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PubMed2000

Perineal endometriosis with anal sphincter involvement: report of a case.

INTRODUCTION: Perineal endometriosis with anal sphincter involvement is an infrequent occurrence. Wide excision is the best chance of cure of perineal endometriosis but may cause incontinence when the anal sphincter is involved. Conversely, narrow excision may result in incomplete removal, with increased recurrence rates and need of additional therapy. Wide excision with primary sphincteroplasty and narrow excision surgical techniques are reviewed. METHODS: One case report of perineal endometriosis with anal sphincter involvement and previously reported cases were reviewed. Patients were compared based on type of resection (wide or narrow excision) and outcome. RESULTS: Since 1957 there have been seven reported cases of perineal endometriosis with anal sphincter involvement, with the present authors adding one additional case for a total of eight. The mean age was 33 (range, 22-47) years. Surgical treatment included wide excision with primary sphincteroplasty (2 cases), narrow excision (4 cases), and incomplete excision (1 case). One case spontaneously regressed after a subsequent pregnancy. There were two recurrences in the narrow excision group and no recurrences in the wide excision group. There were no complications reported for any of the procedures. CONCLUSIONS: Although follow-up time was variable and the numbers small, wide excision with primary sphincteroplasty for patients with perineal endometriosis with anal sphincter involvement seems to be the best chance of cure with good functional results. It should be considered particularly in younger patients to obviate the need of long-term subsequent hormonal therapy or re-excision for symptomatic recurrences. In contrast, patients closer to menopause (when endometriosis tends to regress) may be treated optimally by narrow excision to avoid the risks of significant anal sphincter resection.

Adult↗

PubMed1994

Soluble serum interleukin-2 receptor, interleukin-6 and interleukin-1a in patients with endometriosis and in controls.

The aim of this study was to verify to what extent danazol alters cell-mediated immunity. To this end, cell-mediated immunity was studied in 10 infertile patients with endometriosis and in 10 normal controls. Nonspecific parameters studied included serum SIL-2R, IL-6 and IL-1a levels. We also investigated the effect of treatment with Danazol on the levels of SIL-2R, IL-6 and IL-1a in women with endometriosis. Blood SIL-2R, IL-6 and IL-1a levels were measured in endometriotic women before treatment, during the last fifteen days of a 6-months course of Danazol and three months after treatment. Only one blood sample was taken from 10 women without endometriosis. SIL-2R, IL-6 and IL-1a levels were higher in women with endometriosis before treatment compared with controls. Administration of the drug significantly reduced the levels of SIL-2R (P < 0.001), IL-6 (P < 0.05) and IL-1a (P < 0.01). Our findings suggest that endometriosis is a condition which induces a rise in interleukin levels. Danazol also appears significantly to reduce endometriosis-associated autoimmune abnormalities.

Adult↗

PubMedDate not supplied

Staging of pelvic endometriosis based on MRI findings versus laparoscopic classification according to the American Fertility Society.

BACKGROUND: Preoperative staging of pelvic endometriosis helps the gynecologist plan therapy and offers a prognosis to patients. We compared a staging system of pelvic endometriosis based on magnetic resonance imaging (MRI) findings with the American Fertility Society (AFS) laparoscopic classification. METHODS: Forty-four consecutive females with clinically suspected endometriosis underwent MRI examination to demonstrate the presence of endometriomas and pelvic implants. Laparoscopy was performed within 2 weeks. An MRI score was developed to classify endometriosis into four classes comparable to those of AFS laparoscopic staging. Concordance between MRI and laparoscopic classification was evaluated with kappa statistics. RESULTS: Laparoscopy confirmed 60 of 61 endometriomas detected by MRI. Implants were discovered in 20 of 44 patients with MRI and in 23 of 44 with laparoscopy. MRI detected 50 endometrial implants of 65 detected by laparoscopy (76.9%). With regard to endometriosis staging, we obtained a concordance between MRI and AFS classification in 42 of 44 patients (kappa = 0.913). CONCLUSION: Although MRI has limitations such as suboptimal depiction of small implants and adhesions, this technique is very useful to guide laparoscopy. Moreover, the optimal concordance (95%) between our proposed MRI staging and the AFS laparoscopic classification demonstrated a new advantage of MRI in preoperative staging of endometriosis.

