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Journal articles on the topic 'Endometriosis'
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1
Borisova, E. A., M. N. Bulanov, and T. A. Makarenko. "Ultrasound image of ovarian endometrioma as an indicator of external genital endometriosis." Ultrasound & Functional Diagnostics, no. 3 (February 13, 2024): 37–49. http://dx.doi.org/10.24835/1607-0771-2023-3-37-49.
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Timely preoperative diagnosis of endometrioic cyst (endometrioma), as well as deep endometriosis remains relevant. The aim of the study was to assess the diagnostic value of ultrasound in patients with endometriomas and assess the combination of them with other foci of external genital endometriosis. The study based on retrospective analysis of a date of 95 patients with ultrasound signs of ovarian endometriomas, who underwent examination in MedicoProfi LLC – Borisov Medical and Diagnostic Clinic (Krasnoyarsk) during the period from January 2019 to October 2023. All of patients underwent surgery , followed by morphological evaluation. In the vast majority of cases, it was possible to detect a combination of endometriomas with one or more foci of deep endometriosis. Superficial peritoneal endometriosis and adhesions were found on surgery in all cases when endometriomas appeared isolated on ultrasound. The results of the study showed: endometriomas combined with deep endometriosis in 96.8% of cases. Thus, ultrasound detection of endometrioma is a very reliable sign of deep endometriosis presence. The “kissing ovaries” symptom in bilateral endometriomas can be considered as an absolutely reliable sign of the uterosacral ligaments endometriosis with specificity of 100% and positive predictive value of 100%. The presence of the “kissing ovaries” sign should be depicted in the conclusion of the ultrasound protocol, since it highly suggestive to obliteration of the pouch of Douglas and involvement of adjacent organs (fallopian tubes, intestines, ureters, etc.) in the endometrioid infiltrates, which is extremely important for the surgery planning, as well as in patients with infertility. There is an obvious need to introduce the extended pelvic ultrasound protocol to the diagnostic algorithm for patients with suspected endometriosis, which will more accurately describe the disease extension.
2
Davydov, A. I., L. M. Mikhaleva, M. B. Khabarova, R. A. Chilova, and V. A. Lebedev. "Endometrioid cystadenoma – deep ovarian endometriosis." Voprosy ginekologii, akušerstva i perinatologii 21, no. 3 (2022): 130–37. http://dx.doi.org/10.20953/1726-1678-2022-3-130-137.
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Among all endometriosis lesions of female reproductive organs, ovarian endometrioma is the most discussed nosology. Since 2014, ovarian endometrioid cysts have been classified as benign tumors (WHO Classification of Tumours of Female Reproductive Organs, 4th edition). In 2021, the 11th revision of the International Classification of Diseases (ICD-11) was amended, according to which the term “endometrioid ovarian cyst” (from 2018 to 2021 – heading GA18.3 Ovarian endometriotic cyst, section GA18 Acquired abnormalities of ovary) is no longer used, and the clinical and morphological signs of these cysts are presented in the heading GA10.B5 Deep ovarian endometriosis. In 2020, WHO updated the histological classification of female genital tumors (Female Genital Tumours WHO Classification of Tumours, 5th Edition), in which the section “endometrioid tumors” is presented only with endometrioid cystadenoma and endometrioid adenofibroma without mentioning the endometrioid cyst, but in accordance with the ICD-11, endometrioid cystadenoma is coded as “GA10.B5 Deep ovarian endometriosis”. Thus, on the one hand, ovarian endometrioma is a neoplastic process and requires appropriate approaches when choosing treatment tactics, on the other hand, cystectomy for endometrioma is accompanied by a pronounced loss of ovarian reserve. A possible consensus in this problem seems to be a minimally invasive method in the treatment of patients with ovarian endometriomas – ethanol sclerotherapy with cytological examination of the aspirate obtained from the neoplasm. The effectiveness of sclerotherapy largely depends on the choice of postoperative hormonal therapy. Today, dienogest is considered to be the most effective “anti-endometrioid” progestogen. However, there is an erroneous opinion that ethinylestradiol neutralizes the antiproliferative effect of dienogest and stimulates the growth of endometriosis. On the contrary, ethinylestradiol enhances the inhibitory effect of progestogen on the growth of ovarian endometrioma cells. Key words: endometrioid cystadenoma, ovarian endometrioma, deep ovarian endometriosis, sclerotherapy, dienogest
3
Korchynska, O. O., I. I. Khashcha, and D. Stryzhak. "Oncological aspects of ovarian endometriosis." Reproductive health of woman, no. 1 (March 1, 2024): 10–14. http://dx.doi.org/10.30841/2708-8731.1.2024.301575.
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Ovarian cancer is the second most common cause of death from gynaecological malignancies in the world, and in Ukraine it is the most serious type of gynecological cancer. Ovarian endometriomas significantly increase the risk of ovarian cancer, but their malignant transformation occurs in approximately 1% of cases.The article presents a literature review based on the scientific databases PubMed and Scopus for 2013–2023 on the incidence and frequency of ovarian malignant tumors on the background of ovarian endometriosis, carcinogenic mutations, immunological and hormonal disorders in ovarian endometriosis, which can cause its progression to ovarian cancer.Based on the analyzed scientific data, the connection between ovarian endometriosis and ovarian cancer is presented and all possible pathogenetic pathways through which ovarian endometriosis can lead to the formation of ovarian cancer are determined.According to the scientific literature, ovarian endometriosis can indeed lead to the formation of endometrioid and clear cell carcinomas, as well as other subtypes of malignant ovarian tumors. The risk of malignant changes in patients with ovarian endometriomas increases with age, the highest risk is observed in patients over 50 years of age. Despite this, some researchers believe that there are no time limits in the occurrence of malignant transformation of endometrioid ovarian cysts.Today, it is believed that atypical ovarian endometriosis, which is characterized by cytological atypia and architectural proliferation, is a precursor to ovarian cancer, and this condition that has the greatest risk for malignant process development is observed. Ovarian endometriomas contain a huge amount of heme and free iron, which leads to the appearance of an excess of free iron, and as a result, redox disorders occur, which cause carcinogenic mutations and destruction of cellular structures.Mutations in such genes as ARID1A, PIK3CA, AKT1, ERBB2 and PIK3R1, CTNNB1, KRAS, BRAF, PPP2R1A and occasionally in TP53 gene are involved in the occurrence of malignant changes in ovarian endometriomas. The same mutations are found in endometrioid foci of the ovaries and in endometrioid and clear cell carcinomas, which confirms the cancer development due to endometriosis. Disorders in the immune system in endometrioid lesions of the ovaries play a significant role in possible malignant transformation. The production of tumor necrosis factor, interleukin-1β, interleukin-6 increases, the function of natural killers decreases, and immunosuppression increases.Ovarian endometrioid cysts overexpress estradiol because they have increased amounts of the enzyme aromatase and lack the enzyme 17β-hydroxysteroid dehydrogenase type II, which is required to convert estradiol to estrone. Such changes lead to increased proliferative processes, which can also lead to the activation of oncogenic mutations.Thus, ovarian endometriosis significantly increases the risk of developing ovarian cancer, especially endometrioid and clear cell carcinomas. The mechanism of malignant transformation occurs precisely with the appearance of atypical endometriosis of the ovaries. The main pathogenetic pathways through which a malignant process can develop in ovarian endometriomas include: redox imbalance, which triggers a whole spectrum of oncogenic mutations, as well as immune disorders and exposure to high levels of estrogens. However, if patients with ovarian endometriomas are properly managed, the likelihood of ovarian cancer development is low.
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Wendel, Jillian, Xiyin Wang, and Shannon Hawkins. "The Endometriotic Tumor Microenvironment in Ovarian Cancer." Cancers 10, no. 8 (August 7, 2018): 261. http://dx.doi.org/10.3390/cancers10080261.
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Women with endometriosis are at increased risk of developing ovarian cancer, specifically ovarian endometrioid, low-grade serous, and clear-cell adenocarcinoma. An important clinical caveat to the association of endometriosis with ovarian cancer is the improved prognosis for women with endometriosis at time of ovarian cancer staging. Whether endometriosis-associated ovarian cancers develop from the molecular transformation of endometriosis or develop because of the endometriotic tumor microenvironment remain unknown. Additionally, how the presence of endometriosis improves prognosis is also undefined, but likely relies on the endometriotic microenvironment. The unique tumor microenvironment of endometriosis is composed of epithelial, stromal, and immune cells, which adapt to survive in hypoxic conditions with high levels of iron, estrogen, and inflammatory cytokines and chemokines. Understanding the unique molecular features of the endometriotic tumor microenvironment may lead to impactful precision therapies and/or modalities for prevention. A challenge to this important study is the rarity of well-characterized clinical samples and the limited model systems. In this review, we will describe the unique molecular features of endometriosis-associated ovarian cancers, the endometriotic tumor microenvironment, and available model systems for endometriosis-associated ovarian cancers. Continued research on these unique ovarian cancers may lead to improved prevention and treatment options.
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Manu, Andrei, Ciprian Andrei Coroleucă, Cătălin Bogdan Coroleucă, Diana-Elena Comandașu, Diana-Elena Soare, Alexandra Bauşic, Cristina-Maria Iacob, Mihaela-Arina Banu, Anca Hashemi, and Elvira Brătilă. "Endometriomul ovarian – vârful aisbergului?" Obstetrica şi Ginecologia 2, no. 1 (June 30, 2023): 73–76. http://dx.doi.org/10.26416/obsgin.71.2.2023.8874.
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Endometriosis is a chronic disease that affects around 10% of women who are of reproductive age. It may lead to significant morbidity, and it is a serious public health concern. Ovarian lesions, such as endometriomas or traditional ovarian cysts, are the most common localizations of endometriosis. Transvaginal ultrasonography is the first-line imaging modality for predicting deeply infiltrating endometriosis and is a straightforward diagnostic technique with a good diagnostic accuracy for endometriomas. A total of 437 patients who underwent preoperative ultrasonography examination and underwent surgery for deeply infiltrating endometriosis were included in our retrospective observational study. Of these, 45.2% (152 patients) had an endometriosis cyst diagnosis alone, with no further deep endometriosis lesions detected by ultrasonography; nevertheless, a number of patients had numerous deeply infiltrating lesions diagnosed intraoperatively. The objective of the present research was to evaluate the correlation between the sonographic identification of ovarian endometriomas and the detection of particular extraovarian endometriotic lesions, such as parametrial, rectovaginal and intestinal lesions, using transvaginal ultrasound.
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Blontzos, Nikolaos, Despoina Mavrogianni, Konstantinos Ntzeros, Nikolaos Kathopoulis, Athanasios Moustogiannis, Anastassios Philippou, Michael Koutsilieris, and Athanasios Protopapas. "Differential Expression of Insulin Growth Factor 1 (IGF-1) Isoforms in Different Types of Endometriosis: Preliminary Results of a Single-Center Study." Biomolecules 14, no. 1 (December 20, 2023): 7. http://dx.doi.org/10.3390/biom14010007.
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Endometriosis is a benign, estrogen-dependent gynecological condition with an uncertain exact pathogenetic mechanism. The aim of this study was to evaluate the potential differential expression of Insulin Growth Factor 1 (IGF-1) isoforms in deeply infiltrating endometriotic (DIE) lesions, in ovarian endometriomas, and in the eutopic endometrium of the same endometriosis patients and to compare their expression with that in the eutopic endometrium of women without endometriosis. A total of 39 patients were included: 28 with endometriosis, of whom 15 had endometriomas only, 7 had DIE nodules only, and 6 had both DIE and endometriomas, and 11 without endometriosis served as controls. We noticed a similar pattern of expression between IGF-1Ea and IGF-1Ec, which differed from that of the IGF-1Eb isoform, possibly implying differential biological actions of different isoforms in DIE subtypes. We observed a tendency of lower expression of IGF-1Ea and IGF-1Ec in endometriomas without DIE compared to endometriomas with concurrent DIE or in DIE nodules. In conclusion, differential expression of IGF-1 isoforms may indicate that DIE with its associated ovarian lesions and simple ovarian endometriosis should be considered as two forms of the disease developing under different molecular pathways.
