J Minim Invasive Gynecol. 2008 Sep-Oct;15(5):636-9.

The use of narrowband imaging for identification of endometriosis.

Barrueto FF, Audlin KM.

Minimally Invasive Surgery and Pelvic Reconstruction, Mercy Medical Center, Obstetrics, Gynecology, and Reproductive Science, Univesity of Maryland School of Medicine, Baltimore, Maryland 21202, USA.

A pilot study was designed to evaluate whether a narrowband imaging (NBI) endoscopic light source could detect endometriosis implants that were not identifiable with a visible light spectrum laparoscope. In all, 21 consecutive patients who were undergoing pelviscopy for pelvic pain and possible endometriosis were enrolled in the study. Endoscopic evaluation was performed using an endoscope that was fitted with a NBI light source using 415- and 540-nm filters. Endometriosis was first documented and photographed using visible light and then re-evaluated with NBI. Implants newly found with NBI were documented and photographed. All noted lesions were excised using a harmonic scalpel. In all, 21 consecutive patients (age range 20-40 years) were enrolled in the study with a preoperative diagnosis of pelvic pain and possible pelvic endometriosis. One patient was excluded after evaluation with NBI did not provide additional biopsy specimens. Fourteen of the 20 patients had lesions identified with NBI that were not identified with visible light. A total of 38 biopsy specimens were taken using NBI; 20 (53%) of them were identified histologically as endometriosis. Seven patients did not have endometriosis identified with white light; however, 4 of these patients had lesions identified with NBI that were confirmed endometriosis. This pilot study is a promising start in the process to evaluate NBI endoscopy as an effective tool for evaluating and identifying endometriosis implants that are not visible with white light endoscopy.

J Minim Invasive Gynecol. 2008 Sep-Oct;15(5):566-70.

The influence of adenomyosis in patients laparoscopically treated for deep endometriosis.

Landi S, Mereu L, Pontrelli G, Stepniewska A, Romano L, Tateo S, Dorizzi C, Minelli L.

Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Verona, Italy.

STUDY OBJECTIVE: A strong association exists between adenomyosis and endometriosis and a common pathogenetic mechanism was proposed. The aim of this study was to evaluate whether and how the presence of concurrent adenomyosis can affect the outcome of laparoscopic excision of deep endometriosis. DESIGN: Data were retrospectively collected from our computerized medical records (Canadian Task Force classification II-3). SETTING: General hospital. INTERVENTION: Restrospective evaluation. PATIENTS: From January 2003 through July 2005, 40 consecutive patients affected by concomitant endometriosis and adenomyosis were included in group A and another 40 affected by endometriosis only were included in group B. MEASUREMENTS AND MAIN RESULTS: In group A, 20 women required bowel surgery (17 segmental and 3 full-thickness discoid resections) versus 16 patients in the other group (13 segmental bowel resections with end-to-end anastomosis and 3 discoid resections). Dysmenorrhea and dyspareunia after treatment improved (p<.01) in both groups, whereas dyschezia improved only in group A. The persistence of menometrorrhagia was more frequent in group B (p<.01). During follow-up, patients of group A underwent medical treatment for a longer time than those of group B (p<.001). Clinical detection of endometriosis recurrence was more frequent in patients with adenomyosis (p<.01), whereas no difference existed in the incidence of the recurrence detected by ultrasound. The overall number of pregnancies after surgery was significantly lower in the group with adenomyosis (p=.03). CONCLUSION: Complete excision of deep endometriosis is not always feasible because of adenomyosis. For this reason, preoperative imaging screening for adenomyosis could be included in the preoperative workup when extensive disease is clinically suspected.

Int J Gynaecol Obstet. 2008 Oct;103(1):59-64. Epub 2008 Aug 21.

Histopathology-based combined surgical approach to rectovaginal endometriosis.

Mangler M, Loddenkemper C, Lanowska M, Bartley J, Schneider A, Köhler C.

Department of Gynecology, Charité Campus Mitte, Berlin, Germany. mandy.mangler@charite.de

OBJECTIVE: To describe a new surgical approach to rectovaginal endometriosis. Rectovaginal endometriosis can be infiltrative or superficial involving the bowel. Only infiltrative disease should be treated by intestinal resection. However, infiltration of endometriosis cannot be confirmed by preoperative imaging techniques. METHODS: A total of 48 women with infiltrative rectovaginal endometriosis were included in this prospective study. Surgery was performed using a newly developed technique. All bowel resections were indicated according to operative findings and not on the basis of preoperative imaging technique results. RESULTS: The decision for rectosigmoidal resection was based on the results of the intraoperative dissection of the rectovaginal septum. Histologically, infiltration of the ventral bowel wall was confirmed in all cases. CONCLUSION: This new surgical technique for the treatment of rectovaginal endometriosis allows precise diagnosis and treatment with low morbidity. A resection of the mesorectum is not necessary because the endometriotic nodules are always located on the antimesenteric surface of the bowel.

Clinics (Sao Paulo). 2008 Aug;63(4):525-30.

Does gestrinone antagonize the effects of estrogen on endometrial implants upon the peritoneum of rats?

Lobo VL, Soares JM Jr, de Jesus Simões M, Simões Rdos S, de Lima GR, Baracat EC.

Departamento de Ginecologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

OBJECTIVE: To evaluate the effects of estrogen treatment in combination with gestrinone on an experimental rat model of endometriosis. METHODS: Uterine transplants were attached to the peritoneum of female Wistar rats via a surgical autotransplantation technique. The implanted area was measured during the proestrus phase and after hormonal treatment. We performed morphometric analysis and examined the macroscopic and morphometric alterations of endometrial implants after hormonal treatment in ovariectomized rats. RESULTS: The high dose of estrogen caused macroscopic increases in the endometrial implant group compared with other groups, which were similar to increases in the proestrus phase. The low dose showed morphometric development of implants, such as an increase in number of endometrial glands, leukocyte infiltration and mitosis. Gestrinone antagonized both doses of estrogen. CONCLUSION: Our findings suggest that gestrinone antagonizes estrogen’s effects on rat peritoneal endometrial implants.

Chirurgia (Bucur). 2008 May-Jun;103(3):265-74.

[Guidelines for the management of painful endometriosis]

[Article in Romanian]

Roman H, Puscasiu L.

Clinica Obstetrică-Ginecologie, CHU Charles Nicolle Rouen, Franta. horace.roman@gmail.com

OBJECTIVE: To establish guidelines for the medical and surgical management of painful endometriosis. MATERIAL AND METHODS: An exhaustive review on Medline and Cochrane Database between 1980 and 2006 was performed. RESULTS: GnRH agonists, progestins, continuous monophasic oral contraceptives and danazol have a suppressive effect on dysmenorrhoea, nonmenstrual pain and dyspareunia (grade A). Surgical treatment is effective in painful endometriosis (grade B). Complete surgical excision of deep endometriotic lesions with conservation of uterus and ovaries has a limited term efficacy on pain relief (grade C). A multidisciplinary approach is recommended (grade C). The use of the psychotherapy improves the management of chronic pain (grade A). There is a lack of information concerning the therapeutic strategy able to prevent recurrences. Whether endometriosis recurrences occur, medical treatment should be the first line approach (expert opinion). A hysterectomy with salpingo-oophorectomy and complete excision of the lesions is efficient in women with pain recurrence who no longer desire pregnancy (grade C). CONCLUSIONS: Medical and surgical treatments have a limited term efficacy on painful endometriosis (grade A). The benefit/risk ratio, depending on side-effects, should be assessed on a case to case basis.

Hum Reprod. 2008 Dec;23(12):2701-8. Epub 2008 Aug 20.

Effects of a selective cyclooxygenase-2 inhibitor on endometrial epithelial cells from patients with endometriosis.

Olivares C, Bilotas M, Buquet R, Borghi M, Sueldo C, Tesone M, Meresman G.

Instituto de Biología y Medicina Experimental CONICET, Vuelta de Obligado 2490 C1428ADN, Ciudad Autónoma de Buenos Aires, Argentina.

