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PubMed2002

Abnormal cervicovaginal smears due to endometriosis: a continuing problem.

Endometriosis may be challenging when identified on cervicovaginal smears (CVS), leading to an incorrect interpretation of high-grade squamous intraepithelial lesion (HSIL), or atypical glandular cells of undetermined significance (AGUS) including adenocarcinoma in situ (AIS). Awareness of cervical endometriosis, particularly in predisposed patients, is crucial for a correct diagnosis. While cervical endometriosis has been reported to be a diagnostic pitfall of glandular abnormalities, its characteristic features are still not well-established. This may partially be attributed to the varied cytomorphologic features endometriosis shows, depending on menstrual cycle hormonal changes. We describe our experience with three examples where CVS were interpreted as either AGUS or HSIL, which led to a hysterectomy in 2 of 3 patients. Cervical endometriosis needs to be considered with other well-known benign conditions that mimic glandular abnormalities, including cervicitis, tubal metaplasia, lower uterine segment sampling, and microglandular hyperplasia. Published series and our own experience lead us to suggest that these smears will continue to present diagnostic difficulties.

Adult↗
PubMed2002

Polymorphisms for interleukin-4 (IL-4) -590 promoter, IL-4 intron3, and tumor necrosis factor alpha -308 promoter: non-association with endometriosis.

Interleukin-4 (IL-4) is a cytokine with anti-inflammatory properties. Tumor necrosis factor alpha (TNF-alpha), a pluripotent proinflammatory cytokine, plays an important role in the process of numerous inflammatory and autoimmune diseases. We aimed to investigate whether gene polymorphisms for the IL-4 -590 promoter, IL-4 intron3 and TNFalpha -308 promoter could be used as markers of susceptibility in endometriosis. The subjects, 226 premenopausal Taiwan Chinese women with surgically diagnosed endometriosis and nonendometriosis, were divided into two groups: 1) endometriosis (n = 120) and 2) nonendometriosis (n = 106). Polymorphisms for the IL-4 -590 promoter, IL-4 intron3, and TNFalpha -308 G-to-A promoter were detected by polymerase chain reaction (PCR). Genotypes and allelic frequencies for these gene polymorphisms in both groups were compared. We observed no significant differences in genotype distribution and allele frequency of the IL-4 -590 promoter, IL-4 intron3, and TNFalpha gene polymorphism between both groups. The proportions of the -590*C homozygote/heterozygote/-590* T homozygote for the IL-4 promoter in both groups were 1.6/31.6/66.6% in group 1, and 5.8/33.0/61.2% in group 2. The proportions of the RP1 homozygote/heterozygote/RP2 homozygote for IL-4 intron3 in both groups were 62.5/34.1/2.5% (group 1), and 64.1/32.0/3.9% (group 2). The proportions of -308*A homozygote/heterozygote/-308*G homozygote for the TNFalpha promoter in both groups were 7.5/20.8/71.7% (group 1), and 7.5/17/75.5% (group 2). We concluded that there is no association between endometriosis and the IL-4 and TNFalpha gene polymorphisms. The IL-4 -590 promoter, IL-4 intron3, and TNFalpha -308 G-to-A polymorphisms are not useful markers for predicting susceptibility to endometriosis.

Endometriosis↗
PubMed1998

Endometrial stromal sarcoma of the vulva arising in extraovarian endometriosis: a case report and literature review.

BACKGROUND: Extraovarian malignant transformation of endometriosis is a rare event; 52 cases have been reported. We describe the first published account in the world literature of an endometrial stromal sarcoma (ESS) arising in the vulva from a focus of endometriosis. CASE: A 34-year-old G4 P3 morbidly obese white female was seen with a 1-year history of a palpable lesion arising within the superior aspect of the left labium majus. Radical left hemivulvectomy with clitorectomy was performed. The histopathologic findings were consistent with ESS arising from endometriosis associated with the extrapelvic portion of the round ligament within the canal of Nuck. Twenty months later metatastatic ESS developed in the upper lobe of the right lung and the patient underwent wedge resection. Nine months later she developed a recurrent pulmonary nodule at the site of the previous wedge resection and underwent successful right pulmonary lobectomy. The patient was last seen in October 1995 and had no evidence of disease at that time. CONCLUSIONS: Since approximately 0.7-1.0% of patients with endometriosis have lesions that will ultimately undergo malignant transformation, consideration should be given to bilateral oophorectomy at the time of abdominal surgery in patients with significant endometriosis.

