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PubMedDate not supplied

Increased incidence and recurrence of recent corpus luteum without ovulation stigma (luteinized unruptured follicle syndrome?) in baboons with endometriosis.

OBJECTIVE: To test the hypothesis that a recent corpus luteum (CL) without fresh ovulation stigma (OS) can be found with a higher incidence and recurrence in baboons with endometriosis and is associated with a reduced egg recovery rate after uterine flush. METHODS: One hundred thirty-eight laparoscopies were performed in the early luteal phase of 52 cycles in 32 female baboons with a normal pelvis (controls) and of 86 cycles in 21 animals with endometriosis. The incidence and recurrence of a recent CL without OS was studied during each laparoscopy and during the first three laparoscopies in 15 baboons (five controls, ten with endometriosis), respectively. The association between the presence of a recent CL without OS and the egg recovery rate was evaluated during 65 cycles in 21 baboons after uterine flush. RESULTS: When all 138 laparoscopies were analyzed, the incidence of a recent CL without OS was higher (P < .03) in animals with stage II-IV endometriosis (35%) than in those with stage I disease (19%) or controls (11%). Both the incidence (seven of ten) and recurrence (three of ten) of a recent CL without OS were higher in baboons with endometriosis than in controls (zero of five, P < .02) when studied during the first three laparoscopies. Laparoscopies in primates having a recent CL without OS were associated with a lower egg recovery rate (13%) than in animals with recent CL and OS (54%, P = .005). CONCLUSION: A recent CL without OS was associated with a reduced egg recovery rate and could be found with a higher incidence and recurrence in baboons with endometriosis than in controls, suggesting that luteinized unruptured follicle syndrome exists and could contribute to endometriosis-associated subfertility.

Animals↗

PubMed1995

Endometriosis in adolescent women.

With the aim of determining an effective therapy for adolescent women with endometriosis, the authors analyzed the results of laparotomy performed on 16 cases of female teenagers over a seven-year period. All patients, whose average age of menarche is 12.8, were diagnosed with endometriosis between two months and nine years after the menarche, with an average interval of 5.2 years. The chief symptoms are dysmenorrhea, pelvic pain and abdominal fullness. Of the three patients of unicornuate uterus with rudimentary horn, endometriosis was found only involving the adnexa on the side of the rudimentary horn, two of the three patients had absence of affected side kidney. Conservative operation including six cases of salpingo-oophorectomy and 10 cases of ovarian cystectomy were chosen followed by danazol treatment. One year to seven years after surgical treatment, two patients required subsequent conservative operation for recurrence of endometriosis and two other patients resumed dysmenorrhea. Two married women became pregnant 5 and 10 months after surgical and medical therapy respectively. In conclusion, adolescent endometriosis may occur around five years after menarche and an obstructive uterine anomaly, enhancing retrograde menstruation, increases the occurrence rate. The symptoms and treatment of endometriosis in teenage group do not really differ from that in the older women. In the treatment of endometriosis and for the prevention of recurrence, it is recommended to give three to six months of danazol after surgical treatment.

Adolescent↗

PubMed1996

Urinary tract endometriosis treated by laparoscopy.

OBJECTIVE: To evaluate the efficacy of the laparoscopic approach for the diagnosis and treatment of severe urinary tract endometriosis. DESIGN: Retrospective review of 28 cases of severe urinary tract endometriosis. SETTING: Center for Special Pelvic Surgery, a tertiary referral center. PATIENT(S): Between October 1989 and September 1994, we treated 28 women who had deeply infiltrating urinary tract endometriosis (bladder, 7, ureter, 21). INTERVENTION(S): All procedures were performed laparoscopically. MAIN OUTCOME MEASURE(S): Postoperative urinary function, pain relief, and complications. RESULT(S): Those who had vesical endometriosis underwent partial cystectomy and primary repair. Partial ureteral obstruction was found in 17 women; 10 underwent ureterolysis and excision of endometriosis, and 7 had partial wall resection. Four patients with ureter involvement had complete obstruction. Three underwent partial resection and ureteroureterostomy, and one had ureteroneocystostomy. The rate of ureteral endometriosis in the present series is higher than that reported previously. CONCLUSION(S): Severe infiltrative endometriosis of the bladder and the ureter can present without specific symptoms and can cause silent compromise of renal function. We demonstrated that the laparoscopic approach is safe and effective in the diagnosis and treatment of this entity.

