Nonendometriotic Cysts Research Articles

A comparison of histopathologic findings of ovarian tissue inadvertently excised with endometrioma and other kinds of benign ovarian cyst in patients undergoing laparoscopy versus laparotomy

To evaluate ovarian tissue inadvertently excised with benign cysts during laparotomy or laparoscopy. Prospective study. Private and university hospitals. 260 women, 20 to 35 years old, with unilateral benign ovarian cysts. One hundred fifty women operated by laparoscopic cystectomy stripping technique, and 110 women operated by laparotomy with the same technique. Histopathologic findings of ovarian tissue inadvertently excised in endometrioma compared with other kinds of benign cysts in laparoscopy versus laparotomy. In the laparoscopy group, ovarian tissue was present in 65% of endometrioma and in 32% of nonendometriotic cysts. In the laparotomy group, ovarian tissue was seen in 80% of endometrioma and 41% of nonendometriotic cysts. The surgical approach had no statistically significant impact on conservation of ovarian reserves. The nature of the ovarian cyst played a greater role in the quality and quantity of the excised ovarian tissue.

Contents of Endometriotic Cysts, Especially the High Concentration of Free Iron, Are a Possible Cause of Carcinogenesis in the Cysts through the Iron-Induced Persistent Oxidative Stress

Endometriotic cysts are known to transform into ovarian cancers, such as clear cell and endometrioid carcinomas. We hypothesized that an iron-rich environment produced by the repetition of hemorrhage in the endometriotic cysts during the reproductive period may play a crucial role in carcinogenesis in the cysts through the iron-induced persistent oxidative stress. Contents of human ovarian cysts, including 21 endometriotic cysts, 4 clear cell carcinomas, and 11 nonendometriotic cysts, were analyzed for the concentrations of free "catalytic" iron, lactose dehydrogenase, potential antioxidant, lipid peroxide, and 8-hydroxy-2'-deoxyguanosine (8-OHdG). Iron deposition and 8-OHdG levels were also analyzed histologically. Reactive oxygen species and the mutagenicity of the contents in endometriotic cyst were determined in vitro. The concentration of free iron in endometriotic cysts (100.9 mmol/L) was significantly higher than that in nonendometriotic cysts (0.075 mmol/L; P < 0.01). The average concentrations of lactose dehydrogenase, potential antioxidant, lipid peroxide, and 8-OHdG were also significantly higher in endometriotic cysts (P < 0.01). There was a correlation between the concentration of free iron and that of 8-OHdG (P < 0.01). Histologically, we could observe iron deposits more abundantly in endometriotic cysts than in nonendometriotic cysts (P < 0.01). The level of 8-OHdG in carcinoma associated with endometriosis was higher than that of carcinoma without endometriosis (P < 0.05). In vitro analyses showed that the contents of endometriotic cyst could produce more reactive oxygen species and could induce gene mutations more frequently than the contents in the other cysts. Abundant free iron in the contents of endometriotic cysts was strongly associated with greater oxidative stress and frequent DNA mutations. A long-standing history of the RBCs accumulated in the ovarian endometriotic cysts during the reproductive period produces oxidative stress that is a possible cause for the malignant change of the endometriotic cyst.

Difference in expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 in patients with persistent ovarian cysts

Matrix metalloproteinase-1 (MMP-1), MMP-2, and MMP-9 expression with real-time quantitative polymerase chain reaction were analyzed in endometriotic and nonendometriotic ovarian cysts. Although MMP-1 was not detected, MMP-9 and MMP-2 were expressed in all of the cysts. In particular, in five of six nonendometriotic cysts (83.3%) MMP-2 expression was higher than in endometriotic cysts. These data may represent new molecular elements helpful in differential diagnosis of endometriotic lesions.

