Concurrent Endometriosis Research Articles

Impact of Concurrent Endometriosis on Sonographic Characteristics of Adenomyosis

Impact of Concurrent Endometriosis on Sonographic Characteristics of Adenomyosis

Prevalence and Clinical Correlates of Endometriosis in Patients With IC/BPS.

Interstitial cystitis/bladder pain syndrome (IC/BPS) presents as a complex heterogeneous disorder that poses a significant clinical challenge both for diagnosis and treatment. The identification of patient subgroups with significant overlap in their nonurological associated symptoms, including endometriosis, may enable a more targeted therapeutic approach. This study investigated the prevalence, clinical correlates, and clinical sequelae associated with concurrent endometriosis in patients with IC/BPS. Demographic, clinical, surgical, and questionnaire data from female patients (n = 533) with a diagnosis of IC/BPS were evaluated in this retrospective cohort study. Surgical history was obtained from patient electronic medical records, using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Data from participants with and without concurrent endometriosis were compared using univariate analysis, followed by binary logistic regression to identify associated variables. Of 533 participants, 108 (20.3%) reported a history of endometriosis. Those with concurrent endometriosis were younger, had a larger bladder capacity, and had a higher number of nonurological associated symptoms. Patients with concurrent endometriosis were less likely to have a history of cystectomy (the surgical removal of the bladder) and report allergies but more prone to report comorbidities such as chronic pelvic pain, chronic fatigue, fibromyalgia, migraines, and pelvic floor dysfunction. Binary logistic regression identified a positive association between endometriosis and chronic pelvic pain, and a negative association between allergies and low bladder capacity for those with concurrent endometriosis. Endometriosis is common in younger female patients with IC/BPS and is associated with a non-bladder-centric (ie, systemic pain disorder) phenotype.

Obstetric outcomes in women with pelvic endometriosis: a prospective cohort study

ObjectiveTo determine whether obstetric outcomes differ between women with endometriosis and those without, where all women undergo first trimester screening for endometriosis DesignA prospective observational cohort study SettingThe Early Pregnancy Unit at University College London Hospital, United Kingdom SubjectsWomen with a live pregnancy progressing beyond 12 weeks’ gestation and concurrent endometriosis (n=110) or no endometriosis (n=393). ExposureAll women underwent a pelvic ultrasound examination in early pregnancy to examine for the presence of endometriosis and uterine abnormalities. Main outcome measuresThe primary outcome of interest was preterm birth, defined as delivery before 37 completed weeks’ gestation. Secondary outcomes included late miscarriage, antepartum haemorrhage, placental site disorders, gestational diabetes, hypertensive disorders of pregnancy, neonate small for gestational age, mode of delivery, intrapartum sepsis, postpartum haemorrhage and admission to the neonatal unit. ResultsWomen with a diagnosis of endometriosis did not have statistically significantly higher odds of preterm delivery (aOR 1.85 (95% CI 0.50-6.90)), but they did have higher odds of postpartum haemorrhage during Caesarean section (aOR 3.64 (95% CI 2.07-6.35);) and admission of their newborn baby to the neonatal unit (aOR 3.24 (95% CI 1.08-9.73);). Women with persistent or recurrent deep endometriosis after surgery, also had higher odds of placental site disorders (aOR 8.65 (95% CI 1.17-63.71);) and intrapartum sepsis (aOR 3.47 (95% CI 1.02-11.75);). ConclusionWe observed that women with endometriosis do not have higher odds of preterm delivery, irrespective of their disease subtype. However, they do have higher odds of postpartum haemorrhage during Caearean section and newborn admission to the neonatal unit.

Transcriptomic analyses of ovarian clear-cell carcinoma with concurrent endometriosis.

Endometriosis, a benign inflammatory disease whereby endometrial-like tissue grows outside the uterus, is a risk factor for endometriosis-associated ovarian cancers. In particular, ovarian endometriomas, cystic lesions of deeply invasive endometriosis, are considered the precursor lesion for ovarian clear-cell carcinoma (OCCC). To explore this transcriptomic landscape, OCCC from women with pathology-proven concurrent endometriosis (n = 4) were compared to benign endometriomas (n = 4) by bulk RNA and small-RNA sequencing. Analysis of protein-coding genes identified 2449 upregulated and 3131 downregulated protein-coding genes (DESeq2, P< 0.05, log2 fold-change > |1|) in OCCC with concurrent endometriosis compared to endometriomas. Gene set enrichment analysis showed upregulation of pathways involved in cell cycle regulation and DNA replication and downregulation of pathways involved in cytokine receptor signaling and matrisome. Comparison of pathway activation scores between the clinical samples and publicly-available datasets for OCCC cell lines revealed significant molecular similarities between OCCC with concurrent endometriosis and OVTOKO, OVISE, RMG1, OVMANA, TOV21G, IGROV1, and JHOC5 cell lines. Analysis of miRNAs revealed 64 upregulated and 61 downregulated mature miRNA molecules (DESeq2, P< 0.05, log2 fold-change > |1|). MiR-10a-5p represented over 21% of the miRNA molecules in OCCC with endometriosis and was significantly upregulated (NGS: log2fold change = 4.37, P = 2.43e-18; QPCR: 8.1-fold change, P< 0.05). Correlation between miR-10a expression level in OCCC cell lines and IC50 (50% inhibitory concentration) of carboplatin in vitro revealed a positive correlation (R2=0.93). MiR-10a overexpression in vitro resulted in a significant decrease in proliferation (n = 6; P< 0.05) compared to transfection with a non-targeting control miRNA. Similarly, the cell-cycle analysis revealed a significant shift in cells from S and G2 to G1 (n = 6; P< 0.0001). Bioinformatic analysis predicted that miR-10a-5p target genes that were downregulated in OCCC with endometriosis were involved in receptor signaling pathways, proliferation, and cell cycle progression. MiR-10a overexpression in vitro was correlated with decreased expression of predicted miR-10a target genes critical for proliferation, cell-cycle regulation, and cell survival including [SERPINE1 (3-fold downregulated; P< 0.05), CDK6 (2.4-fold downregulated; P< 0.05), and RAP2A (2-3-fold downregulated; P< 0.05)]. These studies in OCCC suggest that miR-10a-5p is an impactful, potentially oncogenic molecule, which warrants further studies.

