1
|
Barra F, Zorzi C, Albanese M, De Mitri P, Stepniewska A, Roviglione G, Giani M, Albertini G, Ferrero S, Ceccaroni M. Ultrasonographic characterization of parametrial endometriosis: a prospective study. Fertil Steril 2024; 122:150-161. [PMID: 38382700 DOI: 10.1016/j.fertnstert.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE To study the ultrasonographic diagnostic accuracy and characteristics of parametrial endometriosis comprehensively. DESIGN This prospective study enrolled patients with suspected deep endometriosis (DE) scheduled for laparoscopic surgical treatment. Preoperative ultrasonographic examinations were performed following the International Deep Endometriosis Analysis criteria. This study aimed to evaluate the presence of parametrial endometriosis and its ultrasonographic characteristics, using surgical diagnosis as the reference standard. Additionally, indirect signs of DE and concomitant DE nodules associated with parametrial involvement were identified, assessing their predictive significance in the anterior, lateral, and posterior parametrial areas. SETTING Referral institution for endometriosis. PATIENTS Patients with suspected DE scheduled for surgical treatment. INTERVENTIONS Standardized preoperative ultrasonographic examination. MAIN OUTCOME MEASURES The diagnostic accuracy of transvaginal ultrasound in identifying parametrial endometriosis, including sensitivity and specificity, and the ultrasonographic characteristics of parametrial nodules, prevalence in distinct parametrial areas, and associations with indirect DE signs and concomitant DE nodules. RESULTS Surgical confirmation of parametrial nodules was observed in 105 of 545 patients (left, 18.5; right, 17.0%). Transvaginal ultrasound demonstrated a sensitivity of 77.1% (95% confidence interval, 68.0%-84.8%) and specificity of 99.1% (95% confidence interval, 67.7%-99.8%). Parametrial nodules typically exhibited characteristics such as a mild hypoechoic appearance (83.6%), starry morphology (74.7%), irregular margins (70.2%), and low vascularization. The posterior parametrial region was the most common location (52.2%), followed by the lateral (41.0%) and anterior (6.8%) parametrial regions. Concomitant DE nodules in the rectum (63.5%) and infiltrating the rectovaginal septum (56.5%) were significantly more prevalent in patients with parametrial involvement. Indirect DE signs, such as the ovaries fixed to the uterine wall (71.8%) and the absence of a posterior sliding sign (51.8%), were also more common in women with parametrial nodules. Hydronephrosis, although relatively uncommon in patients with parametrial involvement (8.2%), was largely detected in lateral parametrial nodules (70.0%). CONCLUSIONS This study represents a systematic ultrasonographic characterization of parametrial endometriosis. Specifically, it comprehensively assesses the diagnostic accuracy of transvaginal ultrasound in identifying parametrial involvement within a sizable cohort of patients with preoperative suspicion of DE. CLINICAL TRIAL REGISTRATION NUMBER NCT06017531.
Collapse
Affiliation(s)
- Fabio Barra
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Carlotta Zorzi
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Mara Albanese
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Paola De Mitri
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Anna Stepniewska
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Milo Giani
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Giorgia Albertini
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Genoa, Italy.
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar (Verona), Italy
| |
Collapse
|
2
|
Naem A, Krentel H, Moawad G, Naem J, Venezia R, Etrusco A, Terzic S, Laganà AS. Hormonal Therapies before in vitro fertilization in women with endometriosis: The Minotaur's Labyrinth and the Ariadne's Thread. Best Pract Res Clin Obstet Gynaecol 2024; 95:102500. [PMID: 38772765 DOI: 10.1016/j.bpobgyn.2024.102500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/02/2024] [Indexed: 05/23/2024]
Abstract
Endometriosis-related infertility is one of the most debated topics in reproductive medicine. In recent years, prolonged pre-cycle hormonal regimens gained attention as a mean of improving the assisted reproduction technologies (ART) success rates in endometriosis patients. GnRH agonists, dienogest, medroxyprogesterone acetate, and aromatase inhibitors are the most studied medications. Conflicting results and a high risk of bias exist in almost all of the conducted studies in the field. However, current evidence suggests that pre-cycle treatment with GnRH agonists may be beneficial for patients with stage III/IV endometriosis. Dienogest and medroxyprogesterone acetate-based progestin-primed ovarian stimulation protocol was shown to be comparable to the prolonged GnRH agonists protocol. Finally, aromatase inhibitors seem to be of limited benefit to the assisted reproductive outcomes of endometriosis patients. Although it is challenging to draw any clinical conclusions, pre-cycle hormonal treatments seem to be best indicated in endometriosis patients who had previously failed ART treatment.
Collapse
Affiliation(s)
- Antoine Naem
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany; Faculty of Mathematics and Computer Science, University of Bremen, 28359 Bremen, Germany.
| | - Harald Krentel
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC 20037, USA; The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC 22101, USA
| | - Joelle Naem
- Faculty of Medicine of Damascus University, Damascus, Syria
| | - Renato Venezia
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| |
Collapse
|
3
|
Szabó G, Bokor A, Fancsovits V, Madár I, Darici E, Pashkunova D, Arányi Z, Fintha A, Rigó J, Lipták L, Mázsár B, Hudelist G. Clinical and ultrasound characteristics of deep endometriosis affecting sacral plexus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:104-111. [PMID: 38315642 DOI: 10.1002/uog.27602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/03/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To describe the sonomorphological changes and appearance of deep endometriosis (DE) affecting the nervous tissue of the sacral plexus (SP). METHODS This was a retrospective study of symptomatic patients who underwent radical resection of histologically confirmed DE affecting the SP and who had undergone preoperative transvaginal sonography (TVS) between 2019 and 2023. Lesions were described based on the terms and definitions of the International Deep Endometriosis Analysis (IDEA), International Ovarian Tumor Analysis (IOTA) and Morphological Uterus Sonographic Assessment (MUSA) groups. A diagnosis of DE affecting the SP on TVS was made when the sonographic criteria of DE were visualized in conjunction with fibers of the SP and the presence of related symptoms corresponding to sacral radiculopathy. Clinical symptoms, ultrasound features and histological confirmation were analyzed for each patient included. RESULTS Twenty-seven patients with DE infiltrating the SP were identified in two contributing tertiary referral centers. Median age was 37 (range, 29-45) years and all patients were symptomatic and presented one or more of the following neurological symptoms: dysesthesia in the ipsilateral lower extremity (n = 17); paresthesia in the ipsilateral lower extremity (n = 10); chronic pelvic pain radiating in the ipsilateral lower extremity (n = 9); chronic pain radiating in the pudendal region (n = 8); and motor weakness in the ipsilateral lower extremities (n = 3). All DE lesions affecting the SP were purely solid tumors in the posterior parametrium in direct contact with, or infiltrating, the S1, S2, S3 and/or S4 roots of the SP. The median of the largest diameter recorded for each of the DE nodules was 35 (range, 18-50) mm. Echogenicity was non-uniform in 23 (85%) of the DE nodules, with all but one of these nodules containing hyperechogenic areas. The shape of the lesions was irregular in 24 (89%) cases. Only one lesion exhibited a lobulated form, with all other irregular lesions showing a spiculated appearance. An acoustic shadow was produced in 20 (74%) of the nodules, all of which were internal. On color or power Doppler examination, 21 (78%) of the nodules showed no signal (color score of 1). The remaining six (22%) lesions showed a minimal color content (color score of 2). According to pattern recognition, most DE nodules were purely solid, non-uniform, hypoechogenic nodules containing hyperechogenic areas, with internal shadows and irregular spiculated contours, and were poorly vascularized on color/power Doppler examination. CONCLUSION The ultrasound finding of a parametrial, unilateral, solid, non-uniform, hypoechogenic nodule with hyperechogenic areas and possible internal shadowing, as well as irregular spiculated contours, demonstrating poor vascularization on Doppler examination in proximity to or involving the structures of the SP, indicates DE affecting the SP. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- G Szabó
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - A Bokor
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - V Fancsovits
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - I Madár
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - E Darici
- Brussels IVF, Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - D Pashkunova
- Department of Gynecology, Center for Endometriosis, Hospital St John of God, Vienna, Austria
| | - Z Arányi
- Department of Neurology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - A Fintha
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - J Rigó
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Clinical Studies in Obstetrics and Gynecology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - L Lipták
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - B Mázsár
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - G Hudelist
- Department of Gynecology, Center for Endometriosis, Hospital St John of God, Vienna, Austria
- Rudolfinerhaus Private Clinic and Campus, Vienna, Austria
| |
Collapse
|
4
|
Keckstein S, Dippon J, Hudelist G, Koninckx P, Condous G, Schroeder L, Keckstein J. Sonomorphologic Changes in Colorectal Deep Endometriosis: The Long-Term Impact of Age and Hormonal Treatment. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:285-292. [PMID: 38101445 DOI: 10.1055/a-2209-5653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
PURPOSE The progression of deep endometriosis (DE) in women of reproductive age is highly variable. This study aimed to analyze the sonomorphological changes of rectal endometriosis over long periods of time and the influence of hormonal treatment. METHODS This retrospective study included premenopausal women with rectal DE treated conservatively between 2002 and 2021. The lesion length and thickness of the nodule were evaluated at regular intervals over time. We created statistical models with mixed effects to identify potential factors influencing lesion progression and regression. RESULTS 38 patients were monitored over a mean period of 7.2 (± 4.2) years with a mean of 3.1 (± 2.1) check-ups within the observation period. We detected a significant increase in lesion length until the end of the fourth decade of life. In addition, we found a substantial decrease in the length and thickness of the nodule depending on the length of hormonal treatment. CONCLUSION In conservatively managed patients with rectal endometriosis, without hormonal therapy, lesion size can exhibit a moderate increase up to the end of the fourth decade of life, after which it appears to stabilize. This increase does not follow a linear pattern. Hormonal therapy is crucial in impeding further progression, resulting in either a cessation or a regression of lesion growth.
Collapse
Affiliation(s)
- Simon Keckstein
- Department of Obstetrics and Gynecology, LMU University Hospital, Munich, Germany
| | - Juergen Dippon
- Institute for Stochastics and Applications, University of Stuttgart, Stuttgart, Germany
| | | | - Philippe Koninckx
- Department for Gynecology, Latifa Hospital, Dubai, United Arab Emirates
| | - George Condous
- Acute Gynecology, Early Pregnancy & Advanced Endoscopic Surgery Unit, University of Sydney - Sydney Medical School Nepean, Sydney, Australia
| | - Lennard Schroeder
- Department of Obstetrics and Gynecology, LMU University Hospital, Munich, Germany
| | - Joerg Keckstein
- (SEF), Stiftung Endometrioseforschung, Westerstede, Germany
- Gynecological Clinic, Gynecological Clinic Drs Keckstein, Villach, Austria
- Department of Obstetrics and Gynecology, Ulm University Hospital, Ulm, Germany
| |
Collapse
|
5
|
Barra F, Ferrero S, Zorzi C, Evangelisti G, Perrone U, Valente I, Capezzuoli T, D'Ancona G, Bogliolo S, Roviglione G, Ceccaroni M. "From the tip to the deep of the iceberg": Parametrial involvement in endometriosis. Best Pract Res Clin Obstet Gynaecol 2024; 94:102493. [PMID: 38581882 DOI: 10.1016/j.bpobgyn.2024.102493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
Deep endometriosis (DE) can be localized in the parametrium, a complex bilateral anatomical structure, sometimes necessitating intricate surgical intervention due to the potential involvement of autonomic nerves, uterine artery, and ureter. If endometriotic ovarian cysts have been considered metaphorically representative of "the tip of the iceberg" concerning concealed DE lesions, it is reasonable to assert that parametrial lesions should be construed as the most profound region of this iceberg. Also, based on a subdual clinical presentation, a comprehensive diagnostic parametrial evaluation becomes imperative to strategize optimal management for patients with suspected DE. Recently, the ULTRAPARAMETRENDO studies aimed to evaluate the role of transvaginal ultrasound for parametrial endometriosis, showing distinctive features, such as a mild hypoechoic appearance, starry morphology, irregular margins, and limited vascularization. The impact of medical therapy on parametrial lesions has not been described in the current literature, primarily due to the lack of adequate detection at imaging. The extension of DE into the parametrium poses significant challenges during the surgical approach, thereby increasing the risk of intra- and postoperative complications, mainly if performed by centers with low expertise and following multiple surgical procedures where parametrial involvement has gone unrecognized. Over time, the principles of nerve-sparing surgery have been incorporated into the surgical DE treatment to minimize iatrogenic damage and potentially reduce the risk of functional complications.
Collapse
Affiliation(s)
- Fabio Barra
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy; Unit of Obstetrics and Gynecology, P.O. "Ospedale Del Tigullio"-ASL4, Via Gio Batta Ghio 9, Chiavari, 16043, Genoa, Italy.