Adult↗

PubMed2006

Cine MR imaging of uterine peristalsis in patients with endometriosis.

Endometriosis is one of the most important causes of infertility; however the precise mechanism by which it affects female fertility is unclear. The objective of this study was to study the functional aspects of the uterus by evaluating uterine contractility in patients with endometrial cysts of the ovary. The study population was recruited from two institutes and consisted of 26 women (periovulatory (10), luteal (13), and menstrual phase (3); age range: 19-51 years) with untreated endometriosis; the control group consisted of 12 healthy women (age range: 22-41 years). Cine MR imaging obtained by a 1.5T magnet was visually evaluated at 12x faster than real speed, focusing on the presence of uterine peristalsis, the direction and frequency of peristalsis, and the presence of sustained uterine contractions. Uterine peristalsis was identifiable in 3/10, 3/13, and 3/3 of the endometriosis patients in each menstrual cycle, respectively, and in 11/12, 3/12, and 5/12 of their control subjects. Peristaltic detection rate and frequency were significantly less for the endometriosis group than for the controls in the periovulatory phase only (p<0.05). Sustained contractions were recognized in 19/36 control subjects and in 13/26 endometriosis patients, but the difference was not significant. Uterine peristalsis appears to be suppressed during the periovulatory phase in patients with endometriosis, which may have an adverse effect on sperm transport.

Adult↗

PubMed2006

Ureteral mullerian carcinosarcoma (mixed mullerian tumor) associated with endometriosis occurring in a patient with a concentrated soy isoflavones supplementation.

Malignant transformation and particularly malignant mixed mullerian tumor arising in extragenital endometriosis is extremely rare and occurs in the majority of cases after estrogen replacement therapy. We present a case of a 75-year-old woman who developed a ureteral malignant mullerian carcinosarcoma in a context of florid endometriosis. The patient had a history of total hysterectomy with bilateral salpingo-oophorectomy 30 years earlier for extensive endometriosis. Since 5 years, the patient has been on phytoestrogen supplementation consisting of 72 mg/day of superconcentrated soy isoflavones. This is the first case of ureteral mullerian carcinosarcoma arising in endometriosis foci after extensive phytoestrogen supplementation. Our data suggest that phytoestrogens at least in concentrated form may play a role not only in maintenance of endometriosis but also in its malignant transformation. Given the extraordinary popularity and availability of these dietary supplements, several studies are indispensable regarding their safety particularly in women with extensive endometriosis.

Aged↗

PubMed1997

The effect of pregnancy on endometriosis in baboons (Papio anubis, Papio cynocephalus).

BACKGROUND: This study was performed to test the hypothesis that endometriosis undergoes regression during pregnancy. METHODS: This study was performed on 11 baboons with histologically proven endometriosis, housed at the Institute of Primate Research, Nairobi, Kenya. In each individual baboon paired laparoscopies were performed prior to and during pregnancy (6 during first and 5 during second trimester of gestation) with an interval of 5 +/- 3 months. During each laparoscopy the number, size and type of endometriosis implants were noted in detail on a pelvic map; the endometriosis score and stage were calculated according to the revised American Fertility Society (AFS) classification. In each baboon the observations prior to and during pregnancy were compared and analysed by Wilcoxon signed rank test (two-tailed). RESULTS: No significant change was observed in the AFS score or stage of endometriosis, or in the number, size and type of endometriotic lesions in baboons during gestation when compared to the nonpregnant state. CONCLUSION: In baboons pregnancy had no significant effect on endometriosis during the first or second trimester of gestation.

Animals↗

PubMed1997

Detection of chromosomal aneuploidy in endometriosis by multi-color fluorescence in situ hybridization (FISH).

