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PubMed2004

Laboratory testing for endometriosis.

BACKGROUND: Typically, endometriosis is diagnosed surgically by laparoscopy. CA-125 is the principal serum marker used in the diagnosis and management of late-stage endometriosis. The search for a body fluid marker of early stage disease has included studies of serum, peritoneal fluid (PF), and/or tissue levels of secretory proteins, cell adhesion molecules, cytokines, tumor necrosis and vascular endothelial growth factors (VEGFs), chemokines, antiendometrial antibodies, autoantibodies to oxidized lipoproteins, aromatase P-450 expression, cytokeratins, and hormone receptors. We compared the diagnostic accuracy and clinical utility of these various types of substances in the non-surgical identification of patients with endometriosis. METHOD: We reviewed the MEDLINE database for all publications on serum, peritoneal fluid and tissue markers of endometriosis. RESULTS: Except for serum interleukin (IL)-6 and peritoneal fluid tumor necrosis factor (TNF)-alpha levels, the diagnostic accuracy of other markers of endometriosis was either similar or worse than that of CA-125 (sensitivity 24-94%; specificity 83-93%). The diagnostic accuracy of IL-6 and TNF-alpha was 90-100% (sensitivity) and 67-89% (specificity). CONCLUSION: CA-125 has limited diagnostic accuracy in the identification of early stage endometriosis and none of the other markers we reviewed dramatically outperformed CA-125 in this regard with the possible exception of serum IL-6 and peritoneal fluid TNF-alpha levels.

Ascitic Fluid↗

PubMed2006

Endometriosis as a model for inflammation-hormone interactions in ovarian and breast cancers.

Chronic inflammation has been implicated in a variety of cancers. In this review, we consider associations between endometriosis and cancers both local (ovarian) and distant (breast). We review the epidemiological data linking endometriosis to ovarian and breast cancers. We then consider evidence for a role for sex steroid hormones and for inflammation in the aetiology of each of these cancers. Finally, we consider that endometriosis may promote alterations in sex steroid hormones and inflammatory mediators. A possible explanation for the association between endometriosis and these reproductive cancers may then be local and systemic enhancement of aberrant inflammatory and hormonal mediators. If this hypothesis is true, endometriosis may need to be considered as a risk factor for ovarian and breast cancers, triggering increasingly intensive surveillance. Moreover, treatments for endometriosis may require consideration of the impact on long-term cancer risk.

Breast Neoplasms↗

PubMed2004

Genomic alterations in the endometrium may be a proximate cause for endometriosis.

OBJECTIVE: To test the hypothesis that endometriosis may originate from genomic alterations in the endometrium by genomic analysis of endometrial tissues in patients with endometriosis and compare them with those from normal controls. METHODS: Endometrial tissue samples were taken from five women with endometriosis. For controls, we used endometrial tissue samples from four women who underwent elective abortions and one sample from placenta. Using array-based comparative genomic hybridization (CGH), we determined the normal range of variation in CGH signals using normal controls. CGH results were further confirmed by real-time quantitative PCR and loss of heterozygosity analysis. RESULTS: We identified several regions of genomic alterations in all five patients. Some of these regions were the same regions identified previously in endometriotic lesions. For select markers, the genomic alterations were confirmed by real-time PCR and LOH analyses. CONCLUSIONS: There is evidence that the endometrium in women with endometriosis has genomic alterations. This is consistent with numerous reports that the endometrium of women with endometriosis differ from those of women without. Our finding suggests that genomic alterations in the endometrium may be a proximate cause for endometriosis.

Adult↗

PubMed2004

Use of CA125 fluctuation during the menstrual cycle as a tool in the clinical diagnosis of endometriosis; a preliminary report.