Adult↗
PubMed2001

Endometriosis-associated ovarian carcinoma (EAOC): an entity distinct from other ovarian carcinomas as suggested by a nested case-control study.

OBJECTIVES: Endometriosis-associated ovarian carcinoma (EAOC) has recently received increasing attention due to its suggested biological behavior, distinctive from those of usual epithelial ovarian cancer. To elucidate some of the controversies on this intriguing entity, a series of patients with EAOC were compared to ovarian carcinoma cases without concomitant endometriosis. METHODS: To control the confounding effect of age, a nested case-control study was designed, where all 58 EAOC patients (mean age 54.5 +/- 11.5 years) were nested with four perfectly age-matched non-EAOC patients (n = 232; mean age 54.7 +/- 11.7 years) selected among 425 women representing all FIGO stages of ovarian carcinomas without endometriosis. Pertinent clinical data and results of analysis of the tumors were subjected to statistical analyses using life-table, univariate (Kaplan-Meier), and multivariate (Cox) survival techniques to disclose dissimilarities in the key biological characteristics of these two groups as well as the independent prognostic predictors of disease outcome. RESULTS: When compared in a case-control design with four perfectly age-matched non-EAOC patients nested to each EAOC case, the patients with EAOC proved to: (1) have a lower stage disease (both FIGO and TNM) (P = 0.000), (2) show a completely different distribution of histological subtypes (significant overpresentation of endometrioid and clear cell carcinomas) (P = 0.0001), (3) have predominantly lower grade lesions (P = 0.029), (4) be devoid of any primary residual tumor (P = 0.0001), and, most importantly (5) have demonstrated a significantly better overall survival (47/58 versus 126/232; OR 2.89, 95% CI 1.56-5.34, P = 0.0001). This better survival was evident (a) in all age groups and (b) for all histological subtypes, but (c) not explained by a better stage-specific survival in any FIGO stage. The two series also differed in their significant prognostic predictors in Kaplan-Meier and Cox analyses. In the EAOC group, the most significant (P = 0.0001) predictors of OS in univariate analysis were age, histological type, observation time for endometriosis, and distribution of endometriosis. In the non-EAOC group, such significant predictors were age, residual tumor, and type of therapy. In the multivariate (Cox) model, age and FIGO stage were the only two significant independent prognostic factors shared by these two series. In addition, histological type and type of therapy proved to be significant independent predictors in the non-EAOC series. CONCLUSIONS: These data suggest that EAOC deviates from the non-EAOC in many of its key biological characteristics. The implications of these data in the diagnosis, treatment policy, and prognostication still require confirmation by further studies, however.

Adult↗
PubMed1995

Intestinal endometriosis: presentation, investigation, and surgical management.

The study was undertaken to identify the presenting features of intestinal endometriosis and to evaluate its investigation and surgical management. Twenty-six cases of intestinal endometriosis were identified during a fourteen year period. The commonest site of occurrence was the rectosigmoid region (11 cases) followed by the appendix (9 cases), and ileocaecal region (6 cases). Abdominal pain was the main presenting feature in 20 cases, with associated nausea and vomiting in 12 cases and altered bowel habit in ten. Other presenting features included rectal bleeding, abdominal bloating and tenesmus. Endometriosis was not suspected preoperatively in any of the patients without a past history of this condition. Accurate preoperative diagnosis proved very difficult, with only laparoscopy providing definite evidence of intestinal endometriosis prior to formal surgery. Colonic resections were performed in 12 cases, small bowel resection in six cases and appendicectomy in nine cases, together with resection of adjacent adherent structures. This series illustrates the difficulty of establishing an accurate preoperative diagnosis, and the propensity of intestinal endometriosis to mimic other gastrointestinal diseases, particularly carcinoma and inflammatory bowel disease.

Appendix↗
PubMed1975

[On the structural changes induced in adenomyosis uteri and endometriosis externa by hormonal therapy (author's transl)].

