Foci Of Endometriosis Research Articles

The Role of Ankaferd Blood Stopper and Oxytocin as Potential Therapeutic Agents in Endometriosis: A Rat Model.

To evaluate the potential effect of Ankaferd Blood Stopper (ABS) and oxytocin (OT) in an experimental endometriosis model, 18 female Sprague Dawley rats were used in this study. The animals were divided randomly into three groups after surgical induction of endometriosis: group 1: control group (isotonic NaCl, 1 mL/kg/day, intramuscular, n=6); group 2: OT group (OT, 80 U/kg/day, intramuscular, n=6); group 3: ABS group (ABS, 1.5 mL/kg/day, intraperitoneal, n=6). Each group was treated for four weeks (two times per week). Volumes of endometriotic explants were measured in biopsy samples for histopathological analysis. Vascular endothelial growth factor (VEGF), monocyte chemotactic protein-1 (MCP-1), and tumour necrosis factor (TNF-α) levels were measured in plasma and peritoneal fluid. Endometriotic explant volumes were significantly decreased after OT administration (P<0.0001). The epithelial score was significantly decreased in both treatment groups compared to the control group (P<0.05). TUNEL immunohistochemistry showed more apoptotic changes in the endometriosis foci (gland epithelium and surrounding tissue) in the OT group than in the control group (P<0.05). The levels of VEGF, MCP-1, and TNF-α were significantly reduced in the OT group (P<0.05), whereas no significant changes in protein levels were found in the ABS-applied group. The results indicate that OT has greater potential as a therapeutic agent in experimentally induced peritoneal endometriosis, where ABS, which is a VEGF modulator, appears to act through different mechanisms to show its palliative effects on a rat model of peritoneal endometriosis.

Clinical and morphological features of combined hyperplastic diseases of the uterus against the background of adenomyosis

To determine clinical and morphological features of combined uterine hyperplastic diseases in premenopausal women at the background of adenomyosis, 62 patients operated on for chronic abnormal uterine bleeding were examined. The control group consisted of 30 premenopausal patients who applied for preventive examination. Anthropometric and ultrasound examinations, assessment of carbohydrate and lipid metabolism, histologic examination were done. It has been established that uterine hyperplasia patients often had lipid metabolism damages (dislipidemy) and damages of carbohydrate one (alimentary – constitutional obesity, metabolic syndrome) which worsen the clinical course of the main disease. According to histological examination data, the activity of adenomyosis foci in patients with comorbid uterine pathology correlated with the severity of clinical manifestations (abnormal uterine bleeding, pain) and the presence of comorbid lesions (concomitant endometrial hyperplasia, chronic endometriosis, fibroids, endometriosis).

Features of ambulatory and stationary treatment of patients with endometriosis

Background. Most common clinical manifestations of endometriosis (N80) include pelvic pain and infertility, while adenomyosis is associated with abnormal uterine bleeding. At present, approach to the treatment of endometriosis has been revised towards shifting surgery to the second-line therapy; medications are considered as the first-line therapy: gonadotropin releasing hormone agonists, progestogens, aromatase inhibitors.&#x0D; Aim. Comparison of clinical and anamnestic characteristics and therapeutic procedures in women who were treated on an outpatient basis and those who were hospitalized and underwent surgical intervention.&#x0D; Materials and methods. Clinical-anamnestic and morphological characteristics were studied in two groups of women: 1st group (n=27) received drug therapy, 2nd group (n=28) underwent surgical intervention.&#x0D; Results and discussion. In the 1st group, 25.9% of patients received microdosed combined oral contraceptives which contain dienogest as a progestogen component, 44.4% of patients received monotherapy with dienogest, and 22.2% of patients received dydrogesterone in a prolonged mode. In the 2nd group, 39 foci of endometriosis, isolated and in a combination of various loci, were revealed during surgery, of which 30.8% were ovarian cysts, 10.2% were foci on the sacro-uterine ligaments, 23.1% were on the pelvis peritoneum. Surgical approach was determined by the urgency of intervention, an expect localization of endometriosis foci, a comorbidity of endometriosis with another pathology of the internal genitalia, 82.1% of surgery were performed by laparoscopic approach.&#x0D; Conclusions. The choice of treatment method depends on the severity of symptoms, the severity of endometriosis, the woman age and her reproductive intentions. When choosing a surgical treatment, one should be guided not only by the need for the most radical removal of endometriosis foci, but also should consider a surgical approach to minimize discomfort and provide a good quality of life after surgery. A three-stage model for the management of patients with endometriosis is proposed, which includes an assessment of treatment effectiveness and the need to develop a rehabilitation program.