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Carlotta Zorzi
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Giulio Evangelisti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Unit of Obstetrics and Gynecology, San Paolo Hospital - ASL2, Savona, 17100, Italy
| | - Umberto Perrone
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Irene Valente
- Unit of Radiology, P.O. "Ospedale del Tigullio"-ASL4, Via Gio Batta Ghio 9, Chiavari, 16043, Genoa, Italy
| | - Tommaso Capezzuoli
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Gianmarco D'Ancona
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Stefano Bogliolo
- Unit of Obstetrics and Gynecology, P.O. "Ospedale Del Tigullio"-ASL4, Via Gio Batta Ghio 9, Chiavari, 16043, Genoa, Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| |
Collapse
|
6
|
Kula H, Ilgen O, Kurt S, Yılmaz F. Patterns of proliferation and fibrosis in a rat model of endometriosis following administration of Allium cepa. Clin Exp Reprod Med 2024; 51:112-119. [PMID: 38263589 PMCID: PMC11140262 DOI: 10.5653/cerm.2023.06261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE Endometriosis is a common gynecological disease among reproductive-age women. Numerous hypotheses exist regarding the pathogenesis of endometriosis. In Turkey, the consumption of Allium cepa (commonly known as the "onion cure") is a popular treatment employed to alleviate a variety of gynecological disorders. METHODS In this study, our objective was to assess the therapeutic mechanisms of the onion bulb A. cepa using an autologous endometriosis model in Sprague-Dawley rats. Previous research has shown that A. cepa possesses anti-inflammatory, antioxidant, and antiapoptotic properties. We evaluated the pathological condition of endometriotic implants by employing hematoxylin-eosin staining and Ki67 immunohistochemistry analysis. Transforming growth factor-beta 1 (TGF-β1) and alpha-smooth muscle actin (α-SMA) have been identified as profibrotic markers that are highly overexpressed in endometriotic tissues relative to eutopic endometrial tissue. Furthermore, TGF-β1 influences the differentiation and progression of endometriosis. To quantify profibrotic activity, we measured TGF-β1 and α-SMA using the immunosorbent assay method. RESULTS Lower histologic evaluation scores for endometriotic implants were observed in the group receiving high-dose A. cepa relative to the other groups. Ki67 expression was reduced following the high-dose A. cepa regimen, which consisted of 30% A. cepa and 70% normal feed. However, no statistically significant differences in TGF-β1 or α-SMA levels were observed among the groups (p=0.7 and p=0.778, respectively). CONCLUSION The findings suggest that A. cepa could serve as a therapeutic agent in endometriosis treatment, as evidenced by the reduction in proliferative potential. Nevertheless, A. cepa was not associated with significantly lower levels of endometriosis-associated TGF-β1 or α-SMA.
Collapse
Affiliation(s)
- Hakan Kula
- Department of Obstetrics and Gynecology, Dokuz Eylul University, Izmir, Turkey
| | - Orkun Ilgen
- Department of Obstetrics and Gynecology, Dokuz Eylul University, Izmir, Turkey
| | - Sefa Kurt
- Department of Obstetrics and Gynecology, Dokuz Eylul University, Izmir, Turkey
| | - Filiz Yılmaz
- Department of Histology and Embryology, Hitit University, Corum, Turkey
| |
Collapse
|
7
|
Baradwan S, Gari A, Sabban H, Alshahrani MS, Khadawardi K, Bukhari IA, Alyousef A, Abu-Zaid A. The effect of antioxidant supplementation on dysmenorrhea and endometriosis-associated painful symptoms: a systematic review and meta-analysis of randomized clinical trials. Obstet Gynecol Sci 2024; 67:186-198. [PMID: 38221738 PMCID: PMC10948216 DOI: 10.5468/ogs.23210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/11/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024] Open
Abstract
This study aimed to review randomized controlled trials (RCTs) investigating the effects of dietary antioxidant supplements on the severity of endometriosis-related pain symptoms. The PubMed/Medline, Scopus, and Web of Science databases were searched until April 2022. Additionally, we manually searched the reference lists. Endpoints were summarized as standardized mean difference (SMD) with 95% confidence intervals (CIs) in a random-effects model. The I2 statistic was used to assess heterogeneity. Ten RCTs were included in this meta-analysis. Overall, 10 studies were related to dysmenorrhea, four to dyspareunia, and four to pelvic pain. Antioxidants significantly reduced dysmenorrhea (SMD, -0.48; 95% CI, -0.82 to -0.13; I2=75.14%). In a subgroup analysis, a significant reduction of dysmenorrhea was observed only in a subset of trials that administered vitamin D (SMD, -0.59; 95% CI, -1.13 to -0.06; I2=69.59%) and melatonin (SMD, -1.40; 95% CI, -2.47 to -0.32; I2=79.15%). Meta-analysis results also suggested that antioxidant supplementation significantly improved pelvic pain (SMD, -1.51; 95% CI, -2.74 to -0.29; I2=93.96%), although they seem not to have a significant beneficial impact on the severity of dyspareunia. Dietary antioxidant supplementation seems to beneficially impact the severity of endometriosis-related dysmenorrhea (with an emphasis on vitamin D and melatonin) and pelvic pain. However, due to the relatively small sample size and high heterogeneity, the findings should be interpreted cautiously, and the importance of further well-designed clinical studies cannot be overstated.
Collapse
Affiliation(s)
- Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdulrahim Gari
- Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Obstetrics and Gynecology, Al Salama Hospital, Jeddah, Saudi Arabia
| | - Hussein Sabban
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Obstetrics and Gynecology, Faculty of Medicine at Rabigh, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Majed Saeed Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Khalid Khadawardi
- Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ibtihal Abdulaziz Bukhari
- Department of Obstetrics and Gynecology, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdullah Alyousef
- Department of Obstetrics and Gynecology, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Ahmed Abu-Zaid
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| |
Collapse
|
8
|
Mabrouk M, Mahgoub S, Vashisht A, Seracchioli R. Innovative Cadaveric Technique: Utilising n-Butyl Cyanoacrylate (n-BCA) for Deep Endometriosis Excision Simulation in Minimal Invasive Surgery Training. Facts Views Vis Obgyn 2024; 16:83-85. [PMID: 38551478 PMCID: PMC11198881 DOI: 10.52054/fvvo.16.1.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
Background Our study aimed to create a novel technique using n-butyl cyanoacrylate (n-BCA) for minimal access simulation training on cadavers in deep endometriosis excision. Objectives A step-by-step video demonstration of using n-BCA in cadavers to simulate deep endometriosis. This technique is integrated into training sessions using cadavers aimed at enhancing surgical proficiency for deep endometriosis procedures. Material and Methods Video article describing using n-BCA in cadavers as a simulation model. Result This technique has been used in a hands-on cadaveric training course, and positive feedback supports the recommendation to incorporate this technique. Conclusion Utilizing a human cadaver model proves beneficial for enhancing understanding of deep pelvic innervation. Implementing n-BCA in these cadaver dissections demonstrates both reproducibility and safety. This approach significantly contributes to refining surgical expertise in the excision of deep infiltrating endometriosis.
Collapse
|
9
|
Dabi Y, Fauconnier A, Rousset-Jablonski C, Tavenet A, Pizzofferrato AC, Deffieux X. Do women with suspected endometriosis benefit from pelvic examination to improve diagnostic and management strategy? J Gynecol Obstet Hum Reprod 2024; 53:102724. [PMID: 38224817 DOI: 10.1016/j.jogoh.2024.102724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/07/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To analyze the literature and expose best evidence available regarding the benefit of pelvic examination for women with suspected endometriosis METHODS: the AGREE II and GRADE systems for grading scientific evidence. RESULTS Endometriosis is characterized by the heterogeneity in its clinical presentation with many different symptoms reported by patients. In the literature, questioning for each symptom has a high sensitivity, reaching 76-98 %, but lacks specificity (20 - 58 %). The symptom-based approach is limited by its low specificity, the absence of external validation for most of the models developed and the inability to characterize the extent of the disease, which could have major implications in the decision - making process. The latest systematic review and meta-analysis included a total of 30 studies with 4,565 participants, compared the diagnostic performance of several modalities for endometriosis. Physical examination had a pooled sensitivity of 71 % and a specificity of 69 %, with an average diagnostic accuracy of 0.76. Overall, the value of pelvic examination is conferred by its high positive likehood ratio and specificity. Besides its diagnostic value, pelvic examination improves patients' management by allowing the identification of a possible myofascial syndrome as a differential diagnosis. It also increases the quality of the preoperative workup and influences the quality of surgical excision and decreases the time to diagnosis. CONCLUSION Despite the lack of studies in the primary care context, pelvic examination (vaginal speculum and digital vaginal examination) increases the diagnostic value for suspected endometriosis in association with questioning for symptoms.
Collapse
Affiliation(s)
- Yohann Dabi
- Sorbonne Université, Hôpital Tenon, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Assistance Publique des Hôpitaux de Paris, Paris, France; Groupe de Recherche Clinique 6 (GRC6), Centre Expert Endométriose (C3E), Sorbonne Université, France.
| | - Arnaud Fauconnier
- Université Paris-Saclay, UVSQ, Unité de recherche 7285 Risques cliniques et sécurité en santé des femmes et en santé périnatale, Montigny-le-Bretonneux, France; Université Department of Obstetrics and Gynecology, intercommunal Hospital of Poissy / Saint-Germain-en-Laye, Poissy, France
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, Lyon, France; Service de Gynécologie Obstétrique, Centre Hospitalier Lyon Sud, Pierre Bénite, France; INSERM U1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Anne-Cécile Pizzofferrato
- Faculté de Médecine et Pharmacie, Université de Poitiers, Inserm CIC 1402, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU de Poitiers, Poitiers, France
| | - Xavier Deffieux
- Université Paris Saclay, Service de gynécologie obstétrique, hôpital Antoine Béclère, APHP, Clamart, F-92140 France
| |
Collapse
|
10
|
Martire FG, Giorgi M, D’Abate C, Colombi I, Ginetti A, Cannoni A, Fedele F, Exacoustos C, Centini G, Zupi E, Lazzeri L. Deep Infiltrating Endometriosis in Adolescence: Early Diagnosis and Possible Prevention of Disease Progression. J Clin Med 2024; 13:550. [PMID: 38256683 PMCID: PMC10816815 DOI: 10.3390/jcm13020550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Endometriosis has a prevalence of 10% worldwide in premenopausal women. Probably, endometriosis begins early in the life of young girls, and it is commonly diagnosed later in life. The prevalence of deep infiltrating endometriosis (DIE) in adolescence is currently unknown due to diagnostic limits and underestimation of clinical symptoms. Dysmenorrhea is a common symptom in adolescents affected by DIE, often accompanied by dyspareunia and chronic acyclic pelvic pain. Ultrasonography-either performed transabdominal, transvaginal or transrectal-should be considered the first-line imaging technique despite the potential for missed diagnosis due to early-stage disease. Magnetic resonance imaging should be preferred in the case of virgo patients or when ultrasonographic exam is not accepted. Diagnostic laparoscopy is deemed acceptable in the case of suspected DIE not responding to conventional hormonal therapy. An early medical and/or surgical treatment may reduce disease progression with an immediate improvement in quality of life and fertility, but at the same time, painful symptoms may persist or even recur due to the surgery itself. The aim of this narrative review is to report the prevalence of DIE in adolescents, describe the pathogenetic theories and discuss the management in adolescent women, including the challenging road to diagnosis and the treatment alternatives.
Collapse
Affiliation(s)
- Francesco Giuseppe Martire
- Gynecological Unit, Department of Surgical Sciences, University of Rome “Tor Vergata”, 00133 Rome, Italy; (F.G.M.); (C.E.)
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy; (M.G.); (C.D.); (I.C.); (A.G.); (A.C.); (G.C.); (L.L.)
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy; (M.G.); (C.D.); (I.C.); (A.G.); (A.C.); (G.C.); (L.L.)
| | - Claudia D’Abate
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy; (M.G.); (C.D.); (I.C.); (A.G.); (A.C.); (G.C.); (L.L.)
| | - Irene Colombi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy; (M.G.); (C.D.); (I.C.); (A.G.); (A.C.); (G.C.); (L.L.)
| | - Alessandro Ginetti
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy; (M.G.); (C.D.); (I.C.); (A.G.); (A.C.); (G.C.); (L.L.)
| | - Alberto Cannoni
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy; (M.G.); (C.D.); (I.C.); (A.G.); (A.C.); (G.C.); (L.L.)
| | - Francesco Fedele
- Department of Obstetrics and Gynecology, Fondazione “Policlinico-Mangiagalli-Regina Elena” University of Milan, 20122 Milan, Italy;
| | - Caterina Exacoustos
- Gynecological Unit, Department of Surgical Sciences, University of Rome “Tor Vergata”, 00133 Rome, Italy; (F.G.M.); (C.E.)
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy; (M.G.); (C.D.); (I.C.); (A.G.); (A.C.); (G.C.); (L.L.)
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy; (M.G.); (C.D.); (I.C.); (A.G.); (A.C.); (G.C.); (L.L.)
