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Rizk RC, Yasrab M, Weisberg EM, Chu LC, Fishman EK. Deep pelvic endometriosis causing ureteral obstruction. Radiol Case Rep 2024; 19:3845-3849. [PMID: 39026614 PMCID: PMC11254520 DOI: 10.1016/j.radcr.2024.06.012] [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: 01/09/2024] [Accepted: 06/03/2024] [Indexed: 07/20/2024] Open
Abstract
Endometriosis is a chronic disease characterized by the presence and growth of endometrial glands and stroma outside of the uterine cavity. The pathogenesis is unclear, but a common theory attributes the condition to retrograde menstruation into the peritoneal cavity via the fallopian tubes. Hormonal influence causes these ectopic tissues to undergo cyclical bleeding, resulting in subsequent inflammation and scar tissue formation; however, it can affect postmenopausal women. In rare instances, endometriotic lesions can obstruct the ureter and result in hydroureteronephrosis and subsequent loss of renal function. This condition presents with nonspecific symptoms and is known as an often-silent disease, resulting in challenging and delayed preoperative diagnosis. In this article, we report the case of an asymptomatic 65-year old female who was diagnosed with deep pelvic endometriosis, which obstructed the right distal ureter. We focus on optimizing diagnosis and management through the application of radiological imaging modalities, specifically computed tomography (CT) and magnetic resonance imaging (MRI).
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Affiliation(s)
- Ryan C. Rizk
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Mohammad Yasrab
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Edmund M. Weisberg
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Linda C. Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Elliot K. Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
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2
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Shrateh ON, Siam HA, Ashhab YS, Sweity RR, Naasan M. The impact of vitamin D treatment on pregnancy rate among endometriosis patients: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:4098-4111. [PMID: 38989166 PMCID: PMC11230764 DOI: 10.1097/ms9.0000000000002174] [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: 02/21/2024] [Accepted: 05/08/2024] [Indexed: 07/12/2024] Open
Abstract
Background Vitamin D supplementation is supposed to have an important role in the management of several endometriosis-related aspects, offering potential relief to affected individuals. Herein, the authors aim to evaluate the impact of vitamin D on pregnancy rates and clinical symptoms in women with endometriosis. Methods The authors extensively searched PubMed, Cochrane Library, EMBASE, Ovid MEDLINE, and CINAHL from their inception to 20 July 2023. Results Three randomized controlled trials involving 167 patients were included in this meta-analysis. The findings demonstrated that vitamin D supplementation exhibits efficacy in alleviating dysmenorrhea associated with endometriosis, as evidenced by a meta-analysis showing a significant reduction in dysmenorrhea (mean difference -1.41, 95% CI -2.61 to -0.22, P = 0.02). However, the impact on dyspareunia was inconclusive, with a non-significant mean difference of -0.2 (95% CI -1.62 to 1.22, P = 0.78). In contrast, dyschezia significantly decreased with vitamin D supplementation (mean difference -1.10, 95% CI -2.22 to 0.02, P = 0.05 However, the meta-analysis did not show a significant effect of vitamin D on chronic pelvic pain associated with endometriosis. Conclusion While antioxidant vitamin D supplementation demonstrates general effectiveness in alleviating endometriosis symptoms, such as dysmenorrhea, dyspareunia, and dyschezia, the existing literature lacks direct investigations into the specific impact of vitamin D on enhancing pregnancy rates among endometriosis patients. This observation prompts various hypotheses, suggesting that the positive effects of vitamin D supplementation on endometriosis-related symptoms may indirectly contribute to improved pregnancy outcomes and enhanced fertility.
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Affiliation(s)
| | | | | | | | - Mashhour Naasan
- Department of Obstetrics and Gynecology, Al-Istishari Arab Hospital, Ramallah, Palestine
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3
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Chatroux LR, Einarsson JI. Keep your attention closer to the ureters: Ureterolysis in deep endometriosis surgery. Best Pract Res Clin Obstet Gynaecol 2024; 95:102494. [PMID: 38614884 DOI: 10.1016/j.bpobgyn.2024.102494] [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: 01/08/2024] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 04/15/2024]
Abstract
Endometriosis surgery involving the ureter poses significant challenges requiring meticulous surgical techniques and vigilant postoperative care. This chapter addresses key aspects of ureterolysis techniques, intraoperative management of ureteral injuries, and postoperative care in the context of endometriosis surgery. Ureterolysis methods aim to isolate and mobilize the ureter while preserving its vascularity. Cold instruments and careful dissection are recommended to prevent thermal injury during surgery. Intraoperative tools such as indocyanine green (ICG) show promise in assessing for vascular compromise. Over half of ureteral injuries are detected postoperatively, necessitating a high index of suspicion. Optimal postoperative care in the case of ureteral injury involves Foley catheterization for decompression, ureteral stenting, and meticulous follow-ups to monitor healing and renal function. While advances have been made in surgical techniques and diagnostic tools, gaps persist in preoperative imaging optimization and predictive models for identifying at-risk patients. This chapter aims to bridge existing knowledge gaps, optimize surgical practices, and enhance the overall care and outcomes of patients undergoing endometriosis surgery involving the ureter.
