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Pašalić E, Tambuwala MM, Hromić-Jahjefendić A. Endometriosis: Classification, pathophysiology, and treatment options. Pathol Res Pract 2023; 251:154847. [PMID: 37844487 DOI: 10.1016/j.prp.2023.154847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
The human endometrium is a complex hormone-target tissue consisting of two layers: the lower basalis, and the upper functionalis. The latter of the two goes through a cycle of thickening and shedding without residual scarring or loss of function. This cycle, known as the menstrual cycle, occurs on a monthly basis in most of healthy reproductive-age women. It is, however, associated with a number of reproductive diseases, endometriosis being one of them. Endometriosis is defined as the presence of endometrium at ectopic sites within the peritoneum or, more rarely, other locations outside the abdominal area. It affects around 6-10% of reproductive-age women in the world and causes debilitating pain, heavy menstrual bleeding, pain during penetrative sex, and infertility. The etiology of the disease is not yet fully understood but the generally accepted theory is that the endometriotic lesions originate from viable eutopic endometrial cells that flow back into the peritoneum through the process of retrograde menstruation. Endometriosis is usually classified into four stages: minimal, mild, moderate, and severe, though it is important to note that the presentation of symptoms does not necessarily correspond to the disease progression. The immune system plays an important role in supporting the viability and growth of ectopic endometriotic tissue, all the while promoting chronic inflammation at the lesion sites, which causes prolonged pain. There is no definitive cure for endometriosis, but there are several options for symptom management, including laparoscopy, hormonal therapy, the use of NSAIDs, dietary changes, exercise, and, in cases when all conservative treatments fail, hysterectomy.
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Affiliation(s)
- Elma Pašalić
- Faculty of Engineering and Natural Sciences, Genetics and Bioengineering Department, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Bosnia and Herzegovina
| | - Murtaza M Tambuwala
- Lincoln Medical School, University of Lincoln, Brayford Pool Campus, Lincoln LN6 7TS, UK.
| | - Altijana Hromić-Jahjefendić
- Faculty of Engineering and Natural Sciences, Genetics and Bioengineering Department, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Bosnia and Herzegovina.
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Pant A, Moar K, K Arora T, Maurya PK. Biomarkers of endometriosis. Clin Chim Acta 2023; 549:117563. [PMID: 37739024 DOI: 10.1016/j.cca.2023.117563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
Endometriosis is one of the most severe female reproductive disorders, affecting 6-10% of women between 18 and 35. It is a gynaecological condition where endometrial tissue develops and settles outside the uterus. The aetiology of endometriosis is primarily influenced by genetic, epigenetic, and non-genetic variables, making it highly challenging to create a therapeutic therapy explicitly targeting the ectopic tissue. The delay in the treatment is due to the limitations in the diagnostic approaches, which are restricted to invasive techniques such as laparoscopy or laparotomy. This accords to 70% of the women being diagnosed at later stages. By understanding the subject, several treatment medications have been produced to lessen the disease's symptoms. Nevertheless, endometriosis cannot be permanently cured. A viable or persuasive standard screening test for endometriosis must be utilized in a clinical context. A helpful assessment method for the early identification of endometriosis could be biomarkers. A major research priority is the identification of a biomarker that is sensitive and specific enough for detecting endometriosis. The present article has reviewed studies published on the expression of biomarkers of endometriosis. It outlines various biomarkers from different sample types, such as serum/plasma and urine, in addition to tissue. This would provide a non-invasive approach to diagnosing the disease at the initial stages without any harmful repercussions. Future high-throughput advances in science and technology are anticipated to result in the creation of a potent remedy for endometriosis. To achieve successful outcomes, it is necessary to research the discussed biomarkers that demonstrate substantial results extensively.
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Affiliation(s)
- Anuja Pant
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Kareena Moar
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Taruna K Arora
- Reproductive Biology and Maternal Child Health Division, Indian Council of Medical Research, New Delhi 110029, India
| | - Pawan Kumar Maurya
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India.
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Panwar A, Lata K, Kriplani I, Sharma S, Kriplani A. Role of Laparoscopic Transillumination Guidance During Hysteroscopic Metroplasty in Simplifying Surgical Management of Type II Robert's Uterus. J Obstet Gynaecol India 2022; 72:421-424. [PMID: 36457422 PMCID: PMC9701275 DOI: 10.1007/s13224-021-01609-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/06/2021] [Indexed: 10/18/2022] Open
Abstract
Robert's uterus is a rare variant of septate uterus with an asymmetrical septum which divides the uterine cavity into a noncommunicating hemiuterus causing hematometra and other communicating hemiuterus with a single cervix and a normal fundal contour (U2bC3V4 ESHRE classification). It is a cause of severe dysmenorrhea in young girls. However, there is a type of Robert uterus (Type II) which does not have collection in the blind cavity and causes symptoms later, similar to our case. We describe a case of hysteroscopic septum resection (metroplasty) with laparoscopic guidance by transillumination in a case of Type II Robert's uterus in a 25-year-old nulliparous woman. Thick muscular septum posed a surgical challenge which was supplemented by astutely utilizing laparoscopic transillumination.