Adult↗

PubMed1996

[Immunologic characteristics of peritoneal fluid in endometriosis].

Increased volume of peritoneal fluid is found more frequently in patients with endometriosis (51%) than in infertile patients without endometriosis (13%). Immunologic analysis of the peritoneal fluid shows that in patients with endometriosis the level of immunoglobulin G (IgG) increases. We analyzed 34 samples of peritoneal fluid from patients with and 13 from patients without endometriosis. The mean value of IgG in the group of patients with endometriosis was 7.73g/L and 3.94g/L in the control group. This difference is statistically significant, but there is no statistically significant difference in regard to immunoglobulin A (IgA), while it has been significant for immunoglobulin M (IgM) only in the third stage of the disease. In certain stages of illness there are no statistically significant differences in values of all three immunoglobulin types. A golden standard of immunoglobulin G in peritoneal fluid is 5g/L and in regard to this level we calculated the following: sensitivity, specificity, prognostic value and accuracy of the test. Sensitivity and positive prognostic value reached 85.3%. On the basis of these findings it can be concluded that if no endometriosis can be seen during laparascopy while the volume of peritoneal fluid is increased, immunologic analysis should be performed. If IgG values are 5g/L or higher, the patient should be treated as a patient with possible "precursor endometriosis".

Ascitic Fluid↗

PubMed1998

Allelotyping of endometriosis with adjacent ovarian carcinoma reveals evidence of a common lineage.

Endometriosis is a common gynecological disease in which tissue similar to the endometrium proliferates at sites outside the uterine cavity. Malignant transformation of endometriosis to endometrioid and clear cell ovarian carcinomas has been documented in histological studies, but no molecular genetic evidence exists to support that endometriosis is the clonal precursor of such malignancies. We examined 14 cases of endometriosis synchronous with ovarian cancer for loss of heterozygosity on 12 chromosome arms, X chromosome inactivation, and TP53 mutation to determine whether they shared genetic alterations. In all four of the cases where the carcinoma had arisen within endometriosis and in five of the seven cases where the carcinoma was adjacent to the endometriosis, common genetic lesions were detected, consistent with a common lineage. A TP53 mutation was also detected in one case of endometriosis adjacent to carcinoma. These findings support the numerous histological observations that endometrioid and clear cell ovarian carcinomas may arise through malignant transformation of endometriotic lesions.

Adult↗

PubMed1998

Effects of endometrial stromal cells and peritoneal fluid on fertility associated with endometriosis.

Endometriosis is one cause of infertility. The disease causes severe non-bacterial inflammation and adhesion in the ovarian tubes and/or referred reproductive organs, but a number of types of unexplained infertility without severe organic disorders also exist. In the present study, we investigated the effects of endometrial stromal cells (SC) and peritoneal fluid (PF) in endometriosis on the fertilization and embryonic development rates using mouse ova and embryos. In addition, we prepared endometriosis artificially in rats and investigated the effects of peritoneal perfusate on the fertilization and embryonic development rates. We also investigated the in vitro fertilization rate in these rats. The mouse ova, sperm, and two-cell embryos were cultured on SC isolated surgically from patients with uterine myoma (M) or endometriosis (E), and 24 hours later, the fertilization and embryonic development rates were investigated. To this co-culture system, PF from M or E patients was added, at varying concentrations, and the fertilization and embryonic development rates were investigated. Then, rats with experimental endometriosis were prepared. After confirmation of the presence of lesions, peritoneal perfusate was added, at varying concentrations, to the co-culture system, and the fertilization and embryonic development rates were investigated. In addition, the in vitro fertilization rate was investigated in these rats. Both the fertilization rate and the embryonic development rate were significantly lower for the co-culture system in the E group. In the PF addition system, PF decreased the fertilization and embryonic development rates at lower concentrations in the E group. In rats with artificial endometriosis, peritoneal perfusate from rats with lesions significantly decreased the fertilization and embryonic development rates at lower concentrations. The in vitro fertilization rate was significantly lower in rats with lesions. The above results strongly suggested that inhibitions of fertilization and embryonic development induced by SC and PF, and altered quality of the ovum itself, might be responsible for infertility in endometriosis.

