J Toxicol Environ Health B Crit Rev. 2008 Mar;11(3-4):152-61.

Toward less confusing terminology in endocrine disruptor research.

Foster WG, Agzarian J.

Centre for Reproductive Care and Reproductive Biology Division, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada, L8N 3Z5. fosterw@mcmaster.ca

The realization that environmental contaminants interact with hormone receptors and mimic or antagonize the actions of endogenous hormones led to introduction of terms such as endocrine disruptor, endocrine disrupter, hormonally active chemicals, and hormone mimics into the scientific and lay press. Reports suggesting a link between exposure to chemicals adversely affecting the endocrine system and (1) increasing rates of hormone-dependent cancers (breast, prostate, and testicular), (2) developmental detrimental effects in the male reproductive tract, (3) falling sperm counts, and (4) endometriosis resulted in an explosion of research, regulatory actions, and policy changes aimed at better understanding the hazards posed by these chemicals with subsequent restriction in their use. With increasing concern, there is worldwide action to develop testing strategies to allow for early identification of chemicals possessing endocrine disruptor activity. However, despite an expanding literature and numerous expert panel meetings, there continues to be controversy surrounding how to best define endocrine disruptors, resulting in (1) ambiguous use of the term, (2) confusion in the literature, and (3) publication of contentious lists of chemicals purported to be endocrine disruptors. Herein it is argued in favor of a more restrictive definition with adoption of a less ambiguous term, and in favor of development of a classification system to enhance more effective communication and facilitate appropriate allocation of limited resources in this highly charged area of toxicology.

Vojnosanit Pregl. 2008 Feb;65(2):147-52.

[Efficacy of guided ovarian hyperstimulation in patients with mild type endometriosis]

[Article in Serbian]

Jasović-Siveska E, Jasović V.

Univerzitet Sveti Kliment Ohridski, Visoka medicinska skola, Bitola, Makedonija. medihelp@mt.net.mk

BACKGROUND/AIM: Endometriosis befalls in one of the most frequent gynecologic diseases. It manifests itself by the presence and growth of focus of endometrium out of the uterus cavum that reacts to hormonal stimulations as the normal uterus endometrium does. Hyperstimulation and induction of ovulation together with intrauterine insemination (IUI) are the most frequently used treatments of unexplained infertility in patients with mild type endometriosis. The aim of this study was to compare the effects of stimulation using human meno pausal gonadotrophine (hMG) in the patients with mild type endometriosis to the patients with infertility of unknown ethiology. METHODS: The study included 50 patients with unexplained infertility (group N), as well as 50 patients with mild type endometriosis (group E) confirmed by laparoscopy. Within the same therapeutic protocole hIMG stimulation and horionic gonadotrophine induction (hCG) were used. RESULTS: In the group E ovulation occurred in 74% of the pa tients during the first stimulation, in 77.78% during the second cycle, and in 75% of the patients during the third one. Regarding the group N, ovulation appeared in 82% of the patients during the first stimulation. Stimulation was performed two times more in 38 patients with unknown couse of infertil ity, and ovulation appeared in 84.21 percent of them. In the group N stimulation was performed three times in 28 women resulting in ovulation in 85.71% of them. CONCLUSION: Con sidering the obtained results it can be concluded that hMG stimulation and hCG induction are efficient in the treatment of infertility, particularly in mild type endometriosis.

Expert Opin Investig Drugs. 2008 Apr;17(4):469-79.

Investigational developments for the treatment of progesterone-dependent diseases.

Möller C, Hoffmann J, Kirkland TA, Schwede W.

Bayer Schering Pharma, Global Drug Discovery, Women’s Healthcare, Müllerstrasse 178, 13353 Berlin, Germany.

BACKGROUND: Clinical evidence has shown that conditions such as uterine fibroids, endometriosis and breast cancer are progesterone-dependent diseases. Therefore, progesterone receptor (PR) antagonists and selective PR modulators (SPRMs) are under development for the treatment of these conditions. However, the first PR antagonists that became available exhibit insufficient selectivity or tolerability for the chronic administration required to treat these conditions. Despite initial setbacks, development of second-generation PR antagonists with better selectivity continues forward. OBJECTIVE: In this review we would like to summarise prospects for using PR antagonists for the treatment of uterine fibroids, endometriosis and breast cancer, and to give an overview of the development of new steroidal and non-steroidal PR antagonists. METHOD: Available preclinical and clinical data and publications have been reviewed with the focus on scientific background and use in the three mentioned indications. RESULTS/CONCLUSION: Preclinical and clinical evidence demonstrated that PR antagonists and SPRMs are effective for the treatment of progesterone-dependent diseases. Future development will demonstrate if they can become important drugs.

Urol Int. 2008;80(2):222-4. Epub 2006 Sep 26.

Intrinsic endometriosis of ureter and bladder in young women without gynecological symptoms.

Leonhartsberger N, Zelger B, Rehder P.

Department of Urology, Medical University Innsbruck, Innsbruck, Austria.

Urological endometriosis as the primary and sole form of presentation is rare. With ultrasound being available at routine examinations by the urologist and gynecologist, asymptomatic and incidental hydronephrosis is picked up far more than before. The behavior of endometriosis may be very aggressive in terms of ingrowth and fibrosis of the ureter, the periureteral structures and the bladder. It is important to get to an accurate and timely diagnosis to prevent loss of renal function. We report 2 cases who presented with asymptomatic hydronephrosis. Because of severe ureteric obstruction and infiltration of the ureters and/or bladder, surgery was selected as treatment option. Ureteric stenting was not possible because of severe fibrosis and stricture formation of the distal ureter. Primary surgery gave satisfactory results at more than 1 year of follow-up.

Oncol Rep. 2008 Apr;19(4):843-6.

Endometriosis: pathogenesis, diagnosis, therapy and association with cancer (review).

Baldi A, Campioni M, Signorile PG.

Fondazione Italiana Endometriosi, Rome, Italy. alfonsobaldi@tiscali.it

Endometriosis is a painful reproductive and immunological disease afflicting about 7-10% of women worldwide. It is one of the most frequent benign gynaecological diseases; however, little is known about the pathogenetic processes leading to the development and maintenance of this disease and the currently available therapeutic strategies are unsatisfactory. The goal of this article is to review the most recent advancements in the pathogenesis, diagnosis and therapy of this disease. The risk for cancer among women with endometriosis will be analyzed in light of the most recent epidemiological and functional studies focused on this disease.

AJR Am J Roentgenol. 2008 Apr;190(4):1050-4.

Barium enema evaluation of colonic involvement in endometriosis.

Faccioli N, Manfredi R, Mainardi P, Dalla Chiara E, Spoto E, Minelli L, Mucelli RP.