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Affiliation(s)
- Akshita Panwar
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
| | - Kusum Lata
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences New Delhi, Room No 3076, Third floor, New Delhi, India
| | - Isha Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
| | - Seema Sharma
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
| | - Alka Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
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Masuda H, Schwab KE, Filby CE, Tan CSC, Tsaltas J, Weston GC, Gargett CE. Endometrial stem/progenitor cells in menstrual blood and peritoneal fluid of women with and without endometriosis. Reprod Biomed Online 2021; 43:3-13. [PMID: 34011465 DOI: 10.1016/j.rbmo.2021.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/04/2021] [Accepted: 04/12/2021] [Indexed: 12/18/2022]
Abstract
RESEARCH QUESTION Are endometrial stem/progenitor cells shed into uterine menstrual blood (UMB) and the peritoneal cavity in women with and without endometriosis during menstruation? DESIGN Women with (n = 32) and without endometriosis (n = 29) at laparoscopy (total 61), carried out during the menstrual (n = 41) and non-menstrual phase (n = 20) were recruited. The UMB, peritoneal fluid and peripheral blood were analysed by clonogenicity assay and flow cytometry to quantify the concentrations of endometrial clonogenic cells, SUSD2+ mesenchymal stem cells (eMSC) and N-cadherin+ epithelial progenitor cells (eEPC). RESULTS Clonogenic endometrial cells, eMSC and eEPC were found in most UMB samples at similar concentrations in women with and without endometriosis. In contrast, 62.5% of women with endometriosis and 75.0% without (controls) had clonogenic cells in peritoneal fluid samples during menses. The eMSC were present in the peritoneal fluid of 76.9% of women with endometriosis and 44.4% without, and eEPC were found in the peritoneal fluid of 60.0% of women with and 25.0% without endometriosis during menses. Median clonogenic, eMSC and eEPC concentrations in peritoneal fluid were not significantly different between groups. More clonogenic cells persisted beyond the menstrual phase in the peritoneal fluid of women with endometriosis (menstrual 119/ml [0-1360/ml] versus non-menstrual 8.5/ml [0-387/ml]; P = 0.277) compared with controls (menstrual 76.5/ml [1-1378/ml] versus non-menstrual 0/ml [0-14/ml]; P = 0.0362). No clonogenic endometrial cells were found in peripheral blood. CONCLUSIONS Clonogenic endometrial cells, SUSD2+ eMSC and N-cadherin+ eEPC are present in UMB and the peritoneal fluid of women with and without endometriosis. Further study of the function of these cells may shed light on the cellular origins of endometriosis.
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Affiliation(s)
- Hirotaka Masuda
- The Ritchie Centre, Hudson Institute of Medical Research, TRF L5, 27-31 Wright Street Clayton VIC 3168, Australia; Department of Obstetrics and Gynecology, Monash University, Clayton 3800, Australia
| | - Kjiana E Schwab
- The Ritchie Centre, Hudson Institute of Medical Research, TRF L5, 27-31 Wright Street Clayton VIC 3168, Australia
| | - C E Filby
- The Ritchie Centre, Hudson Institute of Medical Research, TRF L5, 27-31 Wright Street Clayton VIC 3168, Australia; Department of Obstetrics and Gynecology, Monash University, Clayton 3800, Australia
| | - Charmaine S C Tan
- The Ritchie Centre, Hudson Institute of Medical Research, TRF L5, 27-31 Wright Street Clayton VIC 3168, Australia; Department of Obstetrics and Gynecology, Monash University, Clayton 3800, Australia
| | - Jim Tsaltas
- Department of Obstetrics and Gynecology, Monash University, Clayton 3800, Australia
| | - Gareth C Weston
- Department of Obstetrics and Gynecology, Monash University, Clayton 3800, Australia; Monash IVF, Clayton Victoria 3168, Australia
| | - Caroline E Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, TRF L5, 27-31 Wright Street Clayton VIC 3168, Australia; Department of Obstetrics and Gynecology, Monash University, Clayton 3800, Australia.
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Yovich JL, Rowlands PK, Lingham S, Sillender M, Srinivasan S. Pathogenesis of endometriosis: Look no further than John Sampson. Reprod Biomed Online 2019; 40:7-11. [PMID: 31836436 DOI: 10.1016/j.rbmo.2019.10.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/07/2019] [Accepted: 10/11/2019] [Indexed: 11/25/2022]
Abstract
Rather than consider endometriosis as an enigmatic disease, reading John Sampson's two theories/mechanisms explains virtually all cases affecting the female. It is true that Sampson's most recent publication, in 1940, which talks about retrograde menstruation via the fallopian tubes, clearly fails to explain many types of endometriosis, particularly that located in extra-pelvic sites. However, his earlier publications of 1911 and 1912, on radiographic studies of hysterectomy specimens that had been injected with various gelatin/bismuth/pigment mixtures examining the unique uterine vasculature, were more important. These studies enabled him to describe 'the escape of foreign material from the uterine cavity into the uterine veins' in 1918 and subsequently to demonstrate metastatic or embolic endometriosis in the first of his two important publications in 1927. Later in that same year, in response to 'academic banter' from other historic gynaecologists, he published a second article that indicated his studies had been redirected to explore the retrograde tubal menstruation idea; this required undertaking his hysterectomies during menses. That work led to his 1940 presentation at the invitation of The American College of Obstetricians and Gynecologists to focus on the second theory/mechanism of endometriosis. This appears to have caused his more important first theory/mechanism to have been forgotten.
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Affiliation(s)
- John L Yovich
- PIVET Medical Centre, Perth, Western Australia 6007, Australia; Curtin University, Perth, Western Australia 6845, Australia; Cairns Fertility Centre, Cairns, Queensland 4870, Australia.
| | | | | | - Mark Sillender
- PIVET Medical Centre, Perth, Western Australia 6007, Australia
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