, Brussels, Belgium.

A late consequence of ureteral endometriosis is the silent loss of renal function caused by progressive “enclosure” of the lower part of the ureter by the endometriosis. In our experience, in cases of severe loss of renal function with cortical atrophy and residual kidney function (evaluated by Tc99 DMSA scintigraphy) of less than 15%, removal of the endometriosis combined with ureterolysis does not allow recovery of renal function. A nonfunctioning kidney associated with hydronephrosis is a risk factor for vascular hypertension, recurrent pyelonephritis, or kidney stones and therefore an indication for nephrectomy. By means of a case report, this paper describes the combination of laparoscopic nephrectomy, ureterectomy, removal of the rectovaginal endometriotic nodule, and extraction of the kidney through the vagina.

J Minim Invasive Gynecol. 2007 Mar-Apr;14(2):223-7.

Correlation between serum levels of CA 125 and follicular loss after laparoscopic cystectomy in women with ovarian endometrioma.

Vicino M, Resta L, Scioscia M, Marzullo A, Ceci O, Bettocchi S.

Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.

STUDY OBJECTIVE: To preoperatively predict follicular loss after laparoscopic cystectomy of ovarian endometriomas. DESIGN: Case-control study. (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Seventy-six women with ovarian endometrioma and 41 patients with nonendometriotic ovarian cysts who underwent laparoscopy. INTERVENTIONS: Sonographic findings and serum levels of CA 125 and CA 19.9 were recorded. MEASUREMENTS AND MAIN RESULTS: Considered parameters were compared with a histologic score, on the basis of the presence and morphologic features of follicles on the normal ovarian tissue adjacent to the cyst wall surgically removed. Serum levels of CA 125 and CA 19.9 were increased in patients with ovarian endometrioma (p <.001 and p <.01, respectively). Capsule wall thickness, presence of fibrosis, and follicles in the tissue surrounding the capsule were significantly increased in the study group (p <.01). CA 125 serum level was directly correlated to the histologic score (r = 0.46, p <.05) and to cyst diameter (r = 0.12, p = .01), whereas no correlation was found between CA 19.9 or cyst diameter and follicular score. CONCLUSIONS: Our data suggest that the ovarian tissue inadvertently removed along with the endometrioma wall by laparoscopic stripping is due to pericystic fibrosis. Serum levels of CA 125 represent a useful parameter to predict follicular loss before surgery.

J Minim Invasive Gynecol. 2007 Mar-Apr;14(2):172-5.

Efficacy of office diagnostic hysterofibroscopy.

Chang CC.

E-Da Hospital of Kaohsiung County, Taiwan. gazilla0403@yahoo.com.tw

STUDY OBJECTIVE: To evaluate the feasibility and efficacy of hysterofibroscopy as an office diagnostic tool. DESIGN: Prospective cohort study (Canadian Task Force classification 3.PA-3.QZ). SETTING: Private university hospital as a tertiary referral medical center. PATIENTS: All the patients referred to the hospital for diagnostic hysterofibroscopy were enrolled in this study, irrespective of their indications, from January 2002 through December 2004. INTERVENTIONS: All diagnostic hysterofibroscopy procedures were performed on an outpatient basis and without analgesics or anesthetic. MEASUREMENTS AND MAIN RESULTS: Feasibility of hysterofibroscopic diagnosis was evaluated by: (1) the ability of the hysterofibroscope to pass through the cervical canal; (2) the quality of vision in the uterine cavity; (3) the severity of pain experienced by the patients; and (4) the complications of the procedures. If an intrauterine mass was revealed during the procedure, the patient was referred for further transcervical resectoscopy (TCR). The efficacy of the hysterofibroscopic diagnosis was evaluated by comparison with the histopathologic diagnosis after the TCR. Overall 2111 patients were enrolled in this study; 78 (3.69%) patients did not complete the procedures because of cervical stenosis, intractable pain during dilation, or poor visibility in the uterine cavity. Of the 2033 remaining, the postprocedure complication rate was low, with only 8 (0.38%) patients experiencing severe vagal reflex with dizziness and nausea and another 35 (1.66%) patients suffering from a short period of moderate to severe uterine contractile pain after the completion of procedures. In this study, 634 (31.19%) patients had submucosal myoma or endometrial polyps and needed additional TCR. The diagnostic accuracy of hysterofibroscopy was 74% in comparison with a traditional histopathologic examination. The most common diagnostic errors happened between the diagnosis of endometrial polyp and the submucosal myoma. CONCLUSION: Hysterofibroscopy is feasible for the investigation of the uterine cavity in an outpatient setting without anesthesia with acceptable reliability, although some confusion may occur when differentiating between endometrial polyps and submucosal myoma. Postprocedural complications were mostly attributed to vigorous dilation of the cervix.

