Extragenital Endometriosis Research Articles

IFITM1 is a Novel, Highly Sensitive Marker for Endometriotic Stromal Cells in Ovarian and Extragenital Endometriosis

When the presence of endometriotic lesions are not evident by hematoxylin and eosin staining, CD10 is used to highlight and confirm the presence of endometriotic stroma. However, CD10 is not specific only to the endometrial stroma but is also expressed in many other cells. Recently, interferon-inducible transmembrane protein 1 (IFITM1) was reported as a highly specific immunohistochemical marker of normal endometrial stroma and endometrial stromal neoplasm. In this study, we examined the expression of IFITM1 and CD10 in 18 cases of ovarian endometriosis and 44 cases of extragenital endometriosis. Among the 62 patients, 62 (100.0%) were positive for IFITM1 and 60 (96.8%) for CD10, and CD10 was negative in 2 cases that were positive for IFITM1. Additionally, we found that IFITM1 sensitivity was unaffected by the presence or absence of hormonal therapy. To the best of our knowledge, this represents the first demonstration of IFITM1 as a highly sensitive stromal marker of ovarian and extragenital endometriosis.

PAX8: A Highly Sensitive Marker for the Glands in Extragenital Endometriosis

In cases of extragenital endometriosis or microscopic endometriosis lesions, pathological diagnosis can be challenging because endometriotic stroma and glands represent only a minor component of fibrotic endometriotic lesions. For better accuracy of diagnosis, the development of a sensitive and specific epithelial marker is beneficial. Previous studies showed that PAX8 is a highly sensitive and specific marker for primary and metastatic Mullerian epithelial tumors. Therefore, we sought to examine whether PAX8 is a highly sensitive marker for glands in extragenital endometriosis. Eight and 47 samples of ovarian endometrioma and extragenital endometriosis, respectively, were evaluated in this study. We calculated the percentage of samples positively immunostained for PAX8, CD10, estrogen receptor (ER), and progesterone receptor (PR). PAX8 was positive for endometriotic epithelial cells in 95.7% (45/47) of extragenital endometrioses and in 100% (8/8) of ovarian endometrioses. CD10 was positive for endometriotic stromal cells in 97.9% (46/47) of extragenital endometrioses. PAX8 was strongly positive for glands, even in a CD10-negative case. The expression of PAX8, CD10, and PR was not affected by preoperative hormonal therapy, and the positive rate of ER staining was significantly reduced by preoperative hormonal therapy. In conclusion, PAX8 is a highly sensitive epithelial marker for extragenital endometriosis. This specific expression was maintained under hormonal therapy. It is noteworthy that extragenital endometriosis maintains the expression of this lineage marker, although it occurs at various sites, and its cause and mechanism of development might be different. PAX8 nuclear expression can be useful in detecting extragenital endometriosis in clinical practice.

THE PECULIARITIES OF PERIOPERATIVE CLINICAL CHARACTERISTICS OF PATIENTS WITH GENITAL ENDOMETRIOSIS ASSOCIATED WITH HYPOTHYROSIS

Purpose: to elucidate the peculiarities of perioperative clinical characteristics of female patients with genital endometriosis associated with hypothyrosis. To attain our object, the following tasks had to be accomplished:
 
 to determine the localization of endometrioid heterotopia and severity of endometriosis in patients with hypothyrosis;
 to study the types of surgical interventions in patients with endometriosis associated with hypothyrosis;
 to assess the frequency of endometriosis recurrence after surgical treatment in patients with endometriosis associated with hypothyrosis.
 