This study was undertaken to determine whether the hormonal sensitivity of the endometrium might be a measure of the effectiveness of hormonal therapy for adenomyosis and endometriosis. Accordingly, the effects of endogenous and exogenous hormones on the endometrium, adenomyosis, and endometriosis were correlated. The results revealed that, depending on where the ectopic endometrial tissue was located and on the type (duration and intensity) of hormonal treatment, the functional response of the endometriosis varied from that of the endometrium. The variations, however, can be predicted. The response of adenomyosis to hormonal stimulation was most like that of the endometrium. Endometriosis of the ovary often revealed an excessive response to stimulation, especially after gestagens. The other types of extrauterine foci of endometriosis, however, reacted only weakly to hormonal therapy. Important prognostic consequence for therapy can be drawn from the results.

Abdominal Muscles↗
PubMed1995

Peritoneal fluid volume and steroid hormone concentrations in baboons with and without either spontaneous minimal/mild endometriosis or the luteinized unruptured follicle syndrome.

This study was performed to document for the first time peritoneal fluid volumes and steroid hormone levels in baboons with and without endometriosis. A laparoscopy was carried out in 19 female baboons (11 with a normal pelvis and 8 with histologically proven spontaneous minimal/mild endometriosis) during 64 cycles in the early luteal phase. Peritoneal fluid was measured and aspirated. The pelvis was examined for evidence of recent ovulation and endometriosis. Peritoneal fluid and serum were assayed for 17 beta-estradiol and progesterone. The mean volume of peritoneal fluid and its concentration of 17 beta-estradiol and progesterone were 2.6 ml, 679 pmol/l and 64 nmol/l, respectively. No differences were observed between animals with or without either endometriosis or luteinized unruptured follicle syndrome. The peritoneal fluid and serum steroid levels were comparable to those found in women. The results presented are similar to those obtained in women with endometriosis and this suggests that the baboon can be used for the study of this disease.

Animals↗
PubMed1976

[The glycogen content of blood and uterine tissue in women with myoma and endometriosis (author's transl)].

The amount of glycogen in venous blood and uterine tissue from 135 women undergoing gynecologic surgery was quantitatively determined. One group had myoma (n = 48), another endometriosis (n = 30). 18 women had myoma combined with endometriosis of the myometrium. 39 women served as control group. The following samples of the uterus were obtained immediately after removal: endometrium, myometrium, cervix and "tumour". The glycogen content in pathological cases was compared to normal tissue of comparative endocrine state, parity status and glucose tolerance. The significance levels were determined by standard analysis of variance and "t" tests. In the group with endometriosis, a significant difference occurred in the amount of blood glycogen, while a significant decrease was observed in the myometrial tissue. The cervical tissue glycogen levels of patients with myoma or endometriosis were significantly higher and did not exhibit cyclic or menopausal changes. There were no significant cyclic differences in the amount of endometrial tissue glycogen in women with myoma or endometriosis. In these cases the glycogen content was significantly higher than in healthy endometrial tissue. Blood glucose and plasma insulin levels were found to be in a normal spectrum. Pathological glucose tolerance and parity status showed no correlation to the variation of uterine tissue glycogen.

Blood Glucose↗
PubMed1999

Use of anal endosonography in diagnosis of endometriosis of the external anal sphincter: report of a case.

PURPOSE: Perianal endometriosis is an infrequent form of extragenital endometriosis and is usually situated in episiotomy scars. METHODS: We report a rare case involving the external anal sphincter in a 24 year-old female. The precise anatomical location of the endometriotic lesion was confirmed using preoperative and intraoperative anal endosonography. CONCLUSION: We believe this procedure to be essential when history, digital examination, and proctoscopy are not conclusive in the differential diagnosis of perianal pain or mass. Although hormonal suppression often is the therapy of choice in extrapelvic endometriosis, we think surgical excision, respecting the anatomical fiber architecture of the anal sphincter, is the best treatment for perianal endometriosis. Surgical excision is required for histological diagnosis, which is imperative in view of the albeit rare development of malignancy in extragenital endometriosis.

Adult↗
PubMed1988

Diagnosis and management of endometriosis of the colon and rectum.

Colon and rectal endometriosis is a relatively rare entity that may have a wide array of clinical symptomatology and radiographic findings. Thirty-two patients with a diagnosis of colon or rectal endometriosis were seen and treated at the Ferguson Clinic between 1960 and 1986. Diagnostic, pathologic, and therapeutic findings were reviewed. All patients, except one, had large-bowel symptoms. Ten patients had previous histories of pelvic endometriosis. When endometriosis of the colon causes significant symptoms or a neoplasm cannot be ruled out, partial colectomy is recommended. If pelvic endometriosis is extensive, removal of the endometriomas and reproductive organs should be entertained concurrent with bowel resection. Hormonal manipulation may be attempted in certain select patients, with very close follow-up.