BACKGROUND: Celecoxib, a selective cyclooxygenase (COX)-2 inhibitor, also has anti-proliferative properties and pro-apoptotic effects on different in vivo and in vitro models, two actions that may be efficacious in therapy for endometriosis. We evaluated the effects of celecoxib on apoptosis and proliferation, and vascular endothelial growth factor (VEGF) production and COX-2 expression and activity in endometrial epithelial cells (EECs). METHODS AND RESULTS: Thirty-two endometriosis and 13 control women were included in the study. EECs from eutopic endometrium and control biopsies were cultured with different doses of celecoxib. Celecoxib at 50, 75 and 100 microM (versus vehicle control) inhibited EEC proliferation in cultures from controls (P < 0.05, P < 0.01 and P < 0.01, respectively) and patients with endometriosis (P < 0.05, P < 0.01 and P < 0.01), as assessed by (3)H-thymidine uptake. Celecoxib at 50, 75 and 100 microM induced apoptosis in EEC from controls (P < 0.05, P < 0.001 and P < 0.001) and patients with endometriosis (P < 0.001, P < 0.001 and P < 0.01), as revealed by the Acridine Orange-Ethidium Bromide technique. Western blot analysis showed that celecoxib was effective at increasing COX-2 protein at 100 microM in EEC from endometriosis patients (P < 0.05). In EEC from endometriosis patients, celecoxib at 25, 50 and 100 microM was also effective in reducing COX-2 activity, reflected in the reduction of prostaglandin E(2) (PGE(2)) synthesis (P < 0.001), and VEGF secretion (P < 0.001; P < 0.05 and P < 0.001), assessed by enzyme-linked immunosorbent assay. Exogenous PGE(2) did not reverse celecoxib-induced growth inhibition. CONCLUSIONS: This study suggests a direct effect of celecoxib on reduction of endometrial growth and supports further research on selective COX-2 inhibition as a novel therapeutic modality in endometriosis.

Hum Reprod. 2008 Dec;23(12):2692-700. Epub 2008 Aug 20.

Fibromuscular differentiation in deeply infiltrating endometriosis is a reaction of resident fibroblasts to the presence of ectopic endometrium.

van Kaam KJ, Schouten JP, Nap AW, Dunselman GA, Groothuis PG.

Research Institute GROW, University of Maastricht/University Hospital Maastricht, Maastricht, The Netherlands. kimvankaam@yahoo.com

BACKGROUND: In this study, we characterized the fibromuscular (FM) tissue, typical of deeply infiltrating endometriosis, investigated which cells are responsible for the FM reaction and evaluated whether transforming growth factor-beta (TGF-beta) signaling is involved in this process. METHODS: FM differentiation and TGF-beta signaling were assessed in deeply infiltrating endometriosis lesions (n = 20) and a nude mouse model of endometriosis 1, 2, 3 and 4 weeks post-transplantation. The FM reaction was evaluated by immunohistochemistry using different markers of FM and smooth muscle cell differentiation (vimentin, desmin, alpha-smooth muscle actin, smooth muscle myosin heavy chain). TGF-beta signaling was assessed by immunostaining for its receptors and phosphorylated Smad. RESULTS: Deeply infiltrating endometriosis lesions contain myofibroblast-like cells that express multiple markers of FM differentiation. Expression of TGF-beta receptors and phospho-Smad was more pronounced in the endometrial component of the lesions than in the FM component. In the nude mouse model, alpha-smooth muscle actin expression was observed in murine fibroblasts surrounding the lesion, but not in human endometrial stroma. CONCLUSIONS: FM differentiation in deeply infiltrating endometriosis is the result of a reaction of the local environment to the presence of ectopic endometrium. It shares characteristics with pathological wound healing, but cannot be explained by TGF-beta signaling alone.

BJOG. 2008 Oct;115(11):1382-91. Epub 2008 Aug 19.

Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study–Part 1.

Ballard KD, Seaman HE, de Vries CS, Wright JT.

Department of Women’s Health, Postgraduate Medical School, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK. k.ballard@surrey.ac.uk

OBJECTIVE: To determine the value of patient-reported symptoms in diagnosing endometriosis. DESIGN: A national case-control study. SETTING: Data from the UK General Practice Research Database for years 1992-2001. SAMPLE: A total of 5540 women aged 15-55 years, diagnosed with endometriosis, each matched to four controls without endometriosis. METHODS: Data were analysed to determine whether specific symptoms were highly indicative of endometriosis. Odds ratios for these symptoms were derived by conditional logistic regression analysis. MAIN OUTCOME MEASURES: Symptoms associated with endometriosis. RESULTS: The prevalence of diagnosed endometriosis was 1.5%. A greater proportion of women with endometriosis had abdominopelvic pain, dysmenorrhoea or menorrhagia (73%) compared with controls (20%). Compared with controls, women with endometriosis had increased risks of abdominopelvic pain (OR 5.2 [95% CI: 4.7-5.7]), dysmenorrhoea (OR 8.1 [95% CI: 7.2-9.3]), menorrhagia (OR 4.0 [95% CI: 3.5-4.5]), subfertility (OR 8.2 [95% CI: 6.9-9.9]), dyspareunia and/or postcoital bleeding (OR 6.8 [95% CI: 5.7-8.2]), and ovarian cysts (OR 7.3 [95% CI: 5.7-9.4]), and of being diagnosed with irritable bowel syndrome (IBS) (OR 1.6 [95% CI: 1.3-1.8]) or pelvic inflammatory disease (OR 3.0 [95% CI: 2.5-3.6]). Women with endometriosis were also found to consult the doctor more frequently than the controls and were twice as likely to have time off work. CONCLUSIONS: Specific symptoms and frequent medical consultation are associated with endometriosis and appear useful in the diagnosis. Endometriosis may coexist with or be misdiagnosed as pelvic inflammatory disease or IBS.

BJOG. 2008 Oct;115(11):1382-91. Epub 2008 Aug 19.

    Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study–Part 1.

    Ballard KD, Seaman HE, de Vries CS, Wright JT.


    Department of Women’s Health, Postgraduate Medical School, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK. k.ballard@surrey.ac.uk


    OBJECTIVE: To determine the value of patient-reported symptoms in diagnosing endometriosis. DESIGN: A national case-control study. SETTING: Data from the UK General Practice Research Database for years 1992-2001. SAMPLE: A total of 5540 women aged 15-55 years, diagnosed with endometriosis, each matched to four controls without endometriosis. METHODS: Data were analysed to determine whether specific symptoms were highly indicative of endometriosis. Odds ratios for these symptoms were derived by conditional logistic regression analysis. MAIN OUTCOME MEASURES: Symptoms associated with endometriosis. RESULTS: The prevalence of diagnosed endometriosis was 1.5%. A greater proportion of women with endometriosis had abdominopelvic pain, dysmenorrhoea or menorrhagia (73%) compared with controls (20%). Compared with controls, women with endometriosis had increased risks of abdominopelvic pain (OR 5.2 [95% CI: 4.7-5.7]), dysmenorrhoea (OR 8.1 [95% CI: 7.2-9.3]), menorrhagia (OR 4.0 [95% CI: 3.5-4.5]), subfertility (OR 8.2 [95% CI: 6.9-9.9]), dyspareunia and/or postcoital bleeding (OR 6.8 [95% CI: 5.7-8.2]), and ovarian cysts (OR 7.3 [95% CI: 5.7-9.4]), and of being diagnosed with irritable bowel syndrome (IBS) (OR 1.6 [95% CI: 1.3-1.8]) or pelvic inflammatory disease (OR 3.0 [95% CI: 2.5-3.6]). Women with endometriosis were also found to consult the doctor more frequently than the controls and were twice as likely to have time off work. CONCLUSIONS: Specific symptoms and frequent medical consultation are associated with endometriosis and appear useful in the diagnosis. Endometriosis may coexist with or be misdiagnosed as pelvic inflammatory disease or IBS.


Eur J Gynaecol Oncol. 2008;29(4):397-8.

A rare case of low-grade endometrial stromal sarcoma with myxoid differentiation and atypical bizarre cells.

Kibar Y, Aydin A, Deniz H, Balat O, Cebesoy B, Al-Nafussi A.

Department of Pathology, Medical Faculty, Gaziantep University, Turkey.

Endometrial stromal sarcoma (ESS) is a rare mesenchymal tumor with characteristic histological appearances, consisting of diffuse infiltrate of small uniform endometrial stromal cells with a multinodular arrangement and distinct vascular pattern. Less common variants of ESS include “mixed endometrial stromal and smooth muscle tumors”, “endometrial stromal tumors resembling ovarian sex cord tumors” and “endometrial stromal neoplasms with endometrial glands”, and “aggressive endometriosis”. Rarely do endometrial stromal tumors have a prominent fibrous or myxoid appearance which causes confusion and possible misdiagnosis as myxoid leiomyosarcoma. In this report we present a very unusual subtype of ESS in a 32-year-old woman. The tumor revealed atypical pleomorphic bizarre cells which were stained positive only with vimentin and CD10 in an abundant myxoid matrix. A low-proliferative rate was established with MIB-1 staining. To our knowledge such appearance has not been previously reported.