 Material and methods. We examined 100 female patients: 40 patients – with endometriosis associated with hypothyrosis (main group – group I); 60 patients – with endometriosis and without thyroid pathology (group of comparison – group II). We analyzed the results of clinical, laboratory and instrumental examination, including radiological methods (CT-scan, X-ray). The diagnosis in all the patients was based on pathohistological verification. All surgical interventions were performed by the use of endovideosurgical technology.
 Results and discussion. According to the results of patients` examination, we identified the following localization of endometrioid heterotopia and severity of endometriosis:
 Stage I – 38,0 % of patients with ovarian endometrial cysts and adenomiosis;
 Stage II – 27,0 % of patients with peritoneal endometriosis and adenomiosis;
 Stage III – 23,0 % of patients with ovarian endometrial cysts, adenomiosis, peritoneal and urinary tract endometriosis;
 Stage IV – 12,0 % of patients with ovarian endometrial cysts, adenomiosis, peritoneal and retrocervical endometriosis.
 The 80,0 % of patients underwent organ-preserving procedures, and radical surgery was performed in 20,0 % of cases. We used the following surgical approaches to the endometrial lesions: 56,0 % − combined laparoscopy and hysteroscopy; 42,0 % − transvaginal laparoscopy; and only in 2,0 % of cases – conversion to laparotomy. The frequency of endometriosis recurrence after surgical treatment in patients with hypothyrosis was established: 4,0 % − at 6-month follow-up; 6,0 % − at 9-month follow-up; and 10,0% − at 12-month follow-up. We observed complete relief from the endometriosis symptoms in 80,0 % of patients after the surgical procedure. Additionally, the reproductive function was recovered in 24,0 % of females.
 Conclusions. The surgical treatment of patients with endometriosis associated with hypothyrosis should be based on the principle of radical removal of endometriotic lesions, particularly through the combined simultaneous procedures in case of advanced extragenital endometriosis. Additionally, several aspects should be taken into account, namely: localization of endometrioid heterotopia and severity of endometriosis; the age of patients and their interest in the preservation of reproductive function; the presence of the highly qualified surgeons (gynecologists, general surgeons, urologists), as well the high level of anesthetic support with thorough postoperative monitoring.

Post-caesarean Section Cicatricial Parietal Endometriosis: Case Report and Review of the Literature at the Brazzaville University Hospital (Republic of Congo)

Introduction: Defined as the implantation of endometrial tissue within parietal abdominal structures more superficial than the peritoneum, parietal endometriosis is an exceptional localization of extragenital endometriosis, most often secondary to gynecological obstetric surgery. Clinical observation: We report the case of a 32-year-old patient presenting with an abdominal parietal pain syndrome in comparison with a post-caesarean cutaneous cicatrix, cyclic and rhythmic by menstruation. Ultrasonography of the soft tissues revealed two anterior, heterogeneous hypoechoic nodules with posterior reinforcement. A wide surgery with 1cm of healthy margin allowed the excision of the nodule interesting the subcutaneous tissue and the aponeurosis of the rectus abdominis muscle. The histology was in favour of a focal endometriosis of the abdominal wall extended to the fascia of the rectus muscle. Microscopic examination revealed endometrial glands of variable size, sometimes dilated, bordered by regular cylindrical epithelium, associated with a cytogenic chorion and lymphocytic inflammation, sometimes with blood. Immediate postoperative outcomes were simple. An LHRH analogue protocol (Leuprolide acetate 3.75 mg in one intramuscular injection every 28 days for 6 months) was instituted. Conclusion: Although exceptional, it is appropriate to think of an endometriosis before an abdominal pain syndrome abdominal wall of the woman during periods of genital activity.

2015 Primary Umbilical Endometriosis Presenting with Enlarged Fibroid Uterus

Study Objective Extra-genital endometriosis is rare, with umbilical endometriosis accounting for 0.4-4% of cases. Primary umbilical endometriosis (PUE) is even more uncommon and is not associated with prior surgery. The pathogenesis of this disease is unknown but may be secondary to hematogenous/lymphatic spread or coelomic metaplasia. Here we describe the presentation, diagnosis, and management of a case of PUE presenting along with a 19cm multi-fibroid uterus. Design Case report/literature review. Setting Academic affiliated gynecology practice. Patients or Participants 41yo G0 presented with a 2 year history of increasing pain at her umbilicus associated with odor. Symptoms progressed to cyclic bleeding during menses and gradual disfiguration of umbilicus. Biopsy revealed normal benign tissue. Patient also complained of heavy menstrual bleeding. She had no previous surgical history and medical history was significant for endometrial hyperplasia treated with progesterone. Exam revealed a brown firm, tender, multinodular mass measuring 2cm associated with the umbilicus. MRI showed a T1 hypointense contrast-enhancing 2.4 × 2.1cm mass of the umbilicus extending into the subcutaneous tissue as well as a 19 × 13 × 19cm multi-fibroid uterus. Interventions The umbilicus and margin of subcutaneous tissue were excised by general surgery. Laparoscopic survey did not identify pelvic endometriosis. Robotic assisted hysterectomy was performed with tissue extraction through the umbilical defect. Fascia was repaired with 0 PDS and incision was closed to create a cosmetic umbilical appearance. Measurements and Main Results Umbilical endometriosis was confirmed on pathology. The uterine tissue weighed 1444 grams with benign leiomyoma and secretory endometrium. There was no pelvic endometriosis. There were no perioperative complications. Post-operatively she had relief of umbilical pain and bleeding. Conclusion PUE is a rare condition that should be considered in premenopausal women presenting with painful masses of the umbilicus especially if associated with bleeding at time of menses. Primary umbilical endometriosis can be successfully treated with surgical excision with favorable cosmetic outcome and relief of symptoms.