Prevalence of adenomyosis in women with subfertility: systematic review and meta-analysis.

To determine the prevalence of adenomyosis in women with subfertility. A systematic search was conducted in MEDLINE, EMBASE, CINAHL Plus, Google Scholar, PsycINFO and Web of Science Core Collection from database inception to October 2022. The included studies evaluated the prevalence of adenomyosis in women with subfertility, with or without endometriosis and/or uterine fibroids. Secondary analyses were conducted to identify variation in the prevalence of isolated adenomyosis according to geographical location, diagnostic modality, diagnostic criteria, type of ultrasound, ultrasound features of adenomyosis and the use of assisted reproductive technology. Among 21 longitudinal studies evaluating 25 600 women, the overall pooled prevalence of isolated adenomyosis was 10% (95% CI, 6-15%) (I2 = 99.1%; tau2 = 0.12). The pooled prevalence was 1% (95% CI, 0-4%) for adenomyosis with concurrent fibroids (eight studies; I2 = 95.8%; tau2 = 0.03), 6% (95% CI, 3-11%) for adenomyosis with concurrent endometriosis (18 studies; I2 = 98.6%; tau2 = 0.12) and 7% (95% CI, 2-13%) for adenomyosis with concurrent endometriosis and/or fibroids (nine studies; I2 = 98.3%; tau2 = 0.09). The prevalence of isolated adenomyosis varied substantially according to geographical location, with Australia exhibiting the highest pooled prevalence of adenomyosis (19% (95% CI, 12-27%)), which was significantly higher compared with that in Asia (5% (95% CI, 1-12%)). The pooled prevalence of isolated adenomyosis diagnosed using a combination of direct and indirect ultrasound features was 11% (95% CI, 7-16%), whereas it was 0.45% (95% CI, 0-1%) in the study in which only an indirect feature was used as the diagnostic criterion. One in 10 women with subfertility have a diagnosis of isolated adenomyosis. The prevalence of adenomyosis varies according to the presence of concurrent endometriosis and/or fibroids. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Different subtypes of ultrasound-diagnosed adenomyosis and in vitro fertilization outcomes: A systematic review and meta-analysis.

Adenomyosis prevalence among women with infertility is increasing; their management during in vitro fertilization is usually based on ultrasound diagnosis alone. Herein, we summarize the latest evidence on the impact of ultrasound-diagnosed adenomyosis on in vitro fertilization outcomes. The study was registered with The International Prospective Register of Systematic Reviews (CRD42022355584). We searched PubMed, Embase, and Cochrane Library databases from inception to January 31, 2023, for cohort studies on the impact of adenomyosis on in vitro fertilization outcomes. Fertility outcomes were compared according to the presence of adenomyosis as diagnosed by ultrasound, concurrent endometriosis and adenomyosis, and MRI-based or MRI- and ultrasound-based adenomyosis diagnosis. Live birth rate was the primary outcome while clinical pregnancy and miscarriage rates were secondary outcomes. Women diagnosed with adenomyosis by ultrasound had lower live birth (odds ratio [OR] = 0.66; 95% confidence interval [CI]: 0.53-0.82, grade: very low), lower clinical pregnancy (OR = 0.64; 95% CI: 0.53-0.77, grade: very low), and higher miscarriage (OR = 1.81; 95% CI: 1.35-2.44, grade: very low) rates than those without adenomyosis. Notably, symptomatic and diffuse, but not asymptomatic adenomyosis as diagnosed by ultrasound, adversely affected in vitro fertilization outcomes, with lower live birth (OR = 0.57; 95% CI: 0.34-0.96, grade: very low), clinical pregnancy (OR = 0.69; 95% CI: 0.57-0.85, grade: low), and miscarriage (OR = 2.48, 95% CI: 1.28-4.82, grade: low) rates; and lower live birth (OR = 0.37; 95% CI: 0.23-0.59, grade: low) and clinical pregnancy (OR = 0.50; 95% CI: 0.34-0.75, grade: low), but not miscarriage rate (OR = 2.18; 95% CI: 0.72-6.62, grade: very low), respectively. Concurrent adenomyosis in endometriosis is associated with a significantly lower live birth rate (OR = 0.44; 95% CI: 0.26-0.75, grade: low) than endometriosis alone. Finally, the use of MRI-based or MRI- and ultrasound-based adenomyosis diagnosis showed no significant association with in vitro fertilization outcomes (grade: very low for all outcomes). Considering ultrasound findings, symptoms, and different subtypes of adenomyosis may aid in offering personalized counseling, improving treatment decisions, and achieving better outcomes of in vitro fertilization.