Endometriosis affects 10-15% of women of reproductive age and is a common cause of infertility and pelvic pain. Although endometriosis is characterized by abnormal growth or turn-over of cells, the genetic changes involved remain unclear. We employed a multi-color fluorescence in situ hybridization (FISH) strategy to determine the incidence of somatic chromosomal numeric alterations in severe/late stage endometriosis. Using alpha-satellite sequence-specific DNA probes for chromosomes 7, 8, 11, 12, 16, 17, and 18, simultaneous two- and three-color FISH were performed to evaluate the frequency of monosomic, disomic, and trisomic cells in normal control and endometriotic tissue specimens. In one of four endometriosis samples studied, a significantly higher frequency of monosomy for chromosome 17 (14.8%, chi 2(4) = 53.3, P < 0.0001) and 16 (8.8%, chi 2(4) = 11.4, P < 0.05) was observed. An increased number of cells with chromosome 11 trisomy (14.8%, chi 2(4) = 96.2, P < 0.0001) were detected in a second case. In a third case, a distinct colony of nuclei with chromosome 16 monosomy (14.1%, chi 2(4) = 21.39, P < 0.005) was detected. Acquired chromosome-specific aneuploidy may be involved in endometriosis, reflecting clonal expansion of chromosomally abnormal cells. That candidate tumor suppressor genes and oncogenes have been mapped to chromosomes 11, 16, and 17 suggests that chromosomal loss or gain plays a role in the development and/or progression of endometriosis.

Aneuploidy↗

PubMed1986

Endometriosis in association with uterine anomaly.

Endometriosis is frequently a chronic process, which may begin soon after menarche. The process may be enhanced by mechanical obstruction. Theories of retrograde menstruation and metaplasia still remain in vogue. Endometriosis is a cause of both acute and chronic pelvic pain in the adolescent. We present case reports of müllerian lateral wall fusion defects with surgical correction and evidence for resorption of endometriosis. Clinicians must be aware that patients with uterine anomalies may develop extensive endometriosis, which upon creation of an unobstructed outflow tract results in complete resorption. Furthermore, the mechanism of formation of endometriosis in association with an outflow tract obstruction may be very different from that associated with infertility. We recommend consideration of endometriosis and/or a reproductive tract abnormality in the adolescent with persistent pelvic pain.

Adolescent↗

PubMed1989

Elevated serum levels of endometrial secretory protein PP14 in patients with advanced endometriosis. Suppression by treatment with danazol and high-dose medroxyprogesterone acetate.

The circulating concentration of endometrial protein PP14 varied during the menstrual cycle in patients with endometriosis. The highest levels were found on days 1 to 4 of the cycle (176 +/- 123 micrograms/L; mean +/- SD), and the lowest on days 5 to 20 (44.1 +/- 29.7 micrograms/L). Rising levels were observed on days 21 to 30 (58.3 +/- 62.6 micrograms/L). On days 5 to 20 (i.e., during period of the lowest levels) patients with advanced endometriosis had higher PP14 levels (63.9 +/- 39.0 micrograms/L) than those with mild endometriosis (29.3 +/- 18.2 micrograms/L; p less than 0.01). Patients with mild endometriosis had slightly higher serum PP14 levels than apparently healthy control subjects (p less than 0.05), but overlapping of values between the two groups is remarkable. Conservative surgical elimination of endometriosis significantly decreased the serum PP14 levels. Treatment with danazol (600 mg/day), or with medroxyprogesterone acetate (100 mg/day) after laparoscopy also resulted in significant decreases in the serum PP14 concentration. After 6 months of treatment, conservative surgery in combination with danazol or with medroxyprogesterone acetate, yielded more pronounced declines in serum PP14 level than conservative surgery plus placebo. No significant difference was observed between the effects of danazol and medroxyprogesterone acetate. We conclude that endometriosis tissue contributes to the circulating PP14 level, and the decline in PP14 level during danazol and medroxyprogesterone acetate treatments reflects regression of intrauterine and ectopic endometrial tissues.