Endometriosis of the uterine cervix: about a case

This study reports the case of a 46-year old multiparous patient with no particular past medical history, who had given birth vaginally twice, presenting with abnormal isolated inter-menstrual bleeding with well-defined bluish cyst at the level of the anterior labia of the cervix, measuring 4mm in diameter on speculum examination. Pelvic ultrasound showed adenomyosis. A biopsy of the lesion was performed, which showed dark brown chocolate colour liquid. Histological study objectified endometrium embedded under the epithelium, suggesting endometriosis of the uterine cervix. Endometriosis of the uterine cervix can involve the endocervix and the ectocervix. Primary endometriosis of the uterine cervix can develop in the cervix while secondary endometriosis can result from neighboring endometriosis. Trauma is the main cause of these lesions. The de-epithelialization caused by trauma would allow for endometrial transplantation during menstruation. Endometriosis of the uterine cervix is usually asymptomatic. It is usually discovered during a careful systematic examination of the uterine cervix. Rarely, it manifests as minimal, spontaneous metrorrhagias in the premenstrual period. Sometimes, metrorrhagias occur during menstruations and are persistent or are caused by sexual intercourses. Isolated endometriosis of the uterine cervix never causes pain. The treatment of this benign condition is based on the destruction or removal of the endometriosis foci. Diathermocoagulation is the most used procedure.

Frequency and morphology of benign histopathological lesions in total abdominal hysterectomy specimens.

Hysterectomy is one of the most frequently performed gynecological procedure all over the globe undertaken for varying indications, to effectively cure many gynaecological conditions. Histopathological analysis of the hysterectomy specimens should be undertaken for justification of procedure and diagnostic purposes. Objectives: To determine the frequency and morphology of different benign histopathological lesions in total abdominal hysterectomy specimens. Study Design: Descriptive cross-sectional study. Setting: Department of Pathology Fatima Jinnah Medical College. Period: From Jan 2015 to June 2015. Material &amp; Methods: The gross and histopathological findings of uterus and cervix in one hundred Total Abdominal hysterectomy specimens were studied. Non-probability, purposive sampling was done. Total abdominal hysterectomy specimens with or without salpingoophorectomy of patients aged between 20 to 70 years were included. While Total abdominal hysterectomy done in mentally retarded patients and for malignancies were excluded. Patient’s data, presenting complaints and preoperative diagnosis was recorded on predesigned proforma. SPSS version 17 was used as an analytical tool. Results: Age of the patients ranged from 30-55 years with 72% between 41-50 years. The microscopic examination of the cervix revealed features of chronic cervicitis in 75% cases. The commonest neoplastic lesion was leiomyoma present in 66% of cases. Myometrium revealed foci of adenomyosis in 21% cases. Endometrial histology showed hyperplasia in 25% of cases(simple hyperplasia 20%, cystic hyperplasia 4% and complex hyperplasia 1%), hormonal imbalance in 21%, pressure atrophy in 11%, atrophic endometrium in 6% , cystic atrophy in 2% while acute and chronic endometritis in 1% and 2% of cases respectively. Conclusion: The commonest cervical lesion was chronic cervicitis (75%). The commonest benign neoplastic lesion was leiomyoma, present in 66% of cases. Other common pathologies on histology were hyperplasia in 25% of cases, adenomyosis and hormonal imbalance in 21 % of cases each, pressure atrophy in 11%, atrophic endometrium in 6% while endometritis (acute &amp; chronic ) in 3% of cases mainly. Histopathological examination of hysterectomy specimens helps to detect the exact cause and underlined pathology.

Ulipristal Acetate Prior to Surgery for Endometriosis.