J Minim Invasive Gynecol. 2007 Mar-Apr;14(2):169-71.

Laparoscopic management of ureteral endometriosis: our experience.

Frenna V, Santos L, Ohana E, Bailey C, Wattiez A.

Department of Obstetrics and Gynecology, Centre Medico-Chirurgical et Obstetrical-Les Syndicat inter-Hospitalier de la Communauté Urbaine de Strasbourg, Hautepierre Hospital, Strasbourg, France. virginifrenna@libero.com

STUDY OBJECTIVE: Ureteral endometriosis is rare, accounting for less than 0.3% of all endometriotic lesions. The aim of our study is to evaluate the prevalence of extrinsic ureteral endometriosis in women undergoing laparoscopic surgery for severe endometriosis and to suggest that laparoscopic ureterolysis represents a mandatory measure in all cases to avoid ureteral injury. METHODS: A retrospective analysis was performed of all cases of patients who underwent laparoscopic surgery for severe endometriosis at the departments of obstetrics and gynecology at CMCO-SIHCUS and Hautepierre Hospital, Strasbourg, from November 2004 through January 2006. MEASUREMENTS AND MAIN RESULTS: We recorded 54 patients with a mean age of 31 years and a mean body mass index of 21.9. Reported symptoms were dysmenorrhea (88%), severe dyspareunia (88%), severe pelvic pain (38.8%), and infertility (74%). Five women presented with dysuria, frequency, recurrent urinary tract infections, and pain in the renal angle, and 2 patients had hydronephrosis. We observed 3 patients (5.6%) with ureteral stenosis, 35 (64.8%) with adenomyotic tissue surrounding the ureter without stenosis, and 16 (29.6%) with adenomyotic tissue adjacent to the ureter. It was on the left side in 47.4% of cases, on the right side in 31.6% cases, and bilaterally in 21% of cases. In 9 patients, ureteral involvement was associated with bladder endometriosis (16.7%). In all patients, ureterolysis was performed. There was 1 case of ureteral injury during the procedure, 2 of transitory urinary retention, and 1 of uretero-vaginal fistula after surgery. During the first year of follow-up, the disease recurred in 4 patients, with no evidence of the disease in the urinary tract. CONCLUSION: Conservative laparoscopic surgery to relieve ureteral obstruction and remove pathologic tissue is the management of choice. Resection of part of the ureter should be performed only in exceptional cases. Ureterolysis should be performed in all patients before endometriotic nodule resection to recognize and prevent any ureteral damage.

J Minim Invasive Gynecol. 2007 Mar-Apr;14(2):156-60.

Posthysterectomy pelvic adenomyotic masses observed in 8 cases out of a series of 1405 laparoscopic subtotal hysterectomies.

Donnez O, Squifflet J, Leconte I, Jadoul P, Donnez J.

Department of Gynecology, Cliniques Universitaires Saint-Luc, Brussels, Belgium. donnez@gyne.ucl.ac.be