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy; (M.G.); (C.D.); (I.C.); (A.G.); (A.C.); (G.C.); (L.L.)
| |
Collapse
|
11
|
Mongiovi JM, Wallace B, Goodwin M, Vitonis AF, Karevicius S, Shafrir AL, Sasamoto N, DiVasta AD, Sieberg CB, Terry KL, Missmer SA. Differences in characteristics and use of complementary and alternative methods for coping with endometriosis-associated acyclic pelvic pain across adolescence and adulthood. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 5:1306380. [PMID: 38260050 PMCID: PMC10801248 DOI: 10.3389/frph.2023.1306380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Over four million women in the US alone have been diagnosed with endometriosis. For those living with this disease, surgery and hormonal treatment reduce associated pelvic pain in some, while others continue to experience life impacting pain. Therefore, identification of accessible and cost-effective methods of pain reduction to compliment current treatment is urgently needed. Our objective was to quantify the prevalence of complementary and alternative methods used to manage acyclic pelvic pain and their reported benefit among women of different age groups living with endometriosis. Methods We used baseline questionnaire data from laparoscopically-confirmed endometriosis cases who completed a WERF EPHect compliant questionnaire in the longitudinal cohort of The Women's Health Study: From Adolescence to Adulthood (A2A). Participants with acyclic pelvic pain were asked to indicate specific methods or activities that either helped or worsened their pelvic/lower abdominal pain. Differences among age groups [adolescent (<18 years), young adult (18-25 years), and adult (>25 years)] were assessed using Fisher's exact test. Results Of the 357 participants included in analysis, sleep for coping was reported more frequently among adolescents (n = 59, 57.3%) compared to young adults (n = 40, 44.0%) and adults (n = 19, 31.1%; p = 0.004). Adolescents also reported more frequent use of music (n = 29, 21.2%) than young adults (n = 10, 7.0%) and adults (n = 7, 9.1%; p = 0.001). Exercise worsened pain most commonly among adolescents (n = 82, 59.9%), followed by younger adults (n = 67, 46.9%), and adults (n = 27, 35.1%; p = 0.002). Discussion Our analysis of participants in the A2A cohort showed that the prevalence of complementary and alternative methods used for coping with endometriosis-associated acyclic pelvic pain varied by age group. Future studies should aim to provide information that will further inform decisions in making care plans for managing endometriosis-associated pain that is effective, accessible, and tailored to the preferences of the patient.
Collapse
Affiliation(s)
- Jennifer M. Mongiovi
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Britani Wallace
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - McKenzie Goodwin
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, MA, United States
| | - Allison F. Vitonis
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, MA, United States
| | - Sarah Karevicius
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, MA, United States
| | - Amy L. Shafrir
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, MA, United States
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- Department of Nutrition and Public Health, School of Nursing and Health Sciences, Merrimack College, North Andover, MA, United States
| | - Naoko Sasamoto
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, MA, United States
| | - Amy D. DiVasta
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, MA, United States
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Christine B. Sieberg
- Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children’s Hospital, Boston, MA, United States
- Pain & Affective Neuroscience Center, Department of Anesthesiology, Critical Care, & Pain Medicine, Boston Children’s Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kathryn L. Terry
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, MA, United States
| | - Stacey A. Missmer
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, MA, United States
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| |
Collapse
|
12
|
Zheng X, Zhao D, Liu Y, Jin Y, Liu T, Li H, Liu D. Regeneration and anti-inflammatory effects of stem cells and their extracellular vesicles in gynecological diseases. Biomed Pharmacother 2023; 168:115739. [PMID: 37862976 DOI: 10.1016/j.biopha.2023.115739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
There are many gynecological diseases, among which breast cancer (BC), cervical cancer (CC), endometriosis (EMs), and polycystic ovary syndrome (PCOS) are common and difficult to cure. Stem cells (SCs) are a focus of regenerative medicine. They are commonly used to treat organ damage and difficult diseases because of their potential for self-renewal and multidirectional differentiation. SCs are also commonly used for difficult-to-treat gynecological diseases because of their strong directional differentiation ability with unlimited possibilities, their tendency to adhere to the diseased tissue site, and their use as carriers for drug delivery. SCs can produce exosomes in a paracrine manner. Exosomes can be produced in large quantities and have the advantage of easy storage. Their safety and efficacy are superior to those of SCs, which have considerable potential in gynecological treatment, such as inhibiting endometrial senescence, promoting vascular reconstruction, and improving anti-inflammatory and immune functions. In this paper, we review the mechanisms of the regenerative and anti-inflammatory capacity of SCs and exosomes in incurable gynecological diseases and the current progress in their application in genetic engineering to provide a foundation for further research.
Collapse
Affiliation(s)
- Xu Zheng
- Changchun University of Chinese Medicine, Changchun 130117, China
| | - Dan Zhao
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun 130000, China
| | - Yang Liu
- Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun 130000, China
| | - Ye Jin
- Changchun University of Chinese Medicine, Changchun 130117, China
| | - Tianjia Liu
- Changchun University of Chinese Medicine, Changchun 130117, China; Baicheng Medical College, Baicheng 137000, China.
| | - Huijing Li
- Changchun University of Chinese Medicine, Changchun 130117, China.
| | - Da Liu
- Changchun University of Chinese Medicine, Changchun 130117, China.
| |
Collapse
|
13
|
Ikebuchi A, Osaki M, Wada I, Nagata H, Nagira K, Azuma Y, Okada F, Harada T, Taniguchi F. Increased chemokine ligand 26 expression and its involvement in epithelial-mesenchymal transition in the endometrium with adenomyosis. J Gynecol Obstet Hum Reprod 2023; 52:102645. [PMID: 37597576 DOI: 10.1016/j.jogoh.2023.102645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Adenomyosis is a gynecologic disorder characterized by symptoms of dysmenorrhea, abnormal uterine bleeding, and infertility. This study aimed to analyze the expression profiles of key inflammatory cytokines in the endometrium with adenomyosis and their involvement in epithelial-mesenchymal transition (EMT). STUDY DESIGN Endometrial tissues collected from premenopausal women with (n = 3) or without (n = 3) adenomyosis during the secretory phase were subjected to DNA array analysis to examine inflammatory cytokines. The gene and protein expression levels were re-evaluated by reverse transcription-polymerase chain reaction (n = 19) and immunohistochemistry (n = 56). Immunohistochemical analysis using the Histo-scores of chemokine ligand 26 (CCL26) and EMT-related factors was performed with uterine tissues resected for adenomyosis (n = 37), including those from patients treated with gonadotropin-releasing hormone agonist (GnRHa). An invasion assay was also performed using endometrial epithelial cells. RESULTS DNA array results showed that CCL26, IL-1B, and CCL3 were upregulated. CCL26 mRNA expression was markedly higher in the endometrium with adenomyosis than in that without adenomyosis. Immunohistochemical analysis revealed that CCL26 expression was elevated in the epithelial cells of the basal layer of the endometrium with adenomyosis than in that without adenomyosis regardless of GnRHa treatment. In the basal layer of the endometrium with adenomyosis, CCL26 expression was positively correlated with neural-cadherin and ZEB1 expression; additionally, the cases with intrinsic-type adenomyosis had high expression levels of CCL26 and ZEB1. Exogenous CCL26 promoted the invasive activity of endometrial epithelial cells. CONCLUSIONS CCL26, an inflammatory mediator, may be involved in the pathogenesis of adenomyosis by inducing EMT in the basal layer of the endometrium.
Collapse
Affiliation(s)
- Ai Ikebuchi
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Mitsuhiko Osaki
- Division of Experimental Pathology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Ikumi Wada
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Hiroki Nagata
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Kei Nagira
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Yukihiro Azuma
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Futoshi Okada
- Division of Experimental Pathology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Tasuku Harada
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Fuminori Taniguchi
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan.
| |
Collapse
|
14
|
Pais AS, Almeida-Santos T. Recent insights explaining susceptibility to endometriosis-From genetics to environment. WIREs Mech Dis 2023; 15:e1624. [PMID: 37533299 DOI: 10.1002/wsbm.1624] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/17/2023] [Accepted: 06/21/2023] [Indexed: 08/04/2023]
Abstract
Endometriosis is a disease with a heterogeneous pathogenesis, explained by multiple theories, and also with a polymorphic presentation. The purpose of this literature review is to systematize the genetic, inflammatory, and environmental factors related to the pathophysiology of endometriosis. Current evidence suggests that endometriosis is a complex inherited genetic condition, in which the genes that determine susceptibility to the disease interact with the environment to develop different phenotypes. Genetic variants associated with risk of endometriosis have been identified in several genome-wide association studies, in addition to a group of genes related to the pathophysiology of endometriosis, namely the estrogen, progesterone and androgen receptors and the cytochrome P450 gene, as well as the p53 gene. The role of inflammation is controversial; however, it is an essential process, both in the initiation and perpetuation of the disease, in and outside the pelvis. Alterations in reactive oxygen species pathways that consequently determine oxidative stress are typical in the inflammatory environment of endometriosis. The role of environmental factors is a relatively new and broad-spectrum topic, with inconsistent evidence. Multiple factors have been studied such as endocrine-disrupting chemicals, metals, intrauterine exposure to diethylstilbesterol and lifestyle risk factors. In conclusion, endometriosis remains a mysterious condition, with multifactorial factors involved in its pathophysiology. The progress that has been made in the genetic predisposition to endometriosis may allow the establishment of new therapeutic targets. On the other hand, understanding the role of the environment in this disease may allow preventive intervention, minimizing its incidence and/or severity. This article is categorized under: Reproductive System Diseases > Molecular and Cellular Physiology Reproductive System Diseases > Environmental Factors Reproductive System Diseases > Genetics/Genomics/Epigenetics.
Collapse
Affiliation(s)
- Ana Sofia Pais
- Reproductive Medicine Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
- CNC-Center for Neuroscience and Cell Biology, CIBB, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
- Institute of Biophysics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Centre of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Teresa Almeida-Santos
- Reproductive Medicine Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
- CNC-Center for Neuroscience and Cell Biology, CIBB, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| |
Collapse
|
15
|
Menzhinskaya IV, Pavlovich SV, Melkumyan AG, Chuprynin VD, Yarotskaya EL, Sukhikh GT. Potential Significance of Serum Autoantibodies to Endometrial Antigens, α-Enolase and Hormones in Non-Invasive Diagnosis and Pathogenesis of Endometriosis. Int J Mol Sci 2023; 24:15578. [PMID: 37958566 PMCID: PMC10649774 DOI: 10.3390/ijms242115578] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
The objective of the study was to evaluate the profile of serum autoantibodies and their diagnostic and pathogenetic significance in ovarian endometrioma (OEM) and deep infiltrative endometriosis (DIE). The study enrolled 74 patients with endometriosis (Group 1), including 53 patients with OEM (Subgroup 1a); 21 patients with DIE without ovarian lesions (Subgroup 1b); and 27 patients without endometriosis (Group 2). The diagnosis was confirmed by laparoscopic surgery and histologic examination of resected tissues. Antibodies (M, G) to tropomyosin 3 (TPM), tropomodulin 3 (TMOD), α-enolase (ENO), estradiol (E2), progesterone (PG), and human chorionic gonadotropin (hCG) were identified in blood serum using modified ELISA. In endometriosis, antibodies to endometrial antigens, hormones, and ENO were detected more often than antiphospholipid and antinuclear antibodies. Higher levels of IgM to TPM, hCG, E2, and PG and IgG to TMOD, ENO, E2, and hCG were found in Subgroup 1a compared to Group 2. IgM to TPM, hCG, E2, PG, and IgG to E2 and ENO had a high diagnostic value for OEM (AUC > 0.7), with antibodies to TPM having the highest sensitivity and specificity (73.6% and 81.5%). In Subgroup 1b, only the levels of IgM to TPM and hCG were higher than in Group 2. These antibodies had a high diagnostic value for DIE. Thus, endometriosis is associated with autoantibodies to endometrial antigens, α-enolase, steroid, and gonadotropic hormones. A wider spectrum of antibodies is detected in OEM than in DIE. These antibodies have a high diagnostic value for OEM and DIE and potential pathogenetic significance for endometriosis and associated infertility.
Collapse
Affiliation(s)
- Irina V. Menzhinskaya
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Health of the Russian Federation, 117997 Moscow, Russia
| | - Stanislav V. Pavlovich
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Health of the Russian Federation, 117997 Moscow, Russia
- Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119048 Moscow, Russia
| | - Arika G. Melkumyan
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Health of the Russian Federation, 117997 Moscow, Russia
| | - Vladimir D. Chuprynin
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Health of the Russian Federation, 117997 Moscow, Russia
| | - Ekaterina L. Yarotskaya
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Health of the Russian Federation, 117997 Moscow, Russia
| | - Gennady T. Sukhikh
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Health of the Russian Federation, 117997 Moscow, Russia
- Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119048 Moscow, Russia
| |
Collapse
|
16
|
Giudice LC, Oskotsky TT, Falako S, Opoku‐Anane J, Sirota M. Endometriosis in the era of precision medicine and impact on sexual and reproductive health across the lifespan and in diverse populations. FASEB J 2023; 37:e23130. [PMID: 37641572 PMCID: PMC10503213 DOI: 10.1096/fj.202300907] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023]
Abstract
Endometriosis is a common estrogen-dependent disorder wherein uterine lining tissue (endometrium) is found mainly in the pelvis where it causes inflammation, chronic pelvic pain, pain with intercourse and menses, and infertility. Recent evidence also supports a systemic inflammatory component that underlies associated co-morbidities, e.g., migraines and cardiovascular and autoimmune diseases. Genetics and environment contribute significantly to disease risk, and with the explosion of omics technologies, underlying mechanisms of symptoms are increasingly being elucidated, although novel and effective therapeutics for pain and infertility have lagged behind these advances. Moreover, there are stark disparities in diagnosis, access to care, and treatment among persons of color and transgender/nonbinary identity, socioeconomically disadvantaged populations, and adolescents, and a disturbing low awareness among health care providers, policymakers, and the lay public about endometriosis, which, if left undiagnosed and under-treated can lead to significant fibrosis, infertility, depression, and markedly diminished quality of life. This review summarizes endometriosis epidemiology, compelling evidence for its pathogenesis, mechanisms underlying its pathophysiology in the age of precision medicine, recent biomarker discovery, novel therapeutic approaches, and issues around reproductive justice for marginalized populations with this disorder spanning the past 100 years. As we enter the next revolution in health care and biomedical research, with rich molecular and clinical datasets, single-cell omics, and population-level data, endometriosis is well positioned to benefit from data-driven research leveraging computational and artificial intelligence approaches integrating data and predicting disease risk, diagnosis, response to medical and surgical therapies, and prognosis for recurrence.