OBJECTIVE: To elucidate whether endometriosis can be diagnosed clinically by assessing the differences between serum CA125 levels during menstruation and during the rest of the menstrual cycle. METHODS: The study was performed in 28 patients who underwent laparoscopy to check for pelvic causes of infertility. Patients with endometriosis were selected as the study group, and patients with normal laparoscopic findings functioned as the control group. Blood specimens were taken for CA125 determination during menstruation and during the rest of the menstrual cycle. Mean serum CA125 concentrations were compared by the two-sample t-test for between-group comparisons and the paired t-test for within-group comparisons. The receiver operating characteristic curve was applied to assess the usefulness of CA125 level changes during the menstrual cycle in the clinical diagnosis of endometriosis. RESULTS: The mean CA125 concentrations of healthy women during menstruation and during the rest of the menstrual cycle were 12.2 and 10 U ml(-1), respectively. In this group, the mean CA125 concentration was an average of 22% higher during menstruation than during the rest of the menstrual cycle (P < 0.001). The patients with endometriosis showed a similar pattern to that of normal women, but the levels differed by 198.3% in these patients (P < 0.001). Mean CA125 concentrations of these patients during menstruation and in the rest of the cycle were 35.8 and 12 U ml(-1), respectively. The mean CA125 concentration during menstruation was significantly higher in patients with endometriosis than in normal women (P < 0.001), but CA125 concentrations at other points in the menstrual cycle were found to be similar in both groups (P > 0.05). ROC curve analyses set a cutoff of 83% (percentage increment of CA125 level during menstruation compared with that on days without menstrual bleeding), which gives a sensitivity of 93% and specificity of 92%, with a corresponding likelihood ratio of 11.3. CONCLUSIONS: It may be possible to diagnose endometriosis clinically by assessment of the differences in CA125 level during menstruation as against the remainder of the menstrual cycle.

Adolescent↗

PubMed2005

Lipid peroxidation in the peritoneal fluid of infertile women with peritoneal endometriosis.

OBJECTIVE: To assess the level of lipid peroxidation in the peritoneal fluid of infertile women with peritoneal endometriosis and of fertile disease-free controls. STUDY DESIGN: Level of lipid peroxidation (malondialdeyde, malondialdeyde with copper addition, and cholest-3,5-dien-7-one) was measured in the peritoneal fluid obtained from 21 women with endometriosis-related infertility and from 21 fertile women having tubal ligation. RESULTS: : The level of lipid peroxidation did not differ significantly (P > 0.05) according to the stage of endometriosis. The level of lipid peroxidation (malondialdeyde, malondialdeyde with the addition of copper, and cholest-3,5-dien-7-one) did not differ significantly (P > 0.05) between patients with endometriosis-related infertility (0.07 nmol/ml, 0.34 nmol/ml, 0.24 microg/ml, respectively) and disease-free controls (0.04 nmol/ml, 0.21 nmol/ml, 0.25 microg/ml, respectively). CONCLUSION: The level of lipid peroxidation did not differ between women with endometriosis-related infertility and fertile disease-free controls, suggesting that increased reactive oxygen species may not be one of the factors responsible for compromised fertility in patients with endometriosis.

Adult↗

PubMed2005

Laparoscopic treatment of endometriosis in teenagers.

OBJECTIVES: To determine the frequency and severity of endometriosis in adolescent and teenager girls with chronic pelvic pain (CPP) who fail to respond to medical treatment and to evaluate the outcome of radical laparoscopic surgery for severe endometriosis. DESIGN: Retrospective review of case records of all girls under the age of 21 years who underwent diagnostic and/or operative laparoscopy for CPP unresponsive to medical treatment between January 2001 and December 2003. The operative findings and the response to surgery were retrospectively reviewed. RESULTS: Thirty-one girls were referred. No pelvic abnormalities were detected in 11 patients (35.5%). Endometriosis was detected in 11 (35.5%). Six had severe endometriosis. Other diagnoses included: non-functional non-endometriotic ovarian cyst (4 patients), functional ovarian cyst (1 patient), hydrosalpinx (bilateral, 1 patient; unilateral, 1 patient) and obstructed uterine horn (2 patients). Of those with severe disease all six were treated laparoscopically without complications. Five were rendered pain free and one had an improvement in symptoms. CONCLUSIONS: Endometriosis can occur in adolescent and teenager girls. Laparoscopy should be carried out in all adolescents and teenagers with CPP unresponsive to medical treatment. This the first study reporting the outcome of radical excision treatment for severe endometriosis in this age group and early results are encouraging.

Adolescent↗

PubMed2006

Atherosclerosis in women with endometriosis.