STUDY OBJECTIVES: To analyze the prevalence of an unexpected complication due to morcellation and to describe the appearance of this complication on magnetic resonance imaging, as well as its therapy. DESIGN: A well-designed controlled trial without randomization (Canadian Task Force classification II-1). SETTING: Academic hospital. PATIENTS: One thousand four-hundred five patients who underwent laparoscopic subtotal hysterectomy (LASH) in our department from 1990 through 2005 by surgeons using the same technique. INTERVENTION: Morcellation was performed using Steiner’s 15-mm electric morcellator. MEASUREMENTS AND MAIN RESULTS: After 1405 LASH procedures, we encountered 8 cases (0.57%) of deep dyspareunia and pelvic pain caused by heterogeneous masses (median size 45 mm, range 20-80 mm). Symptoms appeared between 2 and 9 years after surgery. Vaginal examination revealed a painful pelvic mass in all 8 patients. The median CA 125 level was 52 IU/mL (range 19.4-128 IU/mL). Magnetic resonance imaging revealed heterogeneous masses containing hyperintense signals on T1-weighted images with saturation of fatty tissue. Injection of gadolinium revealed vascularization of the masses. Laparoscopic excision was performed, and extensive dissection of the rectum and pararectal fossa was required to isolate the masses. Histologic examination showed adenomyosis. Such complications occurred after electric morcellation of myomatous uterine corpora associated with adenomyosis. CONCLUSION: These lesions probably result from the growth of missed fragments of uterine corpus after previous morcellation, culminating in the development of symptomatic iatrogenic adenomyomas. For this reason, the abdominal cavity must be meticulously inspected after electric morcellation, especially in patients with adenomyotic uteri.

Arch Iran Med. 2007 Apr;10(2):258-60.

Papillary serous carcinoma arising from adenomyosis presenting as intramural leiomyoma.

Izadi-Mood N, Samadi N, Sarmadi S, Eftekhar Z.

Department of Pathology, Mirza Koochak Khan Hospital, Tehran University of Medical Sciences, Tehran, Iran. nizadimood@yahoo.com

Adenocarcinoma arising from adenomyosis uteri is rare. Herein, we reported a patient with papillary serous carcinoma arising from adenomyosis. The patient was a 61-year-old woman who received tamoxifen for treatment of her breast cancer over the past five years. In hysterectomy specimen taken for investigating her uncontrolled bleeding with suspicion of uterine myoma, multiple adenomyotic foci were found in the uterine wall. In one of these foci, papillary serous carcinoma was found. No evidence of tumor was seen in endometrial surface, peritoneum, and both adnexa.

J Obstet Gynaecol. 2007 Jan;27(1):89-90.

Ureteric stricture following vaginal hysterectomy and caused by endometriosis.

Helmy W, Evans PW.

Women’s Health Directorate, William Harvey Hospital, Ashford, UK. waelhelmy65@yahoo.com

Arch Androl. 2007 Jan-Feb;53(1):25-8.

Combination of hypoosmotic swelling/eosin Y test for sperm membrane integrity evaluation: correlations with other sperm parameters to predict ICSI cycles.

Cincik M, Ergur AR, Tutuncu L, Muhcu M, Kilic M, Balaban B, Urman B.

Department of Obstetrics and Gynecology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey. mcincik@yahoo.com

The objective of our study was to evaluate the accuracy of the combination of hypoosmotic swelling (HOS) and eosin Y (Ey) exclusion tests to predict the ICSI cycles’ outcome and its correlations with other sperm parameters. The functional and structural integrity of sperm membrane was evaluated with the combined HOS/Ey test in 95 ICSI cycles and the results were correlated with other sperm parameters, including concentration, motility, strict morphology, and total motile sperm count. The combined HOS/Ey test was evaluated for the prediction of the ICSI cycles’ outcome parameters including fertilization, cleavage, and pregnancy rates. The HOS/Ey test presented significant relationships with concentration, motility, and strict morphology (p < 0,0001) but it couldn’t predict the fertilization, cleavage, and pregnancy outcomes of ICSI cycles. The combined HOS/Ey test has strong correlations with motility and strict morphology parameters of sperm samples but is not sufficiently sensitive to estimate the outcome of ICSI cycles.

Fertil Steril. 2007 Nov;88(5):1438.e15-7. Epub 2007 Mar 23.

Ovarian endomyometrioma with atypias: description of a case.

Zannoni GF, Vellone VG, Fadda G, Guerriero M, Carbone A.