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Ilgen, Orkun, Sefa Kurt, Deniz Gokcay, and Emine Cagnur Ulukus. "Malignant transformation of endometriosis on vaginal cuff after hysterectomy: a case report." Journal of Clinical and Investigative Surgery 6, no. 2 (November 15, 2021): 161–65. http://dx.doi.org/10.25083/2559.5555/6.2.13.
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Objective. Endometriotic tissue implants rarely transform to malignant tissue, especially in a patient with a hysterectomy and bilaterally salpingo-oophorectomy. However, several cases with cancer arising from endometriosis after hysterectomy were reported in the literature. Hormone replacement therapy only with estrogen is a crucial risk factor for malignant transformation of persistent endometriotic tissue. Case Report. The present case demonstrates an endometrioid adenocarcinoma arising from persistent endometriosis tissue in a patient who was performed hysterectomy with bilateral salpingectomy 3 years ago. The histopathologic specimens of the previous surgery did not include any malignant tissue. After 3 years, she applied to the hospital with abnormal vaginal bleeding, and her histopathologic examination result found an ulcerated mass at the upper one-third of the vagina that is compatible with endometrioid adenocarcinoma. Conclusion. It is crucial to keep in mind the endometriosis history of the patient, to be able to diagnose cancer arising from endometriosis while evaluating the patient with a hysterectomy.
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Okulova, E. O., O. A. Melkozerova, A. A. Mikhelson, G. B. Malgina, T. B. Tretyakova, and T. A. Putilova. "Activating mutations of genes in the PI3K/AKT/mTOR signaling pathway and ovarian reserve status in patients of reproductive age with deep infiltrating endometriosis." Voprosy ginekologii, akušerstva i perinatologii 20, no. 6 (2021): 92–100. http://dx.doi.org/10.20953/1726-1678-2021-6-92-100.
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Objective. To study the effect of deep infiltrating endometriosis on the status of ovarian reserve in patients of reproductive age and to assess the spectrum of PIK3CA gene mutations among patients with infiltrating form of external genital endometriosis. Patients and methods. The study group included 50 patients of reproductive age with deep infiltrating endometriosis, of whom 18 had deep infiltrating endometriosis combined with ovarian endometriomas. The comparison group included 25 patients of reproductive age who underwent laparoscopic metroplasty of post-cesarean section uterine scar. In all patients, serum levels of anti-mullerian hormone (AMH), follicle-stimulating hormone, and estradiol were determined by enzyme immunoassay, and an antral follicle count in the ovaries was done via transvaginal ultrasound. The search for activating mutations in the PIK3CA gene was performed by next-generation DNA sequencing in the samples of ovarian endometriomas from patients with a combination of infiltrating endometriosis and endometrioid cysts (n = 18) and in biopsy samples of healthy ovarian tissue from all patients in the study (n = 50) and comparison groups (n = 25). Results. Evaluation of the ovarian reserve status in patients from two groups showed that levels of AMH were lower in patients with infiltrating form of external genital endometriosis than in the comparison group by 1.0 ng/mL on average (2.6 ± 2.2 ng/mL in the study group, 3.6 ± 3.5 ng/mL in the comparison group), but the difference was not statistically significant, p > 0.05. The number of antral follicles according to transvaginal ultrasound was significantly lower in the study group (8.5 ± 4.5) than in the comparison group (12.2 ± 4.1), p = 0.001. This difference was statistically significant both for patients with ovarian endometriomas (6.0 ± 4.2, p < 0.001) and for patients without ovarian endometrioid tumors (9.8 ± 4.2, p = 0.04). Our study did not detect PIK3CA gene mutations in any of the ovarian endometrioma tissue samples from patients with a combination of infiltrating endometriosis and endometrioid cysts, and in none of the healthy ovarian tissue biopsy samples from patients in the study and comparison groups. Conclusion. Thus, the presence of deep infiltrating endometriosis is associated with diminished ovarian reserve in patients of reproductive age, regardless of the presence of ovarian endometrioid tumors. Population studies are needed to detect PIK3CA gene mutations in endometriosis, as well as to investigate mutations in other genes encoding regulatory proteins of the PI3K/AKT/mTOR anti-apoptotic signaling pathway to reveal the mechanisms of ovarian reserve depletion in case of infiltrating forms of external genital endometriosis. Key words: infertility, deep infiltrating endometriosis, ovarian reserve, PI3K/AKT/mTOR signaling pathway, ovarian endometrioma
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Melkozerova, Oxana A., Ekaterina O. Okulova, Anna A. Mikhelson, and Tatyana B. Tretyakova. "The role of mutations in the PI3K/AKT/mTOR signal pathway in decreasing ovarian reserve in reproductive patients with deep infiltrative endometriosis." Gynecology 23, no. 6 (December 15, 2021): 548–53. http://dx.doi.org/10.26442/20795696.2021.6.201012.
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Aim. To study the effect of deep infiltrative endometriosis on the state of the ovarian reserve in patients of reproductive age, as well as to evaluate the spectrum of mutations in the PIK3CA gene among patients with infiltrative form of external genital endometriosis.
Materials and methods. The main group of the study included 50 patients of reproductive age with deep infiltrative endometriosis, in 18 of whom deep infiltrative endometriosis was combined with ovarian endometriomas. The comparison group included 25 patients of reproductive age who underwent laparoscopic metroplasty of an inconsistent uterine scar from a cesarean section. All patients underwent determination of the level of anti-Mllerian hormone, follicle-stimulating hormone and estradiol in the blood by enzyme immunoassay, as well as counting the number of antral follicles in the ovaries during transvaginal ultrasound examination. The search for activating mutations of the PIK3CA gene was carried out by sequencing a new generation of DNA in tissue samples of ovarian endometriomas in patients with a combination of infiltrative endometriosis and endometrioid ovarian cysts (n=18), as well as in biopsies of healthy ovarian tissue in all patients of the main group (n=50) and comparison groups (n=25).
Results. When assessing the state of the ovarian reserve in the patients of the two groups, it was found that the anti-Mllerian hormone level in the patient with the infiltration form of external genital endometriosis was 2.62.2 ng/ml, while in the comparison group it was 3.63.5 ng/ml, however, the difference did not reach statistical significance, p0.05. The number of antral follicles according to transvaginal ultrasound was significantly lower in the main group (8.54.5) than in the comparison group (12.24.1), p=0.001. This difference was statistically significant both for patients with ovarian endometriomas (6.04.2, p0.001) and for patients without ovarian endometriomas (9.84.2, p=0.04). Our study did not reveal PIK3CA gene mutations in any of the ovarian endometrioma tissue samples from patients with a combination of infiltrative endometriosis and endometrioid ovarian cysts, as well as in none of the healthy ovarian tissue biopsies from patients of the main group and the comparison group using the new generation DNA sequencing method.
Conclusion. The presence of deep infiltrative endometriosis is associated with a decrease in ovarian reserve in patients of reproductive age, regardless of the presence of endometrioid ovarian lesions. Population studies are needed to identify mutations of this gene in endometriosis, as well as to study mutations of other genes encoding proteins regulating the antiapoptotic signaling pathway PI3K/AKT/mTOR, to identify the mechanism of ovarian reserve depletion in infiltrative form of external genital endometriosis.
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Andreeva, Nelly Yu, Maria I. Yarmolinskaya, Elena V. Misharina, Gulrukhsor Kh Tolibova, and Valeriia O. Semenova. "Evaluation of survivin expression in the endometrium and endometriotic lesions in patients with genital endometriosis, type 1 diabetes mellitus and their comorbidity." Journal of obstetrics and women's diseases 72, no. 3 (July 14, 2023): 5–13. http://dx.doi.org/10.17816/jowd345406.
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BACKGROUND: The prevalence of external genital endometriosis is high, yet there is insufficient understanding of its etiology and pathogenesis. This coupled with the challenges posed by its diagnosis and treatment, and its co-occurrence with type 1 diabetes mellitus, underscores the significance of this issue.
AIM: The aim of this study was to evaluate the expression of survivin in the eutopic endometrium, endometriotic lesions, and their concomitant conditions in patients with external genital endometriosis and type 1 diabetes mellitus.
MATERIALS AND METHODS: This study enrolled 43 female patients of reproductive age who were divided into four groups. The main group (n = 17) included women with surgically and histologically confirmed external genital endometriosis combined with type 1 diabetes mellitus. The external genital endometriosis group (n = 9) comprised women with isolated external genital endometriosis, while the type 1 diabetes mellitus group (n = 6) included patients with type 1 diabetes mellitus only. Finally, the control group (n = 6) consisted of women without any gynecological pathology. Biological specimens were collected during the follicular phase of the menstrual cycle, and morphological examination was carried out through histological and immunohistochemical evaluation of the endometrium and endometrioid heterotopias. Statistical analysis of the data was performed using the Jamovi software program, with statistical significance defined as p 0.05.
RESULTS: Our findings indicate that patients with external genital endometriosis and comorbid type 1 diabetes mellitus exhibit a statistically significant increase in survivin expression in the endometrium compared to the control group or patients with type 1 diabetes mellitus only. However, no significant difference was observed in survivin expression in endometriotiс lesions between patients with external genital endometriosis and those with external genital endometriosis combined with type 1 diabetes mellitus.
CONCLUSIONS: The data obtained suggest the role of survivin in the pathogenesis of external genital endometriosis, regardless of the presence of type 1 diabetes mellitus.
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Maier, Ioana Maria, Adrian Cornel Maier, Andrada Crișan, and Lucian Puşcaşiu. "Clinical and Pathological Significance of Cellular Atypia in Endometriosis." Medicina 57, no. 5 (May 7, 2021): 453. http://dx.doi.org/10.3390/medicina57050453.
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Objective: To highlight the most frequent localization of ovarian endometriosis, the presence of atypical endometriosis, and recurrences. Retrospective review of 259 patients diagnosed with ovarian endometriosis treated at Tîrgu-Mures Emergency County Hospital, Obstetric Gynecology Clinic, between January 2014 and December 2018. Methods: Data were collected and analyzed for demographics, size of ovarian endometriotic cyst, and recurrences. Results: Out of 259 patients, 51 patients presented atypia, 20 on the right, 24 on the left, and seven patients were diagnosed with endometriosis with bilateral atypia. Higher susceptibility for left localization was noted. Thirty-nine patients (15.1%) presented recurrence. A statistically significant correlation (p = 0.006) was noted between patients with recurrence and atypia compared with those without atypia and endometriotic cysts larger than 7 cm. Patients with relapse under the age of 40 were noted to have mainly atypia with localization on the right (p = 0.025, OD = 4.107). Conclusion: The presence of endometrioma was not statistically significant correlated with left or right sided localization; recurrent endometriomas larger than 7 cm represents a risk for atypical endometriosis development. Recurrence and atypia appear more often in patients under the age of 40 and are right-sided. The total removal of the endometriomas can prevent the recurrence and subsequently the appearance of atypia and secondary neoplastic conditions.
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Jindal, Gunjan, Arun Kalpdev, Amit Shrivastava, Simran Jain, and Srishti Mann. "Magnetic resonance imaging in pelvic endometriosis with surgical correlation: a pictorial review." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 12, no. 11 (October 27, 2023): 3436–40. http://dx.doi.org/10.18203/2320-1770.ijrcog20233327.
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Endometriosis is a common gynaecological problem, primarily affecting women of reproductive age. Most common site of endometriosis is ovaries. Extra ovarian sites include uterine ligaments, fallopian tubes, rectosigmoid, laparotomy or C-section scars and urinary bladder. There can be formation of ovarian endometriotic cysts or deep infiltrating endometriosis. The role of MRI is in the evaluation of deep or more complex disease as it enables a large field of view, superior contrast resolution and multiplanar capabilities as compared to ultrasound. In this article, we are describing MRI imaging appearances of endometriomas and deep pelvic endometriosis in the form of a pictorial essay.
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Tingi, Efterpi. "A case report of caesarean scar endometriosis." Hellenic Journal of Obstetrics and Gynecology 17, no. 1 (January 3, 2018): 19–21. http://dx.doi.org/10.33574/hjog.1506.