Collapse
Affiliation(s)
- Linda C. Giudice
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Center for Reproductive SciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Tomiko T. Oskotsky
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Bakar Computational Health Sciences InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Simileoluwa Falako
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Columbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Jessica Opoku‐Anane
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Division of Gynecologic Specialty SurgeryColumbia UniversityNew YorkNew YorkUSA
| | - Marina Sirota
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Bakar Computational Health Sciences InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Department of PediatricsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| |
Collapse
|
17
|
Pados G, Gordts S, Sorrentino F, Nisolle M, Nappi L, Daniilidis A. Adenomyosis and Infertility: A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1551. [PMID: 37763670 PMCID: PMC10534714 DOI: 10.3390/medicina59091551] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Adenomyosis (the presence of ectopic endometrial glands and stroma below the endometrial-myometrial junction) is a benign condition which is increasingly diagnosed in younger women suffering from infertility. The aim of this narrative review was to study the pathophysiology and prevalence of adenomyosis, the mechanisms causing infertility, treatment options, and reproductive outcomes in infertile women suffering from adenomyosis. Materials and Methods: A literature search for suitable articles published in the English language was performed using PubMed from January 1970 to July 2022. Results: The literature search retrieved 50 articles that met the purpose of this review and summarized the most recent findings regarding the accuracy of diagnostic methods, pathophysiology, and the prevalence of adenomyosis and optimal strategies for the treatment of infertile women with adenomyosis. Conclusions: Adenomyosis is a common gynecological disorder, affecting women of reproductive age. It negatively affects in vitro fertilization, pregnancy and the live birth rate, as well as increases the risk of miscarriage. With the advent of non-invasive diagnoses with MRI and TVUS, the role of adenomyosis in infertility has been better recognized. Overall, more randomized controlled trials (RCTs) are needed to provide strong data on the accuracy of diagnostic methods, the pathophysiology and the prevalence of adenomyosis, the fertility outcomes of patients and the optimal strategy for the treatment.
Collapse
Affiliation(s)
- George Pados
- 1st Department of Obstetrics and Gynaecology, Papageorgiou General Hospital, School of Medicine, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece;
| | | | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy;
| | - Michelle Nisolle
- Department of Obstetrics and Gynecology, Hospital de La Citadelle, University of Liege, 4000 Liege, Belgium;
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy;
| | - Angelos Daniilidis
- 1st Department of Obstetrics and Gynaecology, Papageorgiou General Hospital, School of Medicine, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece;
| |
Collapse
|
18
|
Nogueira J, Melo VG, Lima LCS, Costa MVLR, Silva LC, Gomes LMRDS, Freire GIDM, Leal PDC, de Oliveira CMB, Moura ECR. Improved quality of life (EHP-30) in patients with endometriosis after surgical treatment. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230316. [PMID: 37585993 PMCID: PMC10427168 DOI: 10.1590/1806-9282.20230316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/21/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE This study aimed to evaluate the quality of life of patients with endometriosis before and after surgical treatment. METHODS An observational, longitudinal, and prospective study was conducted with 102 women with pelvic pain and endometriosis that was unimproved by clinical treatment and indicated for surgical treatment. The patients' quality of life was assessed using the 30-item Endometriosis Health Profile (EHP-30) questionnaire before and 3 and 6 months after surgery. The statistical tests were analyzed using the Statistical Package for Social Sciences version 17.0, and the Friedman test was used. RESULTS There was a reduction in EHP-30 scores 3 and 6 months after surgery compared to before surgery, as well as 6 months after surgery compared to 3 months after surgery, in the central questionnaire (PART 1) and in Sections A, B, C, E, and F (p<0.0001). For Section D, there was a reduction in scores 6 months after surgery compared to before surgery (p<0.0001). CONCLUSION Surgical treatment of endometriosis improves quality of life in several areas assessed by the EHP-30 questionnaire.
Collapse
Affiliation(s)
- João Nogueira
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
- Hospital São Domingos, Ginecology Service – São Luís (MA), Brazil
| | - Vinicius Gonçalves Melo
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
| | - Luna Carolina Silva Lima
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
| | | | - Leonardo Carvalho Silva
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
| | - Lyvia Maria Rodrigues de Sousa Gomes
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
- Hospital São Domingos, Ginecology Service – São Luís (MA), Brazil
| | | | - Plinio da Cunha Leal
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
- Hospital São Domingos, Ginecology Service – São Luís (MA), Brazil
| | - Caio Marcio Barros de Oliveira
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
- Hospital São Domingos, Ginecology Service – São Luís (MA), Brazil
| | - Ed Carlos Rey Moura
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
- Hospital São Domingos, Ginecology Service – São Luís (MA), Brazil
| |
Collapse
|
19
|
Chiminacio I, Obrzut C, Saggin S. Post-orgasm pain associated with endometriosis and complete resolution of symptoms after laparoscopic en-bloc peritonectomy, a case report. Int J Surg Case Rep 2023; 109:108558. [PMID: 37517255 PMCID: PMC10400870 DOI: 10.1016/j.ijscr.2023.108558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE We report a rare case of post-orgasmic pain associated with endometriosis of the left hypogastric nerve and posterior vaginal wall. It is not a typical symptom of dyspareunia and has not been frequently associated with endometriosis in previous reports. CASE PRESENTATION A 36-year-old woman presented with post-orgasmic pain exclusively at orgasm, but no dyspareunia during intercourse. She also reported bladder irritation and secondary dysmenorrhea. CLINICAL DISCUSSION Physical examination revealed a small mass on the posterior vaginal wall and thickening of the left uterosacral ligament (USL) associated with severe pain. Pelvic magnetic resonance imaging (MRI) revealed endometrial tissue infiltration of the USL, hypogastric nerve tract, and posterior vaginal wall, consistent with endometriosis. Laparoscopic surgical excision was performed. Complete en bloc peritonectomy excision of the posterior pelvic compartment and complete removal of the lesions identified on MRI was performed. There were no postoperative complications and symptoms resolved completely. Histopathological examination revealed endometriosis. CONCLUSION Orgasm-associated pain is rarely associated with endometriosis of the hypogastric nerve. In most cases there is no obvious cause for this symptom in this type of dysorgasmia. The complete resolution of symptoms after removal of the endometriosis by peritonectomy of the posterior pelvic compartment and en bloc excision strongly suggests a causal relationship between endometriosis of the hypogastric nerve and the orgasmic pain and urinary symptoms observed in this case. Also, the effective surgical technique used to treat endometriosis.
Collapse
Affiliation(s)
- Igor Chiminacio
- Chiminacio Medicina da Mulher, Silvio Vidal 175 sl 301, Zip 85505-010 Pato Branco, Paraná, Brazil.
| | | | | |
Collapse
|
20
|
Masternak M, Grabczak M, Szaflik T, Mroczkowska B, Mokros Ł, Smolarz B, Romanowicz H, Szyłło K. The Utility of Rectal Water Contrast Transvaginal Ultrasound for Assessment of Deep Bowel Endometriosis. Life (Basel) 2023; 13:life13051151. [PMID: 37240796 DOI: 10.3390/life13051151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/23/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Deep infiltrating endometriosis (DIE) is characterized by the presence of endometrial tissue outside the uterine cavity that infiltrates at least 5-mm deep below the peritoneal layer. Imagining examinations are the first-choice methods to detect DIE. The aim of this study is to assess whether rectal water contrast transvaginal sonography (RWC-TVS) can be a useful tool for the estimation of the size of deep bowel endometriotic nodules. This retrospective study includes 31 patients subjected to RWC-TVS who underwent surgery due to deep bowel endometriosis between January 2021 and December 2022. Nodule dimensions measured via ultrasound were compared to those of histopathological samples taken after surgery. In total, 52% of patients had endometriosis limited only to the intestines, 19% had endometriotic nodules located at uterosacral ligaments and posterior vaginal fornix, 6% at the anterior compartment, and 13% at a different location. Additionally, 6% of patients had nodules at more than two locations. In all but one case, the intestinal nodules could be seen on RWC-TVS images. The largest nodule dimension measured via RWC-TVS and the size of the equivalent histopathological sample correlated (R = 0.406, p = 0.03). Thus, RWC-TVS allows for the detection of DIE and moderate estimation of the nodule sizes and should be practiced during a diagnostic process.
Collapse
Affiliation(s)
- Martyna Masternak
- Department of Gynecology, Operative Gynecology and Treatment of Endometriosis, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland
| | - Malwina Grabczak
- Department of Gynecology, Operative Gynecology and Treatment of Endometriosis, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland
| | - Tomasz Szaflik
- Department of Gynecology, Operative Gynecology and Treatment of Endometriosis, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland
| | - Beata Mroczkowska
- Department of Gynecology, Operative Gynecology and Treatment of Endometriosis, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland
| | - Łukasz Mokros
- Second Department of Psychiatry, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland
| | - Beata Smolarz
- Laboratory of Cancer Genetics, Department of Pathology, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland
| | - Hanna Romanowicz
- Laboratory of Cancer Genetics, Department of Pathology, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland
| | - Krzysztof Szyłło
- Department of Gynecology, Operative Gynecology and Treatment of Endometriosis, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland
| |
Collapse
|
21
|
Marshall A, Kommoss KF, Ortmann H, Kirchner M, Jauckus J, Sinn P, Strowitzki T, Germeyer A. Comparing gene expression in deep infiltrating endometriosis with adenomyosis uteri: evidence for dysregulation of oncogene pathways. Reprod Biol Endocrinol 2023; 21:33. [PMID: 37005590 PMCID: PMC10067221 DOI: 10.1186/s12958-023-01083-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND The pathogenesis of deep infiltrating endometriosis (DIE) is poorly understood. It is considered a benign disease but has histologic features of malignancy, such as local invasion or gene mutations. Moreover, it is not clear whether its invasive potential is comparable to that of adenomyosis uteri (FA), or whether it has a different biological background. Therefore, the aim of this study was to molecularly characterize the gene expression signatures of both diseases in order to gain insight into the common or different underlying pathomechanisms and to provide clues to pathomechanisms of tumor development based on these diseases. METHODS In this study, we analyzed formalin-fixed and paraffin-embedded tissue samples from two independent cohorts. One cohort involved 7 female patients with histologically confirmed FA, the other cohort 19 female patients with histologically confirmed DIE. The epithelium of both entities was microdissected in a laser-guided fashion and RNA was extracted. We analyzed the expression of 770 genes using the nCounter expression assay human PanCancer (Nanostring Technology). RESULTS In total, 162 genes were identified to be significantly down-regulated (n = 46) or up-regulated (n = 116) in DIE (for log2-fold changes of < 0.66 or > 1.5 and an adjusted p-value of < 0.05) compared to FA. Gene ontology and KEGG pathway analysis of increased gene expression in DIE compared to FA revealed significant overlap with genes upregulated in the PI3K pathway and focal adhesion signaling pathway as well as other solid cancer pathways. In FA, on the other hand, genes of the RAS pathway showed significant expression compared to DIE. CONCLUSION DIE and FA differ significantly at the RNA expression level: in DIE the most expressed genes were those belonging to the PI3K pathway, and in FA those belonging to the RAS pathway.
Collapse
Affiliation(s)
- A Marshall
- Dept. of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - K F Kommoss
- Dept. of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - H Ortmann
- Dept. of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - M Kirchner
- Dept. of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - J Jauckus
- Dept. of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - P Sinn
- Dept. of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - T Strowitzki
- Dept. of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - A Germeyer
- Dept. of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| |
Collapse
|
22
|
Tayade S, Rai S, Pai H, Patel M, Makhija N. Efficacy of Dienogest in Adolescent Endometriosis: A Narrative Review. Cureus 2023; 15:e36729. [PMID: 37123753 PMCID: PMC10139672 DOI: 10.7759/cureus.36729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Teenage endometriosis is seen as a chronic condition that can worsen if untreated. Treatment objectives include relief of symptoms, prevention of disease development, and preservation of future fertility. In many regions, dienogest (DNG), an oral progestin, has emerged as a key treatment in suppressing endometriosis. The usage of DNG for endometriosis in adolescents was researched in papers published between 2015 and 2022 using PubMed and Google Scholar. A thorough search of all identified studies' reference lists and previously published literature reviews was carried out. The study's nature and geographic scope were not restricted. After reviewing these publications, the authors decided on which ones were the most pertinent in light of their personal experiences. The final study consisted of 14 studies that satisfied inclusion requirements. The trials showed that taking DNG 2 mg daily efficiently lowers endometriotic lesions, eases painful endometriosis symptoms, and improves quality-of-life indicators. In most of these investigations, DNG was shown to be safe and tolerated, with predictable and moderate side effects, good patient compliance rates, and low withdrawal rates. Although endometrioma did not enlarge while receiving treatment, significant regression was not typical. Overall, the studies found that DNG is safe and effective in reducing symptoms of endometriosis in adolescents.