Selective progesterone receptor modulators may have a role in the treatment of endometriosis. The aim of this report is to review the effect of ulipristal acetate (UPA) on endometriosis lesions and symptoms in women treated prior to surgery. A pathology review of eutopic endometrium and endometriotic lesions was conducted by two gynecologic pathologists. The main outcome measures reported are pain reduction, amenorrhea, and pathologic progesterone receptor modulator-associated endometrial changes (PAECs). Overall, fifteen women with endometriosis received UPA over a 27-month study period. UPA was administered in an intermittent fashion in the majority of patients while 27% of patients had continuous treatment, between 6 and 24months. Eleven (73%) patients reported amenorrhea on UPA and 11 (92%) of 12 patients with pain reported pain reduction or resolution. Fourteen patients (93%) proceeded with surgical management. Thirteen (93%) patients underwent excision of suspected endometriosis at surgery. Twelve cases (86%) had concurrent eutopic endometrium specimens and PAEC was identified in 58% (n = 7). Among the 14 cases that underwent surgery, a total of 49 extraovarian sites were sampled. Endometriosis was definitively identified in 31 (63%) of these sites. Three cases (21%) showed morphologic features similar to PAEC within foci of endometriosis. All cases of PAEC-like features in endometriosis also had PAEC in the endometrium. These patients had all noted pain reduction and amenorrhea preoperatively. In conclusion, PAECs may be found in endometriosis lesions in patients treated with UPA. Further prospective investigation is required to evaluate the efficacy and safety of SPRMs in women with endometriosis.

Iatrogenic endometriosis following apical pelvic organ prolapse surgery: a case report

BackgroundIatrogenic endometriosis is the presence of endometrial glands and stroma out of the uterus following certain surgical interventions. The rate of iatrogenic endometriosis after gynecologic surgeries due to benign uterine disease is 1–2%. Laparoscopic supracervical hysterectomy is also a part of frequently used surgical treatment of apical pelvic organ prolapse, which is followed by sacrocervicopexy. However, there are no data about iatrogenic endometriosis after apical prolapse surgery in the current literature. Herein, we present a case report of a patient diagnosed with de novo endometriosis 1 year after laparoscopic supracervical hysterectomy and sacrocervicopexy.Case presentationA 46-year-old parous Slavic woman who underwent laparoscopic supracervical hysterectomy and sacrocervicopexy secondary to grade 3 symptomatic apical prolapse 1 year earlier was admitted to the same clinic with pelvic pain that had started 6 months following surgery. Deep vaginal palpation was painful. Transvaginal ultrasonography revealed an area with hypervascularization on the sacral promontory. She was scheduled for diagnostic laparoscopy. A 2 × 2-cm solid, wine-colored, hypervascular hemorrhagic lesion was seen on the sacral promontory. The lesion and the peritoneal layer behind it were totally excised. The patient was discharged on the first postoperative day, without any complications. Pathologic examination revealed foci of endometriosis comprising endometrial glands and stroma within the connective tissue, along with hemosiderin-laden macrophages. The symptoms of the patient resolved after the surgery, and no further adjuvant treatment was needed.ConclusionAlthough the rate of iatrogenic endometriosis is low after laparoscopic supracervical hysterectomy and sacrocervicopexy, the possibility of the occurrence of iatrogenic endometriosis should be discussed with patients who are diagnosed with apical prolapse to determine the type of surgical intervention. Iatrogenic endometriosis should be kept in mind for differential diagnosis in case of pain after laparoscopic supracervical hysterectomy and sacrocervicopexy.

The Effects of Leukocyte- and Platelet-Rich Plasma (L-Prp) and Pure Platelet-Rich Plasma (P-Prp) in a Rat Endometriosis Model

Objective: We aimed to investigate the effect of platelet‑rich plasma (PRP) derivatives, which can be produced from the patient’s blood and have minimal side effects, on endometriosis.Methods: To our knowledge, this is the first study in the literature that studies the relationship between PRP and endometriosis. Endometriosis foci were created in the first operation. In the second operation (30th day), four groups were formed wherein group 1 (n = 8) was administered saline, group 2 (n = 7) leukocyte and platelet‑rich plasma (L‑PRP), group 3 (n = 8) pure platelet‑rich plasma (P‑PRP) and group 4 (n = 10) was used to obtain PRP. In the last operation (60th day), the endometriotic foci was measured and then excised.Findings: There was no statistically significant difference between the pre and post volumes of the endometriotic foci, between their volume differences, and volume difference rates (P > 0.05). However, it was observed that existing implant volumes in all groups decreased statistically significantly within their groups by the end of the experiment compared to the previous volumes (P < 0.05).Conclusion: When the implants were assessed through histopathological scoring in terms of edema, vascular congestion, inflammatory cell infiltration, hemorrhage, epithelial line, and hemosiderin accumulation, and immunohistochemical staining was assessed in terms of VEGF, there was no significant difference in the comparison between the groups. Although L‑PRP and P‑PRP generated more reduction in the endometriosis foci, they did not create any statistical differences. Key words: L‑Prp; P‑Prp; VEGF; endometriosis.