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Although it is uncommon, extrapelvic endometriosis can form a discrete mass known as an abdominal wall endometrioma. The incidence of abdominal wall endometriomas has been estimated to be 0.03% to 0.15% of all cases of endometriosis. We report a case of scar endometriosis in Pfannesteil scar in a 31 year old woman, who presented six years following an emergency Caesarean Section, complaining of some lumps on her incision scar. The patient underwent laparotomy followed by the excision of five endometriotic nodules.
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Leung, Felix, Marcus Q. Bernardini, Kun Liang, Ihor Batruch, Marjan Rouzbahman, Eleftherios P. Diamandis, and Vathany Kulasingam. "Unraveling endometriosis-associated ovarian carcinomas using integrative proteomics." F1000Research 7 (February 14, 2018): 189. http://dx.doi.org/10.12688/f1000research.13863.1.
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Background: To elucidate potential markers of endometriosis and endometriosis-associated endometrioid and clear cell ovarian carcinomas using mass spectrometry-based proteomics. Methods: A total of 21 fresh, frozen tissues from patients diagnosed with clear cell carcinoma, endometrioid carcinoma, endometriosis and benign endometrium were subjected to an in-depth liquid chromatography-tandem mass spectrometry analysis on the Q-Exactive Plus. Protein identification and quantification were performed using MaxQuant, while downstream analyses were performed using Perseus and various bioinformatics databases. Results: Approximately 9000 proteins were identified in total, representing the first in-depth proteomic investigation of endometriosis and its associated cancers. This proteomic data was shown to be biologically sound, with minimal variation within patient cohorts and recapitulation of known markers. While moderate concordance with genomic data was observed, it was shown that such data are limited in their abilities to represent tumours on the protein level and to distinguish tumours from their benign precursors. Conclusions: The proteomic data suggests that distinct markers may differentiate endometrioid and clear cell carcinoma from endometriosis. These markers may be indicators of pathobiology but will need to be further investigated. Ultimately, this dataset may serve as a basis to unravel the underlying biology of the endometrioid and clear cell cancers with respect to their endometriotic origins.
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Leung, Felix, Marcus Q. Bernardini, Kun Liang, Ihor Batruch, Marjan Rouzbahman, Eleftherios P. Diamandis, and Vathany Kulasingam. "Unraveling endometriosis-associated ovarian carcinomas using integrative proteomics." F1000Research 7 (June 20, 2018): 189. http://dx.doi.org/10.12688/f1000research.13863.2.
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Background: To elucidate potential markers of endometriosis and endometriosis-associated endometrioid and clear cell ovarian carcinomas using mass spectrometry-based proteomics. Methods: A total of 21 fresh, frozen tissues from patients diagnosed with clear cell carcinoma, endometrioid carcinoma, endometriosis and benign endometrium were subjected to an in-depth liquid chromatography-tandem mass spectrometry analysis on the Q-Exactive Plus. Protein identification and quantification were performed using MaxQuant, while downstream analyses were performed using Perseus and various bioinformatics databases. Results: Approximately 9000 proteins were identified in total, representing the first in-depth proteomic investigation of endometriosis and its associated cancers. This proteomic data was shown to be biologically sound, with minimal variation within patient cohorts and recapitulation of known markers. While moderate concordance with genomic data was observed, it was shown that such data are limited in their abilities to represent tumours on the protein level and to distinguish tumours from their benign precursors. Conclusions: The proteomic data suggests that distinct markers may differentiate endometrioid and clear cell carcinoma from endometriosis. These markers may be indicators of pathobiology but will need to be further investigated. Ultimately, this dataset may serve as a basis to unravel the underlying biology of the endometrioid and clear cell cancers with respect to their endometriotic origins.
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Yachida, Nozomi, Kosuke Yoshihara, Manako Yamaguchi, Kazuaki Suda, Ryo Tamura, and Takayuki Enomoto. "How Does Endometriosis Lead to Ovarian Cancer? The Molecular Mechanism of Endometriosis-Associated Ovarian Cancer Development." Cancers 13, no. 6 (March 22, 2021): 1439. http://dx.doi.org/10.3390/cancers13061439.
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Numerous epidemiological and histopathological studies support the notion that clear cell and endometrioid carcinomas derive from ovarian endometriosis. Accordingly, these histologic types are referred to as “endometriosis-associated ovarian cancer” (EAOC). Although the uterine endometrium is also considered an origin of endometriosis, the molecular mechanism involved in transformation of the uterine endometrium to EAOC via ovarian endometriosis has not yet been clarified. Recent studies based on high-throughput sequencing technology have revealed that cancer-associated gene mutations frequently identified in EAOC may exist in the normal uterine endometrial epithelium and ovarian endometriotic epithelium. The continuum of genomic alterations from the uterine endometrium to endometriosis and EAOC has been described, though the significance of cancer-associated gene mutations in the uterine endometrium or endometriosis remains unclear. In this review, we summarize current knowledge regarding the molecular characteristics of the uterine endometrium, endometriosis, and EAOC and discuss the molecular mechanism of cancer development from the normal endometrium through endometriosis in an effort to prevent EAOC.
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Hatirnaz, Safak, Sabri Colak, and Abdulkadir Reis. "Cystic Endometriosis in a Huge Degenerated Subserous Leiomyoma Mimicking Bilateral Multicystic Endometriomas in an Infertile Woman with Diminished Ovarian Reserve: A Rare Endometriotic Implantation." Case Reports in Obstetrics and Gynecology 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/2713943.
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Uterine leiomyomas are the most common pelvic tumor in women. Leiomyoma can show atypical locations and degenerations and may not be easily differentiated from adnexal masses. Uterine leiomyoma can undergo cystic degeneration and is said to be found in 4% of all types of degenerations. The commonest type of degeneration is hyaline seen in 60% of patients. Usually uterine leiomyoma does not present as clinical and radiological diagnostic challenge. However, when leiomyoma undergoes massive cystic degeneration they may become clinical and radiological diagnostic dilemmas. The MRI showed a huge cystic mass protruding up to the pelvis not differentiated from bilateral endometriomas and accompanying subserous myomas. Surgery revealed that the mass is not bilateral endometriomas but a huge pedunculated leiomyoma with cystic degeneration and cystic endometriosis. Endometriosis is a troubling gynecologic condition occurring in 10% to 15% of women of reproductive age and is associated with fertility problems. As a peritoneal disease, the locations of endometriotic lesions are predominantly the ovaries (96.4%), followed by the soft tissue (2.8%), gastrointestinal tract (0.3%), and urinary tract (0.2%) and other rare locations. The presented case is multiple sized cystic endometriosis (endometriomas) located in a huge pedunculated subserous leiomyoma in an infertile woman having a history of laparoscopic bilateral endometrioma surgery.Conclusion. To our knowledge, this is the first reported case for endometriotic cysts (endometriomas) located in a huge cystic degenerated leiomyoma. PubMed search revealed no report concerning endometriotic implantation in the leiomyomas.
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Lahori, M., and N. Borazan. "Concurrently Presenting Endometrial And Ovarian Endometrioid Adenocarcinomas- A Clinicopathologic Study Of 52 Cases." American Journal of Clinical Pathology 154, Supplement_1 (October 2020): S48. http://dx.doi.org/10.1093/ajcp/aqaa161.102.
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Abstract Introduction/Objective Concurrent presentation of endometrioid adenocarcinomas in endometrium and ovary is uncommon, but oft-noted. They may arise from ovarian metastasis of endometrial carcinoma, endometrial metastasis of ovarian carcinoma, or synchronous development of independent primary lesions. Scully and Young criteria have been widely used to differentiate the site of origin.1 Role of a field effect in the genesis of synchronous carcinomas is supported by increasing evidence that endometrioid ovarian carcinomas arise from endometriosis. 2–5 Methods All cases of concurrent endometrioid adenocarcinomas of the endometrium and ovary between 2002 and 2019 in the Mount Sinai health system New York were included, using pathology database (Powerpath) and EMR database (Epic). Results 52 cases of concurrent endometrioid adenocarcinomas of endometrium and ovary were identified between 2002 and 2019. Mean age at presentation was 54.07 years (24–80). 69.2% had synchronous origin, 21.15% had endometrial primary and 3.8% had an ovarian primary. Ovarian endometriosis was identified in 51.9% and complex atypical hyperplasia in 26.9%. Lower uterine segment involvement was seen in 26.9%, bilateral ovarian involvement in 40.3%, fallopian tube involvement in 23% and lymphovascular space invasion in 25%. Different histologic grade of ovarian and endometrial counterparts was noted in 25% cases. Synchronous endometrioid carcinomas had the following characteristics: mean age at presentation 50.6 years, associated with CAH in 33.3% and endometriosis in 66.6%, presentation at stage 1 in 63.8% and lower grade of differentiation (grade 1/2) in 80.5% cases. Conclusion In majority of cases, synchronous endometrioid carcinomas have a younger mean age at presentation, are lower grade tumors, present at stage 1 and have associated endometriosis. It can be inferred that the percentage of synchronous tumors with endometriotic foci would be even higher (with extensive sampling & assuming that the neoplastic process has replaced native benign endometriotic foci) – pointing towards the likely role of endometriosis in the genesis of these tumors.
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Zhu, Tian-Hong, Shao-Jie Ding, Tian-Tian Li, Li-Bo Zhu, Xiu-Feng Huang, and Xin-Mei Zhang. "Estrogen is an important mediator of mast cell activation in ovarian endometriomas." Reproduction 155, no. 1 (January 2018): 73–83. http://dx.doi.org/10.1530/rep-17-0457.
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Endometriosis is an estrogen-dependent disease. Previous research has shown that abnormal enzymes associated with estrogen (E2) metabolism and an increased number of mast cells (MCs) in endometriomas are implicated in the pathogenesis of endometriosis. However, it remains unclear how MCs mediate the role of E2 in endometriosis. Accordingly, we investigated whether E2 was associated with the number of MCs, and the rate of degranulation, in local ovarian endometriomas, as well as the role of E2 on MCs during the pathogenesis of endometriosis. Using enzyme-linked immunosorbent assay and immunohistochemistry, we found that concentrations of E2, and the number and activity of MCs, were significantly higher in ovarian endometriomas than in controls, and that these parameters were correlated with the severity of endometriosis-associated dysmenorrhea. By measuring the release of hexosaminidase, we found that the rate of RBL2H3 cell degranulation increased after E2 treatment. Furthermore, activation of RBL2H3 cells by E2 was found to trigger the release of biologically active nerve growth factor, which promotes neurite outgrowth in PC12 cells and also sensitizes dorsal root ganglion cells via upregulation ofNav1.8and transient receptor potential cation channel (subfamily V member 1) expression levels. When treated with E2, endometriotic cells could promote RBL2H3 cell recruitment by upregulating expression levels of stem cell factor, transforming growth factor-β and monocyte chemoattractant protein-1; these observations were not evident with control endometrial cells. Thus, elevated E2 concentrations may be a key factor for degranulation and recruitment of MCs in ovarian endometriomas, which play a key role in endometriosis-associated dysmenorrhea.
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Poli Neto, Omero B., Hebert M. Ferreira;, Leandra N. Z. Ramalho, Júlio C. Rosa e Silva, Francisco J. Candido dos Reis, and Antonio A. Nogueira. "Expression of p63 Differs in Peritoneal Endometriosis, Endometriomas, Adenomyosis, Rectovaginal Septum Endometriosis, and Abdominal Wall Endometriosis." Archives of Pathology & Laboratory Medicine 131, no. 7 (July 1, 2007): 1099–102. http://dx.doi.org/10.5858/2007-131-1099-eopdip.