Cyst of the Canal of Nuck (Female Hydrocele) and Concurrent Endometriosis: Cytological and Histological Appearance of a Poorly Known Association.

Cyst of the Canal of Nuck (Female Hydrocele) and Concurrent Endometriosis: Cytological and Histological Appearance of a Poorly Known Association.

GATA3 expression in clear cell adenocarcinoma of the lower urinary tract: a potential diagnostic pitfall

BackgroundClear cell adenocarcinoma of the lower urinary tract (CCACLUT) is a rare primary malignant neoplasm with heterogenous morphology. There is a paucity of data in the literature regarding its immunohistochemical profile.MethodsThe immunohistochemical features (extent and intensity) of a multinational cohort of CCACLUT were evaluated with comparison between clear cell adenocarcinoma of the female genital tract (CCACFGT, tissue microarray) and nephrogenic adenoma (NA).Results33 CCACLUT (24 female, 9 male; mean age 59 years) were collected. CCACLUT most commonly arose from the urinary bladder (26/33, 78%), particularly from the trigone (10/33, 30.3%) followed by the urethra (8/33, 22%). All 12 NA cases were located at the urinary bladder, whereas the most common CCACFGT location was the ovary (29/56, 52%). None of the CCACLUT patients had, intestinal metaplasia, NA, or urothelial carcinoma. One patient had concurrent endometriosis of the sigmoid colon. Most frequently observed morphology in CCACLUT was papillary/tubulocystic (9/3; 27.3%), followed by papillary/tubular (6/33; 18.2%) and papillary/solid (5/33; 15.2%). GATA3 expression was significantly higher in CCACLUT (18/33, 54.5%) and NA (6/12, 50%), when compared to CCACFGT cases 6/56, 11.7%)(p = 0.001 and p = 0.022, respectively). The extent of GATA3 was significantly higher in CCACLUT group (19.2 ± 16.6%) than the other groups (9.6 ± 22.5% in NA and 2.6 ± 9% in CCACFGT group) (p = 0.001). 4/33 patients (12.1) had weak, 10/33 patients (30.3%) had moderate, and 4/33 patients (12.1%) had strong GATA3 intensity in CCACLUT group. In NA group, one patient (8.3%, 1/12) had weak, one patient (8.3%, 1/12) had moderate and 4 patients (33.3%, 4/12) had strong GATA3 intensity. Most cases (CCACLUT 29/33, 88%; NA 11/12, 92%; CCACFGT 46/56, 82.1%) had positive Napsin A expression, by which CCACLUT had significantly more cases with Napsin A expression (p = 0.034). p63 was consistently negative in all cases (30/33 (91.9%) CCACLUT; 12/12 (100%) NA; 42/56 (75%) CCACFGT. Ki67 (MIB) proliferation index was significantly higher in CCACLUT group (54.6 ± 21%) when compared to NA group (4.5 ± 2.7%) and CCACFGT group (35.5 ± 25.8%) (p = 0.001).ConclusionCCACLUT has consistent GATA3 expression, which may cause challenge in the diagnosis of urothelial carcinoma but can be used to distinguish CCACLUT from CCACFGT.

Somatic mutation analysis of Mesonephric-Like adenocarcinoma and associated putative precursor Lesions: Insight into pathogenesis and potential molecular treatment targets

AimsMesonephric-like adenocarcinoma (MLA) is a recently described histologic tumor subtype of the Müllerian tract. MLA can arise in association with Müllerian lesions that share common mutations. We report three MLAs and hypothesize that concurrent endometriosis and cystadenofibroma with focal borderline changes might also carry common mutations. Methods and resultsWe searched “mesonephric” in our database from 2015 to mid-2021 to retrieve MLA cases. Somatic mutation analysis was performed on tumors and on associated benign proliferative lesions. All MLAs (2 ovarian and 1 uterine) harbored KRAS G12D or G12 V mutations. A PIK3CA alteration (H1047Q) was detected in one MLA and in the associated cystadenofibroma with focal borderline changes. The molecular profile of MLA-associated Müllerian lesions (endometriosis and seromucinous cystadenofibroma with focal borderline changes) was similar to concurrent adenocarcinoma. However, tumor contamination could not be excluded in the endometriotic lesion. Patients presented at various stages, with no evidence of post-operative recurrence after 15 months (FIGO IC) and 33 months (FIGO IIA2). One patient (FIGO IIIA1) died of disease 32 months after surgery. ConclusionsKRAS mutations commonly characterize MLA. At least some MLA-associated Müllerian lesions show MLA-like genetic profiles, suggesting a precursor role. As far as we are aware, we describe for the first time in MLA the potentially actionable H1047Q variant of PIK3CA.