Department of Radiology, University of Verona, Policlinico G. B. Rossi, Piazzale Scuro 10, 37134 Verona, Italy. nfaccioli@sirm.org

OBJECTIVE: The purpose of our study was to define the role of double-contrast barium enema (DCBE) compared with laparoscopy in the diagnosis and local staging of intestinal endometriosis. MATERIALS AND METHODS: A search of our radiology database revealed the cases of 234 women who underwent surgical resection for pelvic endometriosis with associated intestinal surgery for intestinal endometriosis. We retrospectively evaluated all preoperative DCBE images for the presence of bowel endometriosis and the number, site (rectum, sigmoid, cecum), and size of the lesions. The radiographic findings at DCBE were retrospectively correlated with those at surgical pathologic examination. RESULTS: DCBE revealed 211 intestinal lesions of bowel endometriosis in 168 (71.8%) of 234 patients with pelvic endometriosis clinically enrolled. Forty (23.8%) of the 168 women had more than one endometriotic bowel nodule (two nodules in 37 cases, three in three cases). Laparoscopy revealed 233 intestinal lesions in 174 (74.3%) of the patients. Fifty-four (31.0%) of 174 women had more than one endometriotic bowel nodule (two nodules in 49 cases, three in five cases). There was 100% correlation between the DCBE and histologic findings as far as site and size of the lesions were concerned. DCBE had a sensitivity of 88.4%, specificity of 93.0%, positive predictive value of 97.5%, negative predictive of 71.0%, and accuracy of 89.5% in the identification of bowel endometriosis. CONCLUSION: DCBE is helpful in discerning bowel wall involvement in endometriosis, enabling proper surgical planning. DCBE also appears to have a role in the management of endometriosis.

Colorectal Dis. 2008 Jun;10(5):520-1. Epub 2008 Mar 18.

Large bowel obstruction and perforation secondary to endometriosis complicated by a ventriculoperitoneal shunt.

Shaw A, Lund JN, Semeraro D, Cartmill M, Reynolds JR, Tierney GM.

Department of Gastrointestinal Surgery, University of Nottingham, Derby, UK. drshaw@doctors.net.uk

A 36-year-old lady, with a past medical history of hydrocephalus requiring a ventriculoperitoneal (VP) shunt, was admitted with symptoms and signs of large bowel obstruction. Her condition worsened and she underwent laparotomy, where she had faecal peritonitis secondary to a perforated sigmoid colon. The shunt was contaminated with faeces leading to postoperative shunt infection and meningitis. Histology of the resected sigmoid colon revealed endometriosis at the site of perforation. Endometriosis is a rare cause of large bowel obstruction and literature review has found only two other cases of perforation because of endometriosis not associated with pregnancy. No case has been reported involving the concurrent surgical management of a contaminated VP shunt. We discuss the rarity of large bowel perforation and obstruction because of endometriosis, and the complications and management of VP shunts.

Qual Health Res. 2008 Apr;18(4):522-34.

Circuit breaking: pathways of treatment seeking for women with endometriosis in Australia.

Manderson L, Warren N, Markovic M.

School of Psychology, Psychiatry and Psychosocial Sciences, Monash University, Caufield East, Victoria, Australia.

Pain resulting from endometriosis is experienced as both a chronic, ongoing condition and an acute episode at time of menstruation, often occurring in association with diarrhea, vomiting, nausea, heavy bleeding, and other reactions. Women expect pain with menstruation, however, and even if they experience major disruptions as a result, they find it difficult to distinguish normal from pathological discomfort. Drawing on qualitative research conducted from 2004 to 2006, we describe the “circuit breakers” that lead Australian women to seek medical advice. These include outside intercession, major disruptions to everyday life, changes in embodied experience, and difficulties in conception and pregnancy. Women’s ideas of menstrual pain as “normal” are shared by doctors, resulting in further delays before a definitive diagnosis of endometriosis is made. During this time, women move between doctors and in and out of medical care, which they described through particular narrative styles to highlight the complexity of help seeking. We explore the ways in which ideas of gender, informed by women’s embodiment but also the quality of their reporting of symptoms, influence their interactions with health professionals.

Hum Reprod. 2008 May;23(5):1063-8. Epub 2008 Mar 19.

Global gene analysis of late secretory phase, eutopic endometrium does not provide the basis for a minimally invasive test of endometriosis.

Sherwin JR, Sharkey AM, Mihalyi A, Simsa P, Catalano RD, D’Hooghe TM.

Department of Obstetrics and Gynaecology, The Rosie Hospital, Robinson Way, Cambridge CB2 2SW, UK.

BACKGROUND: Endometriosis occurs in 10% of women and is currently diagnosed by invasive laparoscopic testing. We tested the hypothesis that endometrial gene expression in late secretory phase endometrium differs between patients with and without endometriosis. METHODS: Ten patients with laparoscopically proven endometriosis (minimal/mild n = 5 and moderate/severe n = 5) and six controls, underwent endometrial biopsy in the late secretory phase (Day 23 onwards). Microarray interrogation of eutopic endometrial gene expression was performed. RESULTS: Microarray data were obtained for all control samples and eight samples from the endometriosis patients (n = 4 minimal/mild, n = 4 moderate/severe disease). Eight genes were identified as up-regulated and one gene was down-regulated in all endometriotic samples (more than 1.75-fold, P < 0.01). Real-time PCR analysis of protocadherin-17 (PCDH17), protein tyrosine phosphatase, receptor type, R (PTPRR) and interleukin-6 signal transducer (IL6ST) expression validated the microarray findings. CONCLUSIONS: Expression of very few transcripts differs, in late secretory eutopic endometrium, between controls and patients with endometriosis. The median fold changes of these genes are small. No transcripts were identified that could discriminate between minimal/mild and moderate/severe endometriosis. Therefore, interrogation of the late secretory endometrial transcriptome is not likely to form the basis of a minimally invasive diagnostic test for endometriosis.

Fertil Steril. 2008 Feb;89(2 Suppl):e103-8.

Environmental immune disruption: a comorbidity factor for reproduction?

Rier SE.

Division of Environmental Sciences, University of Maine at Machias, Machias, Maine 04654, USA. srier@maine.edu

OBJECTIVE: To review the evidence on exposure to environmental contaminants and immune system disruption, and how this has been demonstrated or hypothesized to impact reproductive health and fertility. DESIGN: Review of literature. RESULT(S): Exposure to environmental contaminants including polyhalogenated aromatic hydrocarbons, heavy metals, and other hormone disrupting chemicals are associated with a wide spectrum of effects on the reproductive, immune, and endocrine systems. Of particular importance is the potential impact of environmental chemicals on the mucosal immune system of the human female reproductive tract. Immune cells within the reproductive tract produce cytokines and chemokines in response to estrogen and progesterone, thereby influencing various reproductive processes including ovulation, sperm migration, fertilization, implantation, endometrial remodeling, and immune response to infectious challenge. Recent research in animals and humans indicates a potential association between exposure to dioxins, endometriosis, and disruption of the immune system. Studies have shown that rhesus monkeys exposed to dioxins with elevated serum levels of certain toxic coplanar PCBs and an increased total serum toxic equivalency had a high prevalence of endometriosis, and the severity of disease correlated with serum concentrations of PCB77. Dioxin-exposed animals with endometriosis showed long-term alterations in immunity associated with elevated levels of dioxin and specific coplanar dioxin-like congeners. CONCLUSION(S): Perspectives on the potential mechanism(s) of toxicity induced by environmental chemicals in endometriosis and other reproductive diseases, important knowledge needs, potential animal models, and considerations integral to future studies are discussed.

Br J Radiol. 2008 Apr;81(964):e118-9.

Case report: A case of polypoid endometriosis: MR pathological correlation.

Takeuchi M, Matsuzaki K, Furumoto H, Nishitani H.