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Abstract Context.—Although there is evidence that endometriosis results from basal endometrium dislocation, the underlying biology is not fully understood. One protein that plays an important role in regulating epithelial proliferation and differentiation is the 63-kDa membrane protein (p63), which is also a marker of basal and reserve cells in the female genital tract. Objective.—To determine whether p63 is expressed differently in peritoneal endometriosis, endometriomas, and adenomyosis, as well as in deep endometriotic nodules of the rectovaginal septum and abdominal wall. Design.—This study includes a prospective series of consecutive patients (Canadian Task Force classification II-2) from a tertiary care university hospital. Specimens collected from 83 patients (15 peritoneal endometriosis specimens, 22 endometrioma specimens, 36 adenomyosis specimens, and 10 rectovaginal septum/abdominal wall specimens) were evaluated. Diagnostic and operative laparoscopies or laparotomies were performed, and tissue samples were obtained. Immunohistochemistry was used to evaluate p63 expression. Results.—Positivity for p63 was detected in 93.3% of the peritoneal endometriosis specimens, 81.8% of the endometrioma specimens, 36.1% of the adenomyosis specimens, and none of the rectovaginal/abdominal wall endometriosis specimens (P < .001). Distribution of p63 immunostaining in the positive specimens was homogeneous. Conclusions.—Endometriotic lesions express p63 differently, and some retain the basal/reserve cell immunophenotype. Nevertheless, it remains unclear whether the lack of p63 expression in some lesions is related to the extent of the disease, to its clinical behavior, or to exacerbation of the accompanying symptoms.
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GABIDULLINA, RUSHANIA I., FARIDA F. MINNULLINA, DINARA I. AKHMETOVA, ALIYA SH ZARIPOVA, KAMILYA I. ZIDIHANOVA, and DARYA A. ROOT. "ON THE RISKS OF MALIGNISATION OF OVARIAN ENDOMETRIOMAS." Bulletin of Contemporary Clinical Medicine 16, no. 4 (August 2023): 78–82. http://dx.doi.org/10.20969/vskm.2023.16(4).78-82.
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Introduction. Endometriosis is a widespread gynecological disease. In the last few years, new data have been accumulating confirming that endometriosis leads to an increased risk of malignant neoplasms of the ovaries, endometrium, breast and thyroid gland. The most commonly found form of endometriosis is endometrioma. Objective: to analyze epidemiological and genetic studies of the risks of neoplastic transformation of ovarian endometriomas based on search results in electronic resources MEDLINE, EMBASE, Elibrary from 2012 to 2023. Results. Epidemiological and genetic studies have proven the risk of malignancy of endometriosis with the development of ovarian cancer related to endometriosis. Studies confirmed, that two histotypes of epithelial ovarian cancer, such as clear-cell and endometrioid cancer, most closely related to endometriosis. Genome-wide association studies (GWAS) have confirmed the risk of endometrial cancer in women with endometriosis, which was shown earlier than epidemiological studies. Finding the genes and pathways underlying these complex diseases is an essential step toward developing better diagnostic and therapeutic tools. Conclusion. The review presents epidemiological and genetic evidence of the risks of ovarian cancer and endometrial cancer in women with endometriosis.
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Hanáček, Jiří, Jan Drahoňovský, Hynek Heřman, Michal Eminger, Petr Křepelka, Petr Velebil, Kateřina Macková, and Markéta Dibonová. "Endometriosis in postmenopause." Česká gynekologie 87, no. 6 (December 23, 2022): 427–31. http://dx.doi.org/10.48095/cccg2022427.
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In our review article, we focused on the rare topic of endometriosis in postmenopause. Endometriosis is primarily a disease of women of reproductive age. In postmenopause, atrophy of endometriosis foci usually occurs. However, recurrence or even de novo occurrence of endometriosis in postmenopause has also been described. The prevalence in postmenopause has been reported to be around 2–5%. Factors that may account for the recurrence of endometriosis are exogenously administered estrogens, self-production of estrogens in peripheral adipose tissue, or activation of aromatase in the focus of endometriosis. When hormonal therapy is required, the best results are achieved by administration of Tibolone. Risk factors for recurrence and subsequent difficulties are the extent of endometriosis, the retained uterus and adnexa. Pain was the most common symptom in 43.5% and palpable finding in 28%. Endometriotic cells are capable of proliferation, survival in an ectopic localization and metastasis to distant locations. The risk of malignant transformation is around 1% and the most common are ovarian tumors. Endometriosis-associated ovarian tumors are typically low-grade disease, histologically endometrioid or clear cell carcinomas. Diagnosis is based on ultrasound and magnetic resonance imaging. The basis of therapy for newly developed endometriosis or when symptoms associated with the risk of endometriosis appear is a surgical solution, primarily to exclude the cancerous process. Key words: endometriosis – postmenopause – malignancy – hormonal treatment
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Ozerskaya, I. A., G. G. Kazaryan, E. V. Minashkona, and A. I. Gus. "International Endometrial Tumor Analysis (IETA) descriptors in the diagnosis of chronic endometritis." Ultrasound & Functional Diagnostics, no. 3 (February 13, 2024): 50–66. http://dx.doi.org/10.24835/1607-0771-2023-3-50-66.
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Objective: to compare the terms, definitions and measurement methods developed by the IETA group with the ultrasound criteria of chronic endometritis (CE) used in Russia.Material and methods. A retrospective cohort study of 158 reproductive age women with clinical and laboratory diagnosis of CE was carried out. Sonographic examination was performed in the early or middle proliferative phase (cycle day 4–10 days) with the use of Affiniti70 ultrasound system (Philips, the Netherlands) with a multifrequency 3D endocavitary probe. Uterine corpus volume, endometrial thickness and volume were measured, followed by percentage endometrial/uterine volume ratio calculation, the so-called adjusted endometrial volume. Qualitative analysis of grayscale imaging included assessment of endometrial structure and echogenicity; closure or separation of the endometrial layers; contour of endometrial midline; the presence of acoustic artifacts, such as reverberation in the presence of gas or liquid in the uterine cavity, described by a number of authors. Relevant IETA descriptions were searched when assessing all qualitative CE features. In parallel, a qualitative score analysis proposed by the IETA group was carried out.Timely preoperative diagnosis of endometrioic cyst (endometrioma), as well as deep endometriosis remains relevant. The aim of the study was to assess the diagnostic value of ultrasound in patients with endometriomas and assess the combination of them with other foci of external genital endometriosis. The study based on retrospective analysis of a date of 95 patients with ultrasound signs of ovarian endometriomas, who underwent examination in MedicoProfi LLC – Borisov Medical and Diagnostic Clinic (Krasnoyarsk) during the period from January 2019 to October 2023. All of patients underwent surgery , followed by morphological evaluation. In the vast majority of cases, it was possible to detect a combination of endometriomas with one or more foci of deep endometriosis. Superficial peritoneal endometriosis and adhesions were found on surgery in all cases when endometriomas appeared isolated on ultrasound. The results of the study showed: endometriomas combined with deep endometriosis in 96.8% of cases. Thus, ultrasound detection of endometrioma is a very reliable sign of deep endometriosis presence. The “kissing ovaries” symptom in bilateral endometriomas can be considered as an absolutely reliable sign of the uterosacral ligaments endometriosis with specificity of 100% and positive predictive value of 100%. The presence of the “kissing ovaries” sign should be depicted in the conclusion of the ultrasound protocol, since it highly suggestive to obliteration of the pouch of Douglas and involvement of adjacent organs (fallopian tubes, intestines, ureters, etc.) in the endometrioid infiltrates, which is extremely important for the surgery planning, as well as in patients with infertility. There is an obvious need to introduce the extended pelvic ultrasound protocol to the diagnostic algorithm for patients with suspected endometriosis, which will more accurately describe the disease extension.Results. The comparative analysis of endometrium description in CE indicates a similar measurement technique for endometrial and intrauterine lesions thickness, both proposed by the IETA group and used in our country. Most of the IETA descriptors for qualitative ultrasound findings may be used in CE diagnosis. However, there are no some significant ultrasound features for identifying the inflammation, such as marked and partially or completely thickened midline, as well as gas focuses within the endometrium or in the uterine cavity, in IETA description.Conclusion. Terminology standardization allows compare the results and perform multicenter studies followed by meta-analysis for the diagnosis of chronic endometritis, if researchers use the similar descriptors.
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Bergamini, Alice, Giorgia Mangili, Alessandro Ambrosi, Gianluca Taccagni, Emanuela Rabaiotti, Luca Bocciolone, Giorgio Candotti, et al. "Endometriosis-Related Ovarian Cancers: Evidence for a Dichotomy in the Histogenesis of the Two Associated Histotypes." Diagnostics 13, no. 8 (April 15, 2023): 1425. http://dx.doi.org/10.3390/diagnostics13081425.
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Evidence indicates that different pathways of malignant degeneration underlie the development of endometriosis-associated ovarian tumors of endometrioid and clear cell histotypes. The aim of this study was to compare data from patients affected by these two histotypes to investigate the hypothesis of a dichotomy in the histogenesis of these tumors. Clinical data and tumor characteristics of 48 patients who were diagnosed with either pure clear cell ovarian cancer and mixed endometrioid–clear cell ovarian cancer arising from endometriosis (ECC, n = 22) or endometriosis-associated endometrioid ovarian cancer (EAEOC, n = 26) were compared. A previous diagnosis of endometriosis was detected more frequently in the ECC group (32% vs. 4%, p = 0.01). The incidence of bilaterality was significantly higher in the EAOEC group (35% vs. 5%, p = 0.01) as well as a solid/cystic rate at gross pathology (57.7 ± 7.9% vs. 30.9 ± 7.5%, p = 0.02). Patients with ECC had a more advanced disease stage (41% vs. 15%; p = 0.04). A synchronous endometrial carcinoma was detected in 38% of EAEOC patients. A comparison of the International Federation of Gynecology and Obstetrics (FIGO) stage at diagnosis showed a significantly decreasing trend for ECC compared to EAEOC (p = 0.02). These findings support the hypothesis that the origin, clinical behavior and relationship with endometriosis might be different for these histotypes. ECC, unlike EAEOC, seems to develop within an endometriotic cyst, thus representing a window of possibility for ultrasound-based early diagnosis.
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Steinbuch, Sophie Charlotte, Anne-Marie Lüß, Stephanie Eltrop, Martin Götte, and Ludwig Kiesel. "Endometriosis-Associated Ovarian Cancer: From Molecular Pathologies to Clinical Relevance." International Journal of Molecular Sciences 25, no. 8 (April 13, 2024): 4306. http://dx.doi.org/10.3390/ijms25084306.
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Endometriosis is a chronic condition affecting reproductive-aged women, characterized by the growth of ectopic endometrial tissue. Despite being benign, endometriosis is associated with an increased risk of certain cancers, including endometriosis-associated ovarian cancer (EAOC). Ovarian cancer is rare, but more common in women with endometriosis, particularly endometrioid and clear-cell carcinomas. Factors such as hormonal imbalance, reproductive history, environmental exposures, and genetic predisposition contribute to the malignant transformation of endometriosis. Thus, understanding potential risk factors causing malignancy is crucial. Over the past few decades, various genetic mutations, microRNAs, as well as tumor microenvironmental factors have been identified, impacting pathways like PI3K/AKT/mTOR, DNA repair mechanisms, oxidative stress, and inflammation. Thus, this review aims to summarize molecular studies involved in EAOC pathogenesis as potential therapeutic targets. However, further research is needed to better understand the molecular and environmental factors driving EAOC development, to target the susceptibility of endometriotic lesions to malignant progression, and to identify effective therapeutic strategies.
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Struk, T., O. Gordeichuk, O. Nikitinа, and O. Lytvak. "THE PECULIARITIES OF PERIOPERATIVE CLINICAL CHARACTERISTICS OF PATIENTS WITH GENITAL ENDOMETRIOSIS ASSOCIATED WITH HYPOTHYROSIS." Клінічна та профілактична медицина 1, no. 1 (March 22, 2020): 40–50. http://dx.doi.org/10.31612/2616-4868.1(11).2020.05.
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Purpose: to elucidate the peculiarities of perioperative clinical characteristics of female patients with genital endometriosis associated with hypothyrosis. To attain our object, the following tasks had to be accomplished:
to determine the localization of endometrioid heterotopia and severity of endometriosis in patients with hypothyrosis;
to study the types of surgical interventions in patients with endometriosis associated with hypothyrosis;
to assess the frequency of endometriosis recurrence after surgical treatment in patients with endometriosis associated with hypothyrosis.
Material and methods. We examined 100 female patients: 40 patients – with endometriosis associated with hypothyrosis (main group – group I); 60 patients – with endometriosis and without thyroid pathology (group of comparison – group II). We analyzed the results of clinical, laboratory and instrumental examination, including radiological methods (CT-scan, X-ray). The diagnosis in all the patients was based on pathohistological verification. All surgical interventions were performed by the use of endovideosurgical technology.