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Affiliation(s)
- Louisa R Chatroux
- Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology Division of Minimally Invasive Gynecologic Surgery, Harvard Medical School, Boston, MA, USA.
| | - Jon I Einarsson
- Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology Division of Minimally Invasive Gynecologic Surgery, Harvard Medical School, Boston, MA, USA
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4
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Tan S, Leonardi M, Lo G, Lee E. Role of ultrasonography in the diagnosis of endometriosis in infertile women: Ovarian endometrioma, deep endometriosis, and superficial endometriosis. Best Pract Res Clin Obstet Gynaecol 2024; 92:102450. [PMID: 38096645 DOI: 10.1016/j.bpobgyn.2023.102450] [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: 11/10/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 02/06/2024]
Abstract
Endometriosis is a complex chronic inflammatory process characterised by the presence of endometrial-like glandular tissue outside the uterine cavity, typically within the pelvic structures. This condition affects up to 10-15 % of women and those assigned female at birth, and can result in chronic pelvic pain and in/subfertility. Treatment goals include medical, surgical options and alternative therapies. Transvaginal ultrasound (TVUS) is the currently recommended first line investigation for endometriosis with magnetic resonance imaging (MRI) reserved for those with equivocal ultrasound findings. In this paper, we aim to outline the commonly seen sonographic appearances of endometriosis divided into anterior, middle and posterior pelvic compartments. Limitations to ultrasound imaging include high operator dependence and patient factors. New imaging techniques and research into the utility of artificial intelligence (AI) into the detection of endometriosis is currently underway, with possibility of reduced diagnostic delay and better patient outcomes.
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Affiliation(s)
- Samantha Tan
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
| | - Mathew Leonardi
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada; Robinson Research Institute, University of Adelaide, Adelaide, Australia.
| | - Glen Lo
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Curtin University Medical School, Perth, Western Australia, Australia; Western Ultrasound for Women, Perth, Western Australia, Australia.
| | - Emmeline Lee
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Western Ultrasound for Women, Perth, Western Australia, Australia.
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5
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Chway C, Flórez S, Muñoz MD, Guerriero S, Alcázar JL. The Diagnostic Accuracy of Transvaginal Ultrasound for Detection of Ureteral Involvement in Deep Infiltrating Endometriosis: A Systematic Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:7-19. [PMID: 37792527 DOI: 10.1002/jum.16335] [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: 04/27/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The aim of this study is to determine the accuracy of transvaginal ultrasound (TVU) for the diagnosis of ureteral involvement in women with deep infiltrating endometriosis (DIE). METHODS The meta-analysis included primary studies comparing the use of TVU for diagnosing endometriotic involvement of the ureter, using laparoscopic surgery and histological diagnosis as the reference standard. Search was performed in several databases (Scopus, Web of Science, and PubMed/MEDLINE). The studies' quality and bias risk were assessed using the Quality Assessment of Diagnostic Accuracy Study-2 (QUADAS-2). Diagnostic performance was estimated by assessing pooled sensitivity and specificity. RESULTS A total of 496 citations were found. Six articles were ultimately selected for this systematic review and meta-analysis after the inclusion and exclusion criteria were applied. Pooled sensitivity and specificity were 0.81 (95% CI: 0.42-0.96), 1.00 (95% CI: 0.93-1.00). The heterogeneity observed was high for both sensitivity and specificity. Overall risk of bias was low. CONCLUSION TVU is a valuable tool for the pre-operative identification of ureteral involvement by DIE.