Animals↗

PubMed2002

Presentation of endometriosis of the cervix in cervical smear: a case report and review of literature.

Endometriosis of the cervix is considered a rare lesion with a predilection in women with a previous history of cervical trauma, such as biopsy, conization, or laser vaporization. Description of endometriosis of the cervix in cytological literature is equally rare with most of the published reports dealing with the role of fine-needle aspiration in diagnosis and how the atypia in cases with cervical endometriosis poses differential diagnosis for other premalignant and malignant endocervical lesions. We present here a case depicting endometriosis of the cervix in a cervical/endocervical smear from a 48-year-old female with intermenstrual spotting. The purpose of this article is 2-fold: to report a case of endometriosis of the cervix in exfoliative cytology and to review pertinent cytological literature. In this article, cytological and histological presentation of cervical endometriosis is described, and the importance of considering cervical endometriosis in the differential diagnosis when dealing with endometrial shedding that is not part of the normal physiology in a cycling woman is emphasized.

Journal Article↗

PubMed2001

Local Epidermal Growth Factor Production in Women with Endometriosis.

The aim of the study was to elucidate the role of epidermal growth factor (EGF) in pathogenesis of endometriosis at different stages of disease. The level of EGF in peritoneal fluid (PF) of fertile and infertile women with endometriosis and in pooled supernatants of 24-h cultures of peritoneal macrophages was assessed by ELISA method. It was found that in fertile women with early stages of disease EGF level in PF did not differ from that in control group, but at the advanced stages of endometriosis the significant elevation of EGF concentration in PF was observed. The spontaneous production of EGF by peritoneal macrophages in this group was diminished. It might be suggested that elevation of EGF concentration in PF in this group is the result of secretory activity of endometriosis lesions and macrophages didn't regulate the local EGF production in fertile women. EGF level in PF of infertile women was increased only in women with minimal manifestations of endometriosis but not in women with advanced stages of the disease. Simultaneously the increase of EGF production by peritoneal macrophages of infertile women with advanced stages of endometriosis was shown. These facts give an evidence in favor of high level of macrophage activation and their participation in regulation of EGF level in peritoneal cavity in infertile women with endometriosis.

Journal Article↗

PubMed1995

Gonadotropin-releasing hormone agonist therapy reduces postoperative adhesion formation and reformation after adhesiolysis in rat models for adhesion formation and endometriosis.

OBJECTIVES: To evaluate the effectiveness of GnRH agonist (GnRH-a) therapy on adhesion formation and reformation in established rat models for surgically induced adhesion formation and endometriosis. DESIGN: Before surgery, female Sprague-Dawley rats were injected with GnRH-a or control diluent. Six days later, rats were assigned to one of four surgical groups: [1] endometriosis, [2] endometriosis sham, [3] adhesion model, or [4] adhesion sham. Three weeks after surgery, a second-look laparotomy was performed, adhesions were scored (0 = no adhesions to 3 = severe adhesions) and mechanically disrupted, and rats received a second GnRH-a or diluent injection either analogous to their initial injection or in a crossover design. Three weeks after the second injection, rats were killed and adhesion reformation was scored. Data were evaluated using nonparameteric tests including Mann-Whitney, Kruskal-Wallis, and Friedman's tests comparing GnRH-a treatments with diluent controls. RESULTS: Preoperative GnRH-a therapy reduced adhesion scores in rats with surgically induced endometriosis (mean +/- SEM; GnRH-a 1.1 +/- 0.2 versus diluent 2.2 +/- 0.2) and adhesions (GnRH-a 0.3 +/- 0.1 versus diluent 0.6 +/- 0.1). Pretreatment GnRH-a therapy did not affect adhesion scores in the endometriosis sham procedure. Combined preoperative and postoperative GnRHa therapy (GnRH-a-GnRH-a) but not postoperative GnRH-a therapy alone (diluent-GnRH-a) reduced adhesion reformation after adhesiolysis in the endometriosis model (GnRH-a-GnRH-a 1.1 +/- 0.3, diluent-GnRH-a 1.6 +/- 0.7), the endometriosis sham (GnRH-a-GnRH-a 0.7 +/- 0.2, diluent-GnRHa 1.8 +/- 0.1), and the adhesion model (GnRH-a-GnRH-a 0.3 +/- 0.2, diluent-GnRHa 1.0 +/- 0.5). No adhesions were observed in the adhesion sham group. CONCLUSIONS: Gonadotropin-releasing hormone agonist therapy was successful in reducing adhesion formation and reformation. These studies suggest that GnRH-a therapy for adhesion prevention in women should be explored.