Adult↗

PubMed1991

Spontaneous and steroid-induced recurrence of endometriosis after suppression by a gonadotropin-releasing hormone antagonist in the rat.

Recurrent endometriosis in women is difficult to study because of the ethical consideration of performing repeated surgeries. Previously in the rat model we described therapeutic regression of endometriosis with the gonadotropin-releasing hormone antagonist antide. Presently we report the spontaneous and steroid-induced recurrence of endometriosis after withdrawal from antide therapy. Rats with endometriosis received antide or vehicle on days 0 (proestrus), 3, 6, and 9 and were killed on days 0, 6, 12, 18, 24, 30, and 42 (n = 4 antide-treated and 4 vehicle-treated rats killed per day). Additional antide-treated rats (n = 4 per treatment) received estrogen, progesterone, both estrogen and progesterone, cholesterol, and no steroid on day 9 and were killed on day 12. Antide significantly suppressed endometriotic implant size on days 12, 18, and 24. However, implant size spontaneously returned to pretreatment values by day 30. Administration of steroids on day 9 elicited regrowth of antide-suppressed endometriosis (estrogen plus progesterone greater than estrogen, progesterone, or cholesterol greater than no steroid) by day 12. This resilience of endometriosis offers an explanation for treatment failure and recurrence of the disease in women.

Animals↗

PubMed1993

Peritoneal fluid concentrations of the cytokine RANTES correlate with the severity of endometriosis.

OBJECTIVE: Endometriosis is a common gynecologic disorder in which the concentration and activation of peritoneal macrophages are increased. The goal of this study was to quantify pelvic fluid concentrations of two cytokines involved in macrophage recruitment and activation. STUDY DESIGN: A case-control study of women undergoing pelvic surgery was conducted by collecting peritoneal fluid from 12 women without evidence of endometriosis (controls), 12 with mild, and 12 with moderate to severe endometriosis. Concentrations of RANTES and interferon gamma, soluble cytokines known to recruit and activate macrophages, were quantified by enzyme-linked immunosorbent assays. RESULTS: Pelvic fluid concentrations of RANTES are elevated in women with endometriosis and the levels correlate with the severity of disease. By contrast, concentrations of interferon gamma appear unaffected by the presence of or severity of endometriosis. CONCLUSION: The findings indicate that RANTES, a cytokine with potent chemotactic activity for human monocytes, may play an important role in the recruitment of peritoneal macrophages in endometriosis.

Adult↗

PubMed1993

Increased chemotactic activity of peritoneal fluid in patients with endometriosis.

OBJECTIVE: Our purpose was to investigate the ability of the peritoneal fluid of patients with endometriosis to induce chemotaxis of neutrophils and macrophages. STUDY DESIGN: Peritoneal fluid samples of patients with endometriosis (n = 20), normal fertile controls (n = 12), or patients with medical suppression (n = 8) were evaluated for chemotactic activity. Results of chemotactic activity were analyzed by analysis of variance. RESULTS: Peritoneal fluid of patients with endometriosis demonstrated a significantly higher chemotactic activity than that of patients without endometriosis or with medical suppression. Patients who had received medical treatment had the lowest chemotactic activity. (p < 0.001 for endometriosis vs control or treatment patients, p = 0.005 for control group vs treatment group). CONCLUSIONS: Patients with endometriosis have a higher chemotactic activity in their peritoneal fluid; prior medical treatment significantly reduces this activity. This chemotactic factor has an estimated weight of 20 kd. The nature and source of this chemotactic factor remains to be determined.

Adult↗

PubMed1993

The presence of luteinized unruptured follicle syndrome and altered folliculogenesis in rats with surgically induced endometriosis.