Department of Radiology, University of Tokushima, Tokushima, Japan. mayumi@clin.med.tokushima-u.ac.jp

We report a case of polypoid endometriosis and correlate the MRI findings with the pathological findings. The polypoid endometriosis appeared as multiple polypoid masses protruding into the adjacent pelvic organs, including the uterus and rectum. The masses were found to show hyperintensity on T(2) weighted images, which was similar to the signal intensity of the uterine endometrium, reflecting the presence of abundant endometrial-type glands. The masses were also surrounded by hypointense rim-like structures on T(2) weighted images. These structures were confirmed by pathology to correspond with fibrous tissues arising from endometriosis. These features, together with an intense enhancement similar to the adjacent uterus, may be a diagnostic clue to this rare entity.

Int J Gynaecol Obstet. 2008 Jul;102(1):34-8. Epub 2008 Mar 17.

Synchronous early-stage endometrial and ovarian cancer.

Signorelli M, Fruscio R, Lissoni AA, Pirovano C, Perego P, Mangioni C.

Clinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy.

OBJECTIVE: To explore the clinicopathologic findings and oncological outcome of early-stage synchronous endometrial and ovarian malignancies. METHODS: A retrospective study of 93 women with synchronous stage I ovarian and stage I-II endometrial cancer treated between December 1981 and August 2005 in the gynecologic oncology department of San Gerardo Hospital, Italy. RESULTS: Fifty-one percent of the ovarian tumors were stage Ia and 71% of the endometrial cancers had minimal myometrial invasion. Endometrioid histology and grade 2 disease were prevalent in both sites. Hyperplasia and endometriosis coexisted in 71% and 22% of endometrial and ovarian cancers, respectively. The actuarial 5-year disease-free and overall survival rates were 83% and 96%, respectively. CONCLUSION: The incidence of synchronous endometrial and ovarian cancer is not negligible, especially among young women. Synchronous cancers show very favorable pathologic features and have an excellent oncologic outcome. Adjuvant therapy should be tailored according to surgical staging and histology.

Fertil Steril. 2008 May;89(5):1263-6. Epub 2008 Mar 12.

Endometrioma and oocyte retrieval-induced pelvic abscess: a clinical concern or an exceptional complication?

Benaglia L, Somigliana E, Iemmello R, Colpi E, Nicolosi AE, Ragni G.

Infertility Unit, Department of Obstetrics and Gynecology, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Milan, Italy. laurabenaglia@hotmail.it

The authors evaluated the risk of developing a pelvic abscess in a series of 214 in vitro fertilization cycles that were performed in women with endometriomas. This complication was never recorded, indicating that its risk is very low (0.0; 95% confidence interval, 0.0-1.7%).

Fertil Steril. 2008 Nov;90(5):2015.e7-9. Epub 2008 Mar 12.

A case of successful laparoscopic resection of adrenal gland endometriosis.

Rehman J, Yildirim G, Khan SA, Chughtai B, Nezhat F.

Department of Urology, SUNY-Stony Brook University Health Sciences Center, School of Medicine, Stony Brook, New York, USA.

OBJECTIVE: To present a case of successful laparoscopic resection of adrenal endometriosis. DESIGN: Case report. SETTING: University Hospital. PATIENT(S): Forty-eight-year-old woman with left-sided abdominal and flank pain. INTERVENTION(S): Laparoscopic radical adrenalectomy. MAIN OUTCOME MEASURE(S): Diagnosis and surgical approach to adrenal endometriosis. RESULT(S): There have been two case reports of adrenal endometriosis. Based on a search of Medline and Google for “adrenal endometriosis,” this is the first known successful laparoscopic resection of adrenal endometriosis. CONCLUSION(S): We report the first case of successful laparoscopic adrenalectomy for the treatment of endometriosis.

Reprod Biomed Online. 2008 Mar;16(3):416-24.

Genetic alterations of HOXA10 and their effect on the severity of endometriosis in a Taiwanese population.

Wu HH, Wang NM, Lin CY, Tsai HD.

Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.

Endometriosis is one of the most common gynaecological diseases and evidence has suggested that it may be inherited as a complex genetic trait. HOXA10, a homeobox gene, is expressed in the developing uterus and participates in endometrium development and may contribute to endometriosis. In this study, the HOXA10 gene was analysed in 112 patients with endometriosis and in 54 women without endometriosis, as diagnosed laparoscopically. The entire HOXA10 gene was amplified using polymerase chain reaction followed by single-strand conformation polymorphism analysis and sequencing. Association between the polymorphism and the clinical parameters of endometriosis were examined. There were 7.23% patients with HOXA10 genetic alterations; however, there was no significant increase in the endometriosis patients compared with the controls. Most of these DNA variants were found to be novel mutations that reside within the HOXA10 homeobox domain. Six variants generate amino acid changes in the protein and one harbours a premature stop codon. It was found that patients with HOXA10 polymorphism were associated with a lower serum cancer antigen-125, a lower American Fertility Society score and less severe obliterated cul-de-sac. It is postulated that genetic alterations in the homeobox domain might lead to less specificity for HOXA10 protein binding to a DNA molecule.

Reprod Biomed Online. 2008 Mar;16(3):410-5.

Diagnostic laparoscopy is needed after abnormal hysterosalpingography to prevent over-treatment with IVF.

Tanahatoe S, Lambalk C, McDonnell J, Dekker J, Mijatovic V, Hompes P.

Department of Obstetrics, Gynecology and Reproductive Medicine, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands.

The additional value of laparoscopy was investigated with respect to diagnosis and further treatment decisions after abnormal hysterosalpingography (HSG) and prior to intrauterine insemination (IUI). In a retrospective chart review, the number of patients with abnormal HSG who finally need IVF treatment based on the laparoscopic findings was evaluated. Independent of whether HSG showed unilateral or bilateral tubal pathology, IVF was the final treatment decision in only 74 (29%) cases where laparoscopy showed bilateral abnormalities. IUI treatment was advised in 121 (48%) patients with laparoscopically normal findings or unilateral abnormalities. Fifty-seven (23%) patients were treated by IUI after receiving laparoscopic surgery of unilateral adhesions or endometriosis stage 1-2 or after ablation of moderate-severe endometriosis in a second operation. In cases of bilateral tubal abnormalities revealed by HSG, bilateral pathology was confirmed by laparoscopy in at least 58 (46%) patients and they were advised to be treated by IVF after laparoscopy. The agreement between abnormalities found by HSG and abnormalities found by laparoscopy requiring IVF treatment was poor even when HSG showed bilateral pathology. Based on these findings, it is concluded that laparoscopy is mandatory after abnormal HSG findings in the work-up prior to IUI to prevent over-treatment with IVF.

Eur J Obstet Gynecol Reprod Biol. 2008 Jun;138(2):127-34. Epub 2008 Mar 11.

Peritoneal fluid flow influences anatomical distribution of endometriotic lesions: why Sampson seems to be right.

Bricou A, Batt RE, Chapron C.

Faculté de Médecine, AP-HP de Paris, GHU Ouest, Service de Gynécologie Obstétrique II et Médecine de la Reproduction (Pr Chapron), CHU Cochin-Saint Vincent de Paul, Université Descartes Paris V, 82 Avenue Denfert Rochereau, Paris, France.