Eur J Gynaecol Oncol. 2008;29(4):393-6.

Ovarian endometriosis associated with carcinoma and sarcoma: case report.

Boruban MC, Jaishuen A, Sirisabya N, Li Y, Zheng HG, Deavers MT, Kavanagh JJ.

Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-1439, USA.

Endometriosis is a common clinical disorder that shares certain characteristics, metastasis and recurrence, with malignant neoplasms. Most malignant ovarian tumors arising from endometriosis are clear cell carcinoma or endometrioid adenocarcinoma. Few reports exist of sarcoma associated with endometriosis, and even fewer exist of multiple types of malignancies occurring simultaneously. Here, we report the case of a 32-year-old woman who presented with infertility and a pelvic mass. She underwent exploratory laparotomy and bilateral salpingo-oophorectomy. She was then referred to our institution for treatment recommendation. The pathologic findings revealed bilateral endometrioid adenofibroma of low malignant potential, which was associated with endometrioid intraepithelial carcinoma in the left ovary and high-grade sarcoma in the right ovary. Both tumors seemed to have arisen from endometriosis. She was treated with 75 mg/m2 of doxorubicin and 10 g/m2 of ifosfamide every three weeks for eight courses. She was later found to have bilateral brain metastases, which were resected and treated by whole-brain irradiation. She was again treated with doxorubicin and ifosfamide. The optimal treatment for endometriosis-associated ovarian cancer depends on the type of malignancy; simultaneously occurring multiple tumor types should be treated individually.

Ceska Gynekol. 2008 Jul;73(4):213-7.

[Semiquantitative analysis of mRNA aromatase expression in eutopic endometrium as a diagnostic marker of endometriosis and estrogen dependent diseases]

[Article in Slovak]

Visnovský J, Galo S, Zúbor P, Hatok J, Racay P, Danko J.

Gynekologicko-pôrodnícka klinika JLF UK a MFN, Martin. visnovsky@jfmed.uniba.sk

OBJECTIVE: To determine clinical benefits of mRNA aromatase expression in entopic endometrium as a diagnostic marker of endometriosis. DESIGN: Prospective clinical trial. SETTING: Department of Obstetrics and Gynaecology of Jessenius Medical Faculty and Faculty Hospital, Martin. METHODS: The expression of mRNA aromatase of eutopic endometrium was determined among women who underwent laparoscopy or laparotomy due to pelvic pain, infertility or benign pelvic tumor. Endometriosis was confirmed histologicaly and classified by rAFS. RESULTS: On the basis of entering criteria 23 women were enrolled in this study and divided into two subgroups: 12 endometriotic and 11 without endometriosis. Sensitivity of aromatase expression was 75% and specificity 54.5% at the cut-off value of at least minimal aromatase activity. By the presence of estrogen-dependent diseases- endometriosis, myomas or endometrial hyperplasia 18 women were compared to 5 disease free women. In this case, sensitivity of aromatase expression was 72.2 and specificity 80%. CONCLUSION: Aromatase expression in eutopic endometrium is a good diagnostic marker for endometriosis.

Sao Paulo Med J. 2008 May 1;126(3):190-3.

Postmenopausal intestinal obstructive endometriosis: case report and review of the literature.

Popoutchi P, dos Reis Lemos CR, Silva JC, Nogueira AA, Feres O, Ribeiro da Rocha JJ.

Department of Surgery and Anatomy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto,São Paulo, Brazil.

CONTEXT: Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity, which is commonly detected in gynecological practice but rarely reported as a coloproctological disorder. The objective of the present report was to discuss a rare case of postmenopausal intestinal endometriosis simulating a malignant lesion, following a review of the literature. CASE REPORT: A 74-year-old woman with complaints of hematochezia and tenesmus of two months’ duration accompanied by liquid feces and pelvic pain, but with no other gastrointestinal or gynecological complaints, was referred to our service. She had been menopausal for 22 years, with no hormone replacement treatment, and had undergone panhysterectomy three years before the referral to us, due to endometrial thickening and a right adnexal cyst. Five months before this referral, she had undergone laparotomy due to acute obstructive abdomen, which revealed a tumor mass involving the small bowel. Anatomopathological examination of the enterectomy suggested a hypothesis of intestinal endometriosis. A proctological examination was normal. Computed tomography of the pelvis revealed thickening of the rectosigmoid transition and colonoscopy revealed friable tumor formation in the rectum. A biopsy of the lesion revealed mucosal fragments of endometrial type, which led to a review of the previous anatomopathological examination. The patient underwent rectosigmoidectomy with protective transversotomy, with a good postoperative course, and anatomical examination confirmed the intestinal endometriosis. The patient subsequently suffered a stenosing recurrence of the lesion and has undergone colostomy since then.

Expert Opin Pharmacother. 2008 Sep;9(13):2317-25.

Non-contraceptive benefits of oral contraceptives.

Huber JC, Bentz EK, Ott J, Tempfer CB.

University of Vienna School of Medicine, Department of Gynaecologic Endocrinology and Reproductive Medicine, Vienna, Austria. johannes.huber@meduniwien.ac.at

BACKGROUND: There is increasing awareness of the opportunity that many contraceptive interventions may provide for additional health benefits. However, treatment of medical problems with oral contraceptives (OCs) is often an ‘off-label’ practice. OBJECTIVE: The aim of this review is to summarize available data on non-contraceptive benefits of OCs. METHODS: Review of the literature. RESULTS: OCs have been shown to reduce the risk of ovarian, endometrial, and colorectal cancer. It has been suggested that OCs may be used in treatment of endometriosis, menorrhagia, and uterine leiomyomas. Pelvic inflammatory disease, dysmenorrhea, premenstrual syndrome, and acne have been shown to improve under OCs. CONCLUSION: OCs are important for global and female health. Besides contraception, non-contraceptive effects of OCs are evidence based, well established, and commonly used in clinical practice.

Gynecol Obstet Fertil. 2008 Sep;36(9):913-9. Epub 2008 Aug 15.

[Bladder endometriosis and barrenness: diagnostic and treatment strategy]

[Article in French]

Piketty M, Bricou A, Blumental Y, de Carné C, Benifla JL.

Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, avenue du Docteur Arnold-Netter, 75012 Paris, France. matpiketty@yahoo.fr

Deep infiltrating endometriosis is a well-known female disease responsible for chronic pelvic pain, urinary dysfunction, infertility, and altered quality of life. Endometriosis and infertility are complex entities and the optimal choice of management of both of them remains obscure. Mechanism of development of the disease has to be understood to optimize patients care. The link between barrenness and endometriosis is well known, but there is no direct link between bladder lesion and infertility. Bladder endometriosis is a deeply infiltrating endometriosis lesion. Its management is first diagnostic and then remedial. In case of ineffectiveness of medical strategy, surgical treatment is indicated. However, for patient suffering from symptomatic isolated bladder endometriosis, surgical management can be offered in first intention. Isolated bladder injuries due to endometriosis are mostly treated by conservative laparoscopic surgery, after a complete evaluation of endometriosis disease and barrenness by clinical exam and imaging techniques.

Eur J Cancer. 2008 Nov;44(16):2477-84. Epub 2008 Aug 15.

Endometrioid and clear cell ovarian cancers: a comparative analysis of risk factors.

Nagle CM, Olsen CM, Webb PM, Jordan SJ, Whiteman DC, Green AC; Australian Cancer Study Group; Australian Ovarian Cancer Study Group.

Collaborators (131)

Bowtell D, Chenevix-Trench G, Green A, Webb P, deFazio A, Gertig D, Traficante N, Moore S, Hung J, Fereday S, Harrap K, Sadkowsky T, Mellon A, Robertson R, Vanden Bergh T, Maidens J, Nattress K, Chiew YE, Stenlake A, Sullivan H, Alexander B, Ashover P, Brown S, Corrish T, Green L, Jackman L, Martin K, Ranieri B, White J, Jayde V, Bowes L, Mamers P, Schmidt T, Shirley H, Viduka S, Tran H, Bilic S, Glavinas L, Proietto A, Braye S, Otton G, Bonaventura T, Stewart J, Friedlander M, Bell D, Baron-Hay S, Ferrier A, Gard G, Nevell D, Young B, Camaris C, Crouch R, Edwards L, Hacker N, Marsden D, Robertson G, Beale P, Beith J, Carter J, Dalrymple C, Hamilton A, Houghton R, Russell P, Brand A, Jaworski R, Harnett P, Wain G, Crandon A, Cummings M, Horwood K, Obermair A, Wyld D, Nicklin J, Papadimos D, Perrin L, Ward B, Davy M, Hall C, Dodd T, Healy T, Pittman K, Oehler M, Henderson D, Hyde S, Miller J, Pierdes J, Blomfield P, Challis D, McIntosh R, Parker A, Brown B, Rome R, Allen D, Grant P, Hyde S, Laurie R, Robbie M, Healy D, Jobling T, Maniolitas T, McNealage J, Rogers P, Susil B, Veitch A, Constable J, Tong SP, Robinson I, Simpson I, Phillips K, Rischin D, Waring P, Loughrey M, O’Callaghan N, Murray B, Billson V, Galloway S, Pyman J, Quinn M, Hammond I, McCartney A, Leung Y, Haviv I, Purdie D, Whiteman D, Zeps N, Green AC, Parsons PG, Hayward NK, Webb PM, Purdie DM, Whiteman DC.