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Affiliation(s)
- Cizar Chway
- Faculty of Medicine, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Sandra Flórez
- Department of Obstetrics and Gynecology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Maria Dolores Muñoz
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Stefano Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria - Policlinico Duilio Casula, Monserrato, University of Cagliari, Cagliari, Italy
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
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Trigui M, Ouanes Y, Chaker K, Zehani A, Chelly I, Nouira Y. Bladder endometriosis: A serious disease. Urol Case Rep 2023; 48:102400. [PMID: 37123512 PMCID: PMC10133648 DOI: 10.1016/j.eucr.2023.102400] [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: 02/28/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023] Open
Abstract
Urinary tract endometriosis (UTE) is a very rare but serious form of infiltrating endometriosis because of the risk of urinary tract obstruction and loss of renal function. We report the case of A 42-year-old female patient admitted for intense right back pain with lower urinary tract disorders. An abdomino-pelvic ultrasound was done showing right uretero-hydronephrosis. Ureteroscopy showed an inflammatory-like stenosis of the right pelvic ureter. Given the young age of the patient, the poor quality of the right kidney, we opted for a right total nephro ureterectomy. The anatomopathological examination showed a bladder endometriosis .
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Affiliation(s)
- Mohamed Trigui
- Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
- Corresponding author. La Rabta Hospital, Department of Urology, Bab Saadoun, 1006, Tunis, Tunisia.
| | - Yassine Ouanes
- Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Kays Chaker
- Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Alia Zehani
- Department of Pathology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Ines Chelly
- Department of Pathology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Yassine Nouira
- Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
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Millischer AE, Santulli P, Da Costa S, Bordonne C, Cazaubon E, Marcellin L, Chapron C. Adolescent endometriosis: prevalence increases with age on magnetic resonance imaging scan. Fertil Steril 2023; 119:626-633. [PMID: 36592649 DOI: 10.1016/j.fertnstert.2022.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the prevalence on magnetic resonance imaging (MRI) of ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE) in adolescents presenting with severe dysmenorrhea. DESIGN Prospective study. SETTING Clinic. PATIENT(S) A total of 345 adolescents aged 12-20 years referred to the radiologic MRI department unit between September 2019 and June 2020. INTERVENTION(S) Multiplanar pelvic MRI with cine MRI was performed. Data on the medical history with systematic questioning were collected for each patient before the scan. MAIN OUTCOME MEASURE(S) Data on the endometriosis phenotypes (OMA and/or DIE), distribution of anatomical lesions, and adenomyosis were evaluated and recorded using a dedicated MRI spreadsheet. Myometrial contractions were systematically reported for each case. The data were correlated with the characteristics of the patients and severity of painful symptoms evaluated using a visual analog scale. RESULT(S) The prevalence rates of endometriosis and adenomyosis were 39.3% (121 patients) and 11.4% (35 patients), respectively. Among the adolescents with endometriosis, 25 (20.7%) presented with OMA, and 107 (88.4%) presented with DIE. The odds ratios (confidence intervals) for each pairwise comparison between the age distributions were 2.3 (1.4-3.8) for 15-18 vs. <15 years of age and 3.3 (1.2-8.5) for 18-20 vs. <15 years of age, highlighting a predominance of cases after 18 years of age. Uterine contractions were visualized in 34.4% of cases, with no particular association with endometriosis. No clinical risk factor was identified as being particularly associated with endometriosis. Notably, the visual analog scale score was the same for cases with and without endometriosis. CONCLUSION(S) Severe endometriosis phenotypes (OMA and/or DIE) can be observed in adolescents with intense dysmenorrhea, with a linear increase in prevalence over time resulting in a clear predominance after 18 years of age. Endometriosis in adolescents is a challenging clinical problem with a long delay in diagnosis. Imaging can help reduce this delay in young patients with suggestive symptoms. CLINICAL TRIAL REGISTRATION NUMBER NCT05153512.
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Affiliation(s)
- Anne-Elodie Millischer
- Imagerie Médicale Paris Centre (IMPC) Bachaumont-IFEEN - Ramsay Santé, Centre de Radiologie, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Pediatric Radiology Department (Prof. Boddaert), Centre Hospitalier Universitaire (CHU) Necker, Paris, France.