Эндометриоз нижнего отдела гениталий. Тактика лечения

The issues of endometriosis of the lower genital tract, its most frequent symptoms, diagnosis and main treatment methods were considered. Special attention was paid to cervical endometriosis. Surgical intervention allows obtaining histological confirmation and removal of visible foci of endometriosis, which is a priority regarding endometriosis of the lower genital tract. The aspects of hormone therapy in patients with endometriosis of the lower genital tract were also covered, the advantages of dienogest were shown. Key words: dienogest, treatment, endometriosis, cervical endometriosis

Role of magnetic resonance tomography in diagnosis of genital endometriosis among women of reproductive age

Aim. To estimate the informativity of the technique of magnetic resonance tomography (MRT) of pelvic organs in diagnosis of genital endometriosis in women of reproductive age.&#x0D; Materials and methods. The results of pelvic organs MRT from 415 women aged 1845 years were analyzed. The examination was implemented using the apparatus Philips Intera 1.5 Tl. The method of copying the results of MR-investigations was used to receive the data on localization, degree of dissemination of endometriosis foci and concomitant diseases of female reproductive system, which were later compared with the results of the existing echographic studies of pelvic organs.&#x0D; Results. The study demonstrated higher informativity of magnetic resonance tomography in diagnosis of different forms of endometriosis and gynecological pathology associated with it, unlike echography. Out of 415 women, who underwent magnetic resonance tomography of pelvic organs, endometriosis was diagnosed in 20 % of the examined women, while echographic study only in 4 %. When implementing ultrasound, the signs of malignant neoplasms of the uterine neck and ovaries were not detected in a part of patients, whereas revealed with MRT of pelvic organs and further confirmed by the results of histological studies.&#x0D; Conclusions. Application of magnetic resonance tomography permits to improve significantly diagnosis of endometriosis that is important for determination of adequate tactics of treatment, taking into account the existing concomitant gynecological pathology.

Dye diffusion during laparoscopic tubal patency tests may suggest a lymphatic contribution to dissemination in endometriosis: A prospective, observational study.

AimWomen with adenomyosis are at higher risk of endometriosis recurrence after surgery. This study was to assess if the lymphatic vessel network drained from the uterus to near organs where endometriosis foci lied.MethodsA prospective, observational study, Canadian Task Force Classification II-2, was conducted at Sacro Cuore Don Calabria Hospital, Negrar, Italy. 104 white women aged 18–43 years were enrolled consecutively for this study. All patients underwent laparoscopy for endometriosis and a tubal dye test was carried out.ResultsEvidence of dye dissemination through the uterine wall and outside the uterus was noted in 27 patients (26%) with adenomyosis as it permeated the uterine wall and a clear passage of the dye was shown in the pelvic lymphatic vessels regardless whether the tubes were unobstructed. Histological assessment of the uterine biopsies confirmed adenomyosis.ConclusionAdenomyosis is characterized by ectatic lymphatics that allow the drainage of intrauterine fluids (the dye and, perhaps, menstrual blood) at minimal intrauterine pressure from the uterine cavity though the lymphatic network to extrauterine organs. Certainly, this may not be the only explanation for endometriosis dissemination but the correlation between the routes of the dye drainage and location of endometriosis foci is highly suggestive.

