Ovarian Chocolate Cyst Research Articles

A case of cystic adenomyosis presenting as uterine malignancy on gross appearance

Adenomyosis of uterus is a relatively a common condition and is usually divided into two main types, the diffuse adenomyosis and focal adenomyosis. However, there is third rare variant called as cystic adenomyosis which is due to repeated focal haemorrhages and results in cystic spaces filled with altered blood. Here, we are presenting a unique case of 25 years old girl who presented with severe dysmenorrhoea with 26 weeks abdominal lump. USG showed uterine fibroid with right ovarian chocolate cyst. Patient was planned for myomectomy with cystectomy. Intraoperatively large, irregular solid cystic mass (25x15x10 cm3) was removed which appeared malignant and total hysterectomy with bilateral salpingectomy was done. But mass was identified as cystic adenomyosis associated with diffuse adenomyosis of uterus on histopathology. Thus, although rare, but adenomyosis may be abnormally enlarged, solid, irregular, malignant in appearance and MRI may be required preoperatively for correct diagnosis and plan of management. Keywords - Cystic adenomyosis, diffuse adenomyosis, Focal adenomyosis, Juvenile adenomyosis, Solid cystic mass.

Gonadotropin-Releasing Hormone Analogues Reduce the Proliferation of Endometrial Stromal Cells but Not Endometriotic Cells

Aims: We investigated the potential of gonadotropin-releasing hormone (GnRH) agonists and GnRH antagonists to inhibit cell proliferation in endometriotic and endometrial stromal cells. Methods: Twenty patients with ovarian endometriomas and 18 patients with uterine fibromas were recruited. Endometriotic and endometrial stromal cells were obtained from the ovarian chocolate cyst linings and the eutopic endometria of premenopausal women with uterine fibromas, respectively. Results: GnRH agonist or antagonist treatment attenuated tumor necrosis factor (TNF)-α-induced cell proliferation in the endometrial stromal cells, whereas endometriotic stromal cells did not respond to treatment. The endometriotic stromal cells exhibited a decreased expression of the type I GnRH receptor compared with the endometrial stromal cells. GnRH agonists or antagonists did not repress TNF-α-induced IL-8 production in endometriotic stromal cells. Conclusion: GnRH agonists and antagonists have similar effects in slowing the growth of endometrial stromal cells. Endometriotic stromal cells resist the antiproliferative effect of GnRH agonists and antagonists.

Peritoneal papillary serous cystadenocarcinoma at a previous laparoscopic trocar site

The peritoneum is a serous lining of mesothelial cells with rich vascular and lymphatic capillary networks that covers the abdominal and pelvic walls and organs. Peritoneal neoplasia can originate de novo from peritoneal tissues (primary) or invade or metastasize into the peritoneum from adjacent or remote organs (secondary). Many primary cancers originate from the peritoneum, some of which have been implicated in many cases of carcinomas of unknown primary origin. Ovarian cancer arising in women severalyearsafterabilateraloophorectomyisbelievedtobeone of these primary peritoneal cancers. Other described primary peritonealcancersandtumorsincludemalignantmesothelioma, benign papillary mesothelioma, desmoplastic small round-cell tumor, peritoneal angiosarcoma, leiomyomatosis peritonealis disseminata, and peritoneal hemangiomatosis. The patient in our case report had a past history of laparoscopic cystectomy for a left ovarian chocolate cyst. Three years after the operation, a mass in her left lower abdominal quadrant was noted under the scar of the trocar site of the previous laparoscopic procedure. An unmarried 38-year-old G0P0 woman had undergone laparoscopic cystectomy 3 years previously for a left ovarian chocolate cyst, by retaining the cyst in an endobag before pulling it out from the trocar site. She noted a palpable mass with tenderness in her left lower abdominal quadrant beginning 4 months previously. Ultrasonography showed a solid mass (5.0 cm 4.4 cm 4.7 cm) in her left pelvic wall. A clinical examination showed that the location of the peritoneal mass was just at the site of a trocar port of the previous laparoscopic operation.