| | - Pietro Santulli
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Faculté de Médecine Paris Centre, Université de Paris, Faculté de Santé, Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Prof. Chapron), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department of "Development, Reproduction and Cancer," Institut Cochin, INSERM U1016, Paris, France
| | - Sabrina Da Costa
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Pediatric Gynecology Department (Prof. Polak), Centre Hospitalier Universitaire (CHU) Necker, Paris, France
| | - Corinne Bordonne
- Imagerie Médicale Paris Centre (IMPC) Bachaumont-IFEEN - Ramsay Santé, Centre de Radiologie, Paris, France; Department of Radiology (Prof. Dion), Centre Hospitalier Universitaire (CHU) Hôtel Dieu, Paris, France
| | - Elise Cazaubon
- IQVIA statistic Real World Solutions, Biometric, Paris, France
| | - Louis Marcellin
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Faculté de Médecine Paris Centre, Université de Paris, Faculté de Santé, Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Prof. Chapron), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department of "Development, Reproduction and Cancer," Institut Cochin, INSERM U1016, Paris, France
| | - Charles Chapron
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Faculté de Médecine Paris Centre, Université de Paris, Faculté de Santé, Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Prof. Chapron), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department of "Development, Reproduction and Cancer," Institut Cochin, INSERM U1016, Paris, France
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8
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Alsahabi J, Dendini M, Al-Zahrani EF, Alosiami A, Bamanie E. Paraurethral Endometriosis as a Common Pathology in an Uncommon Location: A Case Report and a Review of the Literature. Cureus 2023; 15:e35024. [PMID: 36938183 PMCID: PMC10022841 DOI: 10.7759/cureus.35024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Paraurethral endometriosis is an extremely rare condition. To the best of our knowledge, only seven cases with details on variable risk factors have been reported in the English literature. Herein, we present the case of a third nulliparous patient described in the literature at the time of diagnosis. A 30-year-old woman presented with mild urinary symptoms. A well-defined 2.3 cm paraurethral cystic lesion was found on clinical examination, and MRI findings were suggestive of hemorrhagic content, with no evidence of pelvic endometriosis. Complete surgical excision was performed, and the patient's symptoms improved. The patient experienced no recurrence for 10 months postoperatively. The histopathological findings were suggestive of endometriosis. These findings might indicate that embryonic remnants are possible causes of the pathogenesis of paraurethral endometriosis.
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Affiliation(s)
- Jawaher Alsahabi
- Urogynecology and Reconstructive Pelvic Surgery Division, King Abdul-Aziz Medical City Ministry of National Guard Health Affairs, Riyadh, SAU
- Obstetrics and Gynecology, King Abdullah International Medical Research Center, Riyadh, SAU
- Obstetrics and Gynecology, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Mohammad Dendini
- Urogynecology and Reconstructive Pelvic Surgery Division, King Abdul-Aziz Medical City Ministry of National Guard Health Affairs, Riyadh, SAU
- Obstetrics and Gynecology, King Abdullah International Medical Research Center, Riyadh, SAU
- Obstetrics and Gynecology, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Eman F Al-Zahrani
- Urogynecology and Reconstructive Pelvic Surgery Division, King Abdul-Aziz Medical City Ministry of National Guard Health Affairs, Riyadh, SAU
- Obstetrics and Gynecology, King Abdullah International Medical Research Center, Riyadh, SAU
- Obstetrics and Gynecology, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Abdulaziz Alosiami
- Radiology, King Abdul-Aziz Medical City Ministry of National Guard Health Affairs, Riyadh, SAU
- Radiology, King Abdullah International Medical Research Center, Riyadh, SAU
- Radiology, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Elham Bamanie
- Urogynecology and Reconstructive Pelvic Surgery Division, King Abdul-Aziz Medical City Ministry of National Guard Health Affairs, Riyadh, SAU
- Obstetrics and Gynecology, King Abdullah International Medical Research Center, Riyadh, SAU
- Obstetrics and Gynecology, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
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9
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Quesada J, Härmä K, Reid S, Rao T, Lo G, Yang N, Karia S, Lee E, Borok N. Endometriosis: A multimodal imaging review. Eur J Radiol 2023; 158:110610. [PMID: 36502625 DOI: 10.1016/j.ejrad.2022.110610] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/07/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Endometriosis is a chronic inflammatory disorder characterized endometrial-like tissue present outside of the uterus, affecting approximately 10% of reproductive age women. It is associated with abdomino-pelvic pain, infertility and other non - gynecologic symptoms, making it a challenging diagnosis. Several guidelines have been developed by different international societies to diagnose and classify endometriosis, yet areas of controversy and uncertainty remains. Transvaginal ultrasound (TV-US) is the first-line imaging modality used to identify endometriosis due to its accessibility and cost-efficacy. Enhanced sonographic techniques are emerging as a dedicated technique to evaluate deep infiltrating endometriosis (DIE), depending on the expertise of the sonographer as well as the location of the lesions. MRI is an ideal complementary modality to ultrasonography for pre-operative planning as it allows for a larger field-of-view when required and it has high levels of reproducibility and tolerability. Typically, endometriotic lesions appear hypoechoic on ultrasonography. On MRI, classical features include DIE T2 hypointensity, endometrioma T2 hypointensity and T1 hyperintensity, while superficial peritoneal endometriosis (SPE) is described as a small focus of T1 hyperintensity. Imaging has become a critical tool in the diagnosis, surveillance and surgical planning of endometriosis. This literature review is based mostly on studies from the last two decades and aims to provide a detailed overview of the imaging features of endometriosis as well as the advances and usefulness of different imaging modalities for this condition.