Lateral distribution of benign ovarian cysts

It is well known that the frequency of endometriotic cysts is higher in the left ovary. Previous studies suggested that ovarian dermoid cysts have a predisposition to a right lateral distribution. In this study we investigated the left- and right- sided distribution of benign ovarian cysts in large series of women undergoing surgery at our institution. Retrospective database review. We examined the clinical records of 1099 consecutive women of reproductive age (range: 15–54 years) with benign ovarian cysts who underwent surgical treatment. Age of patients at time of surgery, sites and sizes of ovarian cysts were recorded. Cyst diameter was assessed by ultrasound examination in the month before surgery. The data were abstracted from a continuously updated database of women undergoing surgery in our institution. Women who had undergone previous abdominal surgery, except appendectomy, were excluded. ANOVA and one-way analysis of variance on ranks were used as appropriate. The χ2-test was used to compare observed and expected events. Forty-four women with cyst of different histology in the same ovary or bilaterally were excluded from the analysis. Accordingly, the final study population included 1055 women. Patients with serous cysts were significantly older that those with endometriotic, dermoid, and paraovarian cysts (p<0.001). Dermoid cysts were unilateral in 202 (91.4%) women and bilateral in 19 (8.6%) patients. Among the women with unilateral dermoid cysts, 55.0% had left-sided cyst and 45.1% had right-sided cyst (not significant, p=0.159). Torsion occurred in 6 women with dermoid cysts; cysts undergoing torsion were significantly larger (p=0.004) than those that did not undergo torsion. Unilateral endometriotic cysts were found more frequently on the left ovary (n = 275, 59.9%) than on the right ovary (n = 184, 40.1%) (p<0.001; 18.041, χ2). Serous, mucinous, and paraovarian cysts were equally distributed on both sides. Bilateral cysts were significantly more frequent in women with endometriotic cysts (19.3%, 95% CI 16.2–22.8%) than in subjects with non-endometriotic cysts (8.4%, 95% CI 6.1–11.3%) (p<0.001, OR 2.60, 95% CI 1.78–3.80). No significant difference was observed in the cyst diameter in right and left-sided cysts in each histologic group. Dermoid cysts as well as serous, mucinous, and paraovarian cysts are equally distributed on both sides. This finding is in contrast with previous reports suggesting a predisposition of dermoid cysts to a right lateral distribution. The presence of bilateral lesions should always be investigated in women with ovarian endometriosis.

Lateral distribution of nonendometriotic benign ovarian cysts.

To investigate the left- and right-sided distribution of nonendometriotic benign ovarian cysts, data were collected on 406 women undergoing first-line surgery for tumours with various histotypes. Considering the unilateral cysts, the observed proportion of left lesions was 65/129 (50.4%) in the serous, 38/79 (48.1%) in the mucinous, 59/134 (44.0%) in the dermoid, 11/21 (52.4%) in the parovarian, and 3/7 (42.9%) in the miscellaneous cysts group, without significant differences from the expected 50%. This contrasts with the finding of a significantly more frequent development of endometriomas on the left ovary, and suggests that the pathogenesis of endometriotic and nonendometriotic cysts is different.

Serum CA-125 in the evaluation of benign adnexal cysts

Because serum CA-125 concentrations are increased in women with endometriosis, our objective was to determine whether CA-125 levels could be used to differentiate endometriotic from nonendometriotic benign cysts. During a 2-year period, all women who had an endometrioma (n = 33) or a nonendometriotic cyst (n = 27) that was greater than or equal to 4 cm were included. Serum CA-125 levels were measured by an immunoradiometric assay, and the mean concentrations in women with an endometriotic cyst increased as the diameter of the cyst increased. The mean CA-125 concentrations in women with cysts greater than or equal to 4 cm were 53 +/- 2 U/ml in 19 women with an endometriotic cyst, 11 +/- 1 U/ml in 20 women with a nonendometriotic cyst, and 15 +/- 1 U/ml in 7 women with a nonendometriotic cyst and endometriosis. In the fluid of 10 endometriomas, the mean CA-125 concentration was 290 +/- 94 X 10(3) U/ml (range 10 to 900 X 10(3) U/ml). With cysts diameters greater than or equal to 4 cm, 19 of 19 women with endometriotic cysts, zero of seven women with nonendometriotic cysts and endometriosis, and zero of 20 women with nonendometriotic cysts had CA-125 concentrations greater than or equal to 20 U/ml (99% upper normal limit). We conclude that serum CA-125 determinations offer an excellent method to differentiate endometriotic from nonendometriotic benign cysts.