Collapse
|
23
|
Merviel P, Rebahi C, James P, Kergastel I, Bourhis‐Guizien F, Conan‐Charlet V, Derquin F, Hardy‐Bessard A, Dupré P, Morcel K. An exceptional case of degenerative endometriosis of the uterine torus. Clin Case Rep 2023; 11:e7130. [PMID: 36992666 PMCID: PMC10040494 DOI: 10.1002/ccr3.7130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/29/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
There are less than ten cases of deep endometriosis degeneration in the literature. The duration of endometriosis, the ovarian stimulation, the perimenopause and the obesity exposes the woman to an increased risk of endometriosis degeneration.
Collapse
Affiliation(s)
- Philippe Merviel
- Service de Gynécologie‐Obstétrique et Médecine de la Reproduction, centre des Cancers Gynécologiques et MammairesCHRU Brest, hôpital Morvan29200BrestFrance
| | - Christie Rebahi
- Service de Gynécologie‐Obstétrique et Médecine de la Reproduction, centre des Cancers Gynécologiques et MammairesCHRU Brest, hôpital Morvan29200BrestFrance
| | - Pandora James
- Service de Gynécologie‐Obstétrique et Médecine de la Reproduction, centre des Cancers Gynécologiques et MammairesCHRU Brest, hôpital Morvan29200BrestFrance
| | - Isabelle Kergastel
- Service d'Imagerie Gynécologique et MammaireCHRU Brest, hôpital Morvan29200BrestFrance
| | - Fanny Bourhis‐Guizien
- Service d'Imagerie Gynécologique et MammaireCHRU Brest, hôpital Morvan29200BrestFrance
| | | | - Fanny Derquin
- Oncologiecentre Armoricain Radiothérapie Imagerie Médicale Oncologie (CARIO)22198PlérinFrance
| | | | - Pierre‐François Dupré
- Service de Gynécologie‐Obstétrique et Médecine de la Reproduction, centre des Cancers Gynécologiques et MammairesCHRU Brest, hôpital Morvan29200BrestFrance
| | - Karine Morcel
- Service de Gynécologie‐Obstétrique et Médecine de la Reproduction, centre des Cancers Gynécologiques et MammairesCHRU Brest, hôpital Morvan29200BrestFrance
| |
Collapse
|
24
|
Yuan X, Wong BWX, Randhawa NK, Win TPP, Chan YH, Ma L, Yong EL. Factors associated with deep infiltrating endometriosis, adenomyosis and ovarian endometrioma. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023. [DOI: 10.47102/annals-acadmedsg.2022334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Introduction: To compare epidemiological features and clinical presentations of deep infiltrating endometriosis with endometrioma and adenomyosis, as well as to identify risk factors for the respective histologically confirmed conditions.
Method: Patients undergoing index surgery at the National University Hospital, Singapore for endometriosis or adenomyosis over a 7-year period—from 2015 to 2021—were identified from hospital databases using the Table of Surgical Procedures coding. Social and epidemiological features of cases with histologically confirmed diagnoses of endometrioma only, adenomyosis only, and deep infiltrating endometriosis were compared. Significant variables from univariate analysis were entered into 3 binary multivariate logistic regression models to obtain independent risk factors for: deep infiltrating endometriosis versus endometrioma only, deep infiltrating endometriosis versus adenomyosis only, and adenomyosis only versus endometrioma only.
Results: A total of 258 patients were included with 59 ovarian endometrioma only, 47 adenomyosis only, and 152 deep infiltrating endometrioses. Compared to endometrioma only, deep infiltrating endometriosis was associated with higher rates of severe dysmenorrhoea (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.02–7.70) and out-of-pocket private surgical care (OR 4.72, 95% CI 1.85–12.04). Compared to adenomyosis only, deep infiltrating endometriosis was associated with a higher fertility desire (OR 13.47, 95% CI 1.01–180.59) and a lower body mass index (OR 0.89, 95% CI 0.79–0.99). In contrast, heavy menstrual bleeding was the hallmark of adenomyosis, being less common in patients with endometriosis.
Conclusion: Deep infiltrating endometriosis is associated with severe dysmenorrhoea, pain related to urinary and gastrointestinal tracts, higher fertility desire and infertility rate. Patients with pain symptomatology and subfertility should be referred early to a tertiary centre with the capability to diagnose and manage deep infiltrating endometriosis.
Keywords: Adenomyosis, deep infiltrating endometriosis, obstetrics and gynaecology, ovarian endometrioma, public health
Collapse
Affiliation(s)
- Xi Yuan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Beverly WX Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Thu PP Win
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Li Ma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eu-Leong Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
25
|
Lamceva J, Uljanovs R, Strumfa I. The Main Theories on the Pathogenesis of Endometriosis. Int J Mol Sci 2023; 24:ijms24054254. [PMID: 36901685 PMCID: PMC10001466 DOI: 10.3390/ijms24054254] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/23/2023] Open
Abstract
Endometriosis is a complex disease, which is defined by abnormal growth of endometrial tissue outside the uterus. It affects about 10% of women of reproductive age all over the world. Endometriosis causes symptoms that notably worsen patient's well-being-such as severe pelvic pain, dysfunction of the organs of pelvic cavity, infertility and secondary mental issues. The diagnosis of endometriosis is quite often delayed because of nonspecific manifestations. Since the disease was defined, several different pathogenetic pathways have been considered, including retrograde menstruation, benign metastasis, immune dysregulation, coelomic metaplasia, hormonal disbalance, involvement of stem cells and alterations in epigenetic regulation, but the true pathogenesis of endometriosis remains poorly understood. The knowledge of the exact mechanism of the origin and progression of this disease is significant for the appropriate treatment. Therefore, this review reports the main pathogenetic theories of endometriosis based on current studies.
Collapse
Affiliation(s)
- Jelizaveta Lamceva
- Faculty of Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
| | - Romans Uljanovs
- Department of Pathology, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
| | - Ilze Strumfa
- Department of Pathology, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Correspondence:
| |
Collapse
|
26
|
Gremillet L, Netter A, Sari-Minodier I, Miquel L, Lacan A, Courbiere B. Endometriosis, infertility and occupational life: women's plea for recognition. BMC Womens Health 2023; 23:29. [PMID: 36670397 PMCID: PMC9853480 DOI: 10.1186/s12905-023-02183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
The objective of this study was to explore and describe the specificities of the occupational life of infertile endometriotic women treated by in vitro fertilization. We conducted a qualitative monocentric study between December 2020 and June 2021. Twelve semi-structured in-depth interviews using a theme-based interview guide with open questions were undertaken with infertile women with deep infiltrating endometriosis. Data analysis was conducted using an inductive approach according to the grounded theory method. Three main themes emerged from the interviews: (i) barriers to reconciling illness and work life, (ii) facilitating factors for well-being at work, and (iii) consequences and outlooks. It appeared that the time of infertility treatment represents a particular period of change in the working lives of women with endometriosis. For most women, these changes are experienced negatively, often with a renunciation of goals. For others, this is the time to communicate the difficulties linked to their illness to their professional entourage. There is a long path ahead to finally achieving recognition of endometriosis in the context of professional life.
Collapse
Affiliation(s)
- Letizia Gremillet
- grid.411535.70000 0004 0638 9491Department of Gynecology-Obstetrics and Reproductive Medicine, AP-HM, La Conception Hospital, 147 Boulevard Baille, Marseille, France
| | - Antoine Netter
- grid.411535.70000 0004 0638 9491Department of Gynecology-Obstetrics and Reproductive Medicine, AP-HM, La Conception Hospital, 147 Boulevard Baille, Marseille, France ,grid.7310.50000 0001 2190 2394CNRS, IRD, IMBE UMR 7263 FR, AP-HM, Aix Marseille Univ, Avignon University, Marseille, France
| | - Irène Sari-Minodier
- grid.7310.50000 0001 2190 2394CNRS, IRD, IMBE UMR 7263 FR, AP-HM, Aix Marseille Univ, Avignon University, Marseille, France ,grid.414336.70000 0001 0407 1584Faculty of Medical and Paramedical Sciences, AP-HM La Timone, University Hospital Service of Medicine and Occupational Health, Aix Marseille Univ 27, Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Laura Miquel
- grid.411535.70000 0004 0638 9491Department of Gynecology-Obstetrics and Reproductive Medicine, AP-HM, La Conception Hospital, 147 Boulevard Baille, Marseille, France
| | - Arnaud Lacan
- grid.17673.340000 0001 2325 5880AMSE, CNRS, UMR 7316, Kedge Business School, EHESS, Marseille, France
| | - Blandine Courbiere
- grid.411535.70000 0004 0638 9491Department of Gynecology-Obstetrics and Reproductive Medicine, AP-HM, La Conception Hospital, 147 Boulevard Baille, Marseille, France ,grid.7310.50000 0001 2190 2394CNRS, IRD, IMBE UMR 7263 FR, AP-HM, Aix Marseille Univ, Avignon University, Marseille, France
| |
Collapse
|
27
|
Cross-Talk between N6-Methyladenosine and Their Related RNAs Defined a Signature and Confirmed m6A Regulators for Diagnosis of Endometriosis. Int J Mol Sci 2023; 24:ijms24021665. [PMID: 36675186 PMCID: PMC9862014 DOI: 10.3390/ijms24021665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
An RNA modification known as N6-methyladenosine (m6A) interacts with a range of coding and non-coding RNAs. The majority of the research has focused on identifying m6A regulators that are differentially expressed in endometriosis, but it has ignored their mechanisms that are derived from the alterations of modifications among RNAs, affecting the disease progression primarily. Here, we aimed to investigate the potential roles of m6A regulators in the diagnostic potency, immune microenvironment, and clinicopathological features of endometriosis through interacting genes. A GEO cohort was incorporated into this study. Variance expression profiling was executed via the "limma" R package. Pearson analysis was performed to investigate the correlations among 767 interacting lncRNAs, 374 interacting mRNAs, and 23 m6A regulators. K-means clustering analysis, based on patterns of mRNA modifications, was applied to perform clinical feature analysis. Infiltrating immune cells and stromal cells were calculated using the Cibersort method. An m6A-related risk model was created and supported by an independent risk assay. LASSO regression analysis and Cox analyses were implemented to determine the diagnostic genes. The diagnostic targets of endometriosis were verified using PCR and the WB method. Results: A thorough investigation of the m6A modification patterns in the GEO database was carried out, based on mRNAs and lncRNAs related to these m6A regulators. Two molecular subtypes were identified using unsupervised clustering analysis, resulting in further complex infiltration levels of immune microenvironment cells in diversified endometriosis pathology types. We identified two m6A regulators, namely METTL3 and YTHDF2, as diagnostic targets of endometriosis following the usage of overlapping genes to construct a diagnostic m6A signature of endometriosis through multivariate logistic regression, and we validated it using independent GSE86534 and GSE105764 cohorts. Finally, we found that m6A alterations might be one of the important reasons for the progression of endometriosis, especially with significant downregulation of the expressions of METTL3 and YTHDF2. Finally, m6A modification patterns have significant effects on the diversity and complexity of the progression and immune microenvironment, and might be key diagnostic markers for endometriosis.
Collapse
|
28
|
Leyendecker G, Wildt L, Laschke MW, Mall G. Archimetrosis: the evolution of a disease and its extant presentation : Pathogenesis and pathophysiology of archimetrosis (uterine adenomyosis and endometriosis). Arch Gynecol Obstet 2023; 307:93-112. [PMID: 35596746 PMCID: PMC9836992 DOI: 10.1007/s00404-022-06597-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/27/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE This article presents a novel concept of the evolution and, thus, the pathogenesis of uterine adenomyosis as well as peritoneal and peripheral endometriosis. Presently, no unifying denomination of this nosological entity exists. METHODS An extensive search of the literature on primate evolution was performed. This included comparative functional morphology with special focus on the evolution of the birthing process that fundamentally differs between the haplorrhine primates and most of the other eutherian mammals. The data were correlated with the results of own research on the pathophysiology of human archimetrosis and with the extant presentation of the disease. RESULTS The term Archimetrosis is suggested as a denomination of the nosological entity. Archimetrosis occurs in human females and also in subhuman primates. There are common features in the reproductive process of haplorrhine primates such as spontaneous ovulation and corpus luteum formation, spontaneous decidualization and menstruation. These have fused Müllerian ducts resulting in a uterus simplex. Following a usually singleton pregnancy, the fetus is delivered in the skull position. Some of these features are shared by other mammals, but not in that simultaneous fashion. In haplorrhine primates, with the stratum vasculare, a new myometrial layer has evolved during the time of the Cretaceous-Terrestrial Revolution (KTR) that subserves expulsion of the conceptus and externalization of menstrual debris in non-conceptive cycles. Hypercontractility of this layer has evolved as an advantage with respect to the survival of the mother and the birth of a living child during delivery and may be experienced as primary dysmenorrhea during menstruation. It may result in tissue injury by the sheer power of the contractions and possibly by the associated uterine ischemia. Moreover, the lesions at extra-uterine sites appear to be maintained by biomechanical stress. CONCLUSIONS Since the pathogenesis of archimetrosis is connected with the evolution of the stratum vasculare, tissue injury and repair (TIAR) turns out to be the most parsimonious explanation for the development of the disease based on clinical, experimental and evolutionary evidence. Furthermore, a careful analysis of the published clinical data suggests that, in the risk population with uterine hypercontractility, the disease develops with a yet to be defined latency phase after the onset of the biomechanical injury. This opens a new avenue of prevention of the disease in potentially affected women that we consider to be primarily highly fertile.
