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Nikolettos K, Patsouras A, Kotanidou S, Garmpis N, Psilopatis I, Garmpi A, Effraimidou EI, Daniilidis A, Dimitroulis D, Nikolettos N, Tsikouras P, Gerede A, Papoutsas D, Kontomanolis E, Damaskos C. Pulmonary Endometriosis: A Systematic Review. J Pers Med 2024; 14:1085. [PMID: 39590577 PMCID: PMC11595740 DOI: 10.3390/jpm14111085] [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: 08/17/2024] [Revised: 09/30/2024] [Accepted: 10/16/2024] [Indexed: 11/28/2024] Open
Abstract
Background/Objectives: Endometriosis is characterized by the presence of ectopic endometrial-like glands and stroma outside the endometrial cavity, which mainly occurs in the pelvic cavity. Pulmonary endometriosis, or thoracic endometriosis syndrome (TES), describes the rare presence of endometrial-like cells in the thoracic cavity and includes catamenial pneumothorax, catamenial hemothorax, hemoptysis, and lung nodules. Our aim is to summarize the results of all reported cases of TES. Methods: Extensive research was conducted through MEDLINE/PUBMED using the keywords "thoracic endometriosis", "thoracic endometriosis syndrome", "catamenial pneumothorax", "catamenial hemoptysis", and "TES". Following PRISMA guidelines, all published cases of TES between January 1950 and March 2024 were included. A systematic review of 202 studies in English, including 592 patients, was performed. Results: The median age of women with TES is 33.8 years old. The most common clinical presentation is catamenial pneumothorax (68.4%), while lesions are mainly found in the right lung unilaterally (79.9%). Chest computed tomography (CT) was used alone or after an X-ray to determine the pathological findings. Ground-glass opacity nodules and cystic lesions represent the most common finding in CT, while pneumothorax is the most common finding in X-rays. Video-assisted thoracoscopic surgery (VATS) is the main therapeutic approach, usually in combination with hormonal therapy, including GnRH analogues, progestins, androgens, or combined oral contraceptives. Hormonal therapy was also administered as monotherapy. Symptom recurrence was reported in 10.1% of all cases after the treatment. Conclusions: High clinical awareness and a multidisciplinary approach are necessary for the best clinical outcome for TES patients. More studies are required to extract safer conclusions.
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Affiliation(s)
- Konstantinos Nikolettos
- Department of Obstetrics and Gynecology, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68110 Alexandroupolis, Greece; (K.N.); (S.K.); (N.N.); (P.T.); (A.G.); (E.K.)
| | - Alexandros Patsouras
- Second Department of Pulmonology, Sotiria General Hospital, 11527 Athens, Greece;
| | - Sonia Kotanidou
- Department of Obstetrics and Gynecology, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68110 Alexandroupolis, Greece; (K.N.); (S.K.); (N.N.); (P.T.); (A.G.); (E.K.)
| | - Nikolaos Garmpis
- Department of Surgery, Sotiria General Hospital, 11527 Athens, Greece; (N.G.); (D.P.)
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Iason Psilopatis
- Department of Obstetrics and Gynecology, University Erlangen Hospital, 91054 Erlangen, Germany
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Eleni I. Effraimidou
- First Surgical Department, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68110 Alexandroupolis, Greece;
| | - Angelos Daniilidis
- First University Department in Obstetrics and Gynecology, Papageorgiou General Hospital, School of Medicine, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece;
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Nikos Nikolettos
- Department of Obstetrics and Gynecology, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68110 Alexandroupolis, Greece; (K.N.); (S.K.); (N.N.); (P.T.); (A.G.); (E.K.)
| | - Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68110 Alexandroupolis, Greece; (K.N.); (S.K.); (N.N.); (P.T.); (A.G.); (E.K.)
| | - Angeliki Gerede
- Department of Obstetrics and Gynecology, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68110 Alexandroupolis, Greece; (K.N.); (S.K.); (N.N.); (P.T.); (A.G.); (E.K.)
| | - Dimitrios Papoutsas
- Department of Surgery, Sotiria General Hospital, 11527 Athens, Greece; (N.G.); (D.P.)
| | - Emmanuel Kontomanolis
- Department of Obstetrics and Gynecology, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68110 Alexandroupolis, Greece; (K.N.); (S.K.); (N.N.); (P.T.); (A.G.); (E.K.)
| | - Christos Damaskos
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Emergency Surgery, Laiko General Hospital, 11527 Athens, Greece
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