OBJECTIVE: Our purpose was to determine in the rat model whether endometriosis could influence ovarian function by altering oocyte release or folliculogenesis. STUDY DESIGN: We histologically examined the ovaries of reproductively cycling rats with (n = 16) and without (n = 10) surgically induced endometriosis. The rats in these two groups were further subdivided into unilaterally ovariectomized or ovarian-intact groups. Serial sections of ovaries were examined, and follicular development and frequency of luteinized unruptured follicles were determined. RESULTS: A significant tenfold increase in the number of luteinized unruptured follicles was observed in the ovaries from rats with endometriosis (2.7 per rat) compared with unoperated and sham-operated control groups (overall mean 0.26 per rat, p < 0.05). Additionally, ovaries from unilateral ovariectomized animals with endometriosis contained four times as many luteinized unruptured follicles (four per rat) as did the ovaries from bilaterally ovarian-intact rats with endometriosis (1.40 per rat, p < 0.01). Fewer follicles were present in rats with endometriosis (180 follicles per ovary) than in control rats (231 follicles per ovary, p < 0.05). CONCLUSION: In the rat model the presence of ectopic endometrium is associated with an increased frequency of luteinized unruptured follicles and altered follicular development.

Animals↗

PubMed1994

Immunohistochemical localization of granulocyte-macrophage colony-stimulating factor in matched endometriosis and endometrial tissues.

OBJECTIVE: Murine endometrial granulocyte-macrophage colony-stimulating factor has been related to macrophage recruitment and activation and postulated to mediate reproductive events. This study was designed to determine whether granulocyte-macrophage colony-stimulating factor is present in normal human endometrium or endometriosis. STUDY DESIGN: Granulocyte-macrophage colony-stimulating factor was immunohistochemically evaluated in matched endometrial and endometriosis biopsy specimens (n = 19) and endometrial biopsy specimens from disease-free patients (n = 8). Staining differences were determined with McNemar's, Fisher's, and Wilcoxon's tests. RESULTS: Granulocyte-macrophage colony-stimulating factor was primarily localized in endometrial and endometriotic epithelial cells. Expression (p = 0.71) and staining intensity (p = 0.37) was similar in matched proliferative-phase endometrium and endometriosis. Matched secretory-phase endometrium and endometriosis also expressed granulocyte-macrophage colony-stimulating factor in similar proportions (p = 0.12), but staining intensity was enhanced in secretory endometriosis compared with secretory endometrium (p = 0.05). Endometrial granulocyte-macrophage colony-stimulating factor did not vary throughout the menstrual cycle, but endometriotic expression (p = 0.013) and staining intensity (p = 0.008) were significantly greater in the secretory phase. CONCLUSIONS: Granulocyte-macrophage colony-stimulating factor is localized in endometrial and endometriotic epithelial cells with increased expression in secretory-phase endometriosis. Granulocyte-macrophage colony-stimulating factor may elicit migration, proliferation, and activation of endometrial and peritoneal macrophages.

Endometriosis↗

PubMed1988

CA 125 in peritoneal fluid and serum of patients with endometriosis.

Serum and peritoneal fluid collected from 48 patients at laparoscopy was assayed for CA 125. Geometric mean serum CA 125 was similar in 21 patients with predominantly early stage endometriosis (13.4 U/ml; confidence intervals (C.I.) 10.8-16.7) and 27 patients without endometriosis (12.9 U/ml; C.I. 9.7-17.2). Mean peritoneal fluid CA 125 was higher in the endometriosis patients (mean 44.4 U/ml; C.I. 34.5-57.2) than controls (35.7 U/ml; C.I. 30.0-42.2), but the difference was not significant. Peritoneal fluid volume was increased in endometriosis patients (p = 0.013), and only after correction for peritoneal fluid volume did total antigenic concentration in aspirated peritoneal fluid show significant elevation (p = 0.0015) in endometriosis patients (mean 340 U/ml; C.I. 212-547) compared with controls (125 U/ml; C.I. 85-184). These results suggest that although CA 125 may be expressed in peritoneal fluid in endometriosis, it is unlikely to be of use as a marker of disease activity in peritoneal fluid obtained by culdocentesis.