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Affiliation(s)
- Juan Quesada
- Department of Obstetrics & Gynecology, Campbelltown Hospital (South-Western Sydney Local Health District), Terry Rd, Campbelltown, NSW 2560, Australia.
| | - Kirsi Härmä
- Department of Diagnostic, Interventional and Pediatric Radiology - University Hospital of Bern, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Shannon Reid
- Western Sydney University, Faculty of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia; Sonacare Women's Health and Ultrasound, Harrington, NSW 2567, Australia
| | - Tanushree Rao
- Department of Obstetrics & Gynecology at Liverpool Hospital, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Glen Lo
- Department of Radiology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; The Western Ultrasound for Women, 1/160a Cambridge St, West Leederville, Perth, WA 6007, Australia.
| | - Natalie Yang
- Department of Radiology, The Austin Hospital, 145 Studley Rd, Heidelberg, Victoria 3084, Australia.
| | - Sonal Karia
- Department of Obstetrics & Gynecology, Campbelltown Hospital (South-Western Sydney Local Health District), Terry Rd, Campbelltown, NSW 2560, Australia.
| | - Emmeline Lee
- Department of Radiology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; The Western Ultrasound for Women, 1/160a Cambridge St, West Leederville, Perth, WA 6007, Australia
| | - Nira Borok
- Department of Radiology, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
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10
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Martire FG, Russo C, Selntigia A, Siciliano T, Lazzeri L, Piccione E, Zupi E, Exacoustos C. Transvaginal ultrasound evaluation of the pelvis and symptoms after laparoscopic partial cystectomy for bladder endometriosis. J Turk Ger Gynecol Assoc 2022; 23:145-153. [PMID: 36065973 PMCID: PMC9450928 DOI: 10.4274/jtgga.galenos.2022.2022-5-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate transvaginal sonography (TVS) findings after laparoscopic partial cystectomy for bladder endometriosis and to correlate postsurgical ultrasound findings with symptoms. Material and Methods: A retrospective study including women who underwent laparoscopic partial cystectomy for bladder endometriosis. Within 12 months after surgery, TVS examination was conducted in all patients to evaluate the bladder morphology, and the presence of any postsurgical sonographic findings of the pelvis. Painful symptoms were assessed using a visual analogue scale. Results: A total of 40 women were included. At the follow-up visit, 25 patients were receiving medical treatment while 15 had declined post-surgical therapy and had tried to conceive. The presence of bladder deep-infiltrating endometriosis (DIE) was found in nine (22.5%), fibrotic thickening of the bladder wall was found in 15 (37.5%), and normal bladder morphology was observed in 16 (40%). There was a correlation between anterior adenomyosis and bladder DIE, and fibrotic thickening of the bladder. Patients with TVS signs of bladder DIE and anterior adenomyosis suffered more dysmenorrhea and dysuria than patients with normal bladder. Conclusion: Post-operative TVS can detect the alteration of pelvis and could explain the causes of the persistence of symptoms.
