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PubMed1999

Clear cell carcinoma arising in a Cesarean section scar endometriosis: a case report.

Endometriosis of a surgical scar is rare and occurs mainly when a hysterectomy or Cesarean section was performed. We describe a 54-year-old woman with a large suprapubic mass as a definite case of a endomerioid carcinoma developing within the scar endometriosis following Cesarean section. Scar endometriosis, as well as endometriosis at other sites, can turn malignant. Endometrioid carcinoma is the most common histological pattern of malignant tumor arising in endometriosis. But clear cell carcinoma is very unusual. A case of primary clear cell carcinoma in endometriosis of a Cesarean section scar is described. To the best of our knowledge, this is the first documented case of endomerioid carcinoma developing within the scar endometriosis in Korea.

Adenocarcinoma, Clear Cell↗

PubMed2005

[Determination of interleukine-16 levels in peritoneal fluid and serum of women with endometriosis].

OBJECTIVE: To investigate the role of interleukine-16 (IL-16) in the pathogenesis of endometriosis. METHODS: Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of IL-16 in peritoneal fluid and serum specimens of 22 women with different stage endometriosis and 22 controls. RESULTS: The median levels of IL-16 in peritoneal fluid and serum were 290.5 pg/ml and 539.4 pg/ml in women with endometriosis, and 296.6 pg/ml and 778.1 pg/ml in controls, respectively; there was no significant difference between two groups (P>0.05). However, the IL-16 levels in peritoneal fluid and serum of patients with minimal/mild stage endometriosis and controls were all significantly higher than those of patients with moderate/severe endometriosis (P<0.01, <0.05). In addition, there was no statistical correlation of peritoneal IL-16 levels with those in serum (P>0.05). CONCLUSION: Reduced levels of IL-16 in peritoneal fluid and serum of women with advanced stage endometriosis may imply a role of IL-16 in the development and progression of endometriosis.

Adult↗

PubMed2006

P53 codon 11, 72, and 248 gene polymorphisms in endometriosis.

OBJECTIVE: Mutated p53 gene is related to the instability of cell growth and cell cycle progression. We aimed to evaluate the association between endometriosis and p53 codon 11, 72 and 248 gene polymorphisms. PATIENTS AND METHODS: Women were divided into two groups: (1) moderate/severe endometriosis (n=148), and (2) non-endometriosis groups (n=150). P53 gene polymorphisms include codon11 Glu/Gln or Lys (GAG->CAG or AAG), codon 72 Arg/Pro (CGC->CCC), and codon 248 Arg/Thr (CGG->TCG). These gene polymorphisms were amplified by polymerase chain reaction and detected by electrophoresis after restriction enzyme (Taq I, BstU I, Hap II) digestions. Associations between the endometriosis and p53 polymorphisms were evaluated. RESULTS: The distributions of p53 codon 72 polymorphisms in both groups were significantly different. The proportions of Arg homozygotes/heterozygotes/Pro homozygotes in both groups were 9.5/66.2/24.3% and 30.7/50/19.3%. The proportions of Arg/Pro alleles were 42.6/57.4% and 56/44%. The distributions of p53 codon 11 and 248 polymorphisms in both groups were non-significantly different. All individuals appeared the wild genotypes (Glu11 and Arg248 homozygotes). CONCLUSION: Association between endometriosis and p53 codon 72 polymorphism exists. P53 codon 72*Pro-related genotype and allele are related with higher susceptibility of endometriosis. P53 codon 11 and 248 polymorphisms are not related with endometriosis susceptibility.

Arginine↗

PubMed1998

[Malignant degeneration in women operated on for endometriosis].

UNLABELLED: The endometriosis can undergo estrogen-dependent changes similar to endometrium and may carry a risk for developing hyperplasia and carcinoma during unopposed estrogen stimulation. We reviewed the existing literature to analyze the potential of malignancy arising from extraovarian endometriosis by estrogen stimulation. Our two cases are also discussed. According to our study there are 21 cases published in the literature of malignant transformation of endometriosis after estrogen stimulation. The most common place for malignant trans formation is the vagina. The most common hystological type is adenocarcinoma in 13 cases. Our two cases were with adenocarcinoma and adenosquamous carcinoma. The incidence of malignant transformation of the endometriosis can not be estimated based upon these cases. There is a need for randomised clinical trials. CONCLUSIONS: The estrogen stimulation may lead to premalignant or malignant transformations of the residual foci of endometriosis. That is why addition of progestins to the estrogen substitutional therapy should be considered in women with endometriosis after total hysterectomy with oophorectomy, especially if a residual foci are present or suspected. With our study we think we can make more clear the way an endometriosis is transformed into a malignancy.