Antigens, Tumor-Associated, Carbohydrate↗

PubMed1994

Mucosal changes in the large bowel with endometriosis: a possible cause of misdiagnosis of colitis?

Endometriotic deposits are not uncommon in the large bowel of women. Because the symptoms produced by endometriosis may lead to investigation by colorectal endoscopic biopsy, the aims of this study were to assess the range of mucosal abnormalities that may occur and to determine whether this could represent a significant potential diagnostic problem. We found mucosal changes in eight of 10 cases of colorectal endometriosis; however, the abnormalities (ulceration, gland architectural disturbance, crypt abscess formation, increased inflammatory cell presence, and smooth muscle fibers between glands in the mucosa) were focal and directly related to endometrial deposits. In one case an abnormal colonic biopsy specimen from a patient with endometriosis supported the erroneous clinical diagnosis of Crohn's disease. Comparing a group of women with endometriosis to a group with adenomyosis of the uterus showed that although more women with endometriosis have endoscopic large bowel biopsies, there was no significant excess of biopsy specimens showing inflammatory changes. Our conclusion is that the endometriosis of the large bowel can masquerade as inflammatory bowel disease or ischemic changes and the possibility should be borne in mind, particularly in cases with atypical clinical features or very focal histological changes.

Adult↗

PubMed1996

PGE2 and PGF2 alpha release by human peritoneal macrophages in endometriosis.

OBJECTIVE: To test for differences in the amount and activity of peritoneal macrophages present in the peritoneal fluid of women with, and without endometriosis using prostaglandin release by macrophages in culture as a marker. PATIENTS: Women of reproductive age undergoing laparoscopy for infertility or chronic pelvic pain with postoperative diagnosis of endometriosis and women undergoing laparoscopy for sterilization. METHODS: Peritoneal fluid was aspirated during laparascopy, volume was recorded, macrophages were isolated via a Ficoll Paque gradient and kept in primary culture. PGE2 and PGF2 alpha release of the cells were measured before and after stimulation with zymosan. RESULTS: Women with endometriosis had significantly more peritoneal macrophages than controls. Peritoneal macrophages of women with endometriosis released significantly more PGE2 than those of the control group: 8.4 +/- 2.0 versus 1.4 +/- 0.4 ng/ml/10(6) cells (mean +/- SEM, p = 0.0005) and PGF2 alpha: 10 +/- 4.3 (endometriosis) versus 1.8 +/- 0.4 (control) ng/ml/10(6) cells (mean +/- SEM, p = 0.045). CONCLUSION: There is a significant increase in the amount of prostaglandins released by peritoneal macrophages from women with endometriosis. These prostaglandins might alter uterine and tubal contractility, thereby affecting fertility.

6-Ketoprostaglandin F1 alpha↗

PubMedDate not supplied

Induction of endometriosis in mice: a new model sensitive to estrogen.

Endometriosis consists of the growth of endometrial tissue outside the uterus. A rat model of endometriosis is available to evaluate the potential for environmental chemicals to promote the disease but may be relatively insensitive for the evaluation of the hazard of certain compounds. Our objective, which was to develop a mouse model for endometriosis, was based on (a) the promotion of endometriosis in primates by 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD), (b) the apparent relationship between endometriosis and immunodeficiency, and (c) evidence that humoral immunity is suppressed in mice but not rats following TCDD exposure. In the mouse model, slices of uterus were sutured to intestinal mesenteric vessels. By 3 weeks after surgery, these sites were cyst-like structures. The growth of the sites was hormone dependent. In intact mice, sites measured 3.60 +/- 0.22 mm; vehicle and estrone (0.5 microgram/day) treatments produced site diameters of 0.95 +/- 0.128 and 5.28 +/- 0.355 mm, respectively. This new mouse model provides a sensitive and useful technique for future studies of the potential for specific xenobiotics to promote the development of endometriosis.

Animals↗