Animals↗

PubMed2000

Progestagens and anti-progestagens for pain associated with endometriosis.

BACKGROUND: Endometriosis is a gynaecological condition that presents either with the problem of infertility or with painful symptoms. The clinical observation of an apparent resolution of symptoms during pregnancy gave rise to the concept of treating patients with a pseudo-pregnancy regime. Initially combinations of high dose oestrogens and progestagens were used but this was subsequently replaced by progestogens alone. More recently progestogens of both progestagens and anti-progestagens in the treatment of symptomatiprogestogenssis OBJECTIVES: To determine the effectiveness of both the progestagens and anti-progestagens in the treatment of painful symptoms ascribed to the diagnosis of endometriosis. SEARCH STRATEGY: The search strategy of the Menstrual Disorders and Subfertility Group was utilised to identify all publications which described or might have described randomised trials of any progestagen or any anti-progestagen in the treatment of symptomatic endometriosis. SELECTION CRITERIA: Trials were included if they were randomised and considered the effectiveness of either a progestagen or an anti-progestagen in the treatment of painful symptoms associated with endometriosis. DATA COLLECTION AND ANALYSIS: Seven studies were considered to be appropriate for inclusion in this review. Only three studies evaluating progestagens were included (comparison with placebo, danazol and oral contraceptive plus danazol). All other studies compared the anti-progestagen, gestrinone, with other medical therapies. MAIN RESULTS: Progestagens appear to be an effective therapy for the painful symptoms associated with endometriosis. Gestrinone is as effective as other established medical therapies (danazol and GnRH analogues). REVIEWER'S CONCLUSIONS: The limited available data suggests that both continuous progestagens and anti-progestagens are effective therapies in the treatment of painful symptoms associated with endometriosis. Progestagens given in the luteal phase are not effective. These conclusions should be accepted cautiously due to a lack of data.

Dydrogesterone↗

PubMed2005

Non-steroidal anti-inflammatory drugs for pain in women with endometriosis.

BACKGROUND: Endometriosis is a common gynaecological condition that affects women and can lead to painful symptoms and infertility. It affects women's quality of life greatly, impacting on their careers, everyday activities, sexual and non-sexual relationships, and fertility. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used first-line treatment for endometriosis. OBJECTIVES: To assess the effects of NSAIDs for the management of pain in women with endometriosis compared to placebo, other NSAIDs, other pain management drugs, or no treatment. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Trials Register (May 2005) published in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to May 2005), EMBASE (1980 to May 2005) and the reference lists from relevant publications. Experts in the field were also contacted for information about possible studies. SELECTION CRITERIA: We included all randomized controlled trials (RCTs) describing the use of NSAIDs in the treatment of endometriosis in women of all ages. DATA COLLECTION AND ANALYSIS: Two review authors (CA and SH) independently read and extracted data from each of the included studies. Crossover trials were analysed using the inverse variance method in RevMan to calculate the odds ratio for binary outcomes. MAIN RESULTS: Two trials were identified but only one trial, with 24 women, was included in the analysis. Comparing NSAIDs (naproxen) to placebo, there was no evidence of a positive effect on pain relief (odds ratio (OR) 3.27, 95% CI 0.61 to 17.69) in women with endometriosis. There was also inconclusive evidence to indicate whether women taking NSAIDs (naproxen) were less likely to require additional analgesia (OR 0.12, 95% CI 0.01 to 1.29) or experience side effects (OR 0.46, 95% CI 0.09 to 2.47) when compared to placebo. AUTHORS' CONCLUSIONS: There is inconclusive evidence to show whether NSAIDs (naproxen) are effective in managing pain caused by endometriosis. There is no evidence to show whether any individual NSAID is more effective than another. As shown in other Cochrane reviews, women using NSAIDs need to be aware of the possibility that these drugs may cause unintended effects.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2006

Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery.

BACKGROUND: Various options exist for treating endometriosis, including ovarian suppression therapy, surgical treatment or a combination of these strategies. Surgical treatment of endometriosis sets out to remove visible areas of endometriosis and restore anatomy by division of adhesions. The aim of medical therapy is to inhibit growth of endometriotic implants by suppression of ovarian steroids and induction of a hypo-estrogenic state. Postoperative treatment with a hormone-releasing intrauterine system, using levonorgestrel (LNG-IUS), has been suggested. OBJECTIVES: To determine if postoperative use of an LNG-IUS in women with endometriosis improves pain symptoms associated with menstruation and reduces recurrence compared with treatment with surgery only, placebo or systemic hormones. SEARCH STRATEGY: The following databases were searched: (1) Cochrane Menstrual Disorders and Subfertility Group Specialised Register of controlled trials; (2) Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 1); (3) MEDLINE (1966 to January 2006) and EMBASE (1980 to January 2006); (4) National Research Register (NRR). (5) The citation lists of relevant publications, review articles, abstracts of scientific meetings and included studies were also searched. SELECTION CRITERIA: Trials were included if they compared women undergoing any type of surgical treatment for endometriosis with uterine preservation then randomized to LNG-IUS insertion within two to three months versus no treatment, placebo (inert IUD) or systemic treatment. Diagnostic laparoscopy alone was excluded. DATA COLLECTION AND ANALYSIS: Two review authors (AM Abou-Setta and HG Al-Inany) independently selected studies for inclusion and extracted data. Statistical analysis was performed in accordance with the statistical guidelines developed by the Cochrane Menstrual Disorders and Subfertility Group. Data extracted from the trials was analyzed on an intention-to-treat basis. For binary data, the overall common odds ratio (OR) (that is, the odds of having clinical symptoms) and the risk difference with 95% confidence interval (CI) were calculated using the Mantel-Haenszel fixed-effect method. MAIN RESULTS: In one small randomized controlled trial (RCT) there was a statistically significant reduction in the recurrence of painful periods in the LNG-IUS group compared with the control group receiving a gonadotrophin-releasing hormone (GnRH) agonist (OR 0.14, 95% CI = 0.02 to 0.75). The proportion of women who were satisfied with their treatment was higher in the LNG-IUS group than in the control group but this difference did not reach statistical difference (OR 3.00, 0.79 to 11.44). AUTHORS' CONCLUSIONS: One small study has shown that postoperative use of the LNG-IUS reduces the recurrence of painful periods in women who have had surgery for endometriosis. There is a need for further well-designed RCTs of this approach.

Contraceptive Agents, Female↗

PubMed2001

p21 gene codon 31 arginine/serine polymorphism: non-association with endometriosis.

p21, an important regulator of the cell cycle, acts as a mediator of the growth-suppressing and -promoting functions of p53. We aimed to investigate the association between codon 31 polymorphisms of p21 gene and endometriosis. Women were divided into two groups: endometriosis (n = 102) and nonendometriosis (n = 119). The gene polymorphism for p21 codon 31 involved a base change from AGC to AGA and amino acid changes from serine (Ser) to arginine (Arg). Polymorphisms (Ser homozygotes, heterozygotes, Arg homozygotes) between both groups were detected and compared. Associations between the endometriosis and polymorphisms were evaluated. The results revealed that the distributions of different p21 polymorphisms in both groups were nonsignificantly different. The proportions of Ser homozygote/heterozygote/Arg homozygote in endometriosis and nonendometriois populations were 26.5/48.0/25.5% and 17.6/50.4/31.9%, respectively. We concluded the noncorrelation between the endometriosis and the p21 codon 31 polymorphism. p21 gene codon 31 arginine/serine polymorphism is not a useful marker for prediction of endometriosis susceptibility.