ENDOMETRIOSIS OF THE LUNG PRESENTING AS INNUMERABLE NODULES

ENDOMETRIOSIS OF THE LUNG PRESENTING AS INNUMERABLE NODULES

ENDOMETRIOSIS OF POSTOPERATIVE SCAR

Postoperative scar endometriosis (PSE) is considered to be a rare form of extragenital endometriosis and some case reports or small case series are published in the literature. Most frequently PSE is diagnosed after cesarean sections although observations of the given pathology after transabdominal gynecological and surgical procedure are also described. The authors present the case of preoperatively diagnosed and surgically treated PSE three years after cesarean section. The diagnosis was confirmed after morphological research of the removed macropreparation. There was no PSE recurrence in the long-term follow up period. We propose the literature review regarding the etiology, pathogenesis, particularities of the clinical signs, sensitivity and specificity of the radiological methods of diagnosis, as well as the principles of PSE surgical management.

Clinical aspects and management of inguinal endometriosis: A case series of 20 patients.

This study aimed to describe the clinical presentation, diagnostic evaluation, and operative or medical management of inguinal endometriosis. In this study, we retrospectively reviewed 20 cases of inguinal endometriosis in our facility, particularly on the clinical characteristics, diagnosis, and surgical and medical treatment. We retrospectively investigated the following items for each patient: age at diagnosis, surgical history, presence of extragenital endometriosis, symptoms, imaging modalities, surgical therapy, hormonal therapy, follow-up period, postoperative recurrence and time to recurrence. We identified 20 cases of inguinal endometriosis in our facility. First, 75% of the patients had right inguinal endometriosis. Second, T1-weighted or fat-saturated T1-weighted images showed hyperintensity in the lesions in 17 patients (17/18 patients, 94.4%). Third, in 5 of 6 patients who underwent surgical therapy, we performed radical surgery to excise the inguinal lesion including the round ligament. One patient had disease relapse. Fourth, in 6 of 7 cases, dienogest effectively improved pain without significant adverse effects, but oral contraceptive was effective in 1 of 4 patients without significant adverse effects. We retrospectively reviewed 20 patients with inguinal endometriosis in our facility. We have shown that magnetic resonance imaging can be a useful imaging modality to obtain a specific diagnosis of this disease. In addition, inguinal endometriosis can be managed with radical surgery to resect lesions including the round ligament and with hormonal treatment. In particular, dienogest ameliorated symptoms, which can be an option for patients who do not want surgery.

A National Survey of Umbilical Endometriosis in Japan

To identify the clinical presentation, diagnostic evaluation, operative or medical management, and postoperative recurrence of umbilical endometriosis. A retrospective national survey. Obstetrics and Gynecology and Plastic Surgery Departments at a teaching hospital in Japan. Patients with umbilical endometriosis or malignant transformation. A national survey was conducted to identify and evaluate cases of umbilical endometriosis or malignant transformation documented between 2006 and 2016. The following were evaluated for each patient: age at diagnosis, body mass index, medical history, presence of extragenital endometriosis, surgical history, symptoms, imaging modalities, surgical therapy, hormonal therapy, follow-up period, postoperative recurrence, and time to recurrence. Ninety-six patients were identified with pathologically diagnosed benign umbilical endometriosis. The patients frequently had swelling (86.5%), pain (81.3%), or bleeding (44.8%) in the umbilicus. Sensitivity was 87.1% for physical examination, 76.5% for transabdominal ultrasonography, 75.6% for computed tomography, and 81.8% for magnetic resonance imaging. The cumulative recurrence rate was 1.34% at 6 months, 6.35% at 12 months, and 6.35% at 60 months after surgery. Importantly, there was no recurrence after wide resection including of the peritoneum (0 of 37 cases). The efficacy of dienogest (an oral progestin), gonadotropin-releasing hormone agonists, and oral contraceptives was 91.7%, 81.8%, and 57.1%, respectively. Finally, 2 cases of malignant transformation were identified. There was a low recurrence rate following surgery, and hormonal treatment is an option, although the current findings suggest surgical therapy as the first choice of treatment for umbilical endometriosis.

