Endometriosis

Gynecological pelvic pain as emergency pathology

Acute pelvic pain is a common condition in emergency. The sources of acute pelvic pain are multifactorial, so it is important to be familiar with this type of pathologies. The purpose of this article is review the main causes of gynecological acute pelvic pain and their radiologic appearances to be able to make an accurate diagnosis and provide objective criteria for patient management.

Predictive factors for the presence of malignant transformation of pelvic endometriosis

OBJECTIVES

To determine predictive factors for the presence of malignant transformation in ovarian endometriotic cysts.

STUDY DESIGN

This was an IRB approved, case control study analyzing patient data from 2004 to 2013. Pathology database records were searched to identify patients with benign endometrioma and ovarian carcinoma arising in the background of endometriosis. Inclusion criteria required each patient to have a preoperative diagnosis of adnexal mass and no other findings concerning for malignancy. Patient clinical records were queried for preoperative symptoms, serum CA125 levels and radiologic findings. Pathologic data were collected including histology, tumor grade and stage.

RESULTS

A total of 138 patients met inclusion criteria; 42 women with ovarian cancer arising in the background of endometriosis and 96 women with benign endometrioma. Women diagnosed with ovarian cancer were significantly older than women with endometriosis (53.6 vs. 39.2 years). There was no difference in presence of symptoms between the two groups. Women with malignant tumors were found to have significantly larger cysts (14 cm vs. 7.5 cm; p<0.0001) that were more often multilocular (45.7% vs. 12.2%; p<0.0001), and contained solid components (77.1% vs. 14.5%; p<0.0001). Among patients that were observed prior to surgery there was a significant difference in the change in size of the mass over time with 4.2 cm increase for cases vs. 1.0 cm increase for controls (p=0.02). Multiple logistic regression analysis indicated that for every 5 years increase in age there was an adjusted OR of 2.17 (p=0.003). An age of 49 years or greater had an 80.6% sensitivity (95% CI: 62.5-92.5%) and an 82.9% specificity (95% CI: 67.9-92.8%) for malignancy, and solid component on imaging had an adjusted OR of 23.7 (p<0.0001). Serum CA125 levels tended to be higher in patients with malignant tumors but did not reach statistical significance with a mean of 204.9 vs. 66.9 (p=0.1).

CONCLUSIONS

Significant predictors for malignant transformation of endometriosis include cyst characteristics and age. Women above the age of 49 with multilocular cysts and solid components are at high risk for malignant transformation of endometriosis. Serum CA125 level is not a significant predictor of malignant transformation.

Ser312Gly Polymorphism of the HSD17β1 Gene is not Associated with Endometriosis in Brazilian Patients

Purpose

The aim of this study was to determine whether a polymorphism of the HSD17β1 gene (rs605059), involved in estrogen synthesis, is associated with endometriosis in Brazilian patients.

Methods

A case-control study was conducted in 231 women. All patients in the case group had a histopathological diagnosis of endometriosis. Genomic DNA was genotyped by nested-PCR, followed by digestion of the PCR product with the enzyme BstUI.

Results

The frequencies of the genotypes detected in the case and control groups were 22.4% GG, 52.2% AG and 25.4% AA; and 31.3% GG, 49.3% AG and 19.4% AA, respectively, with no significant difference between groups. The prevalence of the G allele was 48.5% and 56% in the case and control groups, respectively. No significant difference in genotype or allele frequency was detected between the different stages of endometriosis (p>0.05).

Conclusions

The results suggested that the Ser312Gly polymorphism of the HSD17β1 gene is not associated with endometriosis in Brazilian patients.

Laparoscopic rectal resection of deep infiltrating endometriosis

PURPOSE

Deep infiltrating endometriosis with colorectal involvement is a complex disorder, often requiring segmental bowel resection. Complete removal of all visible lesions is considered the adequate treatment of infiltrating endometriosis in order to reduce recurrence. In this article, we describe our experience with laparoscopic management of deep infiltrating endometriosis with involvement of the rectum.

METHODS

A retrospective analysis of data from patients with deep infiltrating endometriosis with rectal involvement who underwent a laparoscopic surgery in the years 2002-2009 at the Department of Obstetrics and Gynecology at our institution was done.

RESULTS

Between 2002 and 2009, a laparoscopic partial rectal resection was performed in 52 patients, and laparoscopic disk resection was performed in 4 cases with deep infiltrating endometriosis. The mean age of patients was 34.4 years (range, 22-62 years). Preoperative symptoms included dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. The laparoscopic procedure was converted to formal laparotomy in 3 patients (5.4%). The mean duration of surgery was 145 minutes. Postoperative complications included 3 cases of anastomotic leakage with rectovaginal fistula in two cases and intraabdominal bleeding in 1 case. The mean hospital stay was 7 days. Postoperatively, nine patients had a normal delivery, two of them after in vitro fertilization treatment.

CONCLUSION

Laparoscopic rectal resection for deep infiltrating endometriosis is a relatively safe procedure, when performed by a surgeon and a gynecologist with sufficient experience in laparoscopic colorectal surgery.

Ultrassonografia nas massas anexiais: aspectos de imagem

A ultrassonografia realizada por um habilidoso e experiente examinador é considerada, atualmente, método de elevada acurácia no diagnóstico diferencial das massas anexiais. Os autores expõem uma revisão baseada em imagens ultrassonográficas das principais apresentações das massas anexiais, descrevendo suas características e localizações.