Endometriosis is a frequent pathology for which the dominant signs and symptoms are pelvic pain and infertility. The physiopathology remains the subject of controversy. Four physiopathological hypotheses have been put forward: regurgitation, metaplasia, induction and (vascular and lymphatic) embolization. The anatomical distribution of endometriotic lesions would appear to be fundamental for a better understanding of Sampson’s menstrual regurgitation theory of endometriosis. Analysis of the results in the literature and comparison with our experience clearly shows that the distribution of endometriotic lesions is asymmetrical in several respects. Abdominopelvic anatomy and peritoneal fluid flow can explain this asymmetrical distribution of endometriotic lesions in the great majority of cases. These observations are a very strong argument in favour of the crucial role played by tubal regurgitation and the peritoneal fluid in the physiopathology of endometriosis. The similarity in anatomical distribution of endometriomas, superficial and deeply invasive endometriotic lesions would tend to indicate a common origin for these different types of lesions.

Diagn Cytopathol. 2008 Apr;36(4):224-6.

Fine-needle aspiration cytodiagnosis of endometriosis in cesarean section scar and rectus sheath mass lesions — a study of seven cases.

Gupta RK.

The Valley Diagnostic Laboratories Ltd, Lower Hutt, New Zealand. raj.gupta@xtra.co.nz

The diagnosis of endometriosis is usually established by a biopsy. Since endometriotic lesions can present as a mass lesion, it seems feasible to investigate them by the noninvasive method of fine-needle aspiration cytology (FNAC). In this study, seven cases (5 from a cesarean scar and 2 from rectus sheath) are presented in which FNAC was indicative of endometriosis. The aspirate was obtained using a disposable 10 ml syringe and 22 gauge needle. The material was collected as syringe and needle washings in a cytology container in which 30% ethyl alcohol was present. From half of this material, filter preparations were made on size 3 mum filters and stained by Papanicolaou method, while the remaining aspirate was spun and a cell block was made from the sediment and sections cut and stained with hematoxylin-eosin stain. In all cases the cytologic preparations showed tubular structures indicative of endometrial tissue and stromal cells indicative of endometriosis. This was further confirmed on examination of cell blocks, which showed histologic features of endometriosis characterized by endometrial glands separated by endometrial stroma and rare siderophages. The seven cases described are interesting, since the cytohistological finding in FNAC sample and cell block not only were indicative of the diagnosis of endometriosis, but also obviated the need for an invasive surgical procedure. (c) 2008 Wiley-Liss, Inc.

Gynecol Endocrinol. 2008 Mar;24(3):123-8.

The effect of oral contraceptives on aromatase expression in the eutopic endometrium of patients with endometriosis.

Maia H Jr, Casoy J, Correia T, Freitas LA, Pimentel K, Athayde C.

Centro de Pesquisa e Assistência em Reprodução Humana (CEPARH), Salvador, Bahia, Brazil. ceparh@uol.com.br

OBJECTIVE: To determine the effect of oral contraceptives containing gestodene on aromatase expression in the endometrium of patients diagnosed with endometriosis. PATIENTS AND METHODS: Endometrial biopsies were taken at the time of laparoscopy in 40 patients with endometriosis, 16 of whom were using an oral contraceptive containing gestodene at the time of laparoscopy. The remaining 24 patients were receiving no form of treatment for endometriosis. Endometrial biopsies taken from 23 patients with normal echographic signs and no symptoms were used as controls. Aromatase expression was evaluated in endometrial samples using immunohistochemistry. RESULTS: In the untreated, symptomatic endometriosis patients, aromatase expression was detected during the proliferative phase in 92% of cases, while in the symptom-free control patients aromatase was expressed in only 9% of cases. In patients with endometriosis who were using oral contraceptives, there were significantly fewer cases of positive endometria compared with the untreated patients with endometriosis (6%). CONCLUSION: Oral contraceptives containing gestodene are effective in decreasing aromatase expression in the eutopic endometrium of patients with endometriosis.

Arch Gynecol Obstet. 2008 Dec;278(6):593-5. Epub 2008 Mar 12.

Juvenile cystic adenomyosis mimicking uterine malformation: a case report.

Dogan E, Gode F, Saatli B, Seçil M.

Department of Obstetrics and Gynecology, Dokuz Eylul University, 35340, Inciralti, Izmir, Turkey.

Cystic adenomyosis is a rare form of adenomyosis mostly seen in middle aged women. We report a case of cystic adenomyosis in a juvenile patient presenting with severe dysmenorrhea refractory to any given medication. The patient initially was diagnosed as uterus bicornis with an obstructed rudimentary horn. Surgical exploration and excision of the cystic mass relieved the symptoms of the patient.

Postepy Hig Med Dosw (Online). 2008 Mar 3;62:103-9.

Serum and peritoneal evaluation of vitamin D-binding protein in women with endometriosis.

Borkowski J, Gmyrek GB, Madej JP, Nowacki W, Goluda M, Gabryś M, Stefaniak T, Chełmońska-Soyta A.

University School of Physical Education, Department of Biochemistry, Wrocław, Poland.

INTRODUCTION: Vitamin D-binding protein (also called DBP or Gc-globulin) is recognized as a multifunctional protein involved in the action scavenger system, the transport of vitamin D sterols, and the modulation of immune and inflammatory responses. This study evaluated total serum and peritoneal concentrations of vitamin D-binding protein in women with endometriosis, known as an inflammation-associated disease.MATERIALS/METHODS: The total concentration of DBP was measured with an enzyme-linked immunosorbent assay (ELISA) using a polyclonal antibody raised in a goat immunized with human DBP. Serum and peritoneal fluid were collected from women with endometriosis (n=26) and from patients with benign gynecological conditions serving as a control group (n=17). RESULTS: In general, the vitamin D-binding protein concentration was higher in serum than in peritoneal fluid. Women with endometriosis had higher serum but lower peritoneal levels of DBP compared with the control group; however, no significance was noted. When the endometriosis group was divided with regard to severity, an insignificantly higher serum level of DBP was observed in advanced endometriosis compared with the mild form of the disease, whereas the peritoneal concentration was not dependent on disease severity. CONCLUSIONS: It is concluded that serum and peritoneal DBP concentrations are not affected in women with endometriosis; however, based on the latest published data, it is possible that both the serum and peritoneal concentrations of vitamin D-binding protein may be dependent on Gc genotype, which results in differential modulation of monocyte/macrophage activity.

Int J STD AIDS. 2008 Feb;19(2):123-4.

A retrospective audit of the management and complications of pelvic inflammatory disease.

Evans DT, Jaleel H, Kinsella MT, Aggarwal V.

Department of Genito-Urinary Medicine, Southend University Hospital NHS Foundation Trust, UK. Derek.Evans@southend.nhs.uk

Our objective was to examine the management of pelvic inflammatory disease (PID) in Southend Hospital against the British Association for Sexual Health and HIV guidelines. In addition, we reviewed the Genito-Urinary (GU) Medicine and Gynaecology notes for patients who failed treatment for PID in GU medicine. This was to reveal their complications and subsequent management. Thirty of 249 patients diagnosed with PID failed treatment. Chlamydia was found in 30% of these patients, gonorrhoea in 10%, with the rest being categorized into presumed anaerobic/other aetiology. Appropriate antibiotic regimens were used in 96.6% of patients and the 66.7% of contacts who were traced and treated. Eighteen of the 30 patients had a laparoscopy. Findings were: confirmed PID in 5.6%; endometriosis in 27.8%, adhesions with no evidence of PID in 27.8%; and 38% had no abnormalities found. Laparoscopy has an important role in excluding other pathology in patients who have failed to respond to appropriate conservative management.