Arginine↗

PubMed2007

Angiotensin I-converting enzyme insertion-related genotypes and allele are associated with higher susceptibility of endometriosis and leiomyoma.

Endometriosis and leiomyoma display features similar to malignancy, requiring neovascularization to proliferation and growth. Altered vascular-related genes might be related to the development of endometriosis and leiomyoma. Polymorphisms of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) genes have been linked with some vascular diseases. This study investigates whether ACE I/D gene polymorphisms could be used as markers of susceptibility in endometriosis and leiomyoma. Women were divided into three groups: (1) endometriosis (n = 125); (2) leiomyoma (n = 120); (3) normal controls (n = 128). Genomic DNA was obtained from peripheral leukocyte. ACE I/D gene polymorphisms in intron 16 were amplified by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) Genotypes and allelic frequencies in both groups were compared. We observed the genotype distribution and allele frequency of ACE I/D gene polymorphisms in both groups were significantly different. Proportions of ACE*I homozygote/heterozygote/D homozygote in both groups were: (1) 50.4/24/25.6%; (2) 25/23.33/51.67%; (3) 10.2/29.7/60.1%. Proportions of I/D alleles in each group were: (1) 62.4/37.6%; (2) 36.7/63.3%; (3) 25/75%. We concluded that ACE*I/D gene polymorphisms are associated with endometriosis and leiomyoma susceptibilities. ACE*I-related genotypes and allele are strongly related to the occurrence of endometriosis and moderately related to the occurrence of leiomyoma.

Endometriosis↗

PubMed2007

An investigation of the effects of endometriosis on the proteome of human eutopic endometrium: a heterogeneous tissue with a complex disease.

The pathogenesis of endometriosis includes the proliferation of heterogeneous endometrial cells and their invasion into ectopic sites within the peritoneal cavity. This may be due to abnormalities of the eutopic endometrium itself, predisposing the cells to survive and implant ectopically. We investigated the applicability of 2-DE gels and peptide mass mapping to identify candidate endometrial proteins with a role in endometriosis. Despite the heterogeneous nature of endometrium, our results show that combining the analysis of 2-DE gels and peptide mass mapping yields consistent data. We identified dysregulated proteins in women with endometriosis which included: (i) molecular chaperones including heat shock protein 90 and annexin A2, (ii) proteins involved in cellular redox state, such as peroxiredoxin 2, (iii) proteins involved in protein and DNA formation/breakdown, including ribonucleoside-diphosphate reductase, prohibitin and prolyl 4-hydroxylase, and (iv) secreted proteins, such as apolipoprotein A1. These proteins have functions which suggest that they could play a role in the pathogenesis of endometriosis. This study demonstrated that 2-DE gel analysis and mass spectroscopic protein identification are suitable for the identification of proteins with candidate associations with endometriosis. These techniques should be used on a larger scale to identify endometriosis-related proteins, thus improving the understanding of this complex disease.

Adult↗

PubMed1995

Endometrioid adenocarcinoma of the ovary and its relationship to endometriosis.