Results and discussion. According to the results of patients` examination, we identified the following localization of endometrioid heterotopia and severity of endometriosis:
Stage I – 38,0 % of patients with ovarian endometrial cysts and adenomiosis;
Stage II – 27,0 % of patients with peritoneal endometriosis and adenomiosis;
Stage III – 23,0 % of patients with ovarian endometrial cysts, adenomiosis, peritoneal and urinary tract endometriosis;
Stage IV – 12,0 % of patients with ovarian endometrial cysts, adenomiosis, peritoneal and retrocervical endometriosis.
The 80,0 % of patients underwent organ-preserving procedures, and radical surgery was performed in 20,0 % of cases. We used the following surgical approaches to the endometrial lesions: 56,0 % − combined laparoscopy and hysteroscopy; 42,0 % − transvaginal laparoscopy; and only in 2,0 % of cases – conversion to laparotomy. The frequency of endometriosis recurrence after surgical treatment in patients with hypothyrosis was established: 4,0 % − at 6-month follow-up; 6,0 % − at 9-month follow-up; and 10,0% − at 12-month follow-up. We observed complete relief from the endometriosis symptoms in 80,0 % of patients after the surgical procedure. Additionally, the reproductive function was recovered in 24,0 % of females.
Conclusions. The surgical treatment of patients with endometriosis associated with hypothyrosis should be based on the principle of radical removal of endometriotic lesions, particularly through the combined simultaneous procedures in case of advanced extragenital endometriosis. Additionally, several aspects should be taken into account, namely: localization of endometrioid heterotopia and severity of endometriosis; the age of patients and their interest in the preservation of reproductive function; the presence of the highly qualified surgeons (gynecologists, general surgeons, urologists), as well the high level of anesthetic support with thorough postoperative monitoring.
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Rudic-Biljic-Erski, Ivana, Mladenko Vasiljevic, Snezana Rakic, Olivera Dzatic-Smiljkovic, and Sladjana Mihajlovic. "Clear cell/endometrioid type ovarian carcinoma associated with endometriosis of the ipsilateral ovary." Vojnosanitetski pregled 76, no. 5 (2019): 547–51. http://dx.doi.org/10.2298/vsp170424107r.
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Introduction. Ovarian endometriosis has been identified as a risk factor for occurrence of endometriosis-associated ovarian carcinoma. We presented a rare case of simultaneous clear cell/ endometrioid ovarian carcinoma and endometriosis of the ipsilateral ovary. Case report. A 47-yearold patient underwent surgery for right ovarian endometriotic cyst. A total hysterectomy with bilateral salpingooophorectomy, lymphadenectomy in the right psoas muscle region and omentectomy were performed as well as multiple peritoneal biopsies. Six cycles of chemotherapy were instituted postoperatively using the Taxol-CBDCA protocol. Abdominal and pelvic CT did not demonstrate recurrence of the disease postoperatively and after completed chemotherapy treatment. Six months after the completion of treatment, the patient felt well without the disease recurrence. Conclusion. Clear cell and endometrioid subtypes of ovarian carcinoma have good prognosis if they are diagnosed and treated at an early stage of the disease. In our patient, the carcinoma was detected in the first stage and successfully treated with combination therapy, i.e., surgical and chemotherapy.
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Aylamazyan, Edvard K., Mariya I. Yarmolinskaya, Arseniy S. Molotkov, and Dmitry Z. Tsitskarava. "Classifications of endometriosis." Journal of obstetrics and women's diseases 66, no. 2 (March 15, 2017): 77–92. http://dx.doi.org/10.17816/jowd66277-92.
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In the article a review of the main classifications of endometriosis is presented. Main drawbacks of existing classifications have been revealed. A need for a new classification of the disease, which has to be empirical, evidence-based, containing terms that have unambiguous definitions, applicable for various clinical situations, taking into account new clinical forms and able to predict a course of the disease (including the development of pain syndrome and infertility), it’s outcomes and a risk of recurrence is stressed. The new classification of endometriosis has to be based on resolutions of a consensuses and applicable for new guidelines for diagnosis and treatment. For the new classification it is essential to be approachable and easy-to-use in routine clinical practice. It has to allow a physician to determine a stage the disease promptly and meaningfully. A new Protocol taking into account a combination of different forms of endometriosis (superficial, deep infiltrative, adenomyosis, endometriomas, extragenital), color of endometriotic lesions, special aspects of clinical course, results of hormonal examination, reproductive plans and prior hormonal therapy is proposed.
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Bulun, Serdar E., Bahar D. Yilmaz, Christia Sison, Kaoru Miyazaki, Lia Bernardi, Shimeng Liu, Amanda Kohlmeier, Ping Yin, Magdy Milad, and JianJun Wei. "Endometriosis." Endocrine Reviews 40, no. 4 (April 17, 2019): 1048–79. http://dx.doi.org/10.1210/er.2018-00242.
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AbstractPelvic endometriosis is a complex syndrome characterized by an estrogen-dependent chronic inflammatory process that affects primarily pelvic tissues, including the ovaries. It is caused when shed endometrial tissue travels retrograde into the lower abdominal cavity. Endometriosis is the most common cause of chronic pelvic pain in women and is associated with infertility. The underlying pathologic mechanisms in the intracavitary endometrium and extrauterine endometriotic tissue involve defectively programmed endometrial mesenchymal progenitor/stem cells. Although endometriotic stromal cells, which compose the bulk of endometriotic lesions, do not carry somatic mutations, they demonstrate specific epigenetic abnormalities that alter expression of key transcription factors. For example, GATA-binding factor-6 overexpression transforms an endometrial stromal cell to an endometriotic phenotype, and steroidogenic factor-1 overexpression causes excessive production of estrogen, which drives inflammation via pathologically high levels of estrogen receptor-β. Progesterone receptor deficiency causes progesterone resistance. Populations of endometrial and endometriotic epithelial cells also harbor multiple cancer driver mutations, such as KRAS, which may be associated with the establishment of pelvic endometriosis or ovarian cancer. It is not known how interactions between epigenomically defective stromal cells and the mutated genes in epithelial cells contribute to the pathogenesis of endometriosis. Endometriosis-associated pelvic pain is managed by suppression of ovulatory menses and estrogen production, cyclooxygenase inhibitors, and surgical removal of pelvic lesions, and in vitro fertilization is frequently used to overcome infertility. Although novel targeted treatments are becoming available, as endometriosis pathophysiology is better understood, preventive approaches such as long-term ovulation suppression may play a critical role in the future.
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Anastasi, Emanuela, Sara Scaramuzzino, Maria Federica Viscardi, Valentina Viggiani, Maria Grazia Piccioni, Laura Cacciamani, Lucia Merlino, Antonio Angeloni, Ludovico Muzii, and Maria Grazia Porpora. "Efficacy of N-Acetylcysteine on Endometriosis-Related Pain, Size Reduction of Ovarian Endometriomas, and Fertility Outcomes." International Journal of Environmental Research and Public Health 20, no. 6 (March 7, 2023): 4686. http://dx.doi.org/10.3390/ijerph20064686.
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Background: Endometriosis is a chronic, estrogen-dependent, inflammatory disease, whose pivotal symptoms are dysmenorrhea, dyspareunia, and chronic pelvic pain (CPP). Besides the usual medical treatments, recent evidence suggests there are potential benefits of oral N-acetylcysteine (NAC) on endometriotic lesions and pain. The primary objective of this prospective single-cohort study was to confirm the effectiveness of NAC in reducing endometriosis-related pain and the size of ovarian endometriomas. The secondary objective was to assess if NAC may play a role in improving fertility and reducing the Ca125 serum levels. Methods: Patients aged between 18–45 years old with a clinical/histological diagnosis of endometriosis and no current hormonal treatment or pregnancy were included in the study. All patients received quarterly oral NAC 600 mg, 3 tablets/day for 3 consecutive days of the week for 3 months. At baseline and after 3 months, dysmenorrhea, dyspareunia and CPP were assessed using the Visual Analog Scale score (VAS), while the size of the endometriomas was estimated through a transvaginal ultrasound. Analgesics (NSAIDs) intake, the serum levels of Ca125 and the desire for pregnancy were also investigated. Finally, the pregnancy rate of patients with reproductive desire was evaluated. Results: One hundred and twenty patients were recruited. The intensity of dysmenorrhea, dyspareunia and CPP significantly improved (p < 0.0001). The use of NSAIDs (p = 0.001), the size of the endometriomas (p < 0.0001) and the serum levels of Ca125 (p < 0.0001) significantly decreased. Among the 52 patients with reproductive desire, 39 successfully achieved pregnancy within 6 months of starting therapy (p = 0.001). Conclusions: Oral NAC improves endometriosis-related pain and the size of endometriomas. Furthermore, it decreases Ca125 serum levels and may improve fertility in patients with endometriosis.
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Centini, Gabriele, Giorgia Schettini, Emilio Pieri, Matteo Giorgi, Lucia Lazzeri, Francesco Giuseppe Martire, Virginia Mancini, et al. "Endometriosis-Related Ovarian Cancer: Where Are We Now? A Narrative Review towards a Pragmatic Approach." Journal of Clinical Medicine 13, no. 7 (March 27, 2024): 1933. http://dx.doi.org/10.3390/jcm13071933.
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Background: Endometriosis affects more than 10% of reproductive-aged women, causing pelvic pain and infertility. Despite the benign nature of endometriosis, ovarian endometriomas carry a higher risk of developing endometrioid carcinomas (EnOCs) and clear cell ovarian carcinomas (CCCs). Atypical endometriosis, defined as cytological atypia resembling intraepithelial cancer, is considered the precursor of endometriosis-associated ovarian cancer (EAOC). This narrative review aims to provide an overview of EAOC, proposing a practical approach to clinical and therapeutic decision making. Methods: An electronic literature search was conducted from inception up to January 2023, using the MEDLINE database via PubMed to evaluate the existing literature on EAOC, including its pathogenesis, the diagnostic process, and the therapeutic possibilities, with articles not relevant to the topic or lacking scientific merit being excluded. Results: Eighty-one articles were included in the review to present the current state of the art regarding EAOC. A pragmatic clinical flowchart is proposed to guide therapeutic decisions and improve patient outcomes. Conclusions: Endometriosis patients may have an increased risk of developing EAOC (either EnOC or CCC). Despite not being fully accepted, the concept of AE may reshape the endometriosis–ovarian cancer relationship. Further research is needed to understand the unaddressed issues.
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Chadchan, Sangappa B., Pooja Popli, Chandrasekhar R. Ambati, Eric Tycksen, Sang Jun Han, Serdar E. Bulun, Nagireddy Putluri, Scott W. Biest, and Ramakrishna Kommagani. "Gut microbiota–derived short-chain fatty acids protect against the progression of endometriosis." Life Science Alliance 4, no. 12 (September 30, 2021): e202101224. http://dx.doi.org/10.26508/lsa.202101224.
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Worldwide, ∼196 million are afflicted with endometriosis, a painful disease in which endometrial tissue implants and proliferates on abdominal peritoneal surfaces. Theories on the origin of endometriosis remained inconclusive. Whereas up to 90% of women experience retrograde menstruation, only 10% develop endometriosis, suggesting that factors that alter peritoneal environment might contribute to endometriosis. Herein, we report that whereas some gut bacteria promote endometriosis, others protect against endometriosis by fermenting fiber to produce short-chain fatty acids. Specifically, we found that altered gut microbiota drives endometriotic lesion growth and feces from mice with endometriosis contained less of short-chain fatty acid and n-butyrate than feces from mice without endometriosis. Treatment with n-butyrate reduced growth of both mouse endometriotic lesions and human endometriotic lesions in a pre-clinical mouse model. Mechanistic studies revealed that n-butyrate inhibited human endometriotic cell survival and lesion growth through G-protein–coupled receptors, histone deacetylases, and a GTPase activating protein, RAP1GAP. Our findings will enable future studies aimed at developing diagnostic tests, gut bacteria metabolites and treatment strategies, dietary supplements, n-butyrate analogs, or probiotics for endometriosis.