Department of Pathology, Faculty of Medicine Agostino Gemelli, Catholic University, Rome, Italy. gfzannoni@rm.unicatt.it

OBJECTIVE: To report on a patient with endomyometrioma with atypias and to review the literature. DESIGN: Case report and literature review. SETTING: Clinical and pathologic. PATIENT(S): A 33-year-old nulliparous woman with right flank pain and infertility. MAIN OUTCOME MEASURE(S): Accuracy of diagnosis, hypotheses on endomyometrioma pathogenesis. RESULT(S): A 33-year-old woman with an 8-cm right ovarian mass is reported. An extensive review of the literature on this rare disease revealed only nine well-documented cases with different views on pathogenesis. The final diagnosis required an accurate sampling and the aid of immunohistochemical markers. CONCLUSION(S): Endomyometrioma is an extremely rare entity. None of the previous cases showed cytologic atypias. The finding of atypias, in analogy with endometriosis, suggests the müllerian metaplastic theory.

Fertil Steril. 2007 Oct;88(4 Suppl):1058-64. Epub 2007 Mar 23.

Noninvasive assessment of ectopic uterine tissue development in rats using magnetic resonance imaging.

Lenhard SC, Haimbach RE, Sulpizio AC, Brooks DP, Bray JD, Jucker BM.

Cardiovascular and Urogenital Center for Excellence in Drug Discovery, GlaxoSmithKline King of Prussia, Pennsylvania 19406, USA.

OBJECTIVE: To non-invasively characterize ectopic uterine tissue (EUT) development in a modified autologous rat surgical model of endometriosis using magnetic resonance imaging (MRI). DESIGN: Investigational MRI study. SETTING: A pharmaceutical company. ANIMAL(S): Female Sprague Dawley rats. INTERVENTION(S): Uterine tissue was autotransplanted on the right peritoneal wall of rats. Rats were serially imaged after surgery and after endogenous hormone suppression, hormone supplementation, or ovariectomy. In addition, an MRI contrast agent was administered to examine EUT perfusion characteristics. MAIN OUTCOME MEASURE(S): Changes in transplanted EUT volume and perfusion were monitored using MRI. RESULT(S): The EUT growth could be readily monitored non-invasively by MRI. Although EUT growth was rapid during the initial 4 days after surgery, volume stabilized by the third week and maintained for at least 9 weeks after transplantation. The EUT volumes varied with the estrous cycle and were hormonally sensitive to ovariectomy, to Antide (GnRH antagonist), and to Antide followed by 17beta-E(2) supplementation. The use of an MRI contrast agent facilitated visualization of EUT wall perfusion. CONCLUSION(S): MRI allows for noninvasive, dynamic evaluation of transplanted EUT growth in the rat. This reproducible model will allow for performing quantifiable pharmacologic studies in pre-clinical drug discovery for therapies targeting endometriosis.

J Obstet Gynaecol Can. 2007 Jan;29(1):13, 14.

Image of the month. Diaphragmatic endometriosis.

[Article in English, French]

Cooper JK.

Int Urogynecol J Pelvic Floor Dysfunct. 2007 Aug;18(8):949-54. Epub 2007 Mar 15.

Update on the diagnosis and treatment of bladder endometriosis.

Pastor-Navarro H, Giménez-Bachs JM, Donate-Moreno MJ, Pastor-Guzman JM, Ruíz-Mondéjar R, Atienzar-Tobarra M, Salinas-Sánchez AS, Virserda-Rodriguez JA.

Urology Department, Hospital and University Complex of Albacete, Spain.

Bladder endometriosis is rare, although the bladder is the urinary tract structure most often affected by this condition. The common clinical manifestations of bladder endometriosis include menouria and urethral and pelvic pain syndrome occurring cyclically. Imaging methods are not conclusive for the definitive diagnosis. Cystoscopy is the most useful diagnostic test with confirmation by histologic study. Treatment must be individualized according to the patient’s age, desire for future pregnancies, the severity of the symptoms, the site affected, and whether other organs are involved. Two types of treatment are currently used as follows: medical-hormonal and surgical.

Physiol Genomics. 2007 Mar 14;29(1):13-23.