Colonic Neoplasms↗
PubMed2003

Anginogenesis of eutopic and ectopic endometria in endometriosis.

In order to study the angiogenesis in endometriosis, the samples of eutopic and ectopic endometria from patients with endometriosis were quantitatively analyzed by color morphometric image system (CMIS) for vascular surface area, and by examining endometrial blood vessel for microvessel density (MVD). The results showed that within each menstrual phase the vascular surface area and MVD were significantly higher in ectopic endometria with endometriosis than those in eutopic endometria with endometriosis or normal endometrium (P < 0.05). It is concluded that angiogenesis might be involved in the development of endometriosis.

Adult↗
PubMed2000

Changes of cytokines levels in peritoneal fluids of patients with endometriosis and its effect on reproductive activity.

To study the changes of cytokines in peritoneal fluids of patients with endometriosis and their effects on reproductive activity, levels of tumor necrosis factor (TNF) and interleukin 6 (IL-6) in peritoneal fluids and peritoneal macrophages' culture supernatant were studied by using enzyme linked immunoassay (ELISA) in 14 infertile patients with endometriosis (EMT group) and 11 infertile women with normal pelvis (control group). The effects of peritoneal fluids in patients with endometriosis in vitro on sperm motility and development of 2-cell mouse embryos were also studied. The results showed that the levels of TNF and IL-6 in peritoneal fluids and peritoneal macrophages' supernatant in EMT group were elevated significantly as compared with those in the control group (P < 0.01). The percent of sperm straight line movement and total sperm motility were decreased significantly in EMT group (P < 0.01). The percent of 2-cell mouse embryos developing to 16-cells was 32.5% in EMT group, while 47.6% in control group after 48 h co-culture with peritoneal fluid (P < 0.01). It is likely that the elevation of peritoneal fluid cytokines in patients with endometriosis may play a role in infertility associated with endometriosis.

Adult↗
PubMedDate not supplied

Ureteral endometriosis and ovarian mucinous cystadenoma presenting with acute pyonephrosis.

BACKGROUND: Endometriosis is a common disease, but ureteral involvement is rare. Nonspecific clinical presentations of ureteral endometriosis may result in diagnostic difficulty. AIM: To discuss the diagnosis and management of such a case. METHODS: To report a case of ureteral involvement with endometriosis and review the literature. RESULTS: The case presented with right lower quadrant pain giving rise to initial diagnostic possibility of acute appendicitis. Subsequent evaluation revealed the diagnosis of right pyonephrosis due to midureteral endometriosis with right ovarian mucinous cystadenoma. CONCLUSION: The diagnosis of ureteral endometriosis requires a high index of clinical suspicion. The importance of ultrasound in the evaluation of acute abdomen in women can not be overemphasised.

Abdominal Pain↗
PubMed1997

Acute abdomen due to endometriosis as a diagnostic and therapeutic challenge in the treatment of acute myelocytic leukemia.

Acute abdominal pain is a frequent diagnostic and therapeutic challenge in hematologic patients. We report on the very rare case of organ endometriosis with acute abdominal symptoms in a 43-year-old female patient with AML-M5, starting 4 days after induction chemotherapy with idarubicin, ara-C, and etoposide. The patient presented with an acute abdomen with clinical findings of acute cholecystitis, subileus, and local pain in the right upper abdomen accompanied by severe diarrhea. Probably due to impaired intestinal resorption, menstrual bleeding occurred despite regular administration of lynestrenol. Ultrasound examination of the abdomen disclosed a tumor with poor echoes in the pouch of Douglas, a subcapsular splenic hemorrhage, and a thickened gallbladder wall with surrounding edema. A cystic adnex tumor was confirmed by endovaginal ultrasound. Based on history and the findings on ultrasound, an endometriosis was diagnosed, and the LHRH agonist (nafarelin) was administered nasally in combination with lynestrenol. Following this medication the abdominal pain ceased, supporting the diagnosis of endometriosis. Nasal administration of an LHRH agonist in the following cycles of chemotherapy was effective in preventing further abdominal discomfort and vaginal bleeding. LHRH agonists should be given to patients with known endometriosis before starting myeloablative chemotherapy to prevent painful hemorrhage from endometriosis.