O-057 The pregnant outcome after laparoscopy treatment for subtle distal fallopian tube abnormalities in infertile population: a prospective cohort study

Abstract Study question What is the the pregnancy outcome after laparoscopy treatment for subtle distal fallopian tube abnormalities and the factors related with natural pregnancy. Summary answer The natural pregnancy rate is 46.58% after laparoscopy and patients' age, duration time of infertility and concurrent number of abnormalities are related with natural pregnancy. What is known already Subtle distal fallopian tube abnormalities are a group of diseases that are characterized by subtle variations in tubal anatomy including fimbrial agglutination, tubal diverticula, accessory ostium, fimbrial phimosis, and accessory fallopian tube. The prevalence of subtle distal fallopian tube abnormalities is high in infertile women.This group of diseases is highly related to endometriosis, especially its early stage, and may indicate fimbrial abnormalities in endometriosis. Study design, size, duration This was a prospective cohort study conducted in the Reproductive Medicine Center of an university-affiliated teaching hospital from January 2017 to December 2018. Participants/materials, setting, methods 234 patients with subtle distal fallopian tube abnormalities were included. Laparoscopies were performed by four senior reproductive surgeons who were familiar with the diagnostic criteria and surgery treatment for subtle abnormalities. The fallopian tube abnormalities were corrected and endometriosis was treated by either electrical ablation for peritoneal lesions or endometrioma excision.The participants were followed up by phone every 12 months for pregnancy outcome until 36 months after surgery. Main results and the role of chance 167 patients conceived after surgery(clinical pregnancy rate 71.37%). 109 patients conceived naturally (natural pregnancy rate 46.58%) and 59 patients conceived after in IVF（One case conceived naturally after live birth after IVF, four cases conceived naturally twice) . The average time for natural conception after surgery is 8.36±7.47 months. 51.4% of natural pregnancy occurred within 6 months and 79.8% occurred within 12 months.Among the 109 naturally conceived patients, there were 94 cases of live birth, 13 cases of natural abortion (natural abortion rate 11.92%) and 2 cases of ectopic pregnancy (ectopic pregnancy rate 1.83%). No preterm birth, multiple pregnancy or birth defects were reported in this group.The patient age(HR = 0.917,95%CI 0.870-0.917,P=0.001), duration of infertility(HR = 0.846,95%CI 0.740-0.966,P=0.014) and concurrent number of subtle abnormalities (HR = 0.636,95%CI 0.416-0.970,P=0.036) are the factors associated with natural pregnancy. The type of subtle abnormalities, type of infertility, body mess index, concurrent endometriosis, uterine cavity abnormalities and myoma are not related with natural pregnancy. Limitations, reasons for caution Not all kinds of subtle distal abnormalities are included such as paratubal cyst is excluded from the study. Not all the patients had the test of ovarian reserve such as AMH, antral follicle count and FSH level, so we couldn’t evaluate the relationship between ovarian reserve and natural pregnancy. Wider implications of the findings This is the largest clinical study that investigated the pregnancy outcome of subtle fallopian tube abnormalities in the infertile population.Laparoscopy surgery is an effective treatment for infertility patients with subtle distal fallopian tube abnormalities, especially for the young, short duration time of infertility and ≤2 types of subtle abnormalities. Trial registration number ChiCTR2000029095