Temporal analysis of E2 transcriptional induction of PTP and MKP and downregulation of IGF-I pathway key components in the mouse uterus.

Ivanga M, Labrie Y, Calvo E, Belleau P, Martel C, Luu-The V, Morissette J, Labrie F, Durocher F.

Oncology and Molecular Endocrinology Research Center, Centre Hospitalier de l’Université Laval Research Center, Centre Hospitalier Universitaire de Québec, Department of Anatomy and Physiology, Laval University, Quebec, Canada.

17beta-Estradiol (E2) is well known to be associated with uterine cancer, endometriosis, and leiomyomas. Although insulin-like growth factor I (IGF-I) has been identified as a mediator of the uterotrophic effect of E2 in several studies, this mechanism is still not well understood. In the present study, identification of the genes modulated by a physiological dose of E2, in the uterus, has been done in ovariectomized mice using Affymetrix microarrays. The E2-induced genomic profile shows that multiple genes belonging to the IGF-I pathway are affected after exposure to E2. Two phases of regulation could be identified. First, from 0 to 6 h, the expression of genes involved in the cell cycle, growth factors, protein tyrosine phosphatases, and MAPK phosphatases is quickly upregulated by E2, while IGF-I receptor and several genes of the MAPK and phosphatidylinositol 3-kinase pathways are downregulated. Later, i.e., from 6 to 24 h, transporters and peptidases/proteases are stimulated, whereas defense-related genes are differentially regulated by E2. Finally, cytoarchitectural genes are modulated later. The present data show that a physiological dose of E2 induces, within 24 h, a series of transcriptional events that promote the uterotrophic effect. Among these, the E2-mediated activation of the IGF-I pathway seems to play a pivotal role in the uterotrophic effect. Furthermore, the protein tyrosine phosphatases and MAPK phosphatases are likely to modulate the estrogenic uterotrophic action by targeting, at different steps, the IGF-I pathway.

Ceska Gynekol. 2007 Jan;72(1):11-5.

[Transvaginal hydrolaparoscopy and ultrasonographically guided transvaginal hydrolaparoscopy–two outpatient methods of pelvis examination]

[Article in Czech]

Sobek A Jr, Vodicka J, Sobek A.

Fertimed, centrum pro lécu neplodnosti, Olomouc.

OBJECTIVE: The aim of this study is to describe transvaginal hydrolaparoscopy (THL) and ultrasonographically guided transvaginal hydrolaparoscopy (UTHL) used in the examination of the female pelvis in patients treated for infertility. Emphasis was placed on the safety of both procedures. SETTING: Fertimed, Infertility centre, Olomouc. METHODS: Transvaginal hydrolaparoscopy is an outpatient method for the examination of the female pelvis. Optics are inserted via the posterior vaginal wall and the tuboovarian complex is examined in saline solution. In ultrasonographically guided transvaginal hydrolaparoscopy, ultrasound is used during whole examination. The control of position of ultrasound instruments during the whole procedure increases the safety of the procedure and decreases difficulty of the method. RESULTS: 9 patients were examined with transvaginal hydrolaparoscopy. In 2 patients, (22%), insertion of the needle was complicated by bowel injury. Based on the experience with transvaginal hydrolaparoscopy we developed a modified version: Ultrasonographically guided transavaginal hydrolaparoscopy. With this method we examined 460 patients. Access to the abdominal cavity was successful in 100%. In 1.7%, the examination was not done due to a lack of fluid in Douglas space. Bowel injury was not detected. Visualisation of both adnexa was similar in both methods (94.5%). Small asymptomatic periovarial adhesions were found in 16%. In 5.2%, we found grade I endometriosis. Laparoscopy was recommended in 15.7% due to tubarian obstruction, severe adhesions, or poor adnexal visibility. Surgical intervention was necessary in 86.2% of those patients. CONCLUSIONS: Transvaginal hydrolaparoscopy and ultrasonographically guided transvaginal hydrolaparoscopy are new methods for examination of tuboovarian complex. Ultrasonographically guided transvaginal hydrolaparoscopy ensures safer and easier access to the abdominal cavity with low complication rate.