Collapse
Affiliation(s)
| | | | - Matthias W. Laschke
- Institut für Klinisch-Experimentelle Chirurgie, Universität des Saarlandes, 66421 Homburg, Germany
| | - Gerhard Mall
- Wiesenbacher Str. 10, 69151 Neckargemünd, Germany
| |
Collapse
|
29
|
Hartner G, Husslein H, Kuessel L, Gstoettner M, Tiringer D, Wenzl R, Perricos A. The latest advances in the pharmacological management of endometriosis. Expert Opin Pharmacother 2023; 24:121-133. [PMID: 35232316 DOI: 10.1080/14656566.2022.2045274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Endometriosis is a benign disease, characterized by a wide range of symptoms and different degrees of severity, which is why therapy should be individually adapted to the patient's needs. Over the years, a lot of research has gone into finding new therapeutic approaches for this enigmatic disease. AREAS COVERED This review presents the latest advances in pharmacological management of endometriosis and is solely focused on studies published from 2010 to 2021. EXPERT OPINION Clinicians and researchers are constantly searching for new therapeutic strategies for endometriosis patients. As there are well-established treatments, however, any new medication should fulfill at least one of the three criteria: increased efficacy, comparable efficacy but a better safety profile, or treatments that have a lack of accompanying contraceptive effects that are seen in most endometriosis treatments. While some new substances show promising results, further studies are needed to demonstrate the fulfillment of one of the above-mentioned criteria.
Collapse
Affiliation(s)
- Gabriel Hartner
- Department of Obstetrics and Gynecology, Medical University of Vienna Vienna Austria
| | - Heinrich Husslein
- Department of Obstetrics and Gynecology, Medical University of Vienna Vienna Austria
| | - Lorenz Kuessel
- Department of Obstetrics and Gynecology, Medical University of Vienna Vienna Austria
| | - Manuela Gstoettner
- Department of Obstetrics and Gynecology, Medical University of Vienna Vienna Austria
| | - Denise Tiringer
- Department of Obstetrics and Gynecology, Medical University of Vienna Vienna Austria
| | - René Wenzl
- Department of Obstetrics and Gynecology, Medical University of Vienna Vienna Austria
| | - Alexandra Perricos
- Department of Obstetrics and Gynecology, Medical University of Vienna Vienna Austria
| |
Collapse
|
30
|
Li LP, Luo Y, Huang C, Wang XR, Huang TT, Zou YY, Huang SH, Liu YQ, Yang BC. In Vitro Inhibitory Effects of Maqian Essential Oil against Ectopic Endometrial Stromal Cells and LPS-Induced Endometrial Epithelial Cells. Chem Biodivers 2022; 19:e202200756. [PMID: 36377549 DOI: 10.1002/cbdv.202200756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022]
Abstract
Previous studies revealed that MQEO (Maqian fruits essential oil), which is extracted from the fruit of Maqian (Zanthoxylum myriacanthum var. Pubescens), had a good anti-inflammatory effect, but the effect on endometriosis in vitro remains unknown. In the present study, the inhibitory effects of MQEO against the EESCs (ectopic endometrial stromal cells) were investigated. Cells were treated with a concentration gradient (from 0.025 % to 0.15 %) of MQEO for 24 h and cell viability was detected by CCK-8. In addition, apoptotic rates were investigated using flow cytometry. The effect of MQEO on cell migration was determined by wound-healing and transwell assay. The expression of apoptosis-associated and cell adhesion-related proteins was assessed by western blotting. The transcriptional levels of IL-1, IL-6 and TNF-α were determined by Real-time qPCR. RNA-seq was used to identify the DEGs (differentially expressed genes) in MQEO-pretreated EESCs. We found that the MQEO condition dosage-dependently reduced the cell viability of EESCs. Based on flow cytometry results, the number of apoptotic cells increased significantly with dosage. The wound-healing and transwell results showed that MQEO group exhibited a significantly decreased cell motility and migration ability in comparison with the normal group. Western blotting results showed that MQEO down-regulated the expression of Bcl-2, ICAM-1 (intercellular adhesion molecule 1) and CD44, but up-regulated the cleaved caspase-3 expression in EESCs. What's more, MQEO also inhibited the LPS-induced inflammation in human EECs (endometrial epithelial cells). RNA-seq revealed that 221 DEGs were up-regulated genes and 284 DEGs were down-regulated in MQEO-pretreated EESCs. Our data uncovered the beneficial effects of MQEO in endometriosis and provided new insights into the mechanism of the effect of MQEO on EESCs, suggesting MQEO could be a promising new therapeutic agent for endometriosis.
Collapse
Affiliation(s)
- Li-Ping Li
- Medical Genetics Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Birth Defect for Prevention and Control, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
| | - Yong Luo
- Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
| | - Cheng Huang
- Medical Genetics Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Birth Defect for Prevention and Control, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
| | - Xin-Rong Wang
- Medical Genetics Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Birth Defect for Prevention and Control, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
| | - Ting-Ting Huang
- Medical Genetics Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Birth Defect for Prevention and Control, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
| | - Yong-Yi Zou
- Medical Genetics Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Birth Defect for Prevention and Control, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
| | - Shu-Hui Huang
- Medical Genetics Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Birth Defect for Prevention and Control, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
| | - Yan-Qiu Liu
- Medical Genetics Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Birth Defect for Prevention and Control, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
| | - Bi-Cheng Yang
- Medical Genetics Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Birth Defect for Prevention and Control, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China
| |
Collapse
|
31
|
Dissecting into endometriosis classification: why it does not always add up. Fertil Steril 2022; 118:1046-1047. [PMID: 36371320 DOI: 10.1016/j.fertnstert.2022.09.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022]
|
32
|
Endometriosis and pregnancy: The illusion of recovery. PLoS One 2022; 17:e0272828. [PMID: 36327260 PMCID: PMC9632839 DOI: 10.1371/journal.pone.0272828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
The objective of this study was to investigate the feelings and experiences of infertile women with deep infiltrating endometriosis during and after a first pregnancy achieved by in-vitro fertilization (IVF). We conducted a qualitative monocentric study between May and November 2020. Semi-structured interviews were undertaken with infertile women with deep infiltrating endometriosis who achieved a first pregnancy by IVF and delivered at least two years prior to the interview. Data analysis was performed using an inductive approach to identify recurrent categories and themes. Fifteen interviews were conducted to reach data saturation. Pregnancy appeared to improve all components of the experience of endometriosis that were explored (psychological and physical well-being, social relationships, professional life, and sexuality). This improvement was only temporary and all symptoms and negative aspects of the women’s quality of life reappeared after a variable period.
Collapse
|
33
|
Du Y, Hu C, Ye C, Wu R. Risk factors for coexisting deep endometriosis for patients with recurrent ovarian endometrioma. Front Surg 2022; 9:963686. [PMID: 36406381 PMCID: PMC9666391 DOI: 10.3389/fsurg.2022.963686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Aim The aim of this study was to assess the risk factors for coexisting deep endometriosis (DE) in patients with recurrent ovarian endometrioma (OE). Methods We retrospectively reviewed 151 recurrent OE patients who had been diagnosed of OE but not DE at the time of their first surgery and then received a second surgery for recurrent endometriosis with or without DE. Their clinical characteristics at the time of the first and second surgeries were collected. Univariate and multivariate logistic regression analyses were conducted to identify potential risk factors for coexisting DE in patients with recurrent OE. Results Among the 151 recurrent OE patients, 46 were diagnosed of DE during the recurrent surgery and included in the DE group, while the remaining 105 patients were included in the non-DE group. In univariate analysis, there were significant differences in terms of uterine retroversion during the primary surgery and the follow-up time after the primary surgery between the DE and non-DE groups. The multivariate analysis also showed that both uterine retroversion and the follow-up time (≥5 years) were associated with the coexistence of DE during the recurrent surgery. The odds ratio (OR) for uterine retroversion was 3.72 [95% confidence interval (CI) 1.62–8.53], and the OR for follow-up time (≥5 years) was 5.03 (95% CI 2.29–11.02). Conclusions Our study suggested that for recurrent OE patients, uterine retroversion during the first surgery and a follow-up time of at least 5 years are risk factors for the coexistence of DE in recurrent surgery, early prevention and full preparation before the recurrent surgery should be emphasized in these conditions.
Collapse
|
34
|
Bao Q, Zheng Q, Wang S, Tang W, Zhang B. LncRNA HOTAIR regulates cell invasion and migration in endometriosis through miR-519b-3p/PRRG4 pathway. Front Oncol 2022; 12:953055. [PMID: 36338672 PMCID: PMC9634122 DOI: 10.3389/fonc.2022.953055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
Endometriosis is a common benign disease in gynecology and has malignant biological behaviors, such as hyperplasia, invasion, metastasis, and recurrence. However, the pathogenesis of endometriosis remains unclear. The present study aimed to investigate whether LncRNA HOTAIR regulates cell invasion and migration in endometriosis by regulating the miR-519b-3p/PRRG4 pathway. The qRT-PCR results showed that the average relative expression of LncRNA HOTAIR was much higher in ectopic endometrial tissues than in eutopic endometrial tissues. Scratch and transwell assays showed that the cell migration and invasion ability of LncRNA HOTAIR overexpression group was significantly higher than those in the control group. Conversely, the LncRNA HOTAIR knockdown group showed the opposite results. Bioinformatics analysis suggested that the downstream target genes of LncRNA HOTAIR were miR-519b-3p and Prrg4. Knockdown of LncRNA HOTAIR can reduce the up-regulation of Prrg4 by miR-519b-3p and then inhibit the invasion and migration ability of endometrial stromal cells. In Conclusion, LncRNA HOTAIR can regulate the ability of invasion and migration of endometrial stromal cells, and its mechanism is proved by regulating the miR-519b-3p/PRRG4 pathway.
Collapse
Affiliation(s)
- Qiufang Bao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Obstetrics and Gynecology, The First Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Qiaomei Zheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Obstetrics and Gynecology, The First Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Shaoyu Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Obstetrics and Gynecology, The First Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Wenlu Tang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Obstetrics and Gynecology, The First Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Bin Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Obstetrics and Gynecology, The First Clinical College of Fujian Medical University, Fuzhou, Fujian, China
- *Correspondence: Bin Zhang,
| |
Collapse
|
35
|
Lameira P, Abecasis M, Palma S, Leitão J. Catamenial pneumothorax: a rare manifestation of endometriosis. Radiol Case Rep 2022; 17:3119-3125. [PMID: 35774053 PMCID: PMC9237952 DOI: 10.1016/j.radcr.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 11/24/2022] Open
Abstract
Endometriosis is a common gynecological disease that primarily affects premenopausal women. It is mainly found in the pelvis but may be found at several extrapelvic locations. Thoracic endometriosis is a rare extrapelvic location of endometriosis and the leading cause of catamenial pneumothorax. We describe the case of a 35-year-old woman with a background of pelvic pain presenting to the emergency department with chest pain and dyspnea. The chest X-ray in the emergency department showed a large right-sided pneumothorax. Further imaging studies during patient evaluation revealed extensive fibrotic changes in the pelvis and well-defined solid nodules with high signal on T2 and T1-weighted images on MRI in abdominal and thoracic locations, rendering the diagnosis of a catamenial pneumothorax in a patient with pelvic, abdominal and thoracic endometriosis.
Collapse
|
36
|
Oxidative-Stress Related Gene Polymorphism in Endometriosis-Associated Infertility. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081105. [PMID: 36013572 PMCID: PMC9414462 DOI: 10.3390/medicina58081105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Endometriosis is a benign inflammatory disease associated with infertility and chronic pelvic pain, estimated to affect 7−10% of reproductive-age women, with the possibility of malignant transformation. Recent studies focus on oxidative stress and genetic mutations as risk factors in the pathophysiology of endometriosis-associated infertility. Materials and Methods: This case-control study is the first in Eastern European women that aimed to investigate four genes’ genetic polymorphisms that encode antioxidant enzymes involved in oxidative stress (glutathione peroxidase 1, GPX1 198Pro > Leu, catalase CAT-262C > T, glutathione S-transferase M1, and T1 null genotype) and their association with endometriosis-related infertility. We compared 103 patients with endometriosis-associated infertility with 102 post-partum women as the control group. Results: The endometriosis group had a mean age of 34.5 +/− 6.12 years, while the control group’s mean age was 35.03 +/− 5.95 years. For CAT-262C > T polymorphism, the variant genotypes were significantly more frequent in the endometriosis group. Moreover, for the GPX1 198Pro > Leu, the endometriosis group had significantly more frequent CT and TT genotypes. The null genotype of GSTM1 was detected significantly higher in the endometriosis group. No significant differences were found in the frequency of GSTT1 between the two groups. This study suggests that GPX1 198Pro > Leu, CAT-262C > T, and GSTM1 polymorphisms may be risk factors and that the association between the GSTM1-GSTT1 null genotype may play a significant role in endometriosis-associated infertility. Moreover, this study suggests that the GSTT1 null genotype does not influence the disease. Visual identification of endometriotic lesions with microscopic confirmation is the accepted gold standard for diagnosing endometriosis, but general anesthesia and laparoscopy are required. Conclusions: In this regard, a panel of genetic or laboratory markers is needed for the early diagnostics of this prevalent disease, especially in the case of young patients with future pregnancy intention.