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Sendy, Feras. "Laparoscopic Diagnosis and Treatment of Stage 4 Endometriosis after Traumatic Agni karma with Abdominal Scars: a Case Report." Obstetrics Gynecology and Reproductive Sciences 4, no. 2 (August 10, 2020): 01–02. http://dx.doi.org/10.31579/2578-8965/040.
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Agni karma refers to the use of heated metals by traditional physicians. Endometriosis is defined as implantation of endometrial cells outside the endometrial cavity. Presenting symptoms are dyspareunia and dysmenorrhea. Recognition and awareness of such disorder are vital to avoid skin damage. A 31 years old nulliparous presented with dysmenorrhea and dyspareunia after unsuccessful attempts to alleviate symptoms by heated metals. Stage 4 endometrioses was diagnosed via laparoscopy and bilateral ovarian cystectomy was done for endometriomas. Agni karma is an unacceptable treatment for endometriosis as it results in avoidable body damage. Using heated rods is contraindicated in endometriosis, as it does neither alleviate symptoms nor treat the condition. It is used due to its lower cost, rapidity to treat the illness and non-complex equipment. To prevent unnecessary body damages, awareness is crucial along with consulting legal healthcare centers where medical and surgical treatment from qualified healthcare professionals is provided.
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Grandi, Giovanni, Angela Toss, Laura Cortesi, Laura Botticelli, Annibale Volpe, and Angelo Cagnacci. "The Association between Endometriomas and Ovarian Cancer: Preventive Effect of Inhibiting Ovulation and Menstruation during Reproductive Life." BioMed Research International 2015 (2015): 1–10. http://dx.doi.org/10.1155/2015/751571.
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Although endometriosis frequently involves multiple sites in the pelvis, malignancies associated with this disease are mostly confined to the ovaries, evolving from an endometrioma. Endometriomas present a 2-3-fold increased risk of transformation in clear-cell, endometrioid, and possibly low-grade serous ovarian cancers, but not in mucinous ovarian cancers. These last cancers are, in some aspects, different from the other epithelial ovarian cancers, as they do not appear to be decreased by the inhibition of ovulation and menstruation. The step by step process of transformation from typical endometrioma, through atypical endometrioma, finally to ovarian cancer seems mainly related to oxidative stress, inflammation, hyperestrogenism, and specific molecular alterations. Particularly, activation of oncogenic KRAS and PI3K pathways and inactivation of tumor suppressor genes PTEN and ARID1A are suggested as major pathogenic mechanisms for endometriosis associated clear-cell and endometrioid ovarian cancer. Both the risk for endometriomas and their associated ovarian cancers seems to be highly and similarly decreased by the inhibition of ovulation and retrograde menstruation, suggesting a common pathogenetic mechanism and common possible preventive strategies during reproductive life.
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Mosher, A. A., M. W. Tsoulis, J. Lim, C. Tan, S. K. Agarwal, N. A. Leyland, and W. G. Foster. "Melatonin activity and receptor expression in endometrial tissue and endometriosis." Human Reproduction 34, no. 7 (June 18, 2019): 1215–24. http://dx.doi.org/10.1093/humrep/dez082.
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AbstractSTUDY QUESTIONAre melatonin receptors (melatonin receptor 1A (MR1A) and melatonin receptor 1B (MR1B)) expressed in human endometrium and endometriotic tissue, and does melatonin affect endometrial cell proliferation?SUMMARY ANSWERMelatonin receptors are expressed in human eutopic endometrium, endometriomas and peritoneal lesions, although to different extents, and melatonin treatment attenuated estradiol-induced endometrial epithelial cell proliferation in culture.WHAT IS KNOWN ALREADYMelatonin decreased endometriotic lesion volume in a rat model of endometriosis. Melatonin treatment reduced pain scores in and analgesic use by women with endometriosis.STUDY DESIGN, SIZE, DURATIONBasic science study using human endometrial tissue and an endometrial epithelial cell line.PARTICIPANTS/MATERIALS, SETTING, METHODSMeasurement of melatonin receptor expression (mRNA and protein) in women with surgically confirmed endometriosis (endometrioma (n = 20) or peritoneal lesion (n = 11) alone) and women without surgical evidence of endometriosis (control, n = 15). Collection of endometrial and endometriotic tissue samples, gynecologic history and demographic information. Quantification of estradiol (1.0 nM) and melatonin (0.1 nM–1.0 μM) ± estradiol-induced endometrial epithelial cell proliferation in cultures of endometrial epithelial cells (CRL-1671) following 24 and 48 hours of culture.MAIN RESULTS AND THE ROLE OF CHANCEMR1A and MR1B were localized by immunohistochemistry in glandular epithelial cells of endometrial biopsies from women with and without endometriosis. Both receptors were expressed in eutopic and ectopic endometrial tissue. mRNA expression of MR1A and MR1B was significantly greater in peritoneal lesions than in either endometriomas or eutopic endometrium. However, protein expression of MR1A was decreased in peritoneal lesions compared to control eutopic endometrium, whereas MR1B expression did not differ between the groups. Melatonin (0.1 nM–1.0 μM) treatment inhibited estradiol (1.0 nM)-induced endometrial epithelial cell proliferation at 48 hours but not 24 hours of culture.LIMITATIONS, REASONS FOR CAUTIONBeneficial effects of melatonin seen in culture have yet to be comprehensively evaluated in women with endometriosis.WIDER IMPLICATIONS OF THE FINDINGSOur data suggest that melatonin may be useful as an adjunct to current endometriosis treatments.STUDY FUNDING/COMPETING INTEREST(S)This study was supported by the Canadian Institutes of Health Research (grant MOP142230 to W.G.F.). A.A.M. is supported by a resident research grant through the Physicians Services Incorporated Foundation. The authors have no conflicts of interest.
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Yoshino, Osamu, Yosuke Ono, Masako Honda, Kyoko Hattori, Erina Sato, Takehiro Hiraoka, Masami Ito, et al. "Relaxin-2 May Suppress Endometriosis by Reducing Fibrosis, Scar Formation, and Inflammation." Biomedicines 8, no. 11 (October 31, 2020): 467. http://dx.doi.org/10.3390/biomedicines8110467.
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Background: Relaxin (RLX)-2, produced by the corpus luteum and placenta, is known to be potentially effective in fibrotic diseases of the heart, lungs, kidneys, and bladder; however, its effectiveness in endometriosis has not yet been investigated. In the present study, we conducted a comprehensive study on the effect of RLX-2 on endometriosis. We checked the expressions of LGR-7, a primary receptor of RLX-2, in endometriomas using immunohistochemistry. Endometriotic stromal cells (ESCs) purified from surgical specimens were used in in vitro experiments. The effects of RLX-2 on ESCs were evaluated by quantitative-PCR, ELISA, and Western blotting. Gel contraction assay was used to assess the contraction suppressive effect of RLX-2. The effect of RLX-2 was also examined in the endometriosis mouse model. LGR-7 was expressed in endometriotic lesions. In ESCs, RLX-2 increased the production of cAMP and suppressed the secretion of interleukin-8, an inflammatory cytokine, by 15% and mRNA expression of fibrosis-related molecules, plasminogen activator inhibitor-1 (PAI-1), and collagen-I by approximately 50% (p < 0.05). In the gel contraction assay, RLX-2 significantly suppressed the contraction of ESCs, which was cancelled by removing RLX-2 from the medium or by adding H89, a Protein Kinase A (PKA) inhibitor. In ESCs stimulated with RLX-2, p38 MAPK phosphorylation was significantly suppressed. In the endometriosis mouse model, administration of RLX-2 significantly decreased the area of the endometriotic-like lesion with decreasing fibrotic component compared to non-treated control (p = 0.01). RLX-2 may contribute to the control of endometriotic lesion by suppressing fibrosis, scar formation, and inflammation.
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Gerasimov, Aleksei M., Anna I. Malyshkina, Marina V. Kuligina, Angelina K. Krasilnikova, Dmitrii M. Polumiskov, Leila Kh Abdullaeva, Ekaterina V. Fadeeva, and Irina Yu Dvoinova. "Incidence rate and structure of external genital endometriosis in hospital patients." Gynecology 23, no. 2 (May 27, 2021): 184–89. http://dx.doi.org/10.26442/20795696.2021.2.200783.
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Aim. To assess the frequency of genital endometriosis and its various forms based on the analysis of hospitalized morbidity.
Materials and methods. Analysis of the medical data base of the gynecological clinic of the Gorodkov Ivanovo Research Institute of Maternity and Childhood for the period 20002019. The unit of observation is a case of endometriosis in a patient who left the gynecological clinic of a 24-hour hospital. The clinical characteristics of the prevalence of genital endometriosis are given based on the analysis of 9.378 surgery protocols for the period 20002019. The stages of spread of the endometrioid process were assessed according to the 1985 R-AFS classification.
Results. The total number of patients diagnosed with endometriosis was 17% of the total number of gynecological patients. The proportion of hospitalized with endometriosis in 20002019 increased by 2 times from 4.5 to 9.2%. Over 20 years, the proportion of patients with endometriosis of the uterus (N80.0) from 36.2 to 9.0% (p0.001), with endometriosis of the rectovaginal septum and vagina (N80.4) decreased from 2.6 to 0% (p0.01). The proportion of patients with ovarian endometriosis (N80.1) increased from 12.1 to 34.6% (p0.001), pelvic peritoneal endometriosis (N80.3) from 16.5 to 51.1% (p0.001). The proportion of patients with endometriosis of two or more localizations increased from 1.6 to 40.2% (p0.001). Over the 20-year period, there was a decrease in the average age of patients with endometriosis from 37.80.43 years in 2000 to 36.20.34 years in 2009 and 33.80.29 years in 2019 (p0.001). The range of fluctuations in age characteristics ranged from 13 to 55 years. The overwhelming majority of observations are minor forms (I and II stages of the disease) 57.6%. Retrocervical endometriosis was diagnosed in 20.1%. Endometrioid ovarian cysts were in 11.7% of cases. In most cases, endometriotic lesions were combined with adhesions of the small pelvis.
Conclusion. Thus, genital endometriosis is a common gynecological pathology, which is often the reason for hospitalization for surgical intervention in women of different age groups. However in most cases affects in most important period in a womans life reproductive. The given data emphasize the need to study and develop therapeutic measures to improve the system of organizing medical care, to find the most optimal and effective forms of diagnosis, approaches to the treatment and rehabilitation of women with endometrisis, which would significantly reduce the volume of surgical interventions, thus reducing financial costs, including overcoming infertility.
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Petrovskaia, Nikol N., and Victoria A. Pechenikova. "Risk factors for recurrence of endometrioid ovarian cysts after combined treatment." Journal of obstetrics and women's diseases 71, no. 5 (December 18, 2022): 41–50. http://dx.doi.org/10.17816/jowd111044.
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BACKGROUND: The main method of endometrioid ovarian cyst treatment is considered surgery with further hormone therapy. However, the recurrence rate of endometriomas, even 57 years after combined treatment, can reach 50%.
AIM: The aim of this study was to identify risk factors for recurrence of endometrioid ovarian cysts among women of reproductive age after combined treatment.
MATERIALS AND METHODS: This study included 196 women operated on for ovarian endometriosis. We carried out a comparative analysis of the data between the study groups: the main group comprised 45 patients with a relapse of the disease; the comparison group consisted of 151 women without a relapse. Hematoxylin-eosin staining was used for morphological examination of the surgical material, and monoclonal mouse antibodies to Ki-67 and bcl-2 (DAKO, Denmark) were used for immunohistochemical examination. The construction of a statistical model for predicting the recurrence of ovarian endometriosis among women of reproductive age was carried out using multivariate binary logistic regression analysis in reverse stepwise mode. The influence of the independent variable on the likelihood of recurrence was determined using the odds ratio and its 95% confidence interval, with the sensitivity, specificity and diagnostic accuracy evaluated.
RESULTS: A set of predictors has been identified that provides the greatest contribution to recurrence of ovarian endometriosis. Immunohistochemistry study showed that the level of Ki-67 protein was higher in the group with relapsed endometriomas compared to the non-recurrent course: in the epithelial lining of the cyst, 9.08 2.60 and 2.06 1.16%, respectively (p = 0.043); in the cytogenic stroma, 11.67 4.10 and 9.81 3.40%, respectively (p = 0.48). Bcl-2 expression was reduced in the epithelial lining of the cyst capsule in the main group in comparison with the material where there was no recurrence: 0.653 0.043 and 0.961 0.056%, respectively (p = 0.31).