Mol Endocrinol. 2007 May;21(5):1066-81. Epub 2007 Mar 13.

A structural and in vitro characterization of asoprisnil: a selective progesterone receptor modulator.

Madauss KP, Grygielko ET, Deng SJ, Sulpizio AC, Stanley TB, Wu C, Short SA, Thompson SK, Stewart EL, Laping NJ, Williams SP, Bray JD.

Department of Computational, Analytical and Structural Sciences, GlaxoSmithKline Discovery Research, Research Triangle Park, North Carolina 27709, USA.

Selective progesterone receptor modulators (SPRMs) have been suggested as therapeutic agents for treatment of gynecological disorders. One such SPRM, asoprisnil, was recently in clinical trials for treatment of uterine fibroids and endometriosis. We present the crystal structures of progesterone receptor (PR) ligand binding domain complexed with asoprisnil and the corepressors nuclear receptor corepressor (NCoR) and SMRT. This is the first report of steroid nuclear receptor crystal structures with ligand and corepressors. These structures show PR in a different conformation than PR complexed with progesterone (P4). We profiled asoprisnil in PR-dependent assays to understand further the PR-mediated mechanism of action. We confirmed previous findings that asoprisnil demonstrated antagonism, but not agonism, in a PR-B transfection assay and the T47D breast cancer cell alkaline phosphatase activity assay. Asoprisnil, but not RU486, weakly recruited the coactivators SRC-1 and AIB1. However, asoprisnil strongly recruited the corepressor NCoR in a manner similar to RU486. Unlike RU486, NCoR binding to asoprisnil-bound PR could be displaced with equal affinity by NCoR or TIF2 peptides. We further showed that it weakly activated T47D cell gene expression of Sgk-1 and PPL and antagonized P4-induced expression of both genes. In rat leiomyoma ELT3 cells, asoprisnil demonstrated partial P4-like inhibition of cyclooxygenase (COX) enzymatic activity and COX-2 gene expression. In the rat uterotrophic assay, asoprisnil demonstrated no P4-like ability to oppose estrogen. Our data suggest that asoprisnil differentially recruits coactivators and corepressors compared to RU486 or P4, and this specific cofactor interaction profile is apparently insufficient to oppose estrogenic activity in rat uterus.

Diagn Interv Radiol. 2007 Mar;13(1):26-9.

Echogenic foci mimicking adenomyosis presumably due to air intravasation into the myometrium during sonohysterography.

Ors F, Lev-Toaff AS, Bergin D.

Department of Radiology, Gülhane Military Medical Academy, Ankara, Turkey. drfors@yahoo.com

PURPOSE: To report the radiological findings of a pseudolesion in the myometrium mimicking adenomyosis presumably due to air intravasation during sonohysterography (SHG). MATERIALS AND METHODS: We searched magnetic resonance imaging (MRI) and transvaginal ultrasound (TVUS) examination results before and after SHGs, in which echogenic foci were found suggesting adenomyosis in the myometrium, and found 7 female cases. MRI and TVUS findings were compared to the SHG findings to assess the persistence of echogenic foci seen with SHG and other imaging modalities, and to exclude the possibility of pseudolesions secondary to saline-air intravasation into the myometrium during SHG. RESULTS: Ages of the 7 patients ranged from 27 to 60 years; 2 of them were postmenopausal. SHG examinations showed solitary or multiple echogenic foci measuring 4-15 mm, with acoustic shadowing, which were adjacent to the endometrium and consistent with adenomyosis. Only 1 of the patients underwent both MRI and TVUS, 2 of them had TVUS after SHG, and 1 had TVUS before SHG; the 3 remaining patients had TVUS as a baseline examination prior to SHG. None of these TVUS or MRI examinations confirmed the echogenic foci found with SHG. CONCLUSION: In order to differentiate echogenic myometrial pseudolesions from true adenomyosis lesions, a detailed preliminary TVUS is essential before any SHG procedure. If such lesions are encountered despite meticulous care to avoid the inadvertent introduction of air into the endometrial cavity, TVUS findings should be reviewed and a pelvic MRI is recommended in cases with heterogeneous myometrium.

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