2622 an Endometriosis Field Guide: Proposing a Standardized Descriptive Nomenclature

Video Objective Well recognized is the variety of presentations of endometriosis beyond simply the classic black powder-burn lesions of John Sampson (1927). No standardized nomenclature exists to provide either gross morphologic description nor classification of the variety of endometriosis lesions. Borrowing from Dermatology systems of descriptive nomenclature, this video reviews a classification system specific for endometriosis focusing on Primary as well as Secondary lesion characteristics and then demonstrates use of the classification system for a variety of different endometriosis lesions. The purpose of this video is to propose a standardized nomenclature by which to describe the gross morphologic characteristics of endometriosis seen on laparoscopic imaging at the time of surgery. Setting Laparoscopic excision of endometriosis performed in the OR with then pathologic diagnostic correlation. Interventions During the course of laparoscopic radical excision of endometriosis, we identified a wide variety of non-classic or atypical returning with pathologic diagnosis of endometriosis. These variety of then formed the basis for a gross morphologic classification system by which such can be standardly described. Conclusion The wide variety of endometriosis can be described and classified according to a standardized nomenclature based on gross morphologic characteristics easily identified at laparoscopy. This standardized nomenclature not only supports a broader recognition of endometriosis by surgeons but permits comparative studies of grossly identified endometriosis.

BPA Replacement Chemical Concern: New Evidence from a Mouse Model of Endometriosis.

BPA Replacement Chemical Concern: New Evidence from a Mouse Model of Endometriosis.

Vascularization of endometrial tissue in abdominal cavity – the most important link in the pathogenesis of endometriosis or its vulnerable spot in terms of treatment? (review of literature)

In this review, the stepwise mechanism of vascularization of retrogradely torn away endometrial tissue into the abdominal cavity during the formation of endometrioid heterotopy is described. The necessity of the formation of a specific microenvironment and functional rearrangement of endometrial tissue, based on the interaction of endometrial mesenchymal stem cells with peritoneal macrophages, is shown, which is the basis of adaptation to hypoxia and survival in new conditions. Attention is also paid to the similarity of tissue adaptation for endometriosis and tumor growth. The activation mechanisms for the synthesis of a number of angiogenic factors and their significance in the process of vascularization of endometrial tissue, as one of the key links in the pathogenesis of endometriosis, are highlighted. In addition, the example of the peritoneal localization of the endometriosis focus reflects the sequence of the formation of the vascular component of the communication system: an increase in vascular density in the tissue of the implantation area; vascularization of endometrioid heterotopy tissue due to angiogenesis; and the final stage of formation of the vascular network of the endometrial focus - vasculogenesis (as a mechanism for the formation of the microvasculature with the participation of circulating endothelial progenitor cells). Subsequently, the synthesis of angiogenic factors continues and actively contributes to the remodeling and increase in vascular density in the heterotopic tissue. The most important is that the increase in vascular density occurs mainly due to the immature pericyte-unprotected vessels of the microvasculature. These features constitute a fundamental basis for the diagnosis of endometriosis through the qualitative and quantitative determination of some factors in the peritoneal fluid, reflecting activation of vascularization, and for future methods of treating endometriosis by activating an angiostatic effect in the area of the pathologycal focus.

Vulvar endometriosis in the setting of a traumatic neuroma

Endometriosis is a rare documented source of vulvar pain. Extra-pelvic endometriosis and traumatic neuromas have been reported in individual cases as a source of pain in procedure-related scars following gynecologic surgery. However, the presence of vulvar endometriosis within a traumatic neuroma has not been documented before. We describe a case of a 42-year-old woman who presented with a chronic vulvar nodule that became swollen, painful, and pruritic 10 years following a Bartholin’s gland excision. Excision of the lesion was performed, and histological analysis revealed a traumatic neuroma with an embedded focus of endometriosis. The patient had complete resolution of her symptoms following excision. Endometriosis within a traumatic neuroma should be considered as a possible diagnosis in a post-operative scar that becomes painful, swollen, or pruritic in a cyclic nature. Surgical excision with routine and immunohistochemical pathologic analysis aids in the successful diagnosis and treatment.