In order to better understand the clinical presentation and biologic behavior of ovarian carcinomas arising in endometriosis, we performed a historical cohort study of all women with endometrioid adenocarcinoma of the ovary (ECO) diagnosed between 1979 and 1991 at our institutions. A review of pathology reports determined the presence or absence of coexisting endometriosis. Cancers adjacent to endometriosis on the same ovary or arising within endometriosis were labeled endometriosis-associated endometrioid adenocarcinoma (EAEA), while all others were considered typical endometrioid adenocarcinoma (TEA). Associations between tumor type and clinicopathologic variables were analyzed by chi 2 and Fisher's exact tests as indicated. Disease-free interval (DFI) and overall survival were estimated using the Kaplan-Meier method. The independent prognostic significance of clinicopathologic variables was determined by multivariate analysis using the Cox proportional hazards regression model. Of 91 ECO patients identified, 63 (69%) had TEA and 28 (31%) had EAEA. Significant differences between TEA and EAEA existed for age at diagnosis (greater than 55 years; 56 vs 32%, P = 0.039), nulliparity (19 vs 46%, P = 0.007), stage (I and II combined; 37 vs 70%, P = 0.004), and disease status at completion of primary surgery (complete tumor resection; 47 vs 70%, P = 0.04). Synchronous atypical endometrial hyperplasia or uterine carcinoma was found in 7/63 (11%) TEA versus 7/28 (25%) EAEA cases (P = 0.054). Estimated 5-year DFI by life table analysis was significantly longer in the EAEA than in the TEA cohorts (57 vs 25%, P = 0.02); however, the 5-year survival difference was not significant (59 vs 45%, P = 0.18). Multivariate analysis identified only stage as an independent prognostic factor in predicting both DFI and survival. In conclusion, women with EAEA are significantly younger, present with earlier stage disease, and have a longer disease-free survival than those with TEA. These factors may reflect a more favorable biologic behavior of ECO when arising in association with endometriosis.

Adult↗

PubMed2000

Vaginal adenosarcoma arising from endometriosis.

OBJECTIVE: Malignant transformation of endometriosis has been well documented. Endometrioid adenocarcinoma is the most common malignancy to occur in this setting, although other carcinomas and rarely stromal tumors can be seen. We present the first case in the literature of adenosarcoma, a rare mixed mullerian or mesodermal tumor, arising in extrauterine vaginal endometriosis. CASE: A 42-year-old woman underwent multiple medical therapies and surgeries for aggressive endometriosis. A pelvic exenteration was abandoned secondary to severe fibrosis, and low-dose radiotherapy was used to control bleeding from vaginal endometriosis. The pathologic diagnosis of recurrent endometriosis was confirmed multiple times over her 4-year course. Excision of a recurrent vaginal mass revealed adenosarcoma with heterologous elements. CONCLUSION: It is important to biopsy or excise recurrent endometriosis, as malignant transformation can occur, giving rise to epithelial, stromal, or mixed epithelial-mesenchymal tumors.

Adenosarcoma↗

PubMed2002

Epithelial abnormalities in cystic ovarian endometriosis.

OBJECTIVE: To evaluate the prevalence of epithelial abnormalities in cystic ovarian endometriosis. METHODS: In this observational study, the specimens of 388 consecutive patients undergoing a surgical procedure whose final diagnosis included cystic ovarian endometriosis were histopathologically reviewed. The prevalence and patient characteristics of cases featuring epithelial metaplasia, hyperplasia, atypia, and endometrioid carcinoma arising in endometriosis were analyzed. RESULTS: The epithelial lining was evaluable in 339 cases. Left-sided cysts were significantly more common than right-sided ones (P < 0.0001). The observed prevalence was 12.1% for metaplasia, 9.4% for hyperplasia, 5.9% for atypia, and 4.1% for endometrioid carcinoma arising in endometriosis. Complex hyperplasia, but not simple hyperplasia or metaplasia, was significantly more common in cases with associated endometrioid carcinoma than in all other cases (P < 0.00001). A statistically significant trend for increasing age from normal epithelium to carcinoma was observed (P < 0.001). CONCLUSIONS: Epithelial abnormalities are a common finding in cystic ovarian endometriosis. Despite their clinical significance being still debated, complex hyperplasia and atypia can be associated with malignant transformation of endometriosis. Their observation in a surgical specimen, particularly in older patients, should indicate a careful examination of the entire lining of the cyst and a strict follow-up of the patient.

Adult↗