The Association of Endosalpingiosis with Gynecologic Malignancy

Study Objective Endosalpingiosis (ES) has been shown to potentially have a relationship with gynecologic malignancy based on case reports and case series. This study sought to determine the association of ES with gynecologic cancer and provide details regarding cancer type and time until diagnoses. Design A retrospective cohort analysis from 2000 through 2020 of all patients who underwent a gynecologic surgery with pathology consistent with ES at a nationwide, multi-site institution. Data was obtained by searching pathology reports for the search term “endosalpingiosis.” Setting Academic tertiary care centers including three distinct institutions. Patients or Participants Patients with pathology-proven ES. Interventions Gynecologic surgery. Measurements and Main Results A total of 505 patients met inclusion criteria. Demographic data showed a mean age of 52.9 years at the time of surgery (range 15.7 – 95.4), white race (91.7%), and married marital status (64.6%). Mean body mass index (BMI) was 29.8kg/m2 (range 15.3kg/m2 – 58.5kg/m2). Of patients with ES on pathology, 97 (19.2%) had concurrent endometriosis. Indications for surgery varied, with 145 (28.7%) having surgery for a pelvic mass, 149 (29.5%) for known or suspected cancer, and 80 (15.8%) for pelvic pain. There were 57 (11.3%) ES patients with a pre-existing diagnosis of malignancy and 218 (43.2%) with a post-operative diagnosis of malignancy. Of those with a post-operative diagnosis of malignancy, 204 (93.6%) were diagnosed concurrently during surgery for ES. The most common associated cancers were ovarian (n=96, 44.0%) and uterine (n=90, 41.3%). Mean time from ES diagnosis until malignancy diagnosis was 6.3 months. At the time of analysis, 415 patients (82.2%) were still living, with a total mean follow-up time of 75.6 months (range 0 – 249.9). Conclusion The presence of ES has an association with malignancy, specifically, uterine and ovarian cancers. Additional analysis comparing ES and endometriosis is warranted to determine if this association remains significant. Endosalpingiosis (ES) has been shown to potentially have a relationship with gynecologic malignancy based on case reports and case series. This study sought to determine the association of ES with gynecologic cancer and provide details regarding cancer type and time until diagnoses. A retrospective cohort analysis from 2000 through 2020 of all patients who underwent a gynecologic surgery with pathology consistent with ES at a nationwide, multi-site institution. Data was obtained by searching pathology reports for the search term “endosalpingiosis.” Academic tertiary care centers including three distinct institutions. Patients with pathology-proven ES. Gynecologic surgery. A total of 505 patients met inclusion criteria. Demographic data showed a mean age of 52.9 years at the time of surgery (range 15.7 – 95.4), white race (91.7%), and married marital status (64.6%). Mean body mass index (BMI) was 29.8kg/m2 (range 15.3kg/m2 – 58.5kg/m2). Of patients with ES on pathology, 97 (19.2%) had concurrent endometriosis. Indications for surgery varied, with 145 (28.7%) having surgery for a pelvic mass, 149 (29.5%) for known or suspected cancer, and 80 (15.8%) for pelvic pain. There were 57 (11.3%) ES patients with a pre-existing diagnosis of malignancy and 218 (43.2%) with a post-operative diagnosis of malignancy. Of those with a post-operative diagnosis of malignancy, 204 (93.6%) were diagnosed concurrently during surgery for ES. The most common associated cancers were ovarian (n=96, 44.0%) and uterine (n=90, 41.3%). Mean time from ES diagnosis until malignancy diagnosis was 6.3 months. At the time of analysis, 415 patients (82.2%) were still living, with a total mean follow-up time of 75.6 months (range 0 – 249.9). The presence of ES has an association with malignancy, specifically, uterine and ovarian cancers. Additional analysis comparing ES and endometriosis is warranted to determine if this association remains significant.

Altered eutopic endometrial T-regulatory and T-helper 17 lymphocyte ratio in women with unexplained subfertility.

Perturbations in T-helper lymphocyte profiles have previously been associated with endometriosis related subfertility and conception failure. Hence a retrospective in vitro study was conducted to evaluate the relationship between T-regulatory (Treg) and T-helper 17 (Th17) lymphocytes in the eutopic endometrium of women with unexplained subfertility and correlate these profiles to their conception status. Eutopic endometrial biopsies were collected during the mid-secretory phase of the menstrual cycle, from women with unexplained subfertility. These samples were evaluated immunohistochemically for Treg and Th17 lymphocytes as well as the related proinflammatory cytokine, Interleukin-17 (IL-17). These eutopic endometrial T lymphocyte subpopulations were compared to the patients' conception status in subsequent cycles. Though Treg cells were not indicative of conception success in subsequent cycles, patients who maintained their subfertile (no conception) status were observed to have a higher Th17 cell count in their eutopic endometrium. The ratio of Treg:Th17 cell counts was significantly correlated to patient conception status as well. These trends stayed consistent irrespective of concurrent endometriosis. Patients with a high proinflammatory Th17 lymphocyte profile and low Treg:Th17 ratio in their eutopic endometrium during the secretory phase of their menstrual cycle are more likely to not conceive in subsequent cycles.

Ovarian endometrioid carcinoma and clear cell carcinoma: A 21-year retrospective study

ObjectiveThis study aimed to identify the clinical characteristics of Chinese patients with ovarian endometrioid carcinoma (EC) and clear cell carcinoma (CCC) and to assess the impact of concurrent endometriosis on this group.MethodsThe present study reviewed the medical records of patients who received initial treatment and a postoperative pathological diagnosis of EC or CCC at our center in China between 1998 and 2018.ResultsOf 211 patients, 73 had pure EC, and 91 had pure CCC, and the remaining 47 had mixed cancer. The proportion of EC and CCC remained stable over past 21 years. The proportion of EC declined with aging and the age of EC onset to incline to the young. And the age of CCC onset had two peaks, namely, 36 and 77 years. After review by the pathologist, the number of endometriosis cases found in the pathological section of the analysis increased to 114, accounting for 54% of patients. As the stage progressed, the appearance of endometriosis became increasingly scarce in pathological sections(p = 0.001).Compared with CCC, EC had a higher frequency of concurrent endometrial cancer (independent endometrial lesions) and estrogen and progesterone receptor expression(p = 0.000). And more patients were in premenopausal state in EC group(p = 0.040).In the pure group, multivariate analysis showed that correlation existed between relevance to endometriosis and worse outcomes(p = 0.041). In patients with mixed cancer, mixed endometrioid histology was associated with better survival than other subtypes, even with stage III or poorly differentiated tumors(p = 0.001).ConclusionsCCC and EC which are common in ovarian cancer patients who have associated with endometriosis have distinct clinicopathological characteristics. Attention should be paid to ovarian cancer patients with a history of endometriosis and those with concurrent endometriosis in pathological sections.