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Affiliation(s)
- Francesco Giuseppe Martire
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Consuelo Russo
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Aikaterini Selntigia
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Terry Siciliano
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Emilio Piccione
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy,Postgraduate School of Obstetrics and Gynecology, Catholic University Our Lady of Good Counsel, Tirana, Albania
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Caterina Exacoustos
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
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11
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Pascoal E, Wessels JM, Aas-Eng MK, Abrao MS, Condous G, Jurkovic D, Espada M, Exacoustos C, Ferrero S, Guerriero S, Hudelist G, Malzoni M, Reid S, Tang S, Tomassetti C, Singh SS, Van den Bosch T, Leonardi M. Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:309-327. [PMID: 35229963 DOI: 10.1002/uog.24892] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Endometriosis is a chronic systemic disease that can cause pain, infertility and reduced quality of life. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. Research on diagnostic test accuracy in endometriosis can be difficult due to verification bias, as not all patients with endometriosis undergo definitive diagnostic testing. The purpose of this State-of-the-Art Review is to provide a comprehensive update on the strengths and limitations of the diagnostic modalities used in endometriosis and discuss the relevance of diagnostic test accuracy research pertaining to each. We performed a comprehensive literature review of the following methods: clinical assessment including history and physical examination, biomarkers, diagnostic imaging, surgical diagnosis and histopathology. Our review suggests that, although non-invasive diagnostic methods, such as clinical assessment, ultrasound and magnetic resonance imaging, do not yet qualify formally as replacement tests for surgery in diagnosing all subtypes of endometriosis, they are likely to be appropriate for advanced stages of endometriosis. We also demonstrate in our review that all methods have strengths and limitations, leading to our conclusion that there should not be a single gold-standard diagnostic method for endometriosis, but rather, multiple accepted diagnostic methods appropriate for different circumstances. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Pascoal
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - J M Wessels
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
- AIMA Laboratories Inc., Hamilton, Canada
| | - M K Aas-Eng
- Department of Gynecology, Oslo University Hospital Ulleval, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - M S Abrao
- Gynecologic Division, BP-A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - G Condous
- Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School, Nepean Hospital, Sydney, Australia
| | - D Jurkovic
- Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Espada
- Department of Obstetrics and Gynaecology, Blue Mountains ANZAC Memorial Hospital, Katoomba, Australia
- Sydney Medical School, Sydney, Australia
| | - C Exacoustos
- Department of Surgical Sciences, Obstetrics and Gynecological Clinic, University of Rome 'Tor Vergata', Rome, Italy
| | - S Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Cagliari, Italy
| | - G Hudelist
- Department of Gynecology, Center for Endometriosis, St John of God Hospital, Vienna, Austria
- Scientific Endometriosis Foundation (SEF), Westerstede, Germany
| | - M Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | - S Reid
- Department of Obstetrics and Gynaecology, Western Sydney University, Sydney, Australia
| | - S Tang
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - C Tomassetti
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven University Fertility Centre, Leuven, Belgium
| | - S S Singh
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Canada
| | - T Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium
| | - M Leonardi
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
- Sydney Medical School, Sydney, Australia
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
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AN ULTRASOUND-BASED PREDICTION MODEL TO PREDICT URETEROLYSIS AT LAPAROSCOPIC ENDOMETRIOSIS SURGERY. J Minim Invasive Gynecol 2022; 29:1170-1177. [PMID: 35817365 DOI: 10.1016/j.jmig.2022.07.002] [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] [Received: 04/07/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVES To develop a model, including clinical features and ultrasound findings, to predict the need for ureterolysis (i.e. dissection of the ureter) during laparoscopy for endometriosis. DESIGN A retrospective observational study of patients who had transvaginal ultrasound (TVS) according to the International Deep Endometriosis Analysis (IDEA) consensus and subsequent laparoscopy +/- excision of endometriosis between January 2017 and February 2021 was conducted. SETTING Sydney Medical School Nepean, University of Sydney, Nepean Hospital and Blue Mountains Hospital, New South Wales, Australia INTERVENTION: The demographic, clinical, TVS and intra-operative data were extracted through electronic clinical records. MEASUREMENTS Multi-categorical decision-tree and baseline models were built to choose the variables most correlated to the outcome under study. Receiver operating characteristic (ROC) analysis was performed on the binary classification. Based on our results, we selected the variables performing with significant statistical differences (p-value < .05). MAIN RESULTS During the study period, 177 consecutive patients were recruited and divided into two subgroups, ureterolysis (51.4%) and and non-ureterolysis (48.6%). Ureterolysis was noted in 87.5% of patients in which the left ovary was immobile (p-value< .001), and in 82.5% in which the right ovary was fixed (p-value<.001). For patients with right uterosacral ligament (USL) deep endometriosis (DE), ureterolysis was performed on 96.2% (p-value< .001), and 64.6% (p-value= .043) for left USL DE. Among patients with bowel DE, the proportion of patients undergoing ureterolysis was 95.5% (p-value < .001). The prognostic variables utilized in the final model to predict ureterolysis included dyschezia, absence of ovarian mobility, presence of right or left USL DE and presence of bowel DE on TVS. According to the developed model, the baseline risk for performing ureterolysis is 20% in our sample. The overall model performance demonstrated an area under the ROC curve 0.82. CONCLUSION Our study demonstrates that it is possible to predict the need for ureterolysis with clinical and sonographic data. Furthermore, patients presenting with the combination of the variables of our model (dyschezia, ovarian immobility, USL and bowel DE lesions) have a high risk of ureterolysis. On the other hand, patients without these features have a low risk (approximately 20%) of needing ureterolysis.