CONCLUSIONS: Of significance in predicting the risk of recurrence of ovarian endometriosis is a combination of four signs in one patient: primary infertility; pelvic organ surgery in history, unrelated to endometriosis; elevated levels of CA-125 oncoprotein and proliferative changes in cytogenic stroma cells, as well as increased expression of the Ki-67 antigen in the epithelial lining of the endometrioid cyst.
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Mehedintu, Claudia, Marina Antonovici, Lacramioara Brinduse, Elvira Bratila, Ruxandra Stanculescu, Costin Berceanu, Ovidiu Bratu, Silviu Pituru, Mircea Onofriescu, and Daniela Roxana Matasariu. "The Influence of Progesterone on Immunohystochemical Markers in Endometriosis." Revista de Chimie 69, no. 3 (April 15, 2018): 581–84. http://dx.doi.org/10.37358/rc.18.3.6153.
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Endometriosis, one of the most common gynecologic pathologies, is defined as an inflammatory, estrogen-dependent disease characterized by the growth of endometrial stroma and glands outside the uterine cavity. It is a multifactorial disease, conditioned by genetic and immune factors and triggered by hormonal and environmental factors. Estrogen receptors (ER) and progesterone receptors (PR) expression is significantly modified in endometriotic tissue, compared to normal endometrium. We performed a prospective study that included 16 patients with endometriosis: 9 patients that underwent progesterone treatment with 0.075 mg desogestrel, daily for 24 weeks prior to the surgical procedure, and 7 patients that did not follow any kind of treatment. The purpose of the study was to evaluate the changes that occurred in the expression of ER, PR, B-cell lymphoma 2 (Bcl-2) and Ki-67 from the endometriotic tissue. Oral 0.075 mg desogestrel administration proved its benefits in the management of endometriomas.
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Kachurina, M. S., L. F. Zainetdinova, E. L. Kurenkov, T. N. Shamaeva, and S. V. Kvyatkovskaya. "Nucleolar organizer regions activity in women with ovarian endometriosis and infertility." Voprosy ginekologii, akušerstva i perinatologii 20, no. 1 (2021): 71–78. http://dx.doi.org/10.20953/1726-1678-2021-1-71-78.
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Objective. To determine the activity of ribosomal synthesis and its connection with the level of melatonin in women with ovarian endometriosis and infertility. Patients and methods. The study included 49 women with ovarian endometriosis, who were divided into 2 groups: group 1 – 22 women with ovarian endometriosis and infertility, group 2 – 27 women with ovarian endometriosis without infertility. Medical history was collected from all women, who underwent therapeutic and diagnostic laparoscopy, the chronobiological type, the level of 6-sulfatoxymelatonin (aMT6s) in a first morning urine sample and the activity of nucleolar organizer regions in the foci of endometrioid heterotopias of the ovaries were determined. Results. It was found that the level of urinary 6-sulfatoxymelatonin was significantly reduced in patients with ovarian endometriosis and infertility compared to patients with endometriosis without infertility. In group 1, its level was 40.29 ± 7.25 ng/mL, in group 2 – 78.46 ± 15.46 ng/mL (p = 0.044). In patients with ovarian endometriosis and infertility, there was a moderate increase in the activity of ribosomal synthesis due to an increase in the number of intranucleolar inclusions against the background of decreased level of melatonin. In patients of group 2, with a decrease in the level of melatonin, ribosomal synthesis was activated by increasing the number of extranucleolar inclusions. This characterizes the high activity of ribosome synthesis in the cell. Conclusion. In women with ovarian endometriosis and infertility, against the background of low melatonin level, there was an increase in the activity of ribosomal synthesis in the cells of ovarian endometriotic formations. Key words: nucleolar organizer regions activity, melatonin, ovarian endometriosis
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Malysheva, Olga V., Arsenii S. Molotkov, Natalia Yu Shved, Marina A. Mikhailova, and Maria I. Yarmolinskaya. "Evaluation of aromatase expression in endometrioid heterotopias and endometria in patients with external genital endometriosis." Journal of obstetrics and women's diseases 72, no. 5 (November 23, 2023): 39–47. http://dx.doi.org/10.17816/jowd568877.
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BACKGROUND:External genital endometriosis is a multifactorial estrogen-dependent disease. Local estrogen production due to aromatase activity can play an important role in its pathogenesis, so aromatase inhibitors are considered promising drugs for the treatment of the disease. However, the data on their effectiveness are contradictory.
AIM:The aim of this study was to evaluate the expression level of the aromatase-encodingCYP19A1gene in the eutopic endometrium and endometrioid heterotopies of patients with endometriosis and in the eutopic endometrium of women from the comparison group.
MATERIALS AND METHODS:This study included 79 women. The main group consisted of 55 patients with endometriosis, and 24 patients without endometriosis formed a comparison group. All of the patients underwent an endometrial biopsy during surgery, with excision of endometriotic lesions performed in patients with endometriosis.CYP19A1gene expression was studied using reverse transcription real-time polymerase chain reaction.
RESULTS:The data obtained confirm a high level of aromatase expression in endometriosis foci. On average, aromatase expression is increased in the eutopic endometrium of patients with endometriosis when compared to the endometrium of women in the comparison group. However, in a significant number of patients with endometriosis, aromatase is expressed in the endometrium at a low level. We did not find an association of increased aromatase expression with any clinical and anamnestic features of the studied group of women, in particular, with infertility, pain syndrome, prevalence of endometriosis, or relapses of the disease.
CONCLUSIONS:Our findings highlight the heterogeneity of endometriosis and may account for the variable effectiveness of hormone-modulating therapy, in particular aromatase inhibitors.
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Sutrisno, Sutrisno, Muhammad Nooryanto, and Shella Widya Gani. "Comparison of pain intensity, smooth muscle cells density, and alpha-smooth muscle actin expression in ovarial and peritoneal endometriosis." Majalah Obstetri & Ginekologi 29, no. 3 (November 25, 2021): 108. http://dx.doi.org/10.20473/mog.v29i32021.108-117.
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HIGHLIGHT1. Pain intensity, smooth muscle cells density, and alpha-SMA expression can be used to analyze the role of smooth muscle in endometriosis.2. Compared to healthy individuals, those with endometriosis have higher pain intensity, smooth muscle cells density, and alpha-SMA expression. 3. Among endometriotic patients, those with peritoneal endometriosis have higher pain intensity, smooth muscle cells density, and alpha-SMA expression than those with ovarial endometriosis.3. The expression of alpha-SMA, smooth muscle density, and pain intensity were found to correlate significantly in endometriosis. ABSTRACTObjectives: to identify the role of smooth muscle through the analysis of smooth muscle cells density, expression of a-SMA, and the pain intensity.Materials and Methods: Study design is a cross sectional analytic observational. Study sample consists of women with ovarial endometrios and women with peritoneal endometriosis that undergo laparoscopy and laparotomy in RSUD Saiful Anwar Malang and RSIA Melati Malang from January until December 2019. There are 16 samples: 8 samples of ovarial endometriosis and 8 samples of peritoneal endometriosis. Smooth muscle cell density was analyzed by comparing the number of smooth muscle cells with the total area of endometriosis tissue in one microscopical field. a-SMA expression obtained by immunohistochemistry. Degree of pain obatined by filling the part 1 point 1-11 of EHP-30 queistionnaire the day after the procedure. Data was analyzed by Independent T-test and Pearson correlation.Results: Pain intensity, smooth muscle cells density, and a-SMA expression is higher in the endometriosis patient compared to healthy individual. Pain intensity, smooth muscle cells density, and a-SMA expression is lower in the ovarial endometriosis compared to peritoneal endometriosis.Conclusion: There are a significant correlation between the expression of a-SMA, smooth muscle density, and pain intensity in endometriosis.
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Malvezzi, Helena, Bruna Azevedo Cestari, Juliana Meola, and Sérgio Podgaec. "Higher Oxidative Stress in Endometriotic Lesions Upregulates Senescence-Associated p16ink4a and β-Galactosidase in Stromal Cells." International Journal of Molecular Sciences 24, no. 2 (January 4, 2023): 914. http://dx.doi.org/10.3390/ijms24020914.
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Endometriosis affects a significant proportion of women worldwide; however, no definitive cure for this disease has been discovered to date. Oxidative stress promotes endometriotic lesion maintenance in the peritoneal cavity in women. Furthermore, there is evidence of the mitogen-activated protein kinase (MAPK) signaling pathway and senescence involvement in the physiopathogenesis of endometriosis. Reactive oxygen species (ROS) cause oxidative damage and are expected to trigger senescence in the endometrium while also causing alterations in MAPK signaling. However, the role of ROS in the senescence-associated phenotype in endometriosis remains unknown. In this context, this study attempted to delineate the pathways linking ROS to senescence in endometrial and endometriotic lesions of healthy individuals and those with endometriosis. Our results indicate a higher presence of ROS in endometriotic lesions, and the upregulation of MAPK. Furthermore, we show that endometriotic lesions in stromal cells stimulated with hydrogen peroxide develop more senescence traits than eutopic and non-endometriosis endometrium. Overall, endometriotic cells respond differently to extracellular distress. Our contribution to further research in this field contributed to the roadmap of endometriosis’ search for alternative treatments.
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Prosperi Porta, Romana, Chiara Sangiuliano, Alessandra Cavalli, Laila Cristine Hirose Marques Pereira, Luisa Masciullo, Ilaria Piacenti, Sara Scaramuzzino, Maria Federica Viscardi, and Maria Grazia Porpora. "Effects of Breastfeeding on Endometriosis-Related Pain: A Prospective Observational Study." International Journal of Environmental Research and Public Health 18, no. 20 (October 10, 2021): 10602. http://dx.doi.org/10.3390/ijerph182010602.
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Endometriosis is a gynecological estrogen-dependent disease whose commonest pain symptoms are dysmenorrhea, dyspareunia, and acyclic chronic pelvic pain (CPP). Hormonal changes occurring during breastfeeding seem to reduce pain and disease recurrence. The aim of this observational prospective study was to assess the effect of breastfeeding on pain and endometriotic lesions in patients with endometriosis and to evaluate a possible correlation between the duration of breastfeeding, postpartum amenorrhea, and pain. Out of 156 pregnant women with endometriosis enrolled, 123 who breastfed were included in the study and were monitored for 2 years after delivery; 96/123 exclusively breastfed for at least 1 month. Mode of delivery, type and duration of breastfeeding, intensity of pain symptoms, and lesion size before pregnancy and during the 24-month follow-up were analyzed. All patients experienced a significant reduction in dysmenorrhea proportional to the duration of breastfeeding. CPP was significantly reduced only in women who exclusively breastfed. No significant improvement in dyspareunia was observed. Ovarian endometriomas were significantly reduced. Therefore, breastfeeding, particularly if exclusive, may cause improvement in dysmenorrhea and CPP proportional to the duration of breastfeeding, as well as a reduction in the size of ovarian endometriomas.
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Peng, Bo, Fahad T. Alotaibi, Sadaf Sediqi, Mohamed A. Bedaiwy, and Paul J. Yong. "Role of interleukin-1β in nerve growth factor expression, neurogenesis and deep dyspareunia in endometriosis." Human Reproduction 35, no. 4 (April 2020): 901–12. http://dx.doi.org/10.1093/humrep/deaa017.