Adenomyosis, a Predictor of Endometriosis Severity? a Pilot Study.

Study Objective Are sonographic features of adenomyosis associated with the three endometriosis phenotypes, superficial peritoneal endometriosis (SPE), ovarian endometrioma (OE) and deep infiltrative endometriosis (DE)? Design This retrospective cohort study analyses the presence of sonographic features of adenomyosis in reproductive age women with suspected endometriosis who underwent laparoscopic surgery at Liverpool Hospital during 2018-20 period. Setting N/A Patients or Participants 73 women of reproductive age with suspected endometriosis (pelvic pain or infertility). Interventions Women underwent a specialized transvaginal ultrasound (TVUS) by a single expert sonologist, to diagnose deep endometriosis and adenomyosis using the IDEA (International Deep Endometriosis Analysis) and MUSA (Morphological Uterus Sonographic Assessment) diagnostic criteria. All women underwent laparoscopic surgery within 6 months of the TVUS by an advanced laparoscopic surgeon, who documented intraoperative and histopathological findings. Measurements and Main Results The mean age was 35 years. 53/73 (73%) women had endometriosis at laparoscopy. 20/73 (27%) women had features of adenomyosis on TVUS with 14/20 of these women having endometriosis. 6/14 (43%) had DE with pouch obliteration, 7/14 (50%) had SPE and 1/14 (0.1%) had OE. Overall, the most common feature of adenomyosis at TVUS for women with endometriosis was heterogenous myometrium. Echogenic subendometrial lines was the most common TVUS feature for women with DE, whereas heterogenous myometrium was the most frequent TVUS features for women with SPE. An irregular interrupted junctional zone was the most common TVUS feature in women without endometriosis. Conclusion Women with adenomyosis at TVUS appear to be at high risk (70%) of concurrent endometriosis. 43% of women with adenomyosis at TVUS had advanced endometriosis (DE w pouch obliteration), with echogenic subendometrial lines the most common sonographic feature of adenomyosis. Further studies are needed to confirm whether specific features of adenomyosis at TVUS are associated with endometriosis phenotype, which in turn may aid in surgical planning for these women.

Ovarian cancer prognosis in women with endometriosis: a retrospective nationwide cohort study of 32,419 women

Contradicting results regarding ovarian cancer prognosis in women with endometriosis have been reported in the literature. Owing to the small sample size of previous studies, larger studies are required to elucidate the role of endometriosis in ovarian cancer prognosis. This study aimed to evaluate the survival rate in women with ovarian cancer with or without histologically proven endometriosis in a Dutch population-based cohort. All women with ovarian cancer diagnosed between 1990 and 2015 were identified from the Netherlands Cancer Registry. We linked these women with the Dutch nationwide registry of histopathology and cytopathology (Pathologisch-Anatomisch Landelijk Geautomatiseerd Archief) to identify all women with histologically proven endometriosis. We compared the prognosis of patients with ovarian cancer with and without histologically proven endometriosis. Primary outcome was the overall survival with subgroup analyses stratified by histologic ovarian cancer subtype and stage. Multivariable Cox proportional hazard analysis was used to estimate hazard ratios with 95% confidence intervals. We included 32,419 patients with ovarian cancer, of whom 1979 (6.1%) had histologically proven endometriosis. The median age of histologic endometriosis diagnosis was 53 years (interquartile range, 46-62). Of all women with ovarian cancer and endometriosis, 81.2% received a diagnosis of synchronous endometriosis and ovarian cancer. The endometriosis cohort was younger at ovarian cancer diagnosis, had more favorable tumor characteristics, and more often had surgical treatment for ovarian cancer than the women without endometriosis. These variables were included in the multivariable model as confounders. Women with histologically proven endometriosis had a significantly better prognosis in both crude and adjusted analyses (hazard ratio, 0.46; 95% confidence interval, 0.43-0.49; P<.0005, and adjusted hazard ratio, 0.89; 95% confidence interval, 0.83-0.95; P<.05, respectively). Women with ovarian cancer and histologically proven endometriosis had longer overall survival than women with ovarian cancer without endometriosis, even after adjustment for confounders. Future studies on ovarian cancer treatment and prognosis should consider stratifying by endometriosis status to elucidate its role. Furthermore, women diagnosed as having ovarian cancer and concurrent endometriosis should be explained the role of endometriosis in ovarian cancer survival.