Cancer and Population Studies Group, Queensland Institute of Medical Research, Brisbane, QLD, Australia. Christina.Nagle@qimr.edu.au

Endometrioid and clear cell subtypes of ovarian cancer are both known to be closely associated with endometriosis and endometrial pathology, and so have often been combined in studies of causation. We have examined these ovarian cancers separately for potentially distinct risk factors in our population-based, Australia-wide case control study of 142 women with incident invasive endometrioid, 90 with clear cell ovarian cancers and 1508 population controls. Multivariate logistic regression was used to calculated odds ratios (ORs) and 95% confidence intervals (CIs). Increasing parity, and hormonal contraceptive use for > or = 5 years, strongly decreased the risks of both subtypes. Breast feeding and tubal ligation were also inversely associated, but significantly so only for the endometrioid subtype. As expected endometriosis increased the risk of both subtypes (OR 2.2, 95% CI 1.2-3.9 for endometrioid and OR 3.0, 95% CI 1.5-5.9 for clear cell). Obesity was associated only with clear cell cancers, where we observed a two-fold increased risk (OR 2.2, 95% CI 1.2-4.1). Also a significant trend of decreasing risk with increasing intensity of smoking (p trend 0.02) and education beyond high school was associated with decreased development of clear cell cancers only. Endometrioid and clear cell ovarian cancers have some shared as well as some distinct risk factors, and therefore should be considered separately in studies of ovarian cancer.

Chin Med J (Engl). 2008 May 20;121(10):927-31.

Expression of Annexin-1 in patients with endometriosis.

Li CY, Lang JH, Liu HY, Zhou HM.

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.

BACKGROUND: Annexin-1 was identified as an endometriosis-related protein by comparative proteomics in previous study. As an endogenous anti-inflammatory mediator, Annexin-1 has been shown to regulate the immune response, cell proliferation and apoptosis. To investigate whether Annexin-1 is involved in the pathogenesis of endometriosis, we examined the expression of Annexin-1 in eutopic endometrium of women with or without endometriosis, and detected its expression in peritoneal fluids of those with endometriosis. METHODS: Eutopic endometrium samples from twenty-five women with endometriosis and those from sixteen age-matched women without endometriosis were collected. Peritoneal fluids were obtained from ten patients with endometriosis. The expression of Annexin-1 protein in eutopic endometrium was detected by immunohistochemistry and Western blotting, and mRNA detected by real-time PCR. Annexin-1 protein in the peritoneal fluids was detected by Western blotting. RESULTS: Annexin-1 mRNA and protein were overexpressed in eutopic endometrium of endometriosis without significant differences between the proliferative and secretory phase. Immunohistochemistry showed that Annexin-1 protein was expressed mainly in endometrial glandular cells throughout the menstrual cycle. Annexin-1 protein was detected in the peritoneal fluids of all the ten patients with endometriosis. CONCLUSIONS: Annexin-1 is overexpressed in eutopic endometrium and presents in the peritoneal fluids of patients with endometriosis, and may play a role in the pathogenesis of endometriosis.

Cases J. 2008 Aug 18;1(1):97.

Ultrasound and MR-imaging in preoperative evaluation of two rare cases of scar endometriosis.

Pados G, Tympanidis J, Zafrakas M, Athanatos D, Bontis JN.

1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece. mzafrakas@gmail.com.

ABSTRACT: Scar or incisional endometriosis is a rare, often misdiagnosed, pathologic condition of the abdominal wall. Two cases of incisional endometriosis are presented. Both patients presented with atypical cyclic pain and palpable nodules on scars of previous cesarean sections. In both cases, the mass was totally excised, after accurate preoperative evaluation with 2-D ultrasound, power Doppler and MRI. Microscopic examination confirmed the preoperatively presumed diagnosis of cutaneous endometriosis. In cases of suspected scar endometriosis, preoperative diagnostic imaging is valuable in determining the extent of disease, thus enhancing accurate and total excision.

Thorac Cardiovasc Surg. 2008 Sep;56(6):374-5.

Catamenial pneumothorax.

Mikroulis DA, Didilis VN, Konstantinou F, Vretzakis GH, Bougioukas GI.

Department of Cardiothoracic Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece. dmikrou@med.duth.gr

Catamenial pneumothorax is a rare entity of spontaneous, recurrent pneumothorax occurring in synchrony with the menstrual cycle. The etiology is not completely known, but in most cases it is associated with thoracic endometriosis and/or diaphragmatic fenestrations. We report a case of a 35-year-old woman with three episodes of catamenial pneumothorax. The surgical findings were thoracic endometriosis and diaphragmatic holes. She underwent resection of the affected part of the diaphragm and pleurodesis via a mini-thoracotomy and videothoracoscopy assistance.

Cancer Causes Control. 2008 Dec;19(10):1357-64. Epub 2008 Aug 14.

Risk of epithelial ovarian cancer in relation to benign ovarian conditions and ovarian surgery.

Rossing MA, Cushing-Haugen KL, Wicklund KG, Doherty JA, Weiss NS.

Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA 98108-1024, USA. mrossing@fhcrc.org

OBJECTIVE: Some forms of ovarian neoplasms may be preventable through the removal of precursor lesions. We assessed the risk associated with a prior diagnosis of, and ovarian surgery following, ovarian cysts and endometriosis, with a focus on characterizing risk among tumor subgroups. METHODS: Information was collected during in-person interviews with 812 women with ovarian cancer diagnosed in western Washington State from 2002 to 2005 and 1,313 population-based controls. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The risk of a borderline mucinous ovarian tumor associated with a history of an ovarian cyst was increased (OR=1.7, 95% CI: 1.0-2.8), but did not vary notably according to receipt of subsequent ovarian surgery. While risk of invasive epithelial ovarian cancer was slightly increased among women with a cyst who had no subsequent ovarian surgery, it was reduced when a cyst diagnosis was followed by surgery (OR = 0.6, 95% CI: 0.4-0.9). This reduction in risk was most evident for serous invasive tumors. Women with a history of endometriosis had a threefold increased risk of endometrioid and clear cell invasive tumors, with a lesser risk increase among women who underwent subsequent ovarian surgery. CONCLUSIONS: Our results suggest differences in the relation of ovarian cysts and endometriosis with risk of specific subtypes of ovarian cancer as well as the possibility that ovarian surgery in women with these conditions may lower the risk of invasive disease.

Acta Cytol. 2008 Jul-Aug;52(4):475-80.

Clear cell carcinoma in a background of endometriosis. Case report of a finding in a midline abdominal scar 5 years after a total abdominal hysterectomy.

Rust MM, Susa J, Naylor R, Cavuoti D.

Division of Cytopathology, Departments of Pathology and Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.

BACKGROUND: Endometriosis is considered a premalignant process whose association with carcinoma is well documented. We discuss a case of clear cell carcinoma with an unusual presentation in that it was located outside the abdominal cavity and was the only lesion noted clinically and radiologically. The histopathologic diagnostic criteria will be reviewed, as will the association of carcinomas with endometriosis. Furthermore, we will review the current literature of extraovarian clear cell carcinoma associated with endometriosis with regard to clinical outcome. CASE: A 42-year-old Hispanic woman presented to the Fine Needle Aspiration (FNA) Clinic at Parkland Hospital, Dallas, Texas, in August 2005 secondary to a growing area of firmness associated with her midline abdominal hysterectomy scar. A single mass anterior to the abdominal wall was identified radiologically. The FNA sample was reported as highly atypical cells suspicious for adenocarcinoma. Excision of this mass revealed a clear cell carcinoma in a background of endometriosis. CONCLUSION: Clear cell carcinoma is one of the most prevalent carcinomas associated with endometriosis, whether identified in the ovary or extraovarian site. This case is perplexing because the mass was a solitary lesion and the patient never had documented endometriosis. The unusual presentation may make survival difficult to predict.