Nurs Stand. 2008 Feb 6-12;22(22):25.

Lifting the curse.

Jackson S.

Adenomyosis is a condition most women have never heard of. Yet it can cause severe menstrual cramping and heavy bleeding.

Reprod Sci. 2008 Apr;15(3):243-52. Epub 2008 Mar 10.

Expression of Fox head protein 1 in human eutopic endometrium and endometriosis.

Fu L, Girling JE, Rogers PA.

Centre for Women’s Health Research, Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, Clayton, Victoria, Australia.

The objective of this study is to examine the localization and expression of FOXP1 in human endometrium during the menstrual cycle and in endometriotic lesions and endometrial adenocarcinoma. FOXP1 protein expression was analyzed by immunohistochemistry and Western blot. FOXP1 expression was significantly different between glandular epithelial and stromal nuclei and cytoplasm in both endometrial functionalis and basalis. FOXP1 immunostaining was significantly reduced in the early secretory stage in comparison to the mid proliferative stage in the functionalis and the early proliferative stage in the basalis. FOXP1 expression was found in endometriotic lesions but not in endometrial adenocarcinoma. Multiple protein bands of FOXP1 were identified, and their presence varied considerably among patients. Protein expression levels were significantly higher in the mid and late secretory stages in comparison to early proliferative and early secretory stages. FOXP1 protein is present in human endometrium with evidence of cycle stage-dependent changes in expression.

Hum Reprod. 2008 May;23(5):1053-62. Epub 2008 Mar 10.

L1 cell adhesion molecule (L1CAM) as a pathogenetic factor in endometriosis.

Finas D, Huszar M, Agic A, Dogan S, Kiefel H, Riedle S, Gast D, Marcovich R, Noack F, Altevogt P, Fogel M, Hornung D.

Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Ratzeburgerallee 160, 23538 Luebeck, Germany.

BACKGROUND: Endometriosis is a benign and progressive disease with a high prevalence. Women with endometriosis, especially with atypical endometriosis, have a higher probability for developing ovarian cancer compared with women without endometriosis. The L1 cell adhesion molecule (L1CAM) is over expressed in ovarian and endometrial carcinomas and is associated with a bad prognosis. Here, we have analysed L1CAM expression in endometriosis. METHODS AND RESULTS: In our study with the samples from 79 patients with, and 37 patients without, endometriosis, we found that endometriosis cell lines and short-term cultures of endometrium from women with endometriosis expressed L1CAM at the mRNA and protein level. Quantitative RT-PCR analysis showed that L1CAM was expressed at significantly higher level in the epithelial compartment from patients with endometriosis compared with healthy controls (P = 0.0126). By immunohistochemical staining, 15 of 31 ovarian endometriotic lesions (48%) were shown to have L1CAM-positive staining. Of these 15 L1CAM-positive samples, 13 were atypical endometriotic lesions. Soluble L1 present in the conditioned medium of epithelial endometrium cultures from women with endometriosis was able to stimulate neurite outgrowth as measured in a chicken ganglion assay. CONCLUSIONS: We propose that L1CAM could promote endometriosis development by increasing enervation and aggravation. L1CAM expression is higher in atypical endometriosis compared with normal endometriosis.

Fertil Steril. 2008 Mar;89(3):491-501.

Clinical factors affecting endometrial receptiveness in oocyte donation cycles.

Soares SR, Velasco JA, Fernandez M, Bosch E, Remohí J, Pellicer A, Simón C.

IVI-Lisboa, Avenida Infante Dom Henrique, 333-H, 1800-282, Lisboa, Portugal.

OBJECTIVE: To provide a summary of the actual knowledge about the clinical factors affecting the oocyte recipient (other than those associated with uterine cavity abnormalities) on the outcome of oocyte donation cycles. DESIGN: Review of the literature. SETTING: Information regarding the association between age, body mass index (BMI), endometrial priming, tobacco consumption, hydrosalpinx, and endometriosis/adenomyosis in oocyte recipients and the results of oocyte donation cycles. RESULT(S): Recipient age and the presence of hydrosalpinx are clearly associated with a poorer outcome in oocyte donation cycles. The negative impact of tobacco consumption has recently been confirmed. The exact relevance of an elevated BMI is under debate but it is likely that it determines a lower ongoing pregnancy rate (PR). Endometriosis may be significant for endometrial receptiveness in the context of a natural cycle, but no negative impact is detected when standard endometrial priming protocols are used in oocyte donation. The same may be true for adenomyosis, although its relevance to endometrial receptiveness is less clear. CONCLUSION(S): Accumulated knowledge in the field of oocyte donation has led to the recognition of clinical variables that affect cycle outcome by impairing endometrial receptiveness. Many studies are being carried out on endometrial molecular and gene expression changes taking place in these circumstances. In the near future a comprehensive understanding of these processes should be achieved, from a genetic, molecular, and clinical perspective. These advances in the collective knowledge will lead to an improvement in the diagnosis and treatment of infertile patients.

Tuberk Toraks. 2008;56(1):87-91.

Catamenial hemoptysis.

Elbek O, Börekçi S, Dikensoy E, Kibar Y, Bayram H, Bakir K, Dikensoy O.

Department of Chest Diseases, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey. osmanelbek@yahoo.com

Catamenial hemoptysis is a rare condition that is associated with the presence of intrapulmonary or endobronchial endometrial tissue. We describe a case of endobronchial endometriosis with catamenial hemoptysis. The patient was a 22 years-old girl presented with recurrent hemoptysis episodes for the last two years. Bronchoscopic examination was performed within first days of menses, and indicated multiple purplish-red submucosal patches in distal one third of trachea and bilateral bronchial trees that bled easily when touched. The cytological evaluation of the bronchial brushing specimens demonstrated clusters of small cuboidal cells consistent with an endometrial origin. Follow-up bronchoscopic examination at the end of the menstrual cycle revealed that the previous tracheobronchial lesions disappeared. The patient was treated with Gonadotropin-Releasing Hormone (GnRH) analogues and hormones including estrogen and progesterone therapy. Recurrent hemoptysis stopped following the medical treatment.

Best Pract Res Clin Obstet Gynaecol. 2008 Aug;22(4):627-42. Epub 2008 Mar 7.

Diagnosis, imaging and anatomical classification of uterine fibroids.

McLucas B.

Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, 100 UCLA Medical Plaza, Suite 310, Los Angeles, CA 90095, USA. mclucas@ucla.edu

Uterine leiomyomata, commonly referred to as fibroids, are often accompanied by symptoms common to many other pelvic conditions. The correct identification of myomata and the exclusion of other diseases, especially malignancies, are imperative when evaluating therapy options. A confident diagnosis of myomata may be aided by several imaging modalities. The selection of an imaging technique should include an evaluation of both the benefits and the costs associated with the procedure. Imaging can provide information regarding precise myomata location, which may, in turn, dictate treatment options. Myomata may be classified based upon position within the uterus, and may be further described by phase of degeneration. With the increasing popularity of uterine-conserving therapy, accurate diagnosis of myomata becomes even more important.

Fertil Steril. 2008 Nov;90(5):2016.e17-20. Epub 2008 Mar 6.

Hysteroscopic unification of a complete obstructing uterine septum: case report and review of the literature.

Spitzer RF, Caccia N, Kives S, Allen LM.