OBJECTIVE: This study aims to determine whether women with endometriosis have greater subclinical atherosclerosis than the general population. STUDY DESIGN: This case-control study included 66 women with endometriosis and 66 controls matched for age and body mass index. All subjects were >or=35 years old. Exclusion criteria were obesity, diabetes, hypertension, hyperlipidemia, renal or metabolic diseases. Before laparoscopy, all patients underwent a measurement of intima-media thickness (IMT) and distensibility coefficient (DC) on the common carotid artery. In addition, blood samples were taken to determine the levels of lipids, fibrinogen, C-reactive protein, homocysteine, fasting glycemia, antithrombin III, plasminogen, protein C, protein S, and activated protein C resistance. RESULTS: All the biochemical parameters evaluated had similar levels in the two study groups. IMT was similar in women with endometriosis and in controls both on left (p=0.330) and right (p=0.648) carotid artery. Similarly, no significant difference was observed in the DC between women with endometriosis and controls both on left (p=0.539) and right (p=0.178) carotid artery. No significant difference was observed in IMT and DC between women with mild and severe endometriosis. CONCLUSION: Women with endometriosis do not have more subclinical atherosclerosis than the general population.

Adult↗

PubMed2005

Associations between serum levels of selected organochlorine compounds and endometriosis in infertile Japanese women.

Endocrine-disrupting chemicals (EDCs) have been proposed as risk factors for endometriosis. Persistent organochlorine compounds, a group of suspected EDCs, are present to some extent in almost all human adipose tissue and blood via the food chain. A few animal studies have confirmed that exposure to these compounds can increase the incidence of endometriosis. In this study, we examined the associations between endometriosis and exposure to selected organochlorine compounds, including 8 polychlorinated dibenzo-p-dioxins (PCDDs), 10 polychlorinated dibenzofurans (PCDFs), 4 coplanar polychlorinated biphenyls (cPCBs), 36 ortho-substituted polychlorinated biphenyls (PCBs), and 13 chlorinated pesticides or their metabolites. The participants were 139 infertile Japanese women who were examined by laparoscopy and diagnosed as either endometriosis cases (Stages II-IV) or controls (Stages 0-I). The serum levels (lipid adjusted) of the targeted organochlorine compounds were in both 58 cases and 81 controls. There were very few differences in the various levels between endometriosis cases and controls. The total serum toxic equivalency (TEQ) value of PCDDs was significantly higher in the controls than in the cases (P=0.02). No other total TEQ values differed between cases and controls. For PCDDs, PCDFs, cPCBs, and PCBs, the multivariate odds ratio was 0.38 [95% confidence interval (CI), 0.12-1.17] and 0.41 (95% CI, 0.14-1.27) for the third and highest quartiles, respectively, compared to the lowest quartile of total TEQ values. A weak, negative dose-response relationship was evident for total TEQs (P for trend of 0.06). The results of this study provide some evidence that serum levels of these organochlorine compounds are not associated with an increased risk of endometriosis in infertile Japanese women.

Adult↗

PubMed2004

A rare case of extrauterine adenosarcoma arising in endometriosis of the rectovaginal septum.

OBJECTIVE: To present a rare case of endometrial stromal sarcoma arising in endometriosis of the rectovaginal septum. DESIGN: Case report. SETTING: Academic tertiary referral center for endometriosis treatment. PATIENT(S): A 50-year-old woman with a history of endometriosis presented with catamenial rectal pain and deep dyspareunia. Imaging findings suggested new endometriotic lesions in the rectovaginal space. INTERVENTION(S): Total hysterectomy, salpingo-oophorectomy, and excision of the lesion in the rectovaginal septum were performed. Although extemporary pathology confirmed endometriosis, the final histologic diagnosis was extrauterine adenosarcoma in the rectovaginal septum. Two years later, recurrence of the malignancy occurred and was treated by resecting the new perirectal mass. Subsequent radiotherapy and chemotherapy were administered. MAIN OUTCOME MEASURE(S): Imaging findings at follow-up evaluation. RESULT(S): The patient was in good health for 2 years after the initial surgery, when she developed a new lesion at the site of the previous resection. The histologic appearance of the lesion was consistent with recurrence of the tumor. After postoperative therapy, the patient is now without evidence of disease. CONCLUSION(S): Malignant transformation of endometriosis should be considered in the differential diagnosis of a new pelvic lesion in a patient with a history of endometriosis.