IFITM1 is a Novel, Highly Sensitive Marker for Endometriotic Stromal Cells in Ovarian and Extragenital Endometriosis.

When the presence of endometriotic lesions are not evident by hematoxylin and eosin staining, CD10 is used to highlight and confirm the presence of endometriotic stroma. However, CD10 is not specific only to the endometrial stroma but is also expressed in many other cells. Recently, interferon-inducible transmembrane protein 1 (IFITM1) was reported as a highly specific immunohistochemical marker of normal endometrial stroma and endometrial stromal neoplasm. In this study, we examined the expression of IFITM1 and CD10 in 18 cases of ovarian endometriosis and 44 cases of extragenital endometriosis. Among the 62 patients, 62 (100.0%) were positive for IFITM1 and 60 (96.8%) for CD10, and CD10 was negative in 2 cases that were positive for IFITM1. Additionally, we found that IFITM1 sensitivity was unaffected by the presence or absence of hormonal therapy. To the best of our knowledge, this represents the first demonstration of IFITM1 as a highly sensitive stromal marker of ovarian and extragenital endometriosis.

PAX8: A Highly Sensitive Marker for the Glands in Extragenital Endometriosis.

In cases of extragenital endometriosis or microscopic endometriosis lesions, pathological diagnosis can be challenging because endometriotic stroma and glands represent only a minor component of fibrotic endometriotic lesions. For better accuracy of diagnosis, the development of a sensitive and specific epithelial marker is beneficial. Previous studies showed that PAX8 is a highly sensitive and specific marker for primary and metastatic Mullerian epithelial tumors. Therefore, we sought to examine whether PAX8 is a highly sensitive marker for glands in extragenital endometriosis. Eight and 47 samples of ovarian endometrioma and extragenital endometriosis, respectively, were evaluated in this study. We calculated the percentage of samples positively immunostained for PAX8, CD10, estrogen receptor (ER), and progesterone receptor (PR). PAX8 was positive for endometriotic epithelial cells in 95.7% (45/47) of extragenital endometrioses and in 100% (8/8) of ovarian endometrioses. CD10 was positive for endometriotic stromal cells in 97.9% (46/47) of extragenital endometrioses. PAX8 was strongly positive for glands, even in a CD10-negative case. The expression of PAX8, CD10, and PR was not affected by preoperative hormonal therapy, and the positive rate of ER staining was significantly reduced by preoperative hormonal therapy. In conclusion, PAX8 is a highly sensitive epithelial marker for extragenital endometriosis. This specific expression was maintained under hormonal therapy. It is noteworthy that extragenital endometriosis maintains the expression of this lineage marker, although it occurs at various sites, and its cause and mechanism of development might be different. PAX8 nuclear expression can be useful in detecting extragenital endometriosis in clinical practice.

Endometriosis of female reproductive organs. Pathomorphology, diagnosis, treatment and prevention