J Med Assoc Thai. 2008 Jun;91(6):805-12.

Study of the causes and the results of treatment in infertile couples at Thammasat Hospital between 1999-2004.

Chiamchanya C, Su-angkawatin W.

Department of Obstetric and Gynecology, Medical Faculty, Thammasat University, Pathumthani, Thailand.

OBJECTIVE: To study the type, cause, pregnancy rate, and pregnancy outcome of infertile couple in Fertility Clinic of Thammasat Hospital, Thammasat University. MATERIAL AND METHOD: The retrospective study was performed by reviewing the data of infertile couples attending the Fertility Clinic of Thammasat Hospital from 1999 until 2004. The data included age, type of infertility, duration, causes, treatments, and results of treatment of the infertile couples and excluded the data from the cancellation treatment cycles. RESULTS: One thousand seventy two infertile couples revealed 61.8% of primary infertility, 35.6% ofsecondary infertility, and 2.5% of incomplete data record. The overall duration of infertility was mostly between 1-4 years in 58.3%. The age of 65.9% of female partners and 61.2% of male partners were between 30-39 years. The causes of infertility were found in both partners (55.6%), only in male partners (19.4%), only in female partners (17.5%), in unexplained cause (4.7%), and in incomplete data group (2.8%). The causes of female infertility were endometriosis, tubal, ovulatory, uterine, endocrinnological, pelvic factors, and unexplained causes were found in 25.6%, 12.4%, 11.8%, 9.1%, 9.0%, 1.7%, and 25.7% of cases respectively. The causes of male infertility were terato, oligoasthenoterato, asthenoterato, astheno, oligoterato, oligo, asthenooligo, azoospermia, and unexplained causes found in 25.4%, 14.4%, 12%, 2.0%, 1.0%, 0.4%, 0.3%, 4.5%, and 24.2%, respectively. The pregnancy rate of IUI was 14.8% of which 95.5% succeeded in three attempts, where those of IVF, ICSI and ICSI- PESA were 32.3%, 28.0%, and 35.3%, respectively. The outcomes of pregnancy from IUI were 71.6% singleton, 1.5% twins, 1.5% triplets, 19.4% abortion, and 6.0% ectopic pregnancy. The outcomes of pregnancy from IVF were 30% singleton, 20% twins, 40% abortion, and 10% ectopic pregnancy. The outcomes of pregnancy from ICSI were 56.5% singleton, 17.4% twins, 13% triplets, and 13% abortion. Finally, the outcomes of pregnancy from ICSI-PESA were 66.7% singleton, 16.7% twins, and 16.7% abortion. CONCLUSION: Primary infertility cases were more common than secondary infertility cases. More than half of the infertile couples causes were from both male and female partners. The causes of male and female factors were similar to other reports, such as abnormal semen analysis, endometriosis, tubal factor and ovulatory factor The pregnancy rate and pregnancy outcome of IUI, IVF and ICSI were comparable with the other reports.

Fertil Steril. 2008 Nov;90(5):2018.e13-5. Epub 2008 Aug 9.

Successful use of magnetic resonance-guided focused ultrasound surgery to relieve symptoms in a patient with symptomatic focal adenomyosis.

Yoon SW, Kim KA, Cha SH, Kim YM, Lee C, Na YJ, Kim SJ.

Department of Diagnostic Radiology, College of Medicine, Pochon CHA University Bundang CHA General Hospital, Sungnam, South Korea.

OBJECTIVE: To report a successful treatment of symptomatic adenomyosis using magnetic resonance-guided focused ultrasound surgery (MRgFUS). DESIGN: Case study. SETTING: General hospital. PATIENT(S): A 47-year-old premenopausal woman with focal symptomatic adenomyosis. INTERVENTION(S): MRgFUS. MAIN OUTCOME MEASURE(S): Score on the Uterine Fibroids Symptoms Quality of Life (UFS-QOL) questionnaire and the degree of menstrual pain. RESULT(S): Uterine Fibroids Symptoms reduced from 53 to 28 and the degree of menstrual pain reduced from 10 to 5. CONCLUSION(S): For adenomyosis patients who wish to preserve their uterus, MRgFUS may be a promising alternative to hysterectomy. Additional studies of the safety and efficacy of MRgFUS in this indication should be conducted.

Contraception. 2008 Sep;78(3):257-65. Epub 2008 Jul 9.

Oral contraceptives prevent the development of endometriosis in the chicken chorioallantoic membrane model.

Nap AW, Groothuis PG, Punyadeera C, Klein-Hitpass L, Kamps R, Delvoux B, Dunselman GA.

Department of Gynecology and Obstetrics, Maaslandziekenhuis, P.O. Box 5500, 6130 MB Sittard, The Netherlands.

BACKGROUND: Fundamental and genetic differences between women in the endometrium may cause some to develop endometriosis, whereas others do not. Oral contraceptives (OC) may have an effect on the endometrium, rendering the development of endometriosis less likely. STUDY DESIGN: Endometrium from women using OC (OCE) and menstrual endometrium (ME) from normal cycling women were transplanted onto the chicken chorioallantoic membrane (CAM), and endometriosis-like lesion formation was evaluated. Microarray gene expression profiling was performed to identify differentially expressed genes in the endometrium from these groups. Microarray data were validated by real-time PCR. RESULTS: Less endometriosis-like lesions were formed after transplantation of OCE than after transplantation of ME (p<.05). Most of the differentially expressed genes belong to the TGFbeta superfamily. Real-time PCR validation revealed that inhibin betaA (INHBA) expression was significantly decreased in OCE as compared to ME. CONCLUSION: OC use affects the characteristics of endometrium, rendering it less potent to develop into endometriosis.

Clin Ther. 2008 Jul;30(7):1330-5.

Rhabdomyolysis and pancreatitis associated with coadministration of danazol 600 mg/d and lovastatin 40 mg/d.

Hsieh CY, Chen CH.

Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

BACKGROUND: Danazol is a steroid analogue with anabolic and androgenic effects and is indicated for the treatment of endometriosis, fibrocystic diseases of the breast, and hereditary angioedema. Lovastatin has been prescribed to lower total cholesterol and low-density lipoprotein cholesterol, reducing cardiovascular-related morbidity and mortality in patients with hypercholesterolemia. As monotherapies, both danazol and lovastatin have been reported to induce myopathy and pancreatitis. CASE SUMMARY: A 59-year-old Asian woman (height, 155 cm; weight, 54 kg; and body mass index, 22.5 kg/m2) presented to the outpatient neurology clinic with acute progressive quadriparesis and generalized myalgia (without focal sensory loss, numbness, dizziness, diplopia, dysarthria, dysphagia, or sphincter incontinence), lasting for 5 days. She was admitted to the National Cheng Kung University Hospital, Tainan, Taiwan. The patient’s medical history revealed multiple comorbidities (eg, end-stage renal disease, hypertension, diabetes mellitus) for which she was receiving concomitant medication. Her medication history revealed that at the time the patient presented, she was also receiving calcium bicarbonate 1500 mg/d, labetalol 100 mg/d, and glipizide 10 mg/d in the treatment of her other comorbid illnesses. The patient was also receiving alprazolam 0.5 mg/d for insomnia. Her medical records also revealed that lovastatin 40 mg/d (a particularly high dose and not recommended) had been administered for 7 weeks, and danazol 600 mg/d was added ( approximately 15 days later) to treat thrombocytopenia due to hypoplastic bone marrow. Laboratory findings revealed elevated creatine kinase (68,193 U/L), elevated pancreatic enzymes (amylase/lipase, 361/2788 U/L), and elevated liver enzymes (aspartate/alanine aminotransferase, 1496/1493 U/L), consistent with rhabdomyolysis and pancreatitis. After discontinuation of both drugs, the symptoms improved 5 days after admission and completely disappeared 1 month after admission. In addition, laboratory abnormalities completely normalized approximately 2 months after admission.Danazol was resumed to treat persistent thrombocytopenia, while lovastatin was replaced with ezetimibe 10 mg QD to treat high cholesterol (dyslipidemia). CONCLUSION: The coadministration of high-dose lovastatin and danazol was probably associated with rhabdomyolysis and pancreatitis in this patient with multiple underlying comorbidities for which concomitant medications were being administered.

Am J Obstet Gynecol. 2008 Dec;199(6):648.e1-9. Epub 2008 Aug 8.

Single nucleotide polymorphisms in the progesterone receptor gene and association with uterine leiomyoma tumor characteristics and disease risk.