Abdomen, Acute↗
PubMed2003

Terminal ileitis with sealed perforation--a rare complication of intestinal endometriosis: case report and short review of the literature.

INTRODUCTION: Perforation is a rare complication of intestinal endometriosis. We report on a 38-year-old patient with previously known rectovaginal and ileocecal endometriosis who was referred with an acute abdomen. CASE REPORT: On abdominal plain film an ileus of small intestine was diagnosed. The patient had fever, and the C-reactive protein was markedly increased. Upon emergency laparotomy an acute terminal ileitis with omentum-sealed perforation and a stenosis of the anterior wall of the rectum due to endometriosis were found. Partial resection of the ileum with end-to-end anastomosis, appendectomy, and short segmental rectum resection were performed. The postoperative course was uneventful. Histological examination corroborated the intraoperative diagnosis of fistulas, perforation and deep ulceration of the intestine consistent with transmural endometriosis. DISCUSSION: For proper care of these patients excellent cooperation between gynecologists and general surgeons is desirable. A short review of the literature concerning intestinal endometriosis is given.

Adult↗
PubMed2001

Cytokine profiles in autologous peritoneal fluid and peripheral blood of women with deep and superficial endometriosis.

In a preliminary study the hypothesis was tested that cytokine profiles in peripheral blood were higher in women with deep infiltrating endometriosis and cytokine profiles in peritoneal fluid were higher in women with superficial endometriosis. Thirteen women of reproductive age having laparoscopy for infertility (n=9), pain (n=3) or combined pain and infertility (n=1). Peripheral blood and peritoneal fluid were obtained and analyzed for Interleukin-6 (IL-6), Tumor Necrosis Factor-alpha (TNF-alpha), Interleukin-10 (IL-10), Transforming Growth Factor-betal (TGFbeta1), and Interferon-gamma (IFN-gamma). No significant cytokine differences were observed in either peritoneal fluid or peripheral blood between IL-6, TGFbeta1, IFNgamma, TNF-alpha and IL-10 of women with superficial endometriosis (n=7) and women with deeply infiltrating endometriosis (n=6). The results of this preliminary study do not show significant differences in peripheral blood and peritoneal fluid cytokine levels between women with deep infiltrating endometriosis compared to women with superficial disease. Future studies with increased sample size are required to either confirm or refute these preliminary findings.

Adult↗
PubMed2006

Scar endometriosis - a gynaecologic pathology often presented to the general surgeon rather than the gynaecologist: report of two cases.

INTRODUCTION: Scar endometriosis develops in and is adjacent to surgical scars at the site of previous abdominal operations. The most frequent clinical presentation of the disease is that of a palpable subcutaneous mass near surgical scars associated with cyclic pain and swelling during menses. Endometriosis of the surgical scar is often referred to the general surgeons because the clinical presentation suggests an incisional hernia or other conditions related to the general surgery. Cyclical symptoms such as pain and swelling, in relation to surgical scars, which worsen at the time of menstruation, are nearly pathognomonic of scar endometriosis. However, often the diagnosis of endometriosis is not suggested until after histology has been performed. CASE REPORT: We present two cases of cutaneous endometriosis that has occurred on the site of previous cesarean section scar area.

Adult↗
PubMed2002

Laser laparoscopy for endometriosis and endometriotic cysts.

BACKGROUND: Endometriosis is a common and debilitating condition involving women during their reproductive years. It is characterized by the occurrence of endometrial glands and stroma outside the uterine cavity. Presenting symptoms include chronic nonmenstrual pelvic pain, dysmenorrhea, dyspareunia, and subfertility. The condition is diagnosed at laparoscopy, and operative laparoscopic surgery for endometriosis is also possible. METHODS: This article critically evaluates the evidence for the laparoscopic management of endometriosis and endometriotic cysts. It focuses on laser laparoscopy and reviews the contribution made by the Minimal Access Therapy Training Unit, Guildford, UK, to the treatment of this condition. RESULTS: Few randomized controlled trials have been undertaken to evaluate the surgical management of endometriosis. The studies that have been done show that laparoscopic surgery, including laser laparoscopy, is effective in the management of painful symptoms and subfertility and preventing cyst recurrence. Several of the landmark studies in this area have been carried out in Guildford. CONCLUSION: Laparoscopic surgery is the treatment of choice for patients with endometriosis and endometriotic cysts.

Endometriosis↗