Inflammatory diseases, metrofibroma and endometriosis refer to gynecological diseases, most often causing female infertility. International statistics indicate that endometriosis affects from 5 to 50% of women and it ranks third among the most widespread gynecologic pathologies. Despite the centuries-old history of using diagnostic methods in medicine, it is one of the main unresolved problems of modern gynecology. It has been proven that endometriosis leads to a significant impairment of reproductive function, steady pain syndrome (71–87%) and infertility (21–47%). If over twenty years ago the above-mentioned disease was diagnosed at the age of about 40, then nowadays even a teenager may hear this diagnosis. The objective of this research is to analyze the basics of pathomorphology of genital endometriosis, as well as the principles of diagnosis, prevention and treatment that will help to combat the infertility. The analysis is based on the review of articles and research for 2010-2018, using the PubMed databases, eLIBRARY.RU, Web of Science. Endometriosis is a disease of the most active young women in the social life that may be of hereditary nature. When speaking about the mechanisms of disease progression, there are about 10 theories of its origin, and at the present time none of them explain the diversity of forms and types of this pathology. A distinction is made between genital endometriosis, developing in the genital area, and extragenital endometriosis, developing outside of it. The latter is less common (occurs in 6–8. %) in comparison with genital endometriosis (92–94. %). Genital endometriosis is divided into internal and external, their mechanisms of occurrence are slightly different. But the benign nature of formation is common to both of them. Morphological confirmation of the diagnosis is an important task, as far as endometriosis does not refer either to tumour pathology, or to inflammation, or to pathological regeneration. Accordingly, the treatment will be of a specific nature. This pathology manifests itself in a specific triad of symptoms: dysmenorrhea, dyspareunia and dyschezia. The “golden” standard for the disease diagnosis is a direct visualization of endometrioid heterotopias in the course of laparoscopy and histological examination of biopsy materials of endometriosis. In case of disease detection, the main therapeutic goals are the removal of foci of heterotopias, pain relief and restoration of reproductive function. The main objectives of prevention are strengthening of the immune system, prevention of frequent operations and interventions in pelvic organs, the correct approach to the use of oral contraceptives and women's awareness of the necessity of regular visits to gynecologists. So, a comprehensive approach to the study of pathomorphology and diagnosis of endometriosis allows to determine the expansion degree of heterotopias and to prescribe the correct treatment that will further improve the mental and social life of women and help in restoring the reproductive function.

Междисциплинарный подход к лечению эндометриоза мочевого пузыря

Urinary endometriosis a rare condition accounting for 1-5.5% of all of the extragenital endometriosis locations. Bladder endometriosis is the most common form of urinary endometriosis, comprising 85% of cases. There is no single approach to treating bladder endometriosis patients with this pathology. Multidisciplinary collaboration between urologists and gynecologists aimed to develop an appropriate treatment strategy is essential in the management of bladder endometriosis. We report two cases of patients with different location of endometriotic lesions in the bladder, surgical strategy and collaboration between urologists and gynecologists at all stages of treatment.

COMPARISON OF DIAGNOSTIC METHODS AND TREATMENT OF ENDOMETRIOSIS OF ATYPICAL LOCATION

Surgical treatment and subsequent management of women of reproductive age with endometriosis of extragenital localization involving intestine, whose frequency is up to 37%, currently do not have a detailed and clearly described protocol, which may be caused by the complexity of diagnosis at the preoperative stage. In most cases, extragenital localization is an intraoperative finding. The purpose of the article is to evaluate the complexity of diagnosing the atypical location of extragenital endometriosis, systematize the diagnostic protocol and present the chosen treatment tactics. Material and methods. In the clinic of coloproctology and minimally invasive surgery, 4 observations of extragenital endometriosis with intestinal lesions were noted. According to the results of diagnostic studies (multispiral computed tomography - MSCT of the abdominal cavity with intravenous contrast, irrigoscopy with double contrasting, colonoscopy with biopsy), endometriosis was confirmed in 2 patients at the preoperative stage. All patients underwent surgical interventions in the volume of resection of the affected segment of the intestine within the unchanged tissues. Results. According to the intraoperative revision, in all patients there was noted the presence of additional extragenital foci of different localization, which were destroyed by diathermocoagulation. Patients with unverified endometriosis also underwent lymphadenectomy in D2 volume due to the inability to exclude malignant neoplasm. In the early postoperative period, no complications were noted. Only 1 patient decided to take hormonal therapy for 6 months after the operation. At present, none of the relapses have been observed, the mean follow-up time is 17.3 ± 13.6 months (4-33 months). In all patients there was recovered the menstrual cycle, menstruation moderately painful, previous abdominal pains before menstruation and spotting discharges from the rectum stopped. Conclusion. Surgical treatment of extragenital endometriosis of intestinal localization in the volume of resection of the affected intestine within the unchanged tissues is the optimal treatment technique and is not accompanied by significant complications. However, in cases of unverified histologically endometriosis, principles of oncological radicalism should be kept. To select the optimal volume of surgical intervention and access, a multidisciplinary consultation with the coloproctologist, gynecologist and with the obligatory consideration of the patient’s opinion is required.