Department of Pediatrics, Division of Endocrinology, Section of Gynecology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

OBJECTIVE: To report a case of complete obstructing uterine septum repaired in a minimally invasive manner by operative hysteroscopy under laparoscopic guidance. A complete obstructing uterine septum is a rare congenital abnormality. To date, management of such abnormalities has traditionally been by metroplasty. DESIGN: Case report and review of the literature. SETTING: Pediatric and adolescent gynecology service at a tertiary care hospital. PATIENT(S): A 16-year-old nulligravid presented with severe, persistent dysmenorrhea and a history of significant endometriosis. Imaging initially suggested a functional, noncommunicating uterine horn, but magnetic resonance imaging review confirmed a complete obstructing septate uterus. INTERVENTION(S): The patient was managed by menstrual suppression until the time of surgery. The septum was resected by operative hysteroscopy under laparoscopic guidance. The procedure was without complication. MAIN OUTCOME MEASURE(S): The patient recovered well and resumed spontaneous menses without dysmenorrhea. RESULT(S): A second-look hysteroscopy 4 months later confirmed patency of the previously obstructed side and allowed the opportunity to complete the resection of the septum. CONCLUSION(S): Operative hysteroscopy is an effective and safe minimally invasive technique to manage the rare complete obstructing uterine septum. Hysteroscopy is less invasive than traditional metroplasty and is associated with easier recovery. Additionally, there is no uterine scar and thus less implication for future fertility. Further series of such procedures are required to offer greater experience and proof of safety of this approach.

J Womens Health (Larchmt). 2008 Apr;17(3):367-72.

Catamenial pneumothorax: a case report and review of the literature.

Papafragaki D, Concannon L.

Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois 60657, USA. dpapafragaki@hotmail.com

A 39-year-old woman presented with the chief complaint of right-sided chest pressure and shortness of breath with dry cough for 3 days. These symptoms coincided with the onset of her menstrual cycle. Her physical examination was significant for decreased breath sounds at the right lung base. Her chest x-ray showed a moderate sized right pneumothorax extending from the apex to the lung base and a small amount of pleural fluid, findings that were verified by chest CT. The patient was seen by consultants from the pulmonary, obstetrics/gynecology, and thoracic surgery services, who agreed that the clinical diagnosis was catamenial pneumothorax, probably associated with thoracic endometriosis. The patient was discharged on levonorgestrel/ethinyl estradiol tablets, which she opted not to take. Three months later, she had similar symptoms that occurred again at the time of menstruation. Her chest x-ray now showed a 10% right-sided pneumothorax. Catamenial pneumothorax is a rare condition affecting women in their reproductive years. Women with this condition most commonly have right-sided pneumothorax. The proper diagnosis is based on being aware of the existence of this relatively rare condition and relating the symptoms of pneumothorax temporally to the menses.

Rev Prat. 2008 Jan 15;58(1):55-64.

[Difficult contraceptions]

[Article in French]

Bricaire C, Plu-Bureau G.

Médecine de la reproduction, groupe hospitalier Pitié-Salpêtrière, 75651 Paris. clairebricaire@yahoo.fr

Choosing a contraceptive method is difficult in women with a disease or presenting specific risk factors. The possible life-threatening effects of the contraceptive on the disease and the possible drug interactions should be taken into consideration. In this article, we will address the issues faced in patients with neurological diseases (epilepsy, brain tumor, migraine, prolactin-secreting adenoma), vascular diseases (venous thrombosis, biological thrombophilia, arterial diseases), metabolic disorders (obesity, dyslipemias, diabetes), uterine diseases (fibromas, endometriosis), renal failure, benign and malignant breast diseases as well as in HIV-positive women. Unfortunately, the available scientific data are insufficient for several of these conditions, which leads to a non-validated management. Controlled studies are needed to improve knowledge.

Int J Gynaecol Obstet. 2008 Jun;101(3):253-8. Epub 2008 Mar 6.

Identifying biomarkers of endometriosis using serum protein fingerprinting and artificial neural networks.

Wang L, Zheng W, Mu L, Zhang SZ.

The 2nd Affiliated Hospital, Department of Gynecology, Zhejiang University School of Medicine, Hangzhou, China.

OBJECTIVES: To use surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS) protein chip array technology to detect proteomic patterns in the serum of women with endometriosis; build diagnostic models; and evaluate their clinical significance. METHODS: Serum samples from women with endometriosis and healthy women were studied using SELDI-TOF-MS protein chip technology. For every matched pair, two-thirds of the samples were used to look for different patterns and one-third was used for cross-validation. RESULTS: Five potential biomarkers were found and the diagnostic system distinguished endometriosis from validation samples with a sensitivity of 91.7% and a specificity of 90.0%. CONCLUSION: This method shows great potential in identifying biomarkers to be used for endometriosis screening.

Ann Diagn Pathol. 2008 Apr;12(2):128-33.

Endometrial stromal sarcoma of the small bowel.

Kim L, Choi SJ, Park IS, Han JY, Kim JM, Chu YC, Kim KR.

Department of Pathology, Inha Research Institute for Medical Science, Inha University Hospital, Inha University College of Medicine, Incheon 400-711, South Korea.

Endometrial stromal sarcoma (ESS) is a rare mesenchymal neoplasm of the uterus, which is predominantly composed of endometrial stromal cells. When this feature is encountered in the extragenital area, the diagnosis is sometimes difficult especially if endometriosis is not present. We report a case of ESS arising in the small bowel without associated endometriosis in a 75-year-old woman and review the literatures for 16 cases of extrauterine extraovarian ESS. The most common site of the extrauterine extraovarian ESS is the gastrointestinal tract (8/16 cases). It is intimately associated with endometriosis (12/16 cases) as the case of ovarian ESS. Most ESSs were immunoreactive for CD10 (5/5 cases), progesterone receptor (10/10 cases), and estrogen receptor (9/11 cases), and negative for CD34 (0/7 cases). It may have a higher tendency for dissemination beyond its site of origin (12/16 cases) than its uterine counterpart. In conclusion, a careful morphological examination combined with immunohistochemical studies and consideration of ESS in the differential diagnosis would help in obtaining an accurate diagnosis in these rare circumstances.

World J Gastroenterol. 2008 Mar 7;14(9):1453-5.

A case of multiple intra-abdominal splenosis with computed tomography and magnetic resonance imaging correlative findings.

Imbriaco M, Camera L, Manciuria A, Salvatore M.

Department of Radiology, University Federico II and I.B.B. C.N.R., Institute of Bio-structure and Bio-imaging, Via Pansini, 5 Naples 80123, Italy. mimbriaco@hotmail.com

Hepatic splenosis refers to heterotopic auto-transplantation and implantation of splenic tissue resulting from the spillage of cells from the spleen after splenic trauma or splenectomy. The true incidence of splenosis is unknown, because this entity is usually an incidental finding at surgery. Splenic implants are usually multiple, and can be localized anywhere in the peritoneal cavity. Splenic implants in the peritoneal cavity may be confused with renal tumors, abdominal lymphomas and endometriosis. We describe computed tomography (CT) and magnetic resonance imaging (MRI) findings in a rare case of multiple intra-abdominal splenosis located along the hepatic surface and adjacent to the upper pole of the right kidney, mimicking a renal neoplasm.

Bosn J Basic Med Sci. 2008 Feb;8(1):44-7.