The role of steroid receptors in the pathogenesis of adenomyosis in the presence of concomitant endometrial pathology in postmenopause

Determining the pathogenesis of adenomyosis in postmenopausal women is promising, as it will allow a more thorough study of the mechanisms of hormonal changes and resolve issues related to adenomyosis in women of reproductive age. The purpose of the study is to establish the role of steroid receptors in the pathogenesis of adenomyosis in the presence of concomitant endometrial pathology in postmenopausal women. Study material is removed uteri with parovaria from 117 patients of 49-76 years old. The cases were divided into 4 groups depending on the presence of adenomyosis (AM) and background pathology (endometrioid carcinoma of the endometrium (ECE) and endometrial hyperplasia (EHP)): 1) 27 women with adenomyosis and EHP; 2) 30 women with adenomyosis and ECE; 3) 30 women with adenomyosis and age-related changes in the endometrium; 4) 30 women with age-related changes without AM (comparison group). The immunohistochemical reaction was carried out using primary antibodies to estrogen (ER), progesterone (PR) and androgen (AR) receptors. Statistical processing was carried out using parametric methods of variation statistics (calculated the arithmetic mean, standard deviation, confidence interval, Student criterion). The predominance of the ER expression in the glandular and stromal components of the eutopic endometrium in the presence of AM and hyperplastic processes was compared with the comparison group (p&lt;0.01). A high level of ER expression is characteristic of the epithelium of the endometrium with EHP (7.333±0.314) and ECE (6.200±0.712) rather than for the endometrium with atrophic changes in the presence of AM (4.433±0.773). In the stroma, a high ER activity was detected with EHP (7.148±0.276) rather than with atrophic changes (4.567±0.738) and ECE (4.167±0.602). It was established that in the epithelium of adenomyosis foci, ER expression indices were lower in atrophy (3.433±1.074) than with AM foci in ECE (4.667±0.526) and EHP (5.148±0.745). In the stroma of adenomyosis foci, ER expression is higher in EHP than in ECE and atrophy. The activity of PR in the eutopic endometrium decreases from simple non-typical to complex atypical EHP and in patients with adenomyosis and ECE, as the degree of differentiation of cells of ECA decreases (from G1 to G3 ECE). A minimal expression of PR was found in the comparison group. In the cells of internal endometriosis there were positive indices of immunohistochemical reaction with PR. There were obtained minimum scores for receptor expression of AR in eu- and ectopic endometria. Conclusion: adenomyosis foci have a regulatory effect on the uterine endometrium, stimulating the expression of ER and, to a lesser extent, PR, and do not affect the level of AR in the eutopic endometrium.

Uterine cervix and proximal third of vagina agenesis with functional uterus: Case report and literature review

Objectives: We aimed to describe the case of a patient presenting cervix agenesis with presence of vagina and functioning uterus. Methods: A 19-year-old patient was referred to Human Reproduction service due to primary amenorrhea, cyclic pelvic pain, and dyspareunia. She was diagnosed with cervical and vaginal agenesis, and menstrual flow suppression was the chosen treatment. Results: Regarding treatment options, hysterectomy is the classic treatment; however, due to advances in minimally invasive surgery and reproductive medicine, procedures such as uterine-vaginal anastomosis have been proposed. Young patients with no current reproductive wish, may opt for hormonal suppression of the menstrual flow to minimize cyclical discomfort and prevent or treat possible foci of endometriosis. However, for those seeking pregnancy, techniques of assisted reproduction can be considered. The approach should always be individualized, considering the anatomical details, clinical aspects, and patient’s opinion. Conclusions: Management of cervical agenesis is a challenge due to the complexity of the malformation and the difficulty in restoring and preserving fertility. Lastly, report such rare conditions and its treatment options, seems to be beneficial to help other patients with similar conditions.

Etiopathogenesis of internal and external genital endometriosis (evolution of views)

The etiology and pathogenesis of endometriosis and adenomyosis, as well as their interrelations, are not fully understood and are the subject of discussions and research. The question remains whether the endometriosis and adenomyosis are different diseases, or they represent different phenotypes of the same pathology. Considerations are given about the etiopathogenesis of these diseases, which existed in different years. It is now recognized that endometrioid heterotopias in adenomyosis and endometriosis are derivatives of the basal layer of the endometrium - endometrial stem cell. There are three possible ways of spreading the stem cells of the basal layer of the endometrium, leading to the formation of foci of endometriosis and adenomyosis: retrograde cast into the abdominal cavity with menstrual blood, invasive growth in myometrium due to the mechanism of epithelial-mesenchymal transformation and disruption of the endometrium and myometrium connection zone, and neonatal bleeding. Thus, the mechanisms of the appearance of foci of endometriosis in various organs and tissues are quite diverse and are associated with the primary dysfunction of the endometrium itself, retrograde menstruation, pathological regeneration accompanied by epithelial-mesenchymal transformation, as well as pathological changes in the endometrium and myometrium connection zone, neonatal bleeding. The severity of the clinical course of endometriosis, the frequency of relapse after surgical treatment, the effectiveness of conservative therapy, and the overcoming of infertility are probably due to the mechanism of development of this pathology in each specific case.