Adenocarcinoma↗

PubMed1998

[Alteration of peritoneal lymphocyte transformation and its interleukin-2 release in patients with infertility and endometriosis].

OBJECTIVE: To study the relationship between alteration of peritoneal lymphocyte transformation activity, its interleukin-2 (IL-2) release and infertility associated with endometriosis. METHODS: Peritoneal fluid was collected from 15 infertile patients with endometriosis (endometriosis group) and 13 normal fertile women (control group). Lymphocyte transformation activity were determined in peritoneal fluid by morphometry. IL-2 contents were determined in peritoneal fluid and supernatants of cultured pelvic lymphocytes by biological method. RESULTS: Lymphocyte transformation activity reinforced (P < 0.001) and IL-2 contents increased in peritoneal fluid and supernatant of cultured pelvic lymphocyte in the endometriosis group than those in the control group (P < 0.01, P < 0.001 respectively). There is significant positive correlation between lymphocyte transformation rate and IL-2 activity of cultured supernatant in endometriosis group (P < 0.001). CONCLUSION: The increase of IL-2 content in the samples of endometriosis may play an important role in infertility with endometriosis.

Adult↗

PubMed2000

Pregnancy rates after laparoscopic treatment. Differences related to tubal status and presence of endometriosis.

OBJECTIVE: To examine how preexisting tubal adhesions and endometriosis affect pregnancy outcome after laparoscopic treatment in infertile women with no apparent causes of infertility other than tubal factors. STUDY DESIGN: Pregnancy outcomes in 186 infertile women for a follow-up period of 18 months after laparoscopy were analyzed. Laparoscopic manipulations consisted of adhesiolysis of tubes and removal of endometriotic lesions. RESULTS: The patients were classified into three groups, those with no tubal adhesions (group A, n = 83), unilateral tubal adhesions (group B, n = 46) and bilateral tubal adhesions with at least one tube patent (group C, n = 57). The cumulative pregnancy rate in group C (13.2%) was lower than in groups A (41.8%) and B (45.7%) 18 months after laparoscopy. The average time to conception in group A (6.7 +/- 0.8 months) tended to be shorter than that in group B (10.6 +/- 1.2 months). In group A, pregnancy rates were essentially the same between minimal/mild endometriosis and moderate/severe endometriosis. Regarding group B, women with minimal/mild endometriosis exhibited significantly higher pregnancy rates than those with moderate/severe endometriosis, while pregnancy rates in women without endometriosis fell in between. CONCLUSION: Pregnancy rates after laparoscopic treatment are different in relation to tubal status and the presence of endometriosis.

Adult↗

PubMed2001

Contribution of diminished ovarian reserve to hypofertility associated with endometriosis.

OBJECTIVE: To determine if ovarian reserve, as measured by day 3 levels of E2 and FSH, was different in patients with endometriosis as compared to controls. STUDY DESIGN: Case-control study of 75 women with laparoscopically staged endometriosis and 75 age-matched controls undergoing in vitro fertilization/embryo transfer for male factor infertility. RESULTS: In women with stage III/IV endometriosis (revised American Fertility Society staging), day 3 E2 and FSH levels were significantly higher than control levels (51.9 pg/mL and 12.6 mIU/mL versus 34.7 pg/mL and 9.7 mIU/mL, P < .03). In contrast, women with stage I/II endometriosis did not differ significantly when compared to controls (36.8 pg/mL and 10.4 mIU/mL versus 34.0 pg/mL and 10.2 mIU/mL). The total group showed significantly higher E2 levels (41.8 pg/mL versus 34.1 pg/mL, P < .03), but no significant differences in FSH levels were observed. CONCLUSION: These data show that women with stage III/IV endometriosis have relatively diminished ovarian reserve, while this situation is not noted in women with stage I/II endometriosis. This observation is consistent with progressive loss of ovarian reserve in women with increasing stages of endometriosis independent of age.