Should diagnostic hysteroscopy be a routine procedure during diagnostic laparoscopy in infertile women?

Godinjak Z, Idrizbegović E.

Obstetrics and Gynaecology Clinic, University of Sarajevo Clinics Centre, Bolnicka 10, 71000 Sarajevo, Bosnia and Herzegovina.

The aim of this study was to clarify the role of simultaneous combined diagnostic approach using laparoscopy and hysteroscopy in the evaluation of female infertility. In a retrospective study, 360 infertile women underwent complete fertility evaluation. All the patients were examined by simultaneous combined laparoscopy and hysteroscopy as a part of the routine infertility evaluation. Laparoscopy and hysteroscopy were successful in 360 patients. Bilateral tubes were blocked in 18 (5%) and unilateral tubal occlusion were in 30 (8,33%) of patients. Pelvic adhesions were revealed in 40 (11,11%), and myomas in 42 (11,65%) out of that 31 (8,6%) were revealed by laparoscopy and 11 (3,05%) by hysteroscopy. Endometrial polyps were revealed in 26 (7,22%) and Syndrome Asherman in 3(0,83%) of patients. Uterine anomaly was found in 19 (5,27%) of cases and out of that septate uterus in 7 (37,15%), bicornuate uterus in 5 (26,31%), arcuate uterus in 4 (21,26%) and uterus unicornu cum cornu rudimentario in 3 (15,27%) of uterine anomalies. Endometriosis was found in 51 (14,16%), dermoid cysts in 8 (2,22%) and in 16 (4,44%) functional cysts of patients. Also, Fitz-Hugh-Curtis syndrome was revealed in 23 (6,11%) of our patients. Laparoscopy and hysteroscopy play very important role as diagnostic tools in the infertility women. Combined diagnostic simultaneous laparoscopy and hysteroscopy should be performed in all infertile patients before the treatment.

J Med Chem. 2008 Mar 27;51(6):1861-73. Epub 2008 Mar 5.

Design, synthesis, and SAR of new pyrrole-oxindole progesterone receptor modulators leading to 5-(7-fluoro-3,3-dimethyl-2-oxo-2,3-dihydro-1H-indol-5-yl)-1-methyl-1H-pyrrole-2-carbonitrile (WAY-255348).

Fensome A, Adams WR, Adams AL, Berrodin TJ, Cohen J, Huselton C, Illenberger A, Kern JC, Hudak VA, Marella MA, Melenski EG, McComas CC, Mugford CA, Slayden OD, Yudt M, Zhang Z, Zhang P, Zhu Y, Winneker RC, Wrobel JE.

Chemical and Screening Sciences, Biotransformation Division, Drug Safety and Metabolism, Women’s Health and Musculoskeletal Biology, and BioResources, Wyeth Research, 500 Arcola Road, Collegeville, PA 19426, USA. fensoma@wyeth.com

We have continued to explore the 3,3-dialkyl-5-aryloxindole series of progesterone receptor (PR) modulators looking for new agents to be used in female healthcare: contraception, fibroids, endometriosis, and certain breast cancers. Previously we reported that subtle structural changes with this and related templates produced functional switches between agonist and antagonist properties ( Fensome et al. Biorg. Med. Chem. Lett. 2002, 12, 3487; 2003, 13, 1317 ). We herein report a new functional switch within the 5-(2-oxoindolin-5-yl)-1 H-pyrrole-2-carbonitrile class of compounds. We found that the size of the 3,3-dialkyl substituent is important for controlling the functional response; thus small groups (dimethyl) afford potent PR antagonists, whereas larger groups (spirocyclohexyl) are PR agonists. The product from our optimization activities in cell-based systems and also for kinetic properties in rodents and nonhuman primates was 5-(7-fluoro-3,3-dimethyl-2-oxo-2,3-dihydro-1 H-indol-5-yl)-1-methyl-1 H-pyrrole-2-carbonitrile 27 (WAY-255348), which demonstrated potent and robust activity on PR antagonist and contraceptive end points in the rat and also in cynomolgus and rhesus monkeys including ovulation inhibition, menses induction, and reproductive tract morphology.

Int J Gynecol Pathol. 2008 Apr;27(2):199-206.

Immunohistochemical analysis of reserve cell-like cells of ovarian müllerian mucinous/mixed epithelial borderline tumor.

Hamada T, Kiyokawa T, Nomura K, Hano H.

Department of Pathology, Jikei University School of Medicine, Tokyo, Japan. tomhamada@jikei.ac.jp

Ovarian mucinous borderline tumor of müllerian type (MMBT) and mixed epithelial borderline tumor of müllerian type (MEBT) are uncommon subtypes of ovarian surface epithelial tumors. Both are often associated with endometriosis, but their histogenesis is still debated. We have noticed occasional foci of subepithelial cuboidal cells resembling uterine cervical reserve cells (RCs) in MMBTs/MEBTs, which have not been documented in the literature to the best of our knowledge. This study was carried out to identify the presence of RC-like cells (RCLCs) in MMBTs/MEBTs and their immunohistochemical features in comparison to those of cervical RCs. We analyzed 10 consecutive cases of RC-like MMBTs/MEBTs, 6 of which were associated with endometriosis. Immunohistochemistry was performed for p63, cytokeratin 34BE12, cytokeratin 17 (CK17), and low-molecular cytokeratin CAM5.2. In 9 of 10 cases, RCLCs were appreciated in hematoxylin-eosin stain, although their amount in the tumor varied from case to case. Immunohistochemically, RCLCs were positive for p63 in 9 cases. They were positive for both 34BE12 and CK17 and were very weakly positive or negative for CAM5.2 in 8 cases. This immunohistochemical profile is similar to that seen in the cervical RCs. Reserve cell-like cells were also found in the foci of endometriosis coexisting with MMBTs/MEBTs in 1 of 5 cases examined. We draw attention to the existence of the RCLCs in MMBTs/MEBTs and in endometriosis. Their similarity to the cervical RCs may indicate their potential role as precursor cell that may subsequently differentiate into different müllerian cell types, thus merit further study.

Int J Gynecol Pathol. 2008 Apr;27(2):229-35.

Uterine tumors resembling ovarian sex cord tumors: an update.

Czernobilsky B.

Patho-Lab Diagnostics, Ness-Ziona, Israel. bc@patho-lab.com

Tumors of the uterus resembling ovarian sex cord tumors were reported by Clement and Scully in 1976 and were divided in 2 groups: group 1, endometrial stromal tumors, and group 2, mural uterine tumors-both with elements resembling ovarian sex cord tumors. In the former, the sex cord component constitutes a minor portion of an endometrial stromal neoplasm, whereas in the latter, it is the predominant or exclusive component of a uterine wall lesion composed of a variety of mesenchymal elements. An origin from endometrial stromal cells, adenomyosis, stromal myosis, endometriosis, or multipotential cells within the myometrium was postulated in both groups of tumors. In group 1 tumors, the prognosis depends on the type, grade, and stage of the underlying stromal neoplasm. Group 2 tumors seemed to be benign, although because of the occasional recurrence of these tumors, they should be considered of low-grade malignant potential. In recent years, the histological features in group 2 were found to be much more varied than those in group 1 and consisted among others of retiform areas, glomeruloid structures, and Leydig-like cells. In group 1 tumors, the sex cord elements remained limited to cords, trabeculae, nests, and tubules. Eventually, the abbreviation ESTSCLE, or endometrial stromal tumors with sex cord-like elements, was given to group 1 tumors, whereas UTROSCT, or uterine tumor resembling ovarian sex cord tumor, was used for group 2 tumors. The most significant information in recently conducted studies concerns the immunophenotype of these lesions especially of UTROSCT. Out of the plethora of the immunohistochemical stains, a panel of 4 including calretinin, inhibin, CD99, and Melan A has emerged which seemed to be the most characteristic sex cord markers. Positivity for calretinin and at least for 1 of the other above-mentioned markers may thus confirm the diagnosis of UTROSCT. Endometrial stromal tumors with sex cord-like elements, on the other hand, usually express only 1 sex cord marker, mostly calretinin. However, additional studies are necessary to confirm these observations. In conclusion, UTROSCT and, to a lesser degree, ESTSCLE, are polyphenotypic neoplasms, which, according to the evidence available at present, most likely arise from pluripotential uterine mesenchymal cells. In UTROSCT, the differentiation into sex cord components is predominant or exclusive, whereas in ESTSCLE, it is minor.