Adenosarcoma↗

PubMed2004

Evaluation of risk factors associated with endometriosis.

OBJECTIVE: To investigate the association between several factors such as demographics, personal habits, reproductive factors, menstrual characteristics, contraception, and clinical profile and the probability of having endometriosis. SETTING: Ten clinical institutions in the Montreal area. PATIENT(S): A total of 2777 subjects who underwent surgery for diagnostic laparoscopy, tubal ligation, or hysterectomy between January 1998 and July 2002. Eight hundred ninety subjects were classified as cases on the basis of the presence of endometriotic lesions found at the time of surgery, whereas 1881 controls had no surgical evidence of endometriosis. MAIN OUTCOME MEASURE(S): The association between potential risk factors and endometriosis was estimated by Pearson chi(2) and by crude and adjusted odds ratios. RESULT(S): Results indicated a positive association between endometriosis and education level for subjects who underwent hysterectomy. An inverse relation between gravidity and endometriosis was also found within a subgroup of subjects who had diagnostic laparoscopy. Furthermore, the proportion of uterine leiomyoma was significantly higher in cases compared with in controls, among subjects who underwent surgery for diagnostic laparoscopy or hysterectomy but not for tubal ligation. CONCLUSION(S): These observations underline the importance of taking into account the clinical profile of subjects when investigating risk factors for endometriosis.

Educational Status↗

PubMed2005

Quality of sex life in women with endometriosis and deep dyspareunia.

OBJECTIVE: To characterize sexual function among women with endometriosis and deep dyspareunia (DD). DESIGN: Cross-sectional survey. SETTING: University teaching hospital. PATIENT(S): Three-hundred nine women undergoing surgery because of infertility, pelvic pain, or adnexal masses. Three groups of patients with DD were created: women with deep infiltrating endometriosis of the uterosacral ligament (group U), women with endometriosis without uterosacral ligament lesions (group E), and controls (group C). INTERVENTION(S): Laparoscopy. MAIN OUTCOME MEASURE(S): Sexual function questionnaire. RESULT(S): The prevalence of DD since the first intercourse was significantly higher among women with endometriosis than in controls (P=.029). When group U was compared with group E and C, the pain score was higher, the number of intercourses per week was reduced, the orgasm was less satisfying, and the patients felt less relaxed and fulfilled after sex. No significant difference was observed in pain score and coital frequency between subjects with monolateral and bilateral lesions of the uterosacral ligament. CONCLUSION(S): Among subjects with DD, those with deep infiltrating endometriosis of the uterosacral ligament have the most severe impairment of sexual function; the presence of bilateral lesions does not influence the severity of the symptoms. Women with endometriosis have frequently suffered DD during their entire sex lives.

Adult↗

PubMed2005

Allelic loss studies do not provide evidence for the "endometriosis-as-tumor" theory.

OBJECTIVE: To identify consistent genetic changes in endometriosis samples to determine whether endometriosis lesions are true neoplasms. DESIGN: We analyzed ovarian endometriosis lesions for loss of heterozygosity (LOH) at 12 loci of potential importance (D9S1870, D9S265, D9S270, D9S161, D11S29, D1S199, D8S261, APOA2, PTCH, TP53, D10S541, and D10S1765), including some at which genetic changes were previously reported in endometriosis. SETTING: Molecular biology laboratory in a university hospital department. PATIENT(S): Seventeen women with ovarian endometriosis. INTERVENTION(S): Laser capture microdissection to separate the endometriotic epithelium, the adjacent endometriotic stroma, and surrounding normal ovarian stromal tissue, followed by DNA extraction and polymerase chain reaction amplification of polymorphic microsatellite markers. MAIN OUTCOME MEASURE(S): Fluorescence-based quantitation for the LOH analysis. RESULT(S): We identified LOH in only one lesion at one locus (D8S261). CONCLUSION(S): Our data do not support the hypothesis that ovarian endometriosis is a true neoplasm.

Adult↗

PubMed2005

Haptoglobin beta chain isoforms in the plasma and peritoneal fluid of women with endometriosis.