Expression of ARID1A in ovarian seromucinous neoplasms and its clinicopathological significance

Objective: To investigate the clinical, pathological and immunohistochemical features of seromucinous neoplasms, including seromucinous cystadenoma, borderline tumour and seromucinous carcinomas of the ovary. Methods: A retrospective review of the seromucinous neoplasms collected between June 2006 and December 2018 was conducted at the First Medical Center of PLA General Hospital. EnVision immunohistochemical staining was used to detect the expression of CK7, PAX8, ER, PR, WT1, p16, p53 and Baf250a which was encoded by the ARID1A gene. Results: A total of 75 ovarian seromucinous neoplasms were included. There were 30 cases of benign seromucinous cystadenoma, whose patients aged 12 to 83 years (mean, 36 years). The tumor histologically composed of endocervical-type mucinous epithelium and serous-type cells, each of which accounted for more than 10%. Among the 34 cases of seromucinous borderline tumour including 7 cases with concurrent endometriosis, the patients aged 21 to 72 years (mean, 39 years). Characteristic histologic features were broad papilla structure and an admixture of cell types, predominant endocervical-like mucinous cells (non-intestinal, no goblet cells), eosinophilic cells and others such as clear cells, hobnail cells, ciliated cells, and endometrioid cells. The larger papillae tended to have oedematous stroma containing neutrophils. In the 11 cases of seromucinous carcinomas including 2 cases with concurrent endometriosis, patients aged 26 to 61 years (mean, 40 years). Seromucinous carcinomas exhibited a predominant papillary architecture with smaller components of confluent glandular, microglandular and solid structure, expansive stromal invasion pattern, and sometimes locally destructive infiltration. An admixture of epithelial cell types was in seromucinous carcinomas, as well as borderline tumour. Immunohistochemically, the tumours were positive for CK7, PAX8, p16, estrogen receptor and progesterone receptor (positive in 10% to 80% of the cases). They were negative for WT1, while p53staining showed a "wild-type" pattern. The Ki-67 positive rate was 20% to 60%. Loss of ARID1A-encoded protein Baf250a staining was observed in 6 (30%) of the 20seromucinous borderline tumors, and 2 of the 11seromucinous carcinomas. According to FIGO 2014staging system, there were 4 cases of ⅠA, 3 cases of ⅡA and 4 cases of ⅢC. Follow-up information was available in 9 patients of seromucinous carcinomas, and 2 lost to follow-up. Eight were alive (follow-up for 6 to 108 months), including 2 patients with relapse, but 1 patient who initially presented with a stage ⅢC tumor died of disease 60 months after the cancer diagnosis. Thirty-four patients of borderline tumour were all alive at the end of follow-up, including 1 with relapse. Conclusions: Seromucinous neoplasms have characteristic histopathological and immunopathological features. Both borderline tumors and carcinomas have complex structures and cellular components. ARID1A as a tumor-suppressor gene plays a role in the oncogenesis of ovarian seromucinous neoplasms. The loss of staining with ARID1A-encoded Baf250a and wild-type p53 in seromucinous neoplasms together support that seromucinous neoplasms could be type Ⅰ tumor of dualistic model of epithelial ovarian cancer, with favourable prognosis.

Endosalpingiosis: Clinical Presentation and Coexisting Pathology [07H

INTRODUCTION: Describe the clinical presentation and coexisting pathology of women with endosalpingiosis (ES), the presence of ectopic fallopian tube-like epithelium. METHODS: Retrospective analysis of pathology reports containing the keyword “endosalpingiosis” for procedures performed at the University of Kansas Medical Center between 2007-2017 Demographic information, clinical characteristics, and relevant pathology were collected for patients (N=98) with pathologically confirmed ES. RESULTS: Patient Characteristics: the cohort had a mean age of 51 at diagnosis, 52% were post-menopausal, 52% were never smokers, their mean BMI was 32, and 59% had prior abdominal or pelvic surgery. Clinical Presentation: 43% complained of pelvic pain, 31% of the post-menopausal subgroup presented with bleeding, and 26% experienced abdominal pain or bloating. Abdominal or pelvic mass was the most frequent indication for surgery (35%), followed by evaluation of a known gynecologic malignancy (31%) of which 60% were endometrial adenocarcinoma. Pathology Findings: 79% of patients had a single ES lesion on biopsy most likely to be found in an abdominal or pelvic lymph node (38%), ovary (21%), and perimetrium (14%). All 98 women in the cohort had other pathology in addition to ES. A new gynecologic malignancy was diagnosed after surgery in 29% of which 62% were ovarian. The majority also presented with concomitant benign disease (cyst, leiomyoma, etc) and 19% had concurrent endometriosis. CONCLUSION: Women with ES commonly complain of pelvic pain and the majority have a concurrent gynecologic cancer. It appears ES rarely occurs in isolation and further research is necessary to determine its role in the pathogenesis of gynecologic disease.