Case-Control Studies↗

PubMed2001

Peritoneal fluid concentrations of interleukin-4 in relation to the presence of endometriosis, its stage and the phase of the menstrual cycle.

BACKGROUND: Interleukin-4 (IL-4) is a cytokine with both stimulatory and inhibitory effects on the inflammatory system such as macrophage inhibition and T-cell activation. It is known to regulate several monocyte functions, including inhibition of the synthesis of cytokines such as IL-1, IL-6 and TNF-alpha as well as potentiating IL-8. METHOD: In an attempt to clarify the association between IL-4 and endometriosis, we measured the concentration of IL-4 in the peritoneal fluid of 52 women; 24 with endometriosis and 28 with no endometriosis, controlling for the phase of the cycle and the stage of disease. RESULTS: There was no difference in the concentrations of IL-4 between women with (n=28) and without endometriosis (n=24). No difference was found between the IL-4 concentrations in women with different stages of endometriosis. Levels of IL-4 did not show a difference according to the phase of the cycle in either group. CONCLUSION: Our results indicate no association between peritoneal fluid levels of IL-4 and endometriosis and hence suggest that IL-4 is not involved in the pathogenesis of endometriosis.

Ascitic Fluid↗

PubMed2001

[Association of human leukocyte antigen-DQA1 with endometriosis of women in southern China].

OBJECTIVE: To study the genetic susceptibility in patients with endometriosis by genotyping their human leukocyte antigen-DQA1 (HLA-DQA1) alleles. METHODS: The allelic types of HLA-DQA1 were detected by polymerase chain reaction single specific primers (PCR-SSP) technique in 51 patients with endometriosis proven by laparoscopy or histological examination, and 44 control women who had laparoscopic sterilization and without endometriosis. RESULTS: The frequency of HLA-DQA * 0401 allele (12%) in patients with endometriosis group was markedly higher than that in the control group (0%) (P = 0.019). Contrarily, the frequency of HLA-DQA1 * 0301 allele (39%) in control group was higher than that in endometriosis group (14%) (P = 0.005, odds ratio = 0.253). CONCLUSION: Our result indicated that HLA-DQA1 * 0401 may be a susceptible gene in correlation with endometriosis, whereas HLA-DQA1 * 0301 may be a protective gene against endometriosis.

Adult↗

PubMed2002

[Obstructive uropathy secondary to recurrent pelvic endometriosis: description of a clinical case].

The typical presentation of endometriosis is pelvic pain. Patients with with endometriosis often have associated fertility disorders even if their relationship with the symptoms and signs of endometriosis is not evident. The first line of treatment for endometriosis must be surgery. In case of infertility the preferred approach is laparoscopic, maybe in association with medical treatment and possibly followed up by a second-look. In cases with relevant pelvic pain and involvement of other organs, laparotomy is necessary, particularly when a deep endometriosis is infiltrating the uterosacral ligaments, the rectovaginal septum and the bladder. Medical treatment of endometriosis is based upon the hormone-dependency of the endometriotic lesions inducing a resting status. Adhesions, endometriomas or fibrous sequelae do not respond to medical treatment. We describe a case of recurrent endometriosis treated with radical surgery for relevant lesions and fibrous adhesions of ureters with consequent bilateral hydronephrosis.

Adult↗

PubMed2002

Impact of endometriosis on implantation. Data from the Wilford Hall Medical Center IVF-ET Program.