Ultrasound findings in extragenital endometriosis.

We present a report on ultrasound findings in extragenital endometriosis and a literature review accompanied by illustrations. Intestinal endometriosis should be considered in female patients of reproductive age who present with constipation, gastrointestinal bleeding, nausea, vomiting, cramp-like abdominal pain, diarrhoea and pelvic pain. Although definitive preoperative diagnosis of endometriosis is difficult, clinical suspicion and appropriate imaging might prevent extensive surgical procedures with higher morbidity. Contrast-enhanced ultrasound is an efficient non-invasive imaging method without any radiation exposure that supports the early diagnosis of intestinal endometriosis and may help assess the vascularization of endometriotic lesions within the distinct layers of the intestinal wall.

Multimodality imaging and clinicopathologic assessment of abdominal wall endometriosis: knocking down the enigma.

To review the clinical, multimodality imaging, and pathologic characteristics of abdominal wall endometriosis (AWE), the most common type of extra-pelvic endometriosis. 116 women with histopathologically confirmed extragenital endometriosis diagnosed between 2/2014 and 6/2017 were evaluated retrospectively. Of these, 26 (22.4%) were found to have AWE and 18/26 met inclusion criteria for imaging. Available imaging studies were re-reviewed by two expert radiologists. Data regarding clinical features, histopathologic findings, and management were collected through medical record review. 21 pathology-proven AWE deposits were identified by imaging in 18 women [mean age at diagnosis of 38.5years (range 31-48)]. Prior C-section was present in 15/18 (83.3%) and pelvic endometriosis in 3/18 (16.7%) patients. Patients presented with abdominal pain in 14/18 (77.8%) cases, which was cyclical in 8/14; palpable mass in 12/18 (66.7%); fluid discharge in 2/18 (11.1%); and local skin discoloration in 2/18 (11.1%). Of the 21 lesions, 15 were evaluated with US, 10 with CT, and 5 with MRI. Mean lesion dimensions were 2.5 × 2.2 × 2.6cm, and deposits were predominantly located at midline or left hemiabdomen [22/30 (73.3%)], were either stellate [15/30 (50%)] or round [15/30 (50%)] in shape, had ill-defined margins [21/30 (70%)], were heterogenous in appearance [27/30 (90%)], and involved both deep and superficial abdominal wall layers [17/30 (56.7%)]. On US, lesions were mainly isoechoic/hyperechoic [7/15 (46.7%)], and scarcely vascular [8/15 (53.3%)] with a peripheral vascular pattern [8/13 (61.5%)]. On CT, AWEs were hypervascular and homogeneous [8/10 (80%)], superiorly located to scar tissue, and on MRI lesions appeared hyperintense [4/5 (80%)] to muscle with T2 cystic and T1 hemorrhagic foci [4/5 (80%)]. In 23/27 (85.1%) original reports, there was at least one known mass prior to imaging; AWE was correctly diagnosed in only 7/23 (30.4%) cases. In those with no prior knowledge of a mass, the lesion was detected in 3/4 (75%), but AWE was only diagnosed in a single case. Median time between onset of symptoms and histopathology was 24.41 moths (IQR 15.18-47.33). AWE is a challenging clinical entity frequently diagnosed with a significant delay and easily misinterpreted despite multimodality imaging. Familiarity with its radiologic features holds the potential for positively impacting diagnosis.