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Abstract STUDY QUESTION Does interleukin-1β (IL-1β) play a role in promoting nerve growth factor expression, neurogenesis and deep dyspareunia in endometriosis? SUMMARY ANSWER IL-1β directly stimulates nerve growth factor (NGF) expression in endometriosis and is associated with local neurogenesis around endometriosis and more severe deep dyspareunia. WHAT IS KNOWN ALREADY Local nerve density around endometriosis (using the pan-neuronal marker PGP9.5) is associated with deep dyspareunia in endometriosis, mediated in part by NGF expression. STUDY DESIGN, SIZE, DURATION This in vitro study included endometriotic tissue samples from 45 patients. PARTICIPANTS/MATERIALS, SETTING, METHODS This study was conducted in a university hospital affiliated research institute and included 45 women with surgically excised deep uterosacral/rectovaginal endometriosis (DIE, n = 12), ovarian endometriomas (OMA, n = 14) or superficial peritoneal uterosacral/cul-de-sac endometriosis (SUP, n = 19). Immunolocalisation of IL-1β, IL-1 receptor type 1 (IL-1R1), NGF and PGP9.5 in endometriotic tissues was examined by immunohistochemistry (IHC), and the intensity of IHC staining in the endometriotic epithelium and stroma was semi-quantitatively evaluated using the Histoscore method (H-score). For each case, deep dyspareunia was pre-operatively rated by the patient on an 11-point numeric rating scale (0–10). In addition, primary endometriosis stromal cells were isolated and cultured from surgically excised endometriosis. These cells were treated with IL-1β alone or in combination of Anakinra (an inhibitor of IL-1R1), small inference RNA (siRNA) against IL-1R1, siRNA against c-FOS or NGF neutralising antibody. The mRNA and protein levels of target genes (NGF and c-FOS) were assessed by reverse-transcription qPCR and western blot/ELISA, respectively. Furthermore, immunofluorescent microscopy was used to examine the neurite growth of rat pheochromocytoma PC-12 cells, as an in vitro model of neurogenesis. MAIN RESULTS AND THE ROLE OF CHANCE For IHC, IL-1β expression in the endometriosis epithelium was significantly associated with more severe deep dyspareunia (r = 0.37, P = 0.02), higher nerve fibre bundle density around endometriosis (r = 0.42, P = 0.01) and greater NGF expression by the endometriosis epithelium (r = 0.42, P = 0.01) and stroma (r = 0.45, P = 0.01). In primary endometriosis stromal cells, treatment with exogenous IL-1β significantly increased the mRNA and protein levels of NGF and c-FOS. Pre-treatment with Anakinra, siRNA against IL-1R1, or siRNA against c-FOS, each attenuated IL-1 β-induced increases of NGF expression. In addition, supernatants from IL-1β treated endometriosis stromal cells significantly stimulated PC-12 neurite growth compared to controls, and these effects could be attenuated by pre-treatment with NGF neutralising antibody or Anakinra. LARGE-SCALE DATA N/A LIMITATIONS, REASONS FOR CAUTION We did not have data from cultures of endometriosis glandular epithelium, due to the known difficulties with primary cultures of this cell type. WIDER IMPLICATIONS OF THE FINDINGS Our study revealed a mechanism for deep dyspareunia in endometriosis, whereby IL-1β stimulates NGF expression, promoting local neurogenesis around endometriosis, which in turn leads to tender pelvic anatomic sites and thus deep-hitting dyspareunia. There may also be potential for drug targeting of IL-1β and/or NGF in the management of endometriosis-associated pain. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by grants from the Canadian Institutes of Health Research (MOP-142273 and PJT-156084). P.Y. is also supported by a Health Professional Investigator Award from the Michael Smith Foundation for Health Research. MB has financial affiliations with Abbvie and Allergan. Otherwise, there are no conflicts of interest to declare.
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Dewanto, Agung, Muhammad Dimas Reza Rahmana, Regina Arumsari, Nurida Khasanah, Wicesa Nugraha, Vanessa Trizia, and Khoiruddin Anshori. "#125 : The Role of BDNF Receptors in the Incidence of Endometrioma Tissue Invasion Onto the Chorioallantoic Membrane." Fertility & Reproduction 05, no. 04 (December 2023): 629–30. http://dx.doi.org/10.1142/s2661318223743618.
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Background and Aims: Previous studies have explored the role of neurotrophins and their receptors, especially in forming deep endometriosis, endometriosis tissue invasion, and its effects on tissue proliferation. However, these studies do not include research on the pathogenesis of endometriomas. We tried to model the invasion of endometrioma tissue to find out more about its pathogenesis by using the chorioallantoic membrane (CAM) as the host. Immunohistochemistry (IHC) to detect neurotrophin BDNF and its receptors, namely TrkB and P75, are employed and linked between their expression and the process of invasion and proliferation. Method: The endometriotic tissue samples were collected from women (n=27) who underwent hysteroscopy/laparoscopy at Dr. Sardjito Central Hospital. Peritoneal endometriosis (PE) lession, endometrioma (CC), and eutopic endometrium (EN) was analyzed with 15 tissue samples in each group. Samples were placed in a tube containing transport medium and transplanted into CAM of fertile chicken eggs for five days. Transplanted tissue was harvested, and histological preparations were made using the paraffin method. IHC staining was performed on p75, Ki67, TrkB, and BDNF staining. Invasion analysis and IHC evaluation were performed with a semi-quantitative method. Data were analyzed using IBMⓇ SPSS Statistics version 25.0. Statistical significance was accepted at P < 0.05. Results: Normal Endometrium expressed the highest expression of BDNF than peritoneal endometriosis and endometrioma (0.36± 0.38, 0.16± 0.13, 0.07± 0.07, P=0.007). The P75 expression correlated positively with Ki67 expression in PE and CC samples (P=0.012; P=0.008). Conclusion: The p75 receptor may have a role in endometriosis tissue proliferation, but this receptor does not directly influence tissue invasion into CAM. While proliferation in endometriomas positively correlates with invasion into CAM, it is not correlated with peritoneal endometriosis.
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Hu, Zhuoying, Ramanaiah Mamillapalli, and Hugh S. Taylor. "Increased circulating miR-370-3p regulates steroidogenic factor 1 in endometriosis." American Journal of Physiology-Endocrinology and Metabolism 316, no. 3 (March 1, 2019): E373—E382. http://dx.doi.org/10.1152/ajpendo.00244.2018.
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Endometriosis is a gynecologic disease common among reproductive-aged women caused by the growth of endometrial tissue outside the uterus. Altered expression of numerous genes and microRNAs has been reported in endometriosis. Steroidogenic factor 1 (SF-1), an essential transcriptional regulator of multiple genes involved in estrogen biosynthesis, is aberrantly increased and plays an important role in the pathogenesis of endometriosis. Here, we show the expression of SF-1 in endometriosis is regulated by miR-370-3p. Sera and tissue were collected from 20 women surgically diagnosed with endometriosis and 26 women without endometriosis. We found that miR-370-3p levels were decreased in the serum of patients with endometriosis while SF-1 mRNA levels were inversely upregulated in endometriotic lesions compared with respective controls. Transfection of primary endometriotic cells with miR-370-3p mimic or inhibitor resulted in the altered expression of SF-1 and SF-1 downstream target genes steroidogenic acute regulatory protein (StAR) and CYP19A1. Overexpression of miR-370-3p inhibited cell proliferation and induced apoptosis in endometriotic cells. This study reveals that miR-370-3p functions as a negative regulator of SF-1 and cell proliferation in endometriotic cells. We suggest a novel therapeutic strategy for controlling SF-1 in endometriosis.
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Pechenikova, Victoria A., Anastasia S. Danilova, Victoria E. Kvarku, and Nadezhda N. Ramzaeva. "Intestinal endometriosis: features of clinical and morphological diagnostics." Bulletin of the Russian Military Medical Academy 23, no. 1 (May 12, 2021): 41–50. http://dx.doi.org/10.17816/brmma63572.
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A clinical observation of the combined endometriotic lesion of the small intestine and the appendix is given below. Extragenital endometriosis is a rare pathology in which endometrioid heterotopies develop outside the reproductive system organs. At about 1825% of women suffering from the pelvic organs endometriosis, the intestines are involved in the pathological process. In this regard, it is believed that in most cases its lesion is secondary while the primary lesion of the intestine with endometriosis is rarely observed and occurs as a result of hematogenous introduction of endometrial elements into the intestinal wall. Of all parts of the intestine, endometriosis most often affects the rectum and sigmoid colon (7080%), then the jejunum, less often the cecum. The most rare gastrointestinal tract endometriosis localization is the appendix, the frequency of its lesion is 0.8%. It was carried out in a clinicopathologic analysis of 14 endometriosis cases in various parts of the intestine (4 cases of the small intestine lesions, 2 rectosigmoid part of the large intestine, 2 rectum, 2 sigmoid colon, 3 appendix, 1 combined lesion of the small intestine and the appendix). In most cases, the clinical diagnosis of extragenital endometriosis is difficult, and as a rule women come with complaints typical of acute surgical pathology: intestinal obstruction, appendicitis. An important role in differential diagnosis is given to the ultrasound examination of the pelvic organs and abdominal cavity, magnetic resonance imaging, endoscopic research methods, as well as the connection of clinical symptoms with the menstrual cycle.
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Charatsi, Dimitra, Ourania Koukoura, Irontianta Gkorezi Ntavela, Foteini Chintziou, Georgia Gkorila, Manthos Tsagkoulis, Themistoklis Mikos, George Pistofidis, Jiannis Hajiioannou, and Alexandros Daponte. "Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of Extrapelvic Endometriosis." Advances in Medicine 2018 (September 26, 2018): 1–11. http://dx.doi.org/10.1155/2018/3461209.
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Extrapelvic endometriosis is a rare entity that presents serious challenges to researchers and clinicians. Endometriotic lesions have been reported in every part of the female human body and in some instances in males. Organs that are close to the uterus are more often affected than distant locations. Extrapelvic endometriosis affects a slightly older population of women than pelvic endometriosis. This might lead to the assumption that it takes several years for pelvic endometriosis to “metastasize” outside the pelvis. All current theories of the pathophysiology of endometriosis apply to some extent to the different types of extrapelvic endometriosis. The gastrointestinal tract is the most common location of extrapelvic endometriosis with the urinary system being the second one. However, since sigmoid colon, rectum, and bladder are pelvic organs, extragenital pelvic endometriosis may be a more suitable definition for endometriotic implants related to these organs than extrapelvic endometriosis. The sigmoid colon is the most commonly involved, followed by the rectum, ileum, appendix, and caecum. Most lesions are confined in the serosal layer; however, deeper lesion can alter bowel function and cause symptoms. Bladder and ureteral involvement are the most common sites concerning the urinary system. Unfortunately, ureteral endometriosis is often asymptomatic leading to silent obstructive uropathy and renal failure. Surgical excision of the endometriotic tissue is the ideal treatment for all types of extrapelvic endometriosis. Adjunctive treatment might be useful in selected cases.
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Capozzi, Vito Andrea, Elisa Scarpelli, Sara dell’Omo, Martino Rolla, Alessandra Pezzani, Giovanni Morganelli, Michela Gaiano, Tullio Ghi, and Roberto Berretta. "Atypical Endometriosis: A Comprehensive Systematic Review of Pathological Patterns and Diagnostic Challenges." Biomedicines 12, no. 6 (May 29, 2024): 1209. http://dx.doi.org/10.3390/biomedicines12061209.
Full textAbstract:
Endometriosis is a benign condition affecting women of reproductive age. A potential association with ovarian cancer has been documented. Atypical endometriosis (AE) is characterized by deviations from the typical microscopic appearance of endometriosis, including cytologic and architectural atypia. AE has been recognized as a potential precursor to endometriosis-associated ovarian cancers (EAOC), particularly endometrioid and clear cell subtypes. AE presents challenges in diagnosis due to its diverse clinical and pathological features, often requiring careful histological evaluation for accurate identification. Architectural AE, defined by localized proliferation of crowded glands with atypical epithelium resembling endometrial neoplasia, and cytologic AE, characterized by nuclear atypia within the epithelial lining of endometriotic cysts, are key subtypes. Immunohistochemical and molecular studies have revealed aberrant expression of markers such as Ki67, COX-2, BAF250a, p53, estrogen receptor, progesterone receptor, and IMP-3. Long-term follow-up studies suggest relatively low recurrence and malignant transformation rates among patients with AE, but uncertainties persist regarding its exact malignancy potential and optimal management strategies. Integration of artificial intelligence and shared molecular aberrations between AE and EAOC may enhance diagnostic accuracy. Continuous interdisciplinary collaboration and ongoing research efforts are crucial for a deeper understanding of the relationship between endometriosis and carcinogenesis, ultimately improving patient care and surveillance.