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Lukac S, Schmid M, Pfister K, Janni W, Schäffler H, Dayan D. Extragenital Endometriosis in the Differential Diagnosis of Non- Gynecological Diseases. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:361-367. [PMID: 35477509 PMCID: PMC9472266 DOI: 10.3238/arztebl.m2022.0176] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/02/2021] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Endometriosis is a chronic, benign disease that affects approximately 10% of women of childbearing age. Its characteristic clinical features are dysmenorrhea, dyschezia, dysuria, dyspareunia, and infertility. The manifestations of extragenital endometriosis (EE) are a diagnostic challenge, as this disease can mimic other diseases due to its unusual location with infiltration of various organs and corresponding symptoms. METHODS This review is based on publications retrieved by a selective search of the literature on the commonest extragenital sites of endometriosis, including the relevant current guideline. RESULTS Current evidence on the treatment of extragenital endometriosis consists largely of cohort studies and cross-sectional studies. The treatment is either surgical and/or conservative (e.g., hormonal therapy). Gastrointestinal endometriosis is the most common form of EE, affecting the rectum and sigmoid colon in nearly 90% of cases and typically presenting with dyschezia. Urogenital endometriosis is the second most common form of EE. It affects the bladder in more than 85% of cases and may present with dysuria, hematuria, or irritable bladder syndrome. The diaphragm is the most common site of thoracic endometri - osis, potentially presenting with period-associated shoulder pain or catamenial pneumothorax. Endometriosis affecting a nerve often presents with sciatica. In abdominal wall endometriosis, painful nodules arise in scars from prior abdominal surgery. CONCLUSION There is, as yet, no causally directed treatment for chronic endometriosis. The treatment is decided upon individually in discussion with the patient, in consideration of risk factors and after assessment of the benefits and risks. Timely diagnosis is essential.
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Affiliation(s)
- Stefan Lukac
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Marinus Schmid
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Kerstin Pfister
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Henning Schäffler
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Davut Dayan
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
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Lertvikool S, Tingthanatikul Y, Hongsakorn W, Srisombut C, Nakpalat K, Weerakiet S. Outcomes of Laparoscopic Partial Cystectomy of Bladder Endometriosis: A Report of 18 Thai Women. WOMEN'S HEALTH REPORTS 2021; 2:369-374. [PMID: 34671756 PMCID: PMC8524725 DOI: 10.1089/whr.2021.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
Aim: To determine the outcomes of laparoscopic partial cystectomy (LPC) for bladder endometriosis (BE). Methods: This was a retrospective study using medical records of women who underwent LPC for BE between January 2009 and December 2017. Demographic characteristics, surgical findings, including surgical site and size of the bladder lesion, endometriosis at other locations, and pre- and postoperative hormonal treatment data were collected. Results: We analyzed data of 18 women with full-thickness BE. The patients had a mean age of 34 (range, 26–45) years and body mass index of 21.6 (range, 16.1–25) kg/m2. All women had dysmenorrhea. Other symptoms noted include dysuria, gross hematuria, and infertility. BE with a mean diameter of 2.7 cm (range, 1–5) was most commonly found at the posterior wall of the bladder (94.4%). Peritoneal endometriosis (94.4%), endometrioma (33.3%), and deep endometriotic nodules (22.2%) in the posterior compartment were also found. No surgical complications were observed. Postoperative hormonal treatment was administered to 14 (77.8%) patients. All symptoms improved after the surgery. No recurrence was found after 30 (range, 12–74) months of follow-up. Conclusion: LPC is an effective treatment option for BE.