Laparoscopic resection of giant endometriotic cysts with mesenteric implantation

ndometriosis is defined as the presence of tissue which is histologically similar to the endometrium in locations outside the uterus. It affects women of reproductive age mainly and represents one of the main causes for hysterectomy and infertility amongst women. It has a broad spectrum of symptoms which make for a challenging diagnosis. Extragenital endometriosis affects up to 37% of all patients, and intestinal endometriosis has been observed in up to 12% of women affected by the disease, mainly involving the recto-sigmoid colon, ileocecal region and cecal appendix. Intestinal symptoms such as changes in depositional rhythm, diarrhoea and constipation are frequent and can evolve to acute abdominal obstruction in advanced stages of the disease. Authors present the case of a 51-year-old female that presented to the emergency room with abdominal, colic type, diffuse pain in the left flank, early satiety and postprandial fullness, CT scan revealed the presence of a lobed and septate mesenteric cystic tumor, of approximately 15.5 cm in diameter. Serum oncological markers were found to be within normal parameters. The patient underwent laparoscopic resection of the tumor with trans-operatory study, which ruled malignancy out and confirmed the presence of endometriotic tissue. The patient was discharged 72 hrs after surgery and prescribed anastrozole 1 mg orally every 24 hours. Follow up with Abdominal CT scan was performed 6 and 18 months later, showing no evidence of recurrence; the patient remains asymptomatic 18 months after surgery.

PROBLEM OF ENDOMETRIOSIS DIAGNOSIS WITHIN THE FRAMEWORK OF SYSTEMIC DISEASE

Aim. To study the clinical cases of extragenital endometriosis, reveal the key moments of diagnosis and study the risk factors for the development of this disease. Materials and methods. The study was carried out on the basis of gynecological hospitals of Perm in 2000-2015. Retrospective analysis of case histories of 22 patients with extragenital endometriosis of different localization was performed. Prospective analysis by means of questionnaire survey of 20 patients, operated for extragenital endometriosis, was used to assess the quality of life, working ability, prognosis regarding recovery. Results. A mean age of the examined women was 35 ± 3.5 years. Genital endometriosis was diagnosed in 81.8 % of patients, burdened obstetric-gynecological anamnesis - in 86.3 %. The main patients’ complaints were the following: dysmenorrhea and hyperpolymenorrhea (90.9 %), sterility (77.3 %), pain syndrome, dysfunction and hemorrhagic discharges from the damaged organs, cyclically coinciding with menstrual cycle. All patients (100 %) underwent surgical treatment of different forms of extragenital endometriosis, and by the results of histological study of surgical material, stromal and epithelial endometrial cells were detected. Prospectively: prognosis regarding life and working ability was beneficial, as for recovery - doubtful in 55 % of cases, recurrences - 45 % both in previously damaged and other organs. Conclusions. The presented clinical cases demonstrate that endometriosis is an interdisciplinary problem, which needs complex approach to diagnosis and management. Thoroughly collected anamnesis, including obstetric and gynecological as well as questioning, performed by other specialists is required. Patients with the revealed extragenital forms of endometriosis should be treated together with obstetricians and gynecologists.

Atypical Sites of Deeply Infiltrative Endometriosis: Clinical Characteristics and Imaging Findings.

Endometriosis is defined as the presence of endometrial tissue that is located outside the uterine cavity and associated with fibrosis and inflammatory reaction. It is a polymorphic and multifocal disease with no known cure or preventive mechanisms. Patients may be asymptomatic or may experience chronic pelvic pain, dysmenorrhea, dyspareunia, or infertility. The pelvic cavity is the most common location for endometriotic implants, which usually affect the retrocervical space, ovaries, vagina, rectosigmoid colon, bladder dome, and round ligaments. Atypical endometriosis is rare and difficult to diagnose. The most common atypical locations are the gastrointestinal tract, urinary tract, lung, umbilicus, inguinal area, breast, and pelvic nerves, as well as abdominal surgical scars. Gastrointestinal lesions are the most common extragenital manifestation, and the diaphragm is the most frequent extrapelvic site. The catamenial nature of the symptoms (occurring between 24 hours before and 72 hours after the onset of menstruation) may help suggest the diagnosis, but imaging by specialists is fundamental to evaluation. Depending on the area affected, radiography, ultrasonography, thin-section computed tomography, or magnetic resonance imaging can be used to assess suspected lesions. Because isolated extragenital endometriosis is rare, concomitant evaluation of the pelvic cavity is mandatory. Surgical excision is the only therapeutic option for definitive treatment, and comprehensive disease mapping is necessary to avoid residual disease. The authors review atypical locations for endometriosis and emphasize the most appropriate imaging protocols for investigation of various clinical manifestations. Online supplemental material is available for this article. ©RSNA, 2018.

The importance of extragenital endometriosis for surgeons

The importance of extragenital endometriosis for surgeons