Collapse
|
37
|
Margatho D, Makuch MY, Bahamondes L. Experiences of male partners of women with endometriosis-associated pelvic pain: a qualitative study. EUR J CONTRACEP REPR 2022; 27:454-460. [PMID: 35867527 DOI: 10.1080/13625187.2022.2097658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The purpose of the study was to assess the experiences of male partners of women with endometriosis-associated pain after medical treatment in their everyday lives. METHODS We conducted a phenomenological study based on semi-structured interviews with 11 male partners of women with endometriosis-associated pelvic pain at the Department of Obstetrics and Gynaecology, University of Campinas Medical School, Brazil. A thematic analysis of manifest content was performed, a coding frame was drafted, and the main analysis categories were elaborated. RESULTS The interviewed men had been in stable relationships for a median length of 14 years. They reported that they did not have information about endometriosis before their partners' diagnosis and that the endometriosis-associated pelvic pain suffered by their partners affected their personal everyday life, marital relationship, sexual relationship, and intimacy. CONCLUSION Male partners of women with endometriosis-associated pain reported that the disease has both a profound impact on their lives and on their relationship. Our study contributed to an increased understanding of the life experience of men living with women with endometriosis-associated pelvic pain and may contribute to encourage healthcare professionals to incorporate strategies for guidance of the couple during treatment.
Collapse
Affiliation(s)
- Deborah Margatho
- Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Maria Y Makuch
- Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| |
Collapse
|
38
|
Wang M, Wu Y, He Y, Liu J, Chen Y, Huang J, Qi G, Li P. SIRT1 upregulation promotes epithelial-mesenchymal transition by inducing senescence escape in endometriosis. Sci Rep 2022; 12:12302. [PMID: 35853978 PMCID: PMC9296487 DOI: 10.1038/s41598-022-16629-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/13/2022] [Indexed: 02/06/2023] Open
Abstract
Endometrial epithelial cells carry distinct cancer-associated alterations that may be more susceptible to endometriosis. Mouse models have shown that overexpression of SIRT1 associated with oncogene activation contributes to the pathogenesis of endometriosis, but the underlying reason remains elusive. Here, we used integrated systems biology analysis and found that enrichment of endometrial stromal fibroblasts in endometriosis and their cellular abundance correlated negatively with epithelial cells in clinical specimens. Furthermore, endometrial epithelial cells were characterized by significant overexpression of SIRT1, which is involved in triggering the EMT switch by escaping damage or oncogene-induced induced senescence in clinical specimens and in vitro human cell line models. This observation supports that genetic and epigenetic incident favors endometrial epithelia cells escape from senescence and fuel EMT process in endometriosis, what could be overcome by downregulation of SIRT1.
Collapse
Affiliation(s)
- Minghua Wang
- Department of Pathology, Longgang District People's Hospital, Shenzhen, 518172, China.,Department of Pathology, Jinan University School of Medicine, Guangzhou, 510632, China
| | - Yongqi Wu
- Department of Pathology, Jinan University School of Medicine, Guangzhou, 510632, China
| | - Yunbiao He
- Department of Medical Statistics, Jinan University School of Medicine, Guangzhou, 510632, China
| | - Jing Liu
- Department of Pathology, Jinan University School of Medicine, Guangzhou, 510632, China
| | - Yingxing Chen
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Jieqiong Huang
- Department of Pathology, Jinan University School of Medicine, Guangzhou, 510632, China
| | - Guolong Qi
- Department of Medical Statistics, Jinan University School of Medicine, Guangzhou, 510632, China.
| | - Ping Li
- Department of Pathology, Jinan University School of Medicine, Guangzhou, 510632, China.
| |
Collapse
|
39
|
Khan KN, Fujishita A, Mori T. Pathogenesis of Human Adenomyosis: Current Understanding and Its Association with Infertility. J Clin Med 2022; 11:4057. [PMID: 35887822 PMCID: PMC9316454 DOI: 10.3390/jcm11144057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 12/10/2022] Open
Abstract
The aim of this review article was to summarize our current understanding on the etiologies and pathogenesis of human adenomyosis and to clarify the relative association between adenomyosis and infertility. The exact pathogenesis of adenomyosis is still elusive. Among different reported concepts, direction invagination of gland cells from the basalis endometrium deep into myometrium is the most widely accepted opinion on the development of adenomyosis. According to this concept, endometrial epithelial cells and changed fibroblasts, abnormally found in the myometrium in response to repeated tissue injury and/or disruption at the endometrium-myometrium interface (EMI), elicit hyperplasia and hypertrophy of the surrounding smooth muscle cells. In this review, a comprehensive review was performed with a literature search using PubMed for all publications in English and Japanese (abstract in English), related to adenomyosis and infertility, from inception to April 2021. As an estrogen-regulated factor, hepatocyte growth factor (HGF) exhibits multiple functions in endometriosis, a disease commonly believed to arise from the functionalis endometrium. As a mechanistic basis of gland invagination, we investigated the role of HGF, either alone or in combination with estrogen, in the occurrence of epithelial-mesenchymal transition (EMT) in adenomyosis. Aside from microtrauma at the EMI, metaplasia of displaced Müllerian remnants, differentiation of endometrial stem/progenitor cells within the myometrium and somatic mutation of some target genes have been put forward to explain how adenomyosis develops. In addition, the possible role of microRNAs in adenomyosis is also discussed. Besides our knowledge on the conventional classification (focal and diffuse), two recently proposed classifications (intrinsic and extrinsic) of adenomyosis and the biological differences between them have been described. Although the mechanistic basis is unclear, the influence of adenomyosis on fertility outcome is important, especially considering the recent tendency to delay pregnancy among women. Besides other proposed mechanisms, a recent transmission election microscopic (TEM) study indicated that microvilli damage and an axonemal alteration in the apical endometria of human adenomyosis, in response to endometrial inflammation, may be involved in negative fertility outcomes. We present a critical analysis of the literature data concerning the mechanistic basis of infertility in women with adenomyosis and its impact on fertility outcome.
Collapse
Affiliation(s)
- Khaleque N. Khan
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| | - Akira Fujishita
- Department of Gynecology, Saiseikai Nagasaki Hospital, Nagasaki 850-0003, Japan;
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| |
Collapse
|
40
|
Mohaghegh F, Hatami P, Rajabi P, Aryanian Z. Coexistence of cutaneous endometriosis and ovarian endometrioma: a case report. J Med Case Rep 2022; 16:256. [PMID: 35780175 PMCID: PMC9250714 DOI: 10.1186/s13256-022-03483-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Umbilical endometriosis is a rare entity accounting for 0.5–4% of cases with endometriosis. Case presentation Here we report a rare case of umbilical endometriosis with concurrent ovarian endometriomas in a 37-year old primiparous Iranian woman. Conclusion This interesting coexistence reflects the importance of thorough gynecological assessment in patients with cutaneous endometriosis to enable appropriate management.
Collapse
Affiliation(s)
- Fatemeh Mohaghegh
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Parvin Rajabi
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Dermatology, Babol University of Medical Sciences, Babol, Iran.
| |
Collapse
|
41
|
Endometriosis: A Disease with Few Direct Treatment Options. Molecules 2022; 27:molecules27134034. [PMID: 35807280 PMCID: PMC9268675 DOI: 10.3390/molecules27134034] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 12/07/2022] Open
Abstract
Endometriosis is a gynecological condition characterized by the growth of endometrium-like tissues inside and outside the pelvic cavity. The evolution of the disease can lead to infertility in addition to high treatment costs. Currently, available medications are only effective in treating endometriosis-related pain; however, it is not a targeted treatment. The objective of this work is to review the characteristics of the disease, the diagnostic means and treatments available, as well as to discuss new therapeutic options.
Collapse
|
42
|
Kanellopoulos D, Karagianni D, Pergialiotis V, Patsouras G, Patsouras K, Nikiteas N, Lazaris AC, Iliopoulos D. The interplay between endometriosis and fertility in rats: a systematic review. J Med Life 2022; 15:742-746. [PMID: 35928366 PMCID: PMC9321488 DOI: 10.25122/jml-2021-0329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
For the last decades, endometriosis has been a major gynecological problem and a significant cause of infertility for women worldwide. It is estimated that the disease affects about 10-15% of all women of reproductive age and 70% of women suffering from chronic pelvic pain. At the same time, the incidence is about 40-60% in women with dysmenorrhea and 20-30% in women with subfertility. Despite the high percentage of affected women, endometriosis is still characterized by insufficient knowledge of the pathogenic processes, leading to the development and continuity of the disease. For this reason, there is a significant need for insight and understanding of the pathogenesis of endometriosis. This systematic review aims to present the latest data on the use of rats in endometriosis research and to explore how fertility is affected in rats with endometriosis. The methodology included a review of the available publications retrieved by a search in various scientific databases, such as PubMed, Scopus, Medline, and Google Scholar. The initial search generated 30 titles, with 10 articles fulfilling the inclusion criteria. In conclusion, several surgical techniques have been proposed to induce endometriosis, mainly using rats as the appropriate animal model. Studies in rats showed that endometriosis causes infertility and that pregnancy rates are lower for rats with endometriosis than those without endometriosis. In addition, rats with endometriosis have significant abnormalities in the structure of their oocytes as well as in the development of their embryos (genetic abnormalities).
Collapse
Affiliation(s)
- Dimitrios Kanellopoulos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece,Department of Obstetrics and Gynecology, Tzaneio Hospital, Athens, Greece,Corresponding Author: Dimitrios Kanellopoulos, Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece. E-mail:
| | - Dimitra Karagianni
- 1 Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Nikolaos Nikiteas
- 2 Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas C Lazaris
- 1 Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Iliopoulos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
43
|
Sadullayev A, Medvediev M. Comparison of the effect on the ovarian reserve of modern methods of treatment of endometrioid cysts. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:908-914. [PMID: 35483582 DOI: 10.1016/j.jogc.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of autologous platelet-rich plasma (PRP) therapy in laparoscopy and transvaginal sclerotherapy for the treatment of endometrioid cysts for maintaining ovarian reserve. METHODS The study included 71 women under age 35 years with primary and secondary infertility. Twenty women underwent sclerotherapy of endometrioid cysts followed by autologous PRP injection into ovarian tissue, and 21 underwent laparoscopic cyst removal by stripping followed by autologous PRP injection. The control group consisted of 30 women who underwent laparoscopic cystectomy by stripping without autologous PRP injection. We assessed ovarian reserve for all patients before surgery as well 3 and 6 months after surgery by measuring serum anti-Müllerian hormone (AMH) levels and calculating antral follicle count using ultrasound. RESULTS In the control group, AMH levels had decreased significantly at 3 and 6 months post-surgery, whereas levels in laparoscopy and PRP group remained almost unchanged from initial levels. In the sclerotherapy group, we observed a tendency towards increased AMH levels, but it was not statistically significant when compared with initial results. Follicle count changes were similar to AMH patterns. CONCLUSION In this study, sclerotherapy in combination with PRP therapy for ovarian endometriomas was associated with improved measures of ovarian reserve, and the combination of laparoscopic excision of the endometrioma with PRP therapy facilitated ovarian reserve preservation.
Collapse
Affiliation(s)
- Asad Sadullayev
- Department of Obstetrics and Gynecology, Dnipro state medical university, Dnipro, Ukraine, 49044
| | - Mykhailo Medvediev
- Professor, Department of Obstetrics and Gynecology, Dnipro state medical university, Dnipro, Ukraine, 49044.
| |
Collapse
|
44
|
Kamrani S, Amirchaghmaghi E, Ghaffari F, Shahhoseini M, Ghaedi K. Altered gene expression of VEGF, IGFs and H19 lncRNA and epigenetic profile of H19-DMR region in endometrial tissues of women with endometriosis. Reprod Health 2022; 19:100. [PMID: 35459174 PMCID: PMC9034598 DOI: 10.1186/s12978-022-01406-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Endometriosis, as chronic estrogen-dependent disease, is defined by the presence of endometrial-like tissue outside the uterus. Proliferation of endometrial tissue and neoangiogenesis are critical factors in development of endometriosis. Hence, vascular endothelial growth factor (VEGF) as well as insulin‐like growth factor 1 and 2 (IGF1, 2) may be involved as inducers of cellular proliferation or neoangiogenesis. Imprinted long noncoding RNA H19 (lncRNA H19) has been suggested to be involved in pathogenesis of endometriosis via regulation of cellular proliferation and differentiation. Epigenetic aberrations appear to play an important role in its pathogenesis. The present study was designed to elucidate VEGF, IGF1, IGF2 and H19 lncRNA genes expression and epigenetic alterations of differentially methylated region (DMR) of H19 (H19-DMR) regulatory region in endometrial tissues of patients with endometriosis, in comparison with control women. Methods In this case–control study, 24 women with and without endometriosis were studied for the relative expression of VEGF, IGF1, IGF2 and H19 lncRNA genes using real-time polymerase chain reaction (PCR) technique. Occupancy of the MeCP2 on DMR region of H19 gene was assessed using chromatin immunoprecipitation (ChIP), followed by real-time PCR. Results Genes expression profile of H19, IGF1 and IGF2 was decreased in eutopic and ectopic endometrial tissues of endometriosis group, compared to the control tissues. Decreased expression of H19 in ectopic samples was significant in comparison with the controls (P < 0.05). Gene expression of VEGF was increased in eutopic tissues of endometriosis group, compared to control group. Whereas its expression level was lower in ectopic lesions versus eutopic and control endometrial samples. ChIP analysis revealed significant and nearly significant hypomethylation of H19-DMR region II in eutopic and ectopic samples, compared to the control group respectively. This epigenetic change was aligned with expression of IGF2. While methylation of H19-DMR region I was not significantly different between the eutopic, ectopic and control endometrial samples. Conclusion These data showed that VEGF, IGF1, IGF2 and H19 lncRNA genes expression and epigenetic alterations of H19 lncRNA have dynamic role in the pathogenesis of endometriosis, specifically in the way that hypomethylation of H19-DMR region II can be involved in IGF2 dysregulation in endometriosis.