Increased association of ovarian cancer in women with histological proven endosalpingiosis

BackgroundFew studies have investigated the possible association between endosalpingiosis and ovarian cancer, therefore we assessed whether there is an association between histological confirmed endosalpingiosis and ovarian cancer. MethodsWe identified all women with a histological diagnosis of endosalpingiosis between 1990 and 2015 from the Dutch nationwide registry of histopathology and cytopathology (PALGA). We used women with a benign dermal nevus as controls. Histology results for cancer of the ovaries, fallopian tubes and peritoneum between January 1990 and July 2017 were retrieved. Incidence rate ratios (IRR) were estimated for ovarian cancer and its subtypes. ResultsWe found 2490 women with a histological diagnosis of endosalpingiosis, of which 1005 women 40.4 %) had concurrent endometriosis. The age-adjusted IRR for ovarian cancer in endosalpingiosis patients (including endometriosis) was 43.7 (95 %CI 35.1–54.3). Excluding cases with concurrent endometriosis, resulted in an age-adjusted IRR of 38.8 (95 %CI 29.3–50.4). IRRs were 2.4 (95 %CI 1.4–3.9) and 1.8 (95 %CI 0.8–4.0) respectively when excluding synchronously diagnosed cases. The increased IRRs seem to be caused by an increased risk of clear cell and endometrioid ovarian cancer subtypes. ConclusionsThis study shows an association between histological diagnosed endosalpingiosis and ovarian cancer. The association with endometrioid and clear cell subtypes seems most outspoken. Additionally, this study shows that this association is independent of histological endometriosis diagnosis, making it important for pathologists to report endosalpingiosis accurately and for gynaecologists to be more aware of the increased association of ovarian cancer in women with endosalpingiosis.

Clinical Manifestations Of Adenomyosis Patients With Or Without Pain Symptoms.

PurposeOur study aims to investigate the distribution of pain symptoms and the association between pain symptoms and clinical parameters in patients with adenomyosis.Patients and methodsThe clinical and pathological data of 291 patients diagnosed with adenomyosis in the Obstetrics and Gynecology Department of Peking Union Medical College Hospital from March 2012 to September 2015 were collected, and analyzed in regard to the pain symptoms.ResultsThe median age at disease onset was 34 years. 71.8% of the patients had pain symptoms (pain group) and 28.2% had no pain symptoms (painless group). Patients with symptoms accompanied by dysmenorrhea accounted for 68%, among which 30.3% were mild, 36.9% were moderate, and 32.8% severe, while 56.1% presented with progressive pain. Through comparison, significant differences were identified between the pain and painless groups with regard to age at diagnosis (P=0.009), age at onset of disease (P=0.008), and level of pre-surgical CA125 (P<0.001), as well as proportion of patients with rectal irritation (P=0.008), elevated CA125 level (P<0.001), thickened myometrial layer (P<0.001) and concurrent endometriosis (P=0.001). In the multivariable analysis, an elevated level of pre-surgical CA125 (P<0.001) and thickened posterior myometrial layer (P=0.023) were both independent risk factors for the morbidity of pain symptoms. Similar results except for the difference in rectal irritation were noticed when we made further comparison between the dysmenorrhea and non-dysmenorrhea groups in adenomyosis patients.ConclusionOur research analyzes the clinical features related to pain symptoms in patients with adenomyosis, which may provide clues for the possible presurgical diagnosis of adenomyosis, as well as references for pain management of adenomyosis.

It is not all About Size. Incidence and Implications of Concurrent Endometriosis in Women Undergoing Laparoscopic Surgery for Fibroids

Study Objective To assess the incidence and predictive factors associated with endometriosis co-occurrence in patients having surgery for fibroid pathology. Design Retrospective observational study of all premenopausal women who underwent fibroid surgery at the Centre for Advanced Reproductive Endosurgery in Sydney, Australia between October 2008 and December 2016. Setting A single center study from a high volume gynecological practice. Patients or Participants All premenopausal patients who underwent laparoscopic surgery (hysterectomy or myomectomy) who had histologically confirmed fibroids during the study period. Patients were identified from the database at the single pathology service where all surgical specimens were referred for histological analysis. Interventions Standardized demographic, clinical history, operative and pathological findings were collected from the electronic medical record. Descriptive statistics were used to describe baseline patient population characteristics as well as the prevalence of endometriosis and factors associated with higher co-occurrence of the two conditions. Measurements and Main Results 551 women were eligible for inclusion, with a median age of 43 years (range 21-59). 62.4% of the women had a prior pregnancy and 51.1% at least one delivery. 19.8% had previous endometriosis surgery. 61.5% had endometriosis that was identified and treated at the time of the fibroid operation. Factors significantly associated with endometriosis presence included a history of dysmenorrhea (OR 1.92, 95% CI 1.35 -2.72), dyschezia (OR 7.29, 95% CI 1.70 - 31.32) and subfertility (OR 4.44, 95% CI 2.45 – 8.06). Multivariate analysis was undertaken with the aim of establishing a predictive model based on symptomatology however only marginal additional predictive value was gained. Conclusion There is a significant co-occurrence of endometriosis amongst women undergoing fibroid surgery, particularly those with subfertility, dysmenorrhea and dyschezia. Clinical awareness of this co-occurrence is essential for adequate pre-operative patient counselling and strategic surgical planning for women presenting with fibroids. This is especially pertinent for those with subfertility or chronic pelvic pain where symptoms may persist if the endometriosis remains untreated.