OBJECTIVE: To investigate the effect of endometriosis on implantation. STUDY DESIGN: In a retrospective cohort study, 149 consecutive in vitro fertilization retrieved cycles were analyzed. Patients with endometriosis (n = 27, 31 cycles) were compared with a control group with tubal infertility (n = 104, 118 cycles). The main outcome measure was implantation rate (gestational sac per transferred embryo). RESULTS: The patients in the tubal infertility group were slightly younger and tended to have a better response to stimulation and increased number of oocytes retrieved than did the patients in the endometriosis group; however, there were no differences in fertilization rates, number of embryos transferred or clinical pregnancy rates per cycle between the endometriosis group and tubal infertility group. The overall clinical pregnancy rate per cycle was similar for women in the endometriosis and tubal infertility groups (54.8% and 55.1%, respectively). The implantation rate was not different in the endometriosis versus tubal infertility group (28% [28/100] and 29.8%, [108/363], respectively; P = .75, relative risk = .94, 95% confidence interval .66, 1.34). CONCLUSION: For women undergoing in vitro fertilization-embryo transfer with endometriosis, the implantation rate is not markedly different from that for women undergoing in vitro fertilization-embryo transfer with tubal infertility.

Adult↗

PubMed2003

Analysis of an interleukin-6 gene promoter polymorphism in women with endometriosis by pyrosequencing.

Interleukin (IL)-6 has been implicated in the etiology of endometriosis. A single nucleotide polymorphism (SNP) at position -174 in the IL-6 gene promoter appears to influence IL-6 transcription rates in vitro and basal IL-6 levels in vivo. We determined the genotype and the allele frequencies of the -174 IL-6 promoter polymorphism and the corresponding IL-6 serum levels in women with endometriosis. The pyrosequencing technique was used to assess the IL-6 genotypes in 94 women with histologically confirmed endometriosis (study group). A series of 70 healthy women without history of uterine disease served as clinical controls (control group).Allele frequencies for the G allele among women with and without endometriosis were 59.6% and 55.0%, respectively (P =.430; odds ratio [OR] 0.83, 95% confidence interval [CI] 0.53, 1.29). Homozygotes for the protective allele C were present in 17.0% of women with endometriosis and in 18.6% of controls were homozygous for the protective allele C (P =.797; OR 0.90, 95% CI 0.40, 2.02). When patients with various disease manifestations were compared, we found an association between the -174 G allele and chocolate cysts (P =.037). Serum levels of IL-6 were significantly higher in women with endometriosis than in controls (P <.001), with highest levels in women with chocolate cysts. There was no association between serum IL-6 levels and IL-6 genotype. The IL-6 promoter polymorphism -174 G/C does not contribute significantly to overall disease susceptibility but does predispose the carrier to distinct endometriosis with chocolate cysts. A genetically determined high IL-6 response might play a pathogenic role in this disease condition.

Alleles↗

PubMed2002

Depot leuprorelin acetate versus danazol in the treatment of infertile women with symptomatic endometriosis.

PURPOSE OF INVESTIGATION: Endometriosis is a common finding in women with infertility, but the mechanism by which it renders a woman infertile remains unclear. The medical treatment of pelvic endometriosis includes hormonal therapy that directly attacks endometriosis lesions or indirectly by inhibiting endometrial proliferation through estrogenic deprivation. The aim of this study was to compare the efficacy and safety of leuprorelin acetate depot and danazol for endometriosis in infertile women. METHODS: This randomized trial involved 81 women 19-41 years old with regular menses and known pelvic endometriosis who were recruited from the Fertility Center of the Second University of Naples between 1992 and 1999. Fifty-four women were given 3.75 mg of leuprolide acetate depot every 28 days for 24 weeks and the remaining 27 took 200 mg of danazol three times daily for 24 weeks. Efficacy assessments were based on pre-admission and end-of-treatment laparoscopic scores and subjective symptoms scores at 4-week intervals during and after treatment. Safety was evaluated by adverse events and clinical laboratory tests. RESULTS: In each group, endometriosis growth and symptoms significantly improved during treatment (p < 0.001). Significantly fewer patients randomized to leuprorelin acetate (5.5%) withdrew during treatment compared with 18.5% randomized to danazol (p < 0.05). After treatment symptoms returned in each group, but severity was less than at admission at all time points (p < 0.02). Hypoestrogenic side-effects were more common in those receiving leuprorelin, particularly hot flushes, but anabolic/androgenic side-effects of weight gain and acne were more common in those receiving danazol. CONCLUSION: Both leuprorelin acetate depot and danazol are effective in the treatment of endometriosis in infertile patients. The hypoestrogenic side-effects of leuprorelin may be better tolerated than the androgenic, anabolic effects of danazol.