Endometriosis of the perianal region – epidemiology, diagnosis and treatment

Endometriosis is the presence of the uterine endometrium beyond the uterus. The disease usually affects women of childbearing age. Foci of endometriosis are mostly (in 95% of cases) located in the peritoneal cavity (cervix uteri, vaginal vault, vulva, urinary bladder, inguinofemoral region) and only rarely found beyond it. Occasionally, endometriosis is found in the perineal tissues, usually in the episiotomy scar, and, exceptionally rarely, in the anorectal region. Endometriosis usually develops in the period of hormonal activity. The disease may be asymptomatic or manifest with dyspareunia, pelvic pain syndrome, fertility problems, menstrual disorders and heavy menstruation. The diagnosis of anorectal endometriosis is established through a thorough interview and additional tests, including transrectal and transvaginal ultrasound or optionally magnetic resonance imaging. The final diagnosis is determined in a histopathological examination, usually of samples collected intraoperatively. Also, an endoscopic examination should be performed (at least rectoscopy) to rule out other pathological lesions. Treatment includes pharmacotherapy and surgery. In young patients, in the period of hormonal activity, extensive resection with primary sphincter reconstruction seems to be the most optimal option. In older patients, nearing menopause, conservative treatment is a better solution as endometriosis regresses and disease symptoms subside after menopause. In these cases, conservative treatment helps avoid iatrogenic sphincter injury and faecal incontinence.

Assessment of morphological changes and steroid receptors in the uteri of postmenopausal women.

The morphology of the endometrium constantly changes in the reproductive period, depending on the levels of ovarian steroid hormones, and undergoes atrophic changes during menopause as a result of their insufficiency. The purpose of this study was to analyze morphological and morphometric changes in the mucous and muscle layers of the uterine wall in postmenopausal women, and to assess localization and number of cells showing the expression of steroid hormone receptors, namely estrogen receptor α (ER-α), progesterone receptor (PR), and androgen receptor (AR) in glandular epithelial cells and smooth muscle cells in particular groups of women. The study material consisted of uterine specimens sectioned across the full thickness of the uterine wall, and embedded in 164 paraffin blocks. The specimens came from women without menopausal hormone therapy (MHT) operated due to reproductive organ prolapse or uterine myomas. The material was divided into four groups depending on the time interval from menopause to surgery: group I - from 1 to 5 years after menopause, group II - from 6 to 10 years after menopause, group III - more than 11 years after menopause, and group IV - women over 70 years of age. The sections were stained by standard HE, Masson's trichrome, and immunohistochemical methods (ERα, PR, AR). Quantitative assessment of the results was based on computer image analysis. Analysis of morphological changes in the endometrium and myometrium revealed the presence of increasing regressive changes, such as various types of atrophy, fibrosis, and calcification, augmented over time from the last menstruation. Furthermore, endometrial polyps, foci of endometriosis, and leiomyomas were observed. Based on the results of morphometric measurements, a constant decrease in the endometrial and myometrial thickness was noticed in the studied groups (I-IV). Significant differences between the groups were observed in the number of ER-α positive cells in the myometrium, but not in the endometrial glandular epithelium. Statistically significant differences in the number of AR positive cells were detected in the endometrial epithelium and in the uterine muscle. The analysis the number of PR positive cells demonstrated differences between the groups in the endometrial stroma and the myometrium. The uterus of postmenopausal woman undergo major morphological changes (mainly atrophic lesions in the endometrium and myometrium), leading to a decline in their morphometric parameters over time from the last menstruation. Localization and number of cells showing the expression of steroid receptors: ER-α, PR, and AR in the uterus of postmenopausal women, depending on the time interval from the last menstruation.