Renner SP, Strick R, Fasching PA, Oeser S, Oppelt P, Mueller A, Beckmann MW, Strissel PL.

Department of Gynaecology and Obstetrics, University-Clinic Erlangen, Laboratory for Molecular Medicine, Erlangen, Germany.

OBJECTIVE: Uterine benign leiomyomas result from proliferation of a single smooth-muscle cell and their growth is affected by steroid hormones via steroid hormone receptors. This investigation analyzed the +331G/A and the V600L single nucleotide polymorphisms in the progesterone receptor, and correlated their incidence with clinical and tumor parameters as well as disease risk. STUDY DESIGN: Peripheral blood DNA was analyzed for the frequency of both progesterone receptor single nucleotide polymorphisms in 270 women with uterine leiomyomas compared with 163 control women without uterine leiomyomas. RESULTS: No correlation was found for both single nucleotide polymorphisms or the risk for developing myoma; however, statistical significant associations were found for single nucleotide polymorphism genotypes with specific clinical and tumor characteristics, eg, endometriosis, number of live births, menstrual cycle disorder, and leiomyoma focality. CONCLUSION: Our findings support that specific genotypes in the progesterone receptor may be involved in tumor growth and metastasis but not in tumor initiation.

Hum Reprod. 2008 Oct;23(10):2386; author repoly 2386-7. Epub 2008 Aug 9.

Comment on:

Hum Reprod. 2007 Dec;22(12):3092-7.

Diagnosis of rectovaginal endometriosis.

Abrao MS, Podgaec S, Dias JA Jr, Gonçalves MO.


Am J Pathol. 2008 Sep;173(3):700-15. Epub 2008 Aug 7.

Endometrial-peritoneal interactions during endometriotic lesion establishment.

Hull ML, Escareno CR, Godsland JM, Doig JR, Johnson CM, Phillips SC, Smith SK, Tavaré S, Print CG, Charnock-Jones DS.

Department of Pathology,, University of Cambridge, Cambridge, United Kingdom. louise.hull@adelaide.edu.au

The pathophysiology of endometriosis remains unclear but involves a complex interaction between ectopic endometrium and host peritoneal tissues. We hypothesized that disruption of this interaction would suppress endometriotic lesion formation. We hoped to delineate the molecular and cellular dialogue between ectopic human endometrium and peritoneal tissues in nude mice as a first step toward testing this hypothesis. Human endometrium was xenografted into nude mice, and the resulting lesions were analyzed using microarrays. A novel technique was developed that unambiguously determined whether RNA transcripts identified via microarray analyses originated from human cells (endometrium) or mouse cells (mesothelium). Four key pathways (ubiquitin/proteasome, inflammation, tissue remodeling/repair, and ras-mediated oncogenesis) were revealed, demonstrating communication between host mesothelial cells and ectopic endometrium. Morphometric analysis of nude mouse lesions confirmed that necrosis, inflammation, healing and repair, and cell proliferation occurred during xenograft development. These processes were entirely consistent with the molecular networks revealed by the microarray data. The transcripts detected in the xenografts overlapped with differentially expressed transcripts in a comparison between paired eutopic and ectopic endometria from human endometriotic patients. For the first time, components of the interaction between ectopic endometrium and peritoneal stromal tissues are revealed. Targeted disruption of this dialogue is likely to inhibit endometriotic tissue formation and may prove to be an effective therapeutic strategy for endometriosis.


J Obstet Gynaecol Res. 2008 Jun;34(3):307-13.

Evaluation of the effect of pentoxifylline on white blood cell count in serum and peritoneal fluid in female rats with endometriosis.

Mohammadzadeh A, Heidari M, Soltanghoraee H, Jeddi-Tehrani M, Ghaffari Novin M, Akhondi MM, Zeraati H, Mohammadzadeh F.

Department of Reproductive Endocrinology and Embryology, Reproductive Biotechnology Research Center, Avesina Research Institute ACERCR, Tehran, Iran. af23mohammadzadeh@yahoo.com

AIM: Endometriosis is defined as the growth of endometrium outside of the uterus in ectopic places. Immune system disturbances have an important role in endometriosis which may lead to infertility. It seems that inflammatory cytokines, specially tumor necrosis factor-alpha (TNF-alpha), which are produced by activated macrophages, play an important role in the pathology of endometriosis. Based on this theory, anti-TNF-alpha drugs are suggested as new drugs for endometriosis. This experimental study has been performed on female rats to determine the effect of pentoxifylline on the white blood cell count in serum and peritoneal fluid. METHODS: During the proestrous phase, one horn of the bicorn uterus of rats was removed surgically, and the endometrium implanted to different places as follows: subcutaneous, peritoneum and near the ovaries. After 2 months’ observation, female rats were divided randomly into two groups. The treated group (n = 10) were given pentoxifylline (5 mg/kg twice a day), and the control group (n = 10) were given normal saline (the same dose), which was injected subcutaneously. Then via second laparotomy and in the same phase of the cycles, the size of implants and the white blood cell levels in the serum and peritoneum were measured. RESULTS: In the treated group, the total implant mass (mm2) decreased significantly in the right subcutaneous (8.05 mm2 vs 13.5 mm2; P = 0.01), left subcutaneous (7.64 mm2 vs 14.00 mm2; P = 0.01), right ovary (6.64 mm2 vs 15.22 mm2; P = 0.001) and left ovary (7.18 mm2 vs 14.56 mm2; P = 0.005). The total white blood cell count (5254.5455 +/- 178.73 vs 15,833.33 +/- 259.27; P = 0.02) and neutrophils (297.34 +/- 57.34 vs 2736.00 +/- 346.75; P = < 0.001) in the serum were decreased and the total count of lymphocytes (4967.92 +/- 696.194 vs 13,048.33 +/- 178.73; P = 0.003) in serum was increased. There were not any significant changes in the total white blood cell count in the peritoneum in both groups. The number of estrous cycles in both groups was similar. CONCLUSION: Based on our study, pentoxifylline could decrease the size of endometrial implants, especially in the ovaries and subcutaneous areas, and total white blood cell count in serum. Pentoxifylline could increase the lymphocyte count and decrease the neutrophil count in serum, and because these changes it might alter the immune system. Pentoxifylline did not have any adverse effect on rats’ cycles and a good aspect of treatment with pentoxifylline was achieved.

Reprod Biomed Online. 2008 Aug;17(2):281-91.

Adenomyosis and ‘endometrial-subendometrial myometrium unit disruption disease’ are two different entities.

Tocci A, Greco E, Ubaldi FM.

Reproductive Medicine Unit, European Hospital, Rome, Italy. angelotocci@hotmail.com

The diagnosis of adenomyosis is feasible on pathological specimen examination, while it is unreliable on clinical findings, biopsy, hysteroscopy, sonohysterography, and routine ultrasound or magnetic resonance imaging. Several patterns of ‘abnormality’ described on imaging have been linked to adenomyosis, but the correlation is weak and the diagnostic accuracy is low outside of a research context. Nevertheless, thickening or abnormality of the subendometrial myometrium, the outer part of the ‘endometrial-subendometrial myometrium unit’ (thought to be important in human fertility) has been repeatedly documented on imaging, called ‘adenomyosis’ and linked to infertility. This paper discusses the value of the physiological endometrial-subendometrial myometrium unit in human fertility, reviews the current criteria for its imaging, and reports on its relationship to fertility. It is proposed that endometrial-subendometrial myometrium unit disruption disease is considered as a new entity (distinguished from adenomyosis), the diagnosis of which is feasible and straightforward on imaging and expressed mainly by pathological thickening or abnormality of the subendometrial myometrium (myometrial halo or junctional zone). The study also reports on the influence of abnormal thickening or disruption on human fertility and outcome of assisted reproduction techniques, and demonstrates that this new entity is epidemiologically different from adenomyosis.


Reprod Biomed Online. 2008 Aug;17(2):259-64.

Caesarean section and tubal infertility: is there an association?

Saraswat L, Porter M, Bhattacharya S, Bhattacharya S.

Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen AB25 2ZL, UK. luckysaraswat@doctors.org.uk

Rising Caesarean section (CS) rates have fuelled concerns about the effect of abdominal delivery on female fertility due to post-surgical complications affecting the Fallopian tubes. The association between exposure to CS and subsequent tubal infertility was explored by means of a case-control study. This study compared 220 women with secondary infertility due to tubal factor with 1244 women with secondary infertility due to non-tubal causes and 18,376 fertile women (women with a previous live birth followed by another live birth during the time period when the infertile cases were trying to conceive) in terms of exposure to CS. Exposure to CS in women with secondary tubal infertility was similar to other infertile women (21.4% versus 21.6%) but lower in fertile controls (14.5%). After adjusting for confounding factors, CS does not appear to be significantly associated with tubal infertility [adjusted odds ratio (95% confidence interval) for previous CS for infertile and fertile controls were 1.06 (0.73-1.52) and 1.2 (0.9-1.7), respectively]. However, other factors that were found to be predictive of secondary tubal infertility include history of intrauterine device use, pelvic inflammatory disease, ectopic pregnancy, endometriosis and previous pelvic surgery.


Reprod Biomed Online. 2008 Aug;17(2):244-8.

Uterine adenomyosis: a need for uniform terminology and consensus classification.

Gordts S, Brosens JJ, Fusi L, Benagiano G, Brosens I.

Leuven Institute for Fertility and Embryology, Leuven, Belgium.

Modern imaging techniques allow non-invasive diagnosis of adenomyosis, a relatively common disorder characterized by the presence of heterotopic endometrial glands and stroma in the myometrium with hyperplasia of the adjacent smooth muscle. The study of adenomyosis is greatly hampered by a lack of clear terminology and the absence of a consensus classification of the lesions. Any classification of adenomyosis must begin with an evaluation of the myometrium underlying the endometrium, the so-called junctional zone, since homogeneous thickening of this zone has become the standard criterion for non-invasive diagnosis. Although transvaginal sonography is useful for the detection of adenomyosis, the technique is highly operator dependent. Magnetic resonance imaging provides superior soft tissue resolution and currently represents the most accurate technique for non-invasive diagnosis. Adenomyosis represents a spectrum of lesions, ranging from increased thickness of the junctional zone to overt adenomyosis and adenomyomas, which in turn can be subclassified. It is increasingly recognized that adenomyosis is often associated with pelvic endometriosis yet the contribution of myometrial lesions to clinical symptoms, such as infertility and pain, remains poorly understood. Moreover, recent studies indicate that adenomyosis is a progressive disease that changes in appearance during the reproductive years. A consensus classification of uterine adenomyosis is urgently required.

Am J Reprod Immunol. 2008 Oct;60(4):283-9.

Three-dimensional culture of endometrial cells: an in vitro model of endometriosis.

Esfandiari N, Nazemian Z, Casper RF.

Toronto Centre for Advanced Reproductive Technology (TCART) and Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada. nesfand@excite.com

Endometriosis is the presence of endometrial tissue outside of the uterine cavity and is the most common gynecologic disorder in women of reproductive age. Although the quality of life for women with endometriosis is severely compromised, very little is known about the pathophysiology of endometriosis and current therapeutic strategies provide temporary symptomatic relief but not a cure. Endometriosis remains poorly understood primarily because of an inability to identify patients with early stage disease. Animal models have been developed to study early endometriosis but all have some problems that limit their usefulness in determination of the pathophysiology of endometriosis as it occurs in the human. We have preliminary evidence that in the presence of a three-dimensional fibrin matrix, human endometrial glands, stroma, and neovascularization can develop in vitro, mimicking the earliest stages of endometriosis. We believe this model system reflects the situation in the peritoneal cavity of women following retrograde menstruation when endometrial fragments, fibrin, leucocytes and cytokines are trapped in pockets in the dependent parts of the pelvis, allowing endometrial cell proliferation, invasion and angiogenesis to occur. In the present review article, we will further discuss this in vitro model of early endometriosis and discuss possible anti-angiogenic drugs that are already commercially available in an attempt to find an effective and specific treatment for endometriosis.

Curr Drug Metab. 2008 Jul;9(6):532-7.

Influence of polymorphic N-acetyltransferases on non-malignant spontaneous disorders and on response to drugs.

Ladero JM.

Gastroenterology Service (Liver Unit), Hospital Clínico San Carlos. Complutense University, Madrid. Spain. jladero.hcsc@salud.madrid.org

Polymorphic N-acetyl transferases (NAT) 1 and 2 are involved in detoxification of xenobiotic arylamines and hydralazines. These common environmental chemicals may be related to the pathogenesis of many spontaneous disorders, mainly malignancies, but also disimmune or degenerative diseases, for which a polygenic predisposition has been suggested. Hence, polymorphic NAT genes (NAT2 has been the most studied one) may be low-penetrance risk genes for some of these disorders. Although a relation of risk may be definitely discarded for systemic lupus erythematosus (SLE), inflammatory bowel disease and endometriosis, more research is needed for rheumatoid arthritis, Parkinson’s, Alzheimer’s, Behçet’s and periodontal diseases , as current results are inconclusive but suggest a possible relation with NAT2 polymorphism. In diabetes mellitus the possible relation with the rapid phenotype may be due to acquired metabolic changes and more genotyping studies are needed. NAT2 slow metabolizers are more prone to the side effects of polymorphically acetylated drugs, as is the SLE-like syndrome induced by hydralazine and procainamide, the side effects due to sulphasalazine and the skin rash secondary to many sulphonamides. Future research should be based on well-designed studies, with adequate sample sizes and homogeneous recruitment criteria, to obviate the proliferation of small studies that are time- and resource-consuming without offering definite answers.

Hum Reprod. 2008 Nov;23(11):2458-65. Epub 2008 Aug 2.

Combating endometriosis by blocking proteasome and nuclear factor-kappaB pathways.

Celik O, Hascalik S, Elter K, Tagluk ME, Gurates B, Aydin NE.

Department of Obstetrics and Gynecology, Inonu University School of Medicine, 44069, Malatya, Turkey. oncelik@inonu.edu.tr

BACKGROUND: The objective of this study is to investigate the effect of pyrrolidine dithiocarbamate [PDTC; a nuclear factor-kappaB (NF-kappaB) inhibitor] and bortezomib (Velcade; a proteasome inhibitor) on the development of experimental endometriotic implants in rats. METHODS: Endometriosis was surgically induced in 30 rats using the method of Vernon and Wilson. Three weeks later the viability and volume of the implants were recorded and classified. Afterwards, rats were put into three groups with equal numbers. The groups were labelled as the control, the PDTC and the bortezomib groups. Seven days after treatment, a third laparotomy was done and the volume of implants was measured again. The animals were then sacrificed, and the implants were stained with Ki67, proliferating cell nuclear antigen (PCNA), CD34, CD31 and Masson’s trichrome histochemical staining. RESULTS: In 80% of the implanted rats, vesicles at the suture region were observed, and the rats graded according to average vesicle diameter (D) as: Grade 1 (no vesicle, 20% of rats), Grade 2 (D < 2 mm, 33.3% of rats), Grade 3 (2 mm<D > 4.5 mm, 26.7% of rats) and Grade 4 (D > 4.5 mm, 20% of rats). After treatment with PDTC or bortezomib, these percentages were decreased for Grades 3 and 4, and increased in Grade 1. The post-treatment implant volumes were decreased in the PDTC and bortezomib groups (P < 0.002 and P < 0.001), and slightly increased in the control group (P = 0.279). In the PDTC and bortezomib groups, CD34, CD31, PCNA and Ki67 expression levels were similar but were significantly reduced compared with the control group. CONCLUSIONS: PDTC and bortezomib may represent a novel therapeutic strategy for treatment of endometriosis.

Fertil Steril. 2008 Nov;90(5):2014.e1-3. Epub 2008 Aug 3.

Transurethral partial cystectomy and laparoscopic reconstruction for the management of bladder endometriosis.

Pang ST, Chao A, Wang CJ, Lin G, Lee CL.

Department of Surgery, Division of Urology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Tao-Yuan, Taiwan.

OBJECTIVE: To report the successful management of bladder endometriosis with laparoscopic and transurethral partial cystectomy. DESIGN: Case report. SETTING: Tertiary-care university hospital. PATIENT(S): A 36-year-old woman with bladder endometriosis. INTERVENTION(S): Combined laparoscopic and transurethral excision of endometriotic lesions and bladder repair. MAIN OUTCOME MEASURE(S): Symptoms remission. RESULT(S): A hypoestrogenic agent with gonadotropin-releasing hormone (GnRH) agonist was administered for 6 months after the surgery. The patient found to be in good health with normal voiding and full continence during 14 months of regular follow-up evaluations. CONCLUSION(S): Combined laparoscopy and transurethral resectoscopy can be an alternative treatment to traditional laparotomy in women with bladder endometriosis, especially in those who have simultaneous pelvic endometriosis.

Fertil Steril. 2008 Nov;90(5):2014.e1-3. Epub 2008 Aug 3.