Administration, Oral↗

PubMed2003

Determination of HGF concentration in serum and peritoneal fluid in women with endometriosis.

Scatter factor (hepatocyte growth factor, SF/HGF) is a multifunctional polypeptide growth factor that plays an important role in tumor proliferation, angiogenesis and invasiveness. The aim of this study was to investigate the role of HGF in endometriosis and their relationship. Peritoneal fluid and serum samples of 126 women of reproductive age receiving laparoscopy (72 with endometriosis and 54 without endometriosis) were obtained and enzyme-linked immunosorbent assay (ELISA) was employed to measure HGF concentrations. The results revealed that the concentrations of HGF were significantly elevated in women with endometriosis stages I/II and III/IV as compared with HGF level in the control group (peritoneal fluid levels of 0.337+/-0.065, 0.458+/-0.160, 0.915+/-0.113, P<0.001; serum level of 0.335+/-0.663, 0.456+/-0.151, 0.907+/-0.170, P<0.001 respectively). A positive correlation was found between peritoneal fluid and serum levels of HGF, which varied little with phases of the menstrual cycle. Comparisons of the women in the same menstrual cycle between the three groups revealed that increased levels of HGF in patients with advanced endometriosis were not attributed to the cycle phase. Our results indicated that the degree of endometriosis was positively correlated with HGF concentration in peritoneal fluid and serum. Therefore, the detection of serum HGF concentration may be useful in classifying endometriosis, and may also help in selecting the optimal treatment methods.

Adult↗

PubMed1992

[Activated macrophages in the peritoneal fluid of women with endometriosis: examination of the intracytoplasmic localization of endogenous peroxidase and interleukin-1].

In order to study the effect of peritoneal macrophages (M phi) on conception in patients with endometriosis, the total numbers of peritoneal M phi and the proportion of the exudate type, defined on the basis of ultracytochemical localization of endogenous peroxidase (PO) activity, were investigated in 21 patients with endometriosis, five with uterine leiomyoma, three with tubal obstruction and three with carcinomatous peritonitis. An immunocytochemical observation of interleukin-1 (IL-1) was also performed in three patients with endometriosis, one with tubal obstruction, and one male patient with cholelithiasis. The total numbers of peritoneal M phi in patients with endometriosis were significantly higher than in uterine leiomyoma (2.11 x 10(7) v.s. 0.68 x 10(7), p less than 0.025). The total numbers of peritoneal M phi in tubal obstruction (0.96 x 10(7)) were not statistically different from those in uterine leiomyoma. The peritoneal M phi were remarkably increased in number in patients with carcinomatous peritonitis. On ultracytochemical observation of endogenous PO activity, the proportion of exudate M phi to whole M phi was significantly larger in endometriosis than that in uterine leiomyoma (13.3% v.s. 3.5%, p less than 0.025). This type of M phi increased even in stage I endometriosis (p less than 0.005). These data suggest that the abdominal cavity in women with endometriosis is in the stimulated conditions which may lead to infertility. A positive reaction to anti-IL-1 antibody on the cell membrane of all M phi examined in each patient suggests that an immunocytochemical study of IL-1 in M phi is not suitable for evaluating the degree of activation of M phi.

Animals↗

PubMedDate not supplied

CA 125 levels in monitoring therapy for endometriosis and in prediction of recurrence.

CA 125 levels were measured in the serum of 18 patients with laparoscopically diagnosed stage 2 to stage 4 endometriosis (American Fertility Society classification) and in eight normally cycling control women. All endometriosis patients were treated medically with either Danazol or Buserelin. CA 125 levels were measured during treatment and during the 18-month follow-up period. The mean CA 125 level in women with endometriosis was significantly higher than that observed in normal women (28.6 +/- 5.1 (+/- SE) units/mL vs. 11.1 +/- 1.1 units/mL). However, there was considerable overlap of values between controls and patients with stage 2 disease. The levels in patients with stage 3 or stage 4 disease were always greater than 20 units/mL. There was a significant positive correlation (r = .51) between the implant score and CA 125 levels, while there was no correlation between the total score (which includes adhesions and implants) and the CA 125 levels. Four of the patients who had recurrence of symptoms approximately 1 year after treatment had CA 125 levels close to pretreatment levels, and recurrence of endometriosis was confirmed by laparoscopy. The CA 125 levels in the rest of the patients remained suppressed during the follow-up periods. These results indicate that (1) CA 125 level can predict active endometriosis lesions in patients with stage 3 and stage 4 endometriosis, but is of no value for predicting adhesions; (2) CA 125 levels are useful in monitoring therapy during treatment; (3) during the follow-up period, elevations in CA 125 might predict recurrence of disease in women with stage 3 and stage 4 endometriosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Extraperitoneal endometriosis with catamenial pneumothoraces: a review of the literature.