OBJECTIVE: To estimate the expression of haptoglobin (Hp) beta chain isoforms in the peritoneal fluid (PF) and plasma (PL) of women with and without endometriosis. DESIGN: Cross-sectional study. SETTING: University hospital. PATIENT(S): Seventy-two patients with endometriosis and 35 controls. INTERVENTION(S): Peritoneal fluid and PL samples were subjected to two-dimensional gel electrophoresis, silver stained, digitally captured, and compared by semiquantitative computerized analysis. MAIN OUTCOME MEASURE(S): Expression of Hp beta chain isoforms. RESULT(S): No significant difference was observed in the frequency of expression of the Hp beta chain isoforms between the two groups. One beta chain isoform (HpbetaE; molecular weight, 38.40 +/- 0.94 kD; and isoelectric point, 5.63 +/- 0.17) had significantly higher expression in both the PF and PL of women with endometriosis than in the PF and PL of controls. No significant difference was observed in HpbetaE expression between women with mild (revised American Fertility Society [rAFS], stage I-II) and severe (rAFS, stage III-IV) endometriosis. In the control group, HpbetaE expression was correlated with the phase of the menstrual cycle. CONCLUSION(S): Women with endometriosis have higher PF and PL levels of HpbetaE. Further investigation should be aimed at producing antibodies against the HpbetaE-specific epitopes to determine whether its measurement may improve the clinical diagnosis of endometriosis.

Adult↗

PubMed2005

Relation between anatomical courses of the intramural portions of the uterine tubes and pelvic endometriosis.

OBJECTIVE: Endometriosis may originate from implants of endometrium due to retrograde flow of menstrual blood. The flow may be stimulated by anatomical anomalies of uterine tubes or uterus. The aim of the study was to find links between anatomical courses of the intramural portions of the uterine tubes and endometriosis. DESIGN: Retrospective comparative study. SETTING: Academic hospital. PATIENT(S): Women (n = 227) operated on because of various gynecological indications. INTERVENTION(S): Total or subtotal abdominal hysterectomies. MAIN OUTCOME MEASURE(S): Pathological reports correlated with courses of the intramural parts of uterine tubes. To evaluate the intramural courses of uterine tubes, specimens were injected with barium sulfate and x-rayed. RESULT(S): The intramural portions were categorized into three patterns: straight, curved, or tortuous. Logistic regression identified the course of the intramural portion of the uterine tubes and the parity to be associated with endometriosis. Endometriosis was more frequent in women with straight courses and was infrequent in women with tortuous ones. CONCLUSION(S): We suggest that a tortuous course of the intramural portion of the uterine tubes constitutes a normal anatomical finding. It controls the retrograde flow of blood during menstruation and limits the possibility of developing endometriosis. Straight or curved intramural portions represent an anatomical abnormality that may predispose women to endometriosis.

Adult↗

PubMed2006

The endometria of patients with endometriosis show higher expression of class I human leukocyte antigen than the endometria of healthy women.

OBJECTIVE: To compare the expression of class I human leukocyte antigen (HLA I) in endometrial samples from patients with and without endometriosis. DESIGN: Cross-sectional study. SETTING: Acute-care teaching hospital in Barcelona, Spain. PATIENT(S): The endometriosis group included 32 patients for whom the only diagnosis during an operation was endometriosis. The control group included 20 women who underwent a laparoscopy and in whom no evidence of endometriosis or any other genital disease was seen. INTERVENTION(S): Samples of endometrium were obtained by curettage and immediately frozen. A pan-HLA I mouse antihuman IgG2a monoclonal antibody was used for immunohistochemical study. MAIN OUTCOME MEASURE(S): Frequency of positive glandular and stromal cells was evaluated in each section. RESULT(S): A significantly higher expression of HLA I in the endometriosis group than in controls, both in the glandular cells (median 100% vs. 80%) and in the stromal cells (median 60% vs. 20%), was observed. CONCLUSION(S): Patients with endometriosis had a significantly higher expression of HLA I molecules in endometrial cells than did the controls. This could be a possible explanation for their higher resistance to natural killer cytolysis.

Adult↗

PubMed2006

Natural hair color and the incidence of endometriosis.