Transurethral partial cystectomy and laparoscopic reconstruction for the management of bladder endometriosis.

Pang ST, Chao A, Wang CJ, Lin G, Lee CL.

Department of Surgery, Division of Urology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Tao-Yuan, Taiwan.

OBJECTIVE: To report the successful management of bladder endometriosis with laparoscopic and transurethral partial cystectomy. DESIGN: Case report. SETTING: Tertiary-care university hospital. PATIENT(S): A 36-year-old woman with bladder endometriosis. INTERVENTION(S): Combined laparoscopic and transurethral excision of endometriotic lesions and bladder repair. MAIN OUTCOME MEASURE(S): Symptoms remission. RESULT(S): A hypoestrogenic agent with gonadotropin-releasing hormone (GnRH) agonist was administered for 6 months after the surgery. The patient found to be in good health with normal voiding and full continence during 14 months of regular follow-up evaluations. CONCLUSION(S): Combined laparoscopy and transurethral resectoscopy can be an alternative treatment to traditional laparotomy in women with bladder endometriosis, especially in those who have simultaneous pelvic endometriosis.

Med J Aust. 2008 Aug 4;189(3):131-2.

Comment on:

Med J Aust. 2008 Aug 4;189(3):138-43.

Pelvic pain in women: common and challenging.

Farquhar CM.


Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 May;28(5):473-5.

[Clinical application of tripterygium wilfordi for treatment of gynecologic diseases]

[Article in Chinese]

Luo LP, Tan BZ.

Gynecologic Department, The Second Affiliated Hospital of Nanchang University, Nanchang.

Extract of Tripterygium wilfordi (TW) has obvious effects on anti-inflammation, anti-tumor, anti-fertility and immuno-regulation, and it is broadly applied in various clinical departments. Referred to the gynecologic diseases, clinical therapeutic trials of TW on endometriosis, leiomyoma uteri, dysfunctional uterine bleeding and some tumors of women have been carried out, and it can be proved an effective new drug for the treatment of gynecologic diseases.

Fertil Steril. 2008 Aug;90(2):247-57.

Pathogenic mechanisms in endometriosis-associated infertility.

Gupta S, Goldberg JM, Aziz N, Goldberg E, Krajcir N, Agarwal A.

Reproductive Research Center, Department of Obstetrics and Gynecology and Glickman Urological Institute, The Cleveland Clinic, Cleveland, Ohio 44195, USA.

OBJECTIVE: To review the mechanisms by which endometriosis may affect reproductive function. DESIGN: Review of the English literature from 1986 to 2007 after searching Medline, EMBASE, Cochrane, and BIOSIS, as well as relevant meeting abstracts. SETTING: Fertility research center and obstetrics and gynecology department in a tertiary care hospital. RESULT(S): There is compelling evidence in the literature that endometriosis has detrimental effects on ovarian and tubal function and uterine receptivity, resulting in female infertility. The mechanisms of infertility associated with endometriosis remain controversial and include abnormal folliculogenesis, elevated oxidative stress, altered immune function, and hormonal milieu in the follicular and peritoneal environments, and reduced endometrial receptivity. These factors lead to poor oocyte quality, impaired fertilization, and implantation. CONCLUSION(S): Through unraveling the mechanisms by which endometriosis leads to infertility, researchers are sure to find a nonsurgical means to diagnose endometriosis, most likely through serum and peritoneal markers. Cytokines, interleukins, oxidative stress markers, and soluble cellular adhesion molecules all show potential to be used as a reliable marker for diagnosing endometriosis. After analyzing the pathogenic mechanisms of endometriosis, it seems that the future treatment of this entity may include cyclo-oxygenase-2 inhibitors, immunomodulators, or hormonal suppressive therapy to eliminate the need for surgical treatment of endometriosis.

Am J Surg Pathol. 2008 Sep;32(9):1373-9.

Primary ovarian mucinous tumors with signet ring cells: report of 3 cases with discussion of so-called primary Krukenberg tumor.

McCluggage WG, Young RH.

Department of Pathology, Royal Group of Hospitals Trust, Belfast, Northern Ireland. glenn.mccluggage@belfasttrust.hscni.net

The distinction between a primary ovarian mucinous carcinoma or even a borderline mucinous tumor and a metastatic mucinous carcinoma may be difficult. A constellation of clinical, gross pathologic and morphologic features is used in this distinction. One of the most important morphologic features suggesting a metastatic mucinous carcinoma in the ovary is the presence of signet ring cells; these are considered rare in primary ovarian mucinous tumors. In this study, we report 3 primary ovarian mucinous tumors with a component of signet ring cells. The tumors arose in patients aged 27, 55, and 60, were unilateral, confined to the ovary and stage IA. They ranged from 9 to 27 cm; 1 was grossly a multiloculated cystic lesion and 2 were cystic and solid. In one case, the neoplasm had the architecture of a mucinous adenofibroma but had frankly malignant cells lining glands and forming solid aggregates of cells. A second tumor also had the background of an adenofibroma. The third was mostly a mucinous cystadenoma. In one case, endometriosis was present in the same ovary; teratomatous elements were not identified in any case. Immunohistochemistry, performed in 2 cases, showed both to be diffusely positive with CK7 and CA19.9, including the signet ring cells. CK20 was positive in both cases (1 focal; 1 diffuse). Estrogen receptor and CA125 were diffusely positive and carcinoembryonic antigen and CDX2 focally positive in 1 case. Chromogranin and synaptophysin were negative. Investigations to exclude a gastrointestinal neoplasm in 2 cases were negative. Features favoring a primary rather than a metastatic neoplasm are unilateral tumor, low stage, background of adenofibroma or cystadenoma, associated endometriosis in 1 case and an absence of features which are characteristic of secondary mucinous carcinomas in the ovary, such as surface tumor deposits, a nodular growth pattern, and lymphovascular permeation. Immunohistochemistry is of limited value because of overlapping immunophenotype between a primary ovarian mucinous tumor and a metastasis from the stomach, pancreas, biliary tree, appendix, or colorectum, the most likely primary sites for a secondary exhibiting similar features. Our study illustrates that signet ring cells occur rarely in a primary ovarian mucinous tumor; even when conspicuous the features differ from those of the usual Krukenberg tumor. At least some cases of so-called primary Krukenberg tumor may be similar to our cases. However, the designation primary Krukenberg tumor should not be used as, apart from the signet ring cells, a resemblance to a “true” Krukenberg tumor of the secondary type is limited. The tumors should be classified according to the underlying background neoplasm with a notation concerning the signet ring cell component.

Am J Surg Pathol. 2008 Sep;32(9):1380-7.

Expression of PAX8 in nephrogenic adenoma and clear cell adenocarcinoma of the lower urinary tract: evidence of related histogenesis?

Tong GX, Weeden EM, Hamele-Bena D, Huan Y, Unger P, Memeo L, O’Toole K.

Department of Pathology, Columbia University Medical Center, New York, NY 10032, USA. gt2125@columbia.edu

Recent evidence has showed that nephrogenic adenoma is a true “nephrogenic” lesion derived from the proliferation of exfoliated and implanted renal tubular cells in the urinary tract, a process that closely resembles the formation of endometriosis. This new concept has led to the identification of renal transcription factor PAX2 as a diagnostic marker for nephrogenic adenoma. PAX8 is another transcription factor structurally and functionally related to PAX2. Both are cell lineage restricted transcription factors expressed in normal and neoplastic tissues of related origin, including renal tubular cells in both fetal and adult kidneys. In this study, we investigated the expression of PAX8 in nephrogenic adenoma and its mimics. We report here that PAX8 was detected in all nephrogenic adenomas (N=35) and clear cell adenocarcinoma of the lower urinary tract (N=7), but not in prostate adenocarcinoma (N=100), adenocarcinoma (N=9), squamous cell carcinoma (N=5), or urothelial carcinoma (N=48) of the urinary bladder and its variants. PAX8 was neither detected in normal urothelium of the urinary bladder nor in prostate glands and stroma. PAX2 was also detected in 2 of the 7 clear cell adenocarcinomas of the lower urinary tract. We suggest that PAX8 is an additional marker for identifying nephrogenic adenoma. Expression of PAX8 or PAX2 in both nephrogenic adenoma and clear cell adenocarcinoma of the lower urinary tract may indicate a possible related tissue origin for these 2 lesions; both may be derived from proliferating renal tubular cells in the urinary tract. In addition, detection of PAX8 or PAX2 in clear cell adenocarcinoma of the lower urinary tract is helpful in differentiating it from urothelial carcinoma and its variants and adenocarcinomas of the urinary bladder or of the prostate.

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