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Affiliation(s)
- Srithean Lertvikool
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yada Tingthanatikul
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Woradej Hongsakorn
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chartchai Srisombut
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Katanyuta Nakpalat
- Women Health Centre, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhon Royal Academy, Bangkok, Thailand
| | - Sawaek Weerakiet
- Division of Obstetrics and Gynecology, Bangkok Hospital Udonthani, Udonthani, Thailand
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Barra F, Alessandri F, Scala C, Ferrero S. Ultrasonographic 3D Evaluation in the Diagnosis of Bladder Endometriosis: A Prospective Comparative Diagnostic Accuracy Study. Gynecol Obstet Invest 2021; 86:299-306. [PMID: 34157713 DOI: 10.1159/000516634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The use of three-dimensional (3D) transvaginal ultrasonography (TVS) has been investigated for the diagnosis of deep endometriosis (DE). This study aimed to evaluate if 3D reconstructions improve the performance of TVS) in assessing the presence and characteristics of bladder endometriosis (BE). DESIGN This was a single-center comparative diagnostic accuracy study. Participants/Materials, Setting, Methods: Patients referred to our institution (Piazza della Vittoria 14 Srl, Genova, Italy) with clinical suspicion of DE were included. In case of surgery, women underwent systematic preoperative ultrasonographic imaging; an experienced sonographer performed a conventional TVS; another experienced sonographer, blinded to results of the previous exam, performed TVS, with the addition of 3D modality. The presence and characteristics of BE nodules were described in accord with International DE Analysis group consensus. Ultrasound data were compared with surgical and histological results. RESULTS Overall, BE was intraoperatively found in 34 out of 194 women who underwent surgery for DE (17.5%; 95% confidence interval: 12.8-23.5%). TVS without and with 3D reconstructions were able to detect endometriotic BE in 82.2% (n = 28/34) and 85.3% (n = 29/34) of the cases (p = 0.125). Both the exams similarly estimated the largest diameter of BE (p = 0.652) and the distance between the endometriotic nodule and the closest ureteral meatus (p = 0.341). However, TVS with 3D reconstructions was more precise in estimating the volume of BE (p = 0.031). In one case (2.9%), TVS without and with 3D reconstructions detected the infiltration of the intramural ureter, which was confirmed at surgery and required laparoscopic ureterovesical reimplantation. LIMITATIONS The extensive experience of the gynecologists performing the ultrasonographic scans, the lack of prestudy power analysis, and the population selected, which may have been influenced by the position of the institution as a referral center specialized in the treatment of severe endometriosis, are limitations of the current study. CONCLUSION Our results demonstrated the high accuracy of ultrasound for diagnosing BE. The addition of 3D reconstructions does not improve the performance of TVS in diagnosing the presence and characteristics of BE. However, the volume of BE may be more precisely assessed by 3D ultrasound.
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Affiliation(s)
- Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynecology, IRRCS Ospedale Policlinico San Martino, Genova, Italy.,Piazza della Vittoria 14 SRL, Genova, Italy
| | - Franco Alessandri
- Unit of Obstetrics and Gynecology, IRRCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carolina Scala
- Piazza della Vittoria 14 SRL, Genova, Italy.,Unit of Obstetrics and Gynecology, Gaslini Institute, Genova, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynecology, IRRCS Ospedale Policlinico San Martino, Genova, Italy.,Piazza della Vittoria 14 SRL, Genova, Italy
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Mimickers of Urothelial Carcinoma and the Approach to Differential Diagnosis. Clin Pract 2021; 11:110-123. [PMID: 33668963 PMCID: PMC7931042 DOI: 10.3390/clinpract11010017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 01/03/2023] Open
Abstract
A broad spectrum of lesions, including hyperplastic, metaplastic, inflammatory, infectious, and reactive, may mimic cancer all along the urinary tract. This narrative collects most of them from a clinical and pathologic perspective, offering urologists and general pathologists their most salient definitory features. Together with classical, well-known, entities such as urothelial papillomas (conventional (UP) and inverted (IUP)), nephrogenic adenoma (NA), polypoid cystitis (PC), fibroepithelial polyp (FP), prostatic-type polyp (PP), verumontanum cyst (VC), xanthogranulomatous inflammation (XI), reactive changes secondary to BCG instillations (BCGitis), schistosomiasis (SC), keratinizing desquamative squamous metaplasia (KSM), post-radiation changes (PRC), vaginal-type metaplasia (VM), endocervicosis (EC)/endometriosis (EM) (müllerianosis), malakoplakia (MK), florid von Brunn nest proliferation (VB), cystitis/ureteritis cystica (CC), and glandularis (CG), among others, still other cellular proliferations with concerning histological features and poorly understood etiopathogenesis like IgG4-related disease (IGG4), PEComa (PEC), and pseudosarcomatous myofibroblastic proliferations (post-operative spindle cell nodule (POS), inflammatory myofibroblastic tumor (IMT)), are reviewed. Some of these diagnoses are problematic for urologists, other for pathologists, and still others for both. Interestingly, the right identification of their definitory features will allow their correct diagnoses, thus, avoiding overtreatment. The literature selected for this review also focuses on the immunohistochemical and/or molecular data useful to delineate prognosis.
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