OBJECTIVE: To present a case of recurrent catamenial pneumothorax and diaphragmatic endometriosis that was managed thoracoscopically. A review of the literature is also presented. METHODS: A-28-year-old woman presented with bloody stools, chronic constipation, and chest pain. A review of systems was positive for monthly chest pain associated with her menses. A preoperative chest x-ray revealed a right pneumothorax. Colonoscopy revealed biopsy proven endometriosis of the sigmoid colon. A pelvic computed tomography scan revealed bilateral complex, cystic and solid adenexal lesions. RESULTS: A right thoracoscopy was performed. A lesion on the right hemidiaphragm was excised and confirmed to be endometriosis. A wedge section of lung tissue containing a bleb was resected and also contained endometriosis. Three months later, the patient underwent laparoscopic excision of her pelvic endometriosis, including a low anterior rectal resection. Five months later, she presented again with right-sided chest pain. A thoracoscopic right total pleurectomy was performed for recurrent pneumothorax. CONCLUSION: Pullmonary endometriosis may present as chest pain, shortness of breath, or hemoptysis associated with menstrual cycles. This case emphasizes the importance of a careful review of systems in patients with known endometriosis. Management now includes an endoscopic alternative and all of its known benefits.

Adult↗

PubMed2003

[Comparison of assessing the patency of the Fallopian tubes during laparoscopy and during hysterosalpingography on television in infertile women with endometriosis].

OBJECTIVES: Sterility become nowadays not only medical, but as well socio-economic problem. One of its major causes is endometriosis. Recurrent adnexitis--one of the most common symptoms of endometriosis might be the cause of fallopian tubes occlusion. The hysterosalpingography (HSG) can be helpful to diagnose this tubal pathology. DESIGN: To compare the assessment of fallopian tubes patency during HSG with the results of laparoscopy in infertile women with endometriosis. MATERIAL AND METHODS: 331 women with endometriosis who were diagnosed during laparoscopy examination between 1998-2002 due to sterility. The presence of endometriosis was confirmed during laparoscopy. In each patient the control of the patency of both fallopian tubes was performed. These data were confirmed with those from HSG performed during follicular phase on the television path. The absence of the contrast passage through fallopian tubes as well as the only trace contrast passage into abdominal cavity were classified as tubal obstruction. RESULTS: In patients during the HSG physiological uterine shape and size in 91.3%, the bicornis uterus in 6.6%, and the unicornis uterus in 2.1% were observed. During laparoscopy we diagnosed the physiological uterine shape and size in 88.8%, the bicornis uterus in 8.2%, and the unicornis uterus in 3.0%. The diagnostic compatibility of these both examinations was 90.6%. In HSG the correct anatomical course of both fallopian tubes without occlusions in 51.7%, the only unilateral patency in 36.7%, and bilateral occlusions in 11.6% were found. During laparoscopy we diagnosed the anatomical course of both fallopian tubes without occlusions in 36.7%, the only unilateral patency in 33.3%, and bilateral occlusions in 30.0%. The diagnostic compatibility of these both examinations was 49.6% for both fallopian tubes, and 34.2% for the only one fallopian tube. In 16.2% both results were incompatible. CONCLUSIONS: The incorrect contrast passage through the fallopian tubes and its increased pressure during HSG in women with the characteristic history and clinical symptoms can suggest endometriosis. In these cases laparoscopy is necessary as the additional examination in the diagnostics of fallopian tubes patency, but the only objective method in diagnosis of endometriosis.

Adult↗