OBJECTIVE: To investigate a previously hypothesized relation between natural hair color and endometriosis. DESIGN: Prospective cohort study. SETTING: Nurses' Health Study II with 10 years of follow-up. PARTICIPANT(S): A total of 90,065 women, 25-42 years old, who had never been diagnosed with endometriosis, infertility, or cancer at baseline in 1989. MAIN OUTCOME MEASURE(S): Incidence of laparoscopically confirmed endometriosis according to natural hair color. RESULT(S): During 379,422 person-years of follow-up, 1,130 cases of laparoscopically confirmed endometriosis were reported among women with no past infertility. After adjusting for age, calendar time, parity, race, and body mass index at age 18, we observed no association overall. However, compared with women with any other hair color, we observed an increased rate of endometriosis among women with naturally red hair who had never been infertile (incidence rate = 1.3, 95% confidence interval [CI] = 1.0-1.7), but a decreased rate among women with naturally red hair among women who were infertile (incidence rate = 0.4, 95% CI = 0.2-1.2); P value, test for heterogeneity = .03. CONCLUSION(S): Overall, we did not observe a significant relation between red hair color and the rate of endometriosis, however this prospective cohort study suggests that the relation may differ by infertility status.

Adult↗

PubMed2006

Deeply infiltrating endometriosis affecting the rectum and lymph nodes.

OBJECTIVE: To analyze morphologic aspects of bowel endometriosis. DESIGN: Prospective study of 35 consecutive cases of bowel endometriosis. SETTING: Multidisciplinary group practice and teaching hospital. PATIENT(S): Thirty-five patients with bowel endometriosis were assessed between September 2003 and June 2005. INTERVENTION(S): Histologic analysis of 35 tissue samples removed at laparoscopic rectosigmoidectomy. MAIN OUTCOME MEASURE(S): We performed an evaluation of lesion size, number of lesions present in the bowel, intestinal wall layers affected by the endometriotic lesion, circumference of the intestinal loop affected by the endometriotic lesion, and presence of lymph nodes with foci of endometriosis. RESULT(S): Analysis of the surgical samples revealed lymph nodes in the pericolic adipose tissue of 19 (54%), cases and in 5 of these cases (26.3%), endometriosis had affected the lymph nodes. When the thickness of the endometriotic lesion reached 1.75 cm, lymph nodes of all patients were affected, and all patients in whom more than 80% of the circumference of the intestinal loop was affected by endometriosis presented with positive lymph nodes. CONCLUSION(S): This study raises doubts about whether this form of the disease can still be considered a clinically benign disease.

Adult↗

PubMed2006

Clinical evaluation of endometriosis and differential response to surgical therapy with and without application of Oxiplex/AP* adhesion barrier gel.

OBJECTIVE: To correlate parameters of endometriosis obtained during routine clinical evaluation with the subsequent formation of adhesions following surgical treatment by laparoscopy. DESIGN: Randomized, controlled, double-blind, clinical trial. SETTING: Tertiary referral centers for the treatment of endometriosis. PATIENT(S): Thirty-seven patients (65 with adnexa) with stage I-III endometriosis; endometrioma-only patients were excluded. INTERVENTION: Laparoscopic surgical treatment of endometriosis, followed by randomization to Oxiplex/AP (FzioMed, Inc., San Luis Obispo, California) gel treatment (treated group) of adnexa, or surgery alone (control group); follow-up laparoscopy 6-10 weeks later. MAIN OUTCOME MEASURE(S): Adnexal Americn Fertility Society score, correlated with color and location of endometriosis, as well as stage of disease determined by masked review of videotapes. RESULT(S): Control patients with at least 50% red lesions had a greater increase in ipsilateral adnexal adhesion scores than patients with mostly black or white and/or clear lesions. Treated patients with red lesions had a greater decrease in adnexal adhesion scores than control patients. There was a correlation between baseline endometriosis stage and postoperative adhesion formation in control patients, but not treated patients. CONCLUSION(S): Patients with red endometriotic lesions had greater increases in their adhesion scores than patients with only black, white, and/or clear lesions. Oxiplex/AP gel was effective in reducing adhesions, compared to surgery alone, in all groups.

Cellulose↗