Histopathology. 2008 Mar;52(4):510-4.

Intestinal endometriosis morphologically mimicking colonic adenocarcinoma.

Kelly P, McCluggage WG, Gardiner KR, Loughrey MB.

Department of Pathology, Royal Group of Hospitals, Belfast, UK.

J Endourol. 2008 Jan;22(1):83-6.

Cystoscopy-assisted laparoscopic partial cystectomy.

Nerli RB, Reddy M, Koura AC, Prabha V, Ravish IR, Amarkhed S.

Department of Urology, Kles Kidney Foundation, Nehru Nagar, Belgaum, India. director@jleskf.org

BACKGROUND AND PURPOSE: Laparoscopic partial cystectomy is performed in selected patients with isolated diseases, such as bladder endometriosis, pheochromocytoma, leiomyoma, and malignant bladder tumors. Laparoscopic partial cystectomy is indicated for a solitary bladder tumor that is distant from the bladder neck, the ureteral orifices, and the trigone, to allow a resection margin of 1 to 2 cm. We report our experience with cystoscopy-assisted laparoscopic partial cystectomy. MATERIALS AND METHODS: The bladder was mobilized adequately by laparoscopy. Intraoperative cystoscopy was performed Cystoscopic guidance was used for the initial cystotomy. Further excision of the bladder tumor with a safety margin of 1.5 to 2 cm was performed under laparoscopic vision. RESULTS: Three patients underwent cystoscopy-assisted laparoscopic partial cystectomy. Cystoscopy aided in planning a proper and adequate safety margin around the tumor as well as helped in marking the initial cystotomy. CONCLUSIONS: Cystoscopic assistance during laparoscopic partial cystectomy helps to properly place the initial cystotomy as well aids in planning the safety margin around the tumor. It is safe, easy, and does not add to increased operative time or morbidity.

Eur J Obstet Gynecol Reprod Biol. 2008 Jul;139(1):53-8. Epub 2008 Mar 7.

The endothelial nitric oxide synthase Glu298Asp polymorphism is not a risk factor for endometriosis in south Indian women.

Bhanoori M, Kameshwari DB, Zondervan KT, Deenadayal M, Kennedy S, Shivaji S.

Centre for Cellular and Molecular Biology, Uppal Road, Hyderabad 500007, India. bhanoori.m@lycos.com

OBJECTIVE: To investigate whether the eNOS gene influences the risk of developing endometriosis in south Indian women. STUDY DESIGN: The single nucleotide polymorphism, Glu298Asp, in exon7 of the eNOS gene was tested for association in a case-control study of 232 affected women and 210 women with no evidence of disease. All the women were infertile, ascertained from the same infertility clinic. The genotype frequencies of the polymorphism were compared, using polymerase chain reaction and sequencing analysis. The localization and expression of eNOS in the eutopic endometrium of five cases and four controls was also analyzed using immunohistochemistry and western blotting. RESULTS: No statistically significant differences were observed in the genotype distributions and allele frequencies (p=0.3) between the cases and controls according to codominant, dominant and recessive genotype models. The localization and expression of this protein were similar in the endometrium of cases and controls. CONCLUSION: In the present study we could neither observe a difference in the eNOS expression nor establish an association between the eNOS Glu298Asp exon 7 polymorphism in south Indian women with endometriosis.

J Minim Invasive Gynecol. 2008 Mar-Apr;15(2):255-6; author reply 256-7.

Comment on:

J Minim Invasive Gynecol. 2007 Nov-Dec;14(6):680-1.

Ferrari et Al. Defects of the broad ligament of the uterus.

Chatman DL.

J Minim Invasive Gynecol. 2008 Mar-Apr;15(2):235-40.

Urinary complications after surgery for posterior deep infiltrating endometriosis are related to the extent of dissection and to uterosacral ligaments resection.

Dubernard G, Rouzier R, David-Montefiore E, Bazot M, Daraï E.

Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Université Pierre et Marie Curie Paris VI, Assistance Publique des Hôpitaux de Paris, France.

Surgery for deep infiltrating endometriosis can relieve symptoms and improve quality of life. However, few data are available on complications, especially urinary disorders. The aim of this longitudinal study (Canadian Task Force classification II-3) was to evaluate urinary complications of laparoscopic surgery for deep infiltrating endometriosis in 86 patients. The main locations of endometriosis were colorectum (58 patients), uterosacral ligaments (21 patients), and rectovaginal septum (7 patients). Patients requiring surgical resection for posterior deep pelvic endometriosis completed before and after surgery the Bristol Female Lower Urinary Tract Symptom Questionnaire. After surgery, almost all the patients reported significant urinary complications, consisting of hesitancy (p = .02), strain to start (p = .04), stopping flow (p = .01), incomplete emptying (p = .008), and reduced stream (p = .02). Most symptoms were observed postoperatively in the colorectum group. De novo hesitancy (p = .02), stopping flow (p = .02), and incomplete emptying (p = .004) occurred more frequently after colorectal resection than after resection of other locations. The risk of de novo urinary symptoms did not depend on uterosacral ligament resection, except for incomplete emptying (p = .003) when bilateral resection was performed. Extensive dissection in the colorectum group, when combined with uterosacral ligament resection, was associated with significant urinary complications. Urinary complications mainly occurred after segmental colorectal endometriosis resection combined with bilateral uterosacral ligament resection. Surgery designed to spare the pelvic autonomic nerves could reduce the incidence of urinary complications.

J Minim Invasive Gynecol. 2008 Mar-Apr;15(2):202-4.

Urohemoperitoneum during pregnancy with consequent fetal death in a patient with deep endometriosis.

Chiodo I, Somigliana E, Dousset B, Chapron C.

Université Paris V, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Ouest, CHU Cochin-Saint Vincent de Paul, Service de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France.

A 25-year-old woman with unoperated deep endometriosis of the uterosacral ligament suddenly experienced severe abdominal pain, hematuria, hemoperitoneum, and intrauterine death at 31 weeks’ gestation. Surgical intervention revealed active hemorrhage arising from right uterine artery and interruption of the ureter in an area of previously documented but not treated endometriotic nodule. Histologic examination confirmed presence of decidualized endometriosis at this site. Urohemoperitoneum during pregnancy is a rare but possible complication in women carrying deep peritoneal endometriotic nodules.

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