Collapse
Affiliation(s)
- Sedigheh Kamrani
- Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Hezar Jerib Ave, Azadi Square, Isfahan, Iran
| | - Elham Amirchaghmaghi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Regenerative Biomedicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Firouzeh Ghaffari
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Maryam Shahhoseini
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, P.O.Box: 19395-4644, Tehran, Iran. .,Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. .,Department of Cell and Molecular Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran.
| | - Kamran Ghaedi
- Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Hezar Jerib Ave, Azadi Square, Isfahan, Iran.
| |
Collapse
|
45
|
Protopapas A, Vlachos DE, Kathopoulis N, Grigoriadis T, Zacharakis D, Athanasiou S, Chatzipapas I. Total laparoscopic hysterectomy in patients with deep endometriosis: Different technical and postoperative considerations, in comparison with a procedure performed for other benign indications. Taiwan J Obstet Gynecol 2022; 61:216-222. [PMID: 35361379 DOI: 10.1016/j.tjog.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Total laparoscopic hysterectomy (TLH) may be indicated in patients with deep infiltrative endometriosis (DIE) to treat severe chronic pelvic pain symptoms, recurrences, or co-existing uterine disease. This study discusses the challenges and specific operative and postoperative considerations in patients submitted to TLH and excision of DIE, in comparison with those undergoing a procedure for other benign indications. MATERIALS AND METHODS Patients undergoing TLH and excision of DIE were included (N = 18, group 1). These were matched with cases, treated with TLH for other benign indications during the same period (2010-2019), at a 2:1 ratio (N = 36, group 2). The two groups were compared with regards to their characteristics, and intraoperative and postoperative data, including operative time, estimated blood loss (EBL), hospital stays, and rates of complications. RESULTS In group 1, median DIE nodule size was 2.5 cm (range: 1.3-4.2). Simple hysterectomy was performed in 10, and a more extended procedure in 8 cases. All nodules were removed from the bowel wall using the shaving technique. Average EBL was significantly higher (p = .027), and duration of surgery and hospital stays longer (p = .003, and p = .0001, respectively), in group 1 vs. group 2. The rates of long-term (L-T) complications were higher in group 1 but not to a significant level (p = .087). Analysis within the DIE group showed that operative time was significantly related to nodule size, type of hysterectomy (p = .021), presence of adenomyosis (p = .041), uterine size ≥12weeks (p = .039), and the occurrence of L-T complications (p = .016). Increasing nodule size and an extended procedure (p = .005) increased significantly the EBL, which had also a significant effect on the risk of L-T complications (p = .006). CONCLUSIONS TLH in DIE patients is a different, complex and potentially more dangerous procedure compared with TLH for other benign indications. Thorough knowledge of retroperitoneal anatomy, a clear operative plan, and excellent laparoscopic skills are necessary for concomitant radical excision of lesions, with low rates of adverse events.
Collapse
Affiliation(s)
- Athanasios Protopapas
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece.
| | - Dimitrios-Euthymios Vlachos
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece
| | - Themistoklis Grigoriadis
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece
| | - Dimitrios Zacharakis
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece
| | - Stavros Athanasiou
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece
| | - Ioannis Chatzipapas
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece
| |
Collapse
|
46
|
Epigenetic Factors in Eutopic Endometrium in Women with Endometriosis and Infertility. Int J Mol Sci 2022; 23:ijms23073804. [PMID: 35409163 PMCID: PMC8998720 DOI: 10.3390/ijms23073804] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 02/01/2023] Open
Abstract
Eutopic endometrium in patients with endometriosis is characterized by aberrant expression of essential genes during the implantation window. It predisposes to disturbance of endometrial receptivity. The pathomechanism of implantation failures in women with endometriosis remains unclear. This paper aims to summarize the knowledge on epigenetic mechanisms in eutopic endometrium in the group of patients with both endometriosis and infertility. The impaired DNA methylation patterns of gene promoter regions in eutopic tissue was established. The global profile of histone acetylation and methylation and the analysis of selected histone modifications showed significant differences in the endometrium of women with endometriosis. Aberrant expression of the proposed candidate genes may promote an unfavorable embryonic implantation environment of the endometrium due to an immunological dysfunction, inflammatory reaction, and apoptotic response in women with endometriosis. The role of the newly discovered proteins regulating gene expression, i.e., TET proteins, in endometrial pathology is not yet completely known. The cells of the eutopic endometrium in women with endometriosis contain a stable, impaired methylation pattern and a histone code. Medication targeting critical genes responsible for the aberrant gene expression pattern in eutopic endometrium may help treat infertility in women with endometriosis.
Collapse
|
47
|
Impaired Expression of Membrane Type-2 and Type-3 Matrix Metalloproteinases in Endometriosis but Not in Adenomyosis. Diagnostics (Basel) 2022; 12:diagnostics12040779. [PMID: 35453827 PMCID: PMC9025324 DOI: 10.3390/diagnostics12040779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
Matrix metalloproteinases (MMPs) play an important role in menstruation and endometriosis; however, the membrane-type matrix metalloproteinases (MT-MMPs) are not well studied in endometriosis and adenomyosis. We analyzed MT2-MMP (MMP15) and MT3-MMP (MMP16) in eutopic endometrium with and without endometriosis and with and without adenomyosis and ectopic endometrium of deep infiltrating endometriosis (DIE), peritoneal endometriosis (PE), and ovarian endometriosis (Ov) by immunohistochemistry. Preferential expression of both proteins was observed in the glandular and luminal epithelial cells of the eutopic endometrium of patients with and without endometriosis with a ~2.5-fold stronger expression of MT3-MMP compared to MT2-MMP. We did not observe any differences during menstrual cycling and in eutopic endometrium of patients with and without endometriosis. Similarly, eutopic endometrium and adenomyotic tissue with and without endometriosis showed similar protein levels of MT2-MMP and MT3-MMP. In contrast, MT2-MMP and MT3-MMP protein was decreased in ectopic compared to eutopic endometrium and adenomyosis. The similar expression of MT2-MMP and MT3-MMP in eutopic endometrium in patients with and without endometriosis in contrast to the impaired expression in ectopic endometrium suggests that alterations occur after and not before endometrial implantation possibly by distinct interactions with the different environments. The differential protein expression of MT2/3-MMP in adenomyosis compared to endometriosis might suggest a different pathogenesis pathway for the two diseases.
Collapse
|
48
|
Liakopoulou MK, Tsarna E, Eleftheriades A, Arapaki A, Toutoudaki K, Christopoulos P. Medical and Behavioral Aspects of Adolescent Endometriosis: A Review of the Literature. CHILDREN 2022; 9:children9030384. [PMID: 35327756 PMCID: PMC8947708 DOI: 10.3390/children9030384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/19/2022] [Accepted: 03/07/2022] [Indexed: 12/02/2022]
Abstract
The majority of young women will experience discomfort associated with menstrual cycles and miss out on education and social opportunities. Endometriosis, the presence of endometrial glands and stroma outside of uterus, is the most common cause of secondary dysmenorrhea and characterized by pain despite treatment with nonsteroidal anti-inflammatory drugs and hormonal agents. The true prevalence of adolescent endometriosis is not clear. Delay in diagnosis leads to persistent pain, affects quality of life, and potentially contributes to disease progression and subfertility. A laparoscopic diagnosis is the gold standard, but the surgical appearance may differ from adults, as endometriotic lesions are usually red or clear, making their identification a challenge for gynecologists who are unexperienced with endometriosis in adolescents. A personalized medical–surgical treatment is regarded as the most effective therapeutic strategy to achieve remission of symptoms, suppress disease progression, and protect future fertility. Studies have demonstrated how adolescent endometriosis negatively affects patients’ quality of life and psychosocial functioning. Development of therapeutic interventions targeting psychosocial function and quality of life is imperative for adolescent patients.
Collapse
|
49
|
Li N, Yi K, Li X, Wang Y, Jing J, Hu J, Wang Z. MiR-143-3p facilitates motility and invasiveness of endometriotic stromal cells by targeting VASH1/TGF-β signaling. Reprod Biol 2022; 22:100592. [PMID: 34995817 DOI: 10.1016/j.repbio.2021.100592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/11/2021] [Accepted: 11/27/2021] [Indexed: 12/22/2022]
Abstract
Endometriosis is a benign gynecological disease. Accumulating evidence has revealed the participation of dysregulated miRNAs in the progression of endometriosis. Here, the function and molecular mechanism of miR-143-3p in endometriosis were investigated. The levels of vasohibin 1 (VASH1) and miR-143-3p in endometrial tissues and endometriotic stromal cells (ESCs) were detected by RT-qPCR. Migrative and invasive phenotypes of ESCs were tested by Transwell assays. The protein expression of VASH1, TGF-β signaling markers, and epithelial to mesenchymal transition (EMT) markers was examined by western blotting. The targeted relationship between miR-143-3p and VASH1 was confirmed by bioinformatics analysis and luciferase reporter assay. We found that miR-143-3p expression was significantly upregulated in ectopic endometrial tissues compared to that in eutopic and normal endometrial tissues. MiR-143-3p knockdown restrained EMT process, invasive and migrative behaviors of ESCs. Mechanically, miR-143-3p targeted VASH1 and negatively regulated VASH1. VASH1 downregulation reserved the effects of miR-143-3p knockdown in ESCs. MiR-143-3p activated TGF-β signaling via targeting VASH1. Furthermore, activation of TGF-β signaling counteracted the miR-143-3p knockdown-caused suppression of migration, invasion and EMT process in ESCs. Overall, miR-143-3p activates TGF-β signaling by targeting VASH1 to facilitate migration and invasion of ESCs.
Collapse
Affiliation(s)
- Na Li
- Department of Gynecology, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University; People's Hospital of Henan University, Zhengzhou, 450003, Henan, China
| | - Keyun Yi
- Department of Gynecology, Zhou kou Central Hospital, Zhoukou 466000, Henan, China
| | - Xia Li
- Department of Gynecology, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University; People's Hospital of Henan University, Zhengzhou, 450003, Henan, China
| | - Yue Wang
- Department of Gynecology, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University; People's Hospital of Henan University, Zhengzhou, 450003, Henan, China
| | - Jiayu Jing
- Department of Gynecology, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University; People's Hospital of Henan University, Zhengzhou, 450003, Henan, China
| | - Jiaxuan Hu
- Department of Obstetrics and Gynecology, Zhoukou Maternal and Child Health Care, Zhoukou, 466000, Henan, China
| | - Zhenhua Wang
- Department of Gynecology, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University; People's Hospital of Henan University, Zhengzhou, 450003, Henan, China.
| |
Collapse
|
50
|
Tubal Endometriosis: From Bench to Bedside, A Scoping Review. J Pers Med 2022; 12:jpm12030362. [PMID: 35330363 PMCID: PMC8955934 DOI: 10.3390/jpm12030362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 12/04/2022] Open
Abstract
Tubal endometriosis (EM) refers to the detection of ectopic endometrial implants on tubes. It may cause a significant defect of the tubes, translating into dysmenorrhea, pelvic pain, and infertility. We aimed to evaluate the disease characteristics, prevalence, histopathological findings and genetic profile of patients with tubal EM. A thorough search of three electronic databases was performed for studies that presented outcomes of patients with tubal EM. Thirteen studies (four observational, seven case reports, two genetic) were considered eligible for inclusion. The prevalence of tubal EM ranged from 6.9% to 69%. The predominant symptoms for referral of patients were infertility and abdominal pain. Women of reproductive age underwent salpingectomy for the management of the disease. Only one case of malignant transformation was recorded in a 60-year-old patient. The prevalence of tubal EM ranges depending on the indication for surgery, the presence of concomitant pelvic EM and the type of diagnosis and treatment. Further, more extensive, larger studies are warranted to evaluate the impact of tubal EM in the progression and prognosis of EM, the effect of salpingectomy in the improvement of disease-related symptoms and to designate the group of patients that could benefit from risk-reducing salpingectomy based on the risk of developing ovarian malignancy.
Collapse
|