The NFκB inhibitor parthenolide reduces cell proliferation and PGE2 synthesis in human endometriotic stromal cells and inhibits development of endometriosis in murine model

Parthenolide is a sesquiterpene lactone derived from the plant feverfew, which has been used in folk medicine for its anti-inflammatory action. We sought to evaluate effects of parthenolide on ESCs, and on endometriotic lesions in a murine model. Aim of this study was to investigate usefulness of parthenolide as a possible therapeutic agent for endometriosis Experimental study. Ectopic endometrial tissue from ovarian chocolate cysts was collected from premenopausal women. ESCs were isolated from these tissues. ESCs were pretreated with parthenolide and exposed to TNFα. After treatment with TNFα, the levels of IL-8 and COX-2 gene expression were evaluated by real-time RT-PCR. After adding TNFα, IL-8 and PGE2 protein expression were determined by ELISA. Cell proliferation after adding TNFα was assessed by BrdU-ELISA. TNFα-induced phosphorylation of signaling pathways was evaluated by Western blot analysis. As an endometriosis model, estradiol-treated ovariectomized mice were injected intraperitoneally with endometrial fragments of donor mice. After 4 weeks of parthenolide injections, the extent of endometriotic lesions was evaluated. With parthenolide pretreatment, TNFα-induced IL-8 gene and protein expression were significantly repressed. TNFα-induced COX-2 expression and PGE2 synthesis were also inhibited. Adding parthenolide significantly suppressed BrdU incorporation of ESCs. Pretreatment with parthenolide inhibited TNFα-induced IκB phosphorylation, although it did not attenuate ERK1/2, p38MAPK, Akt, and JNK1/2 phosphorylation. Using the mice endometriosis model, administrating parthenolide significantly reduced surface area and weight of endometriotic lesions. These findings suggest that parthenolide represses development of endometriosis possibly by suppressing peritoneal inflammatory status through the NFκB pathway.

Ultrasound-Guided Interventional Therapy for Recurrent Ovarian Chocolate Cysts

The aim of this study was to determine the effectiveness of ultrasound-guided interventional therapy in the treatment of postoperative recurrent chocolate cysts. The 198 patients enrolled in this study were divided into three groups. In group 1, the saline washing group, the cavity of the cyst was washed thoroughly with warm saline. In group 2, the ethanol short-time retention group, after washing with saline, the cyst was injected with 95% ethanol with a volume of half of the fluid aspirated from the cyst. Ten minutes later, the rest of the ethanol was aspirated. In group 3, the ethanol retention group, the procedures were the same as with the ethanol short-time retention group, except that 95% of the ethanol was retained in the cyst. An ultrasound examination was performed in the third, sixth and 12th months after therapy. The chocolate cyst cure rate was significantly higher in the ethanol retention group (96%, 66/69) than in the ethanol short-time retention group (82%, 56/68) and no case was cured in the first group (saline washing). We conclude that ultrasound-guided injection and 95% ethanol retention are an effective therapy for the treatment of postoperative recurrent chocolate cysts.

OP21.01: Ultrasound‐guided interventional therapy of recurrent ovarian chocolate cysts

OP21.01: Ultrasound‐guided interventional therapy of recurrent ovarian chocolate cysts

Fertility-sparing operation for recurrence of uterine cervical perivascular epithelioid cell tumor

Perivascular epithelioid cell tumors (PEComa) are mesenchymal tumors composed of histologically and immunohistochemically distinctive perivascular epithelial cells. Although the uterine corpus seems to be one of the most prevalent sites of involvement, PEComa of the uterine cervix are very rare. Only four cervical PEComa cases have been described, and were treated with hysterectomy and radiotherapy.We report a case of a 24-year-old nulligravida woman who presented with acute abdominal pain and was diagnosed with a rupture of an ovarian chocolate cyst. Subsequent surgery revealed that the tumor arose in the uterus, and the histological diagnosis was uterine PEComa with low potential malignancy. Recurrent PEComa in the uterine cervix were excised twice, and she remains disease free 12 months after the last operation. To the best of our knowledge, this is the first report of recurrent cervical PEComa with fertility-preserving surgery. Estimating the malignant potential and appropriate surgery are essential for young patients with uterine PEComa.

Outcomes of laparoscopic surgery for bilateral ovarian chocolate cysts, with emphasis on recurrence, fertility, and ovarian reserve

Outcomes of laparoscopic surgery for bilateral ovarian chocolate cysts, with emphasis on recurrence, fertility, and ovarian reserve

The role of survivin in the resistance of endometriotic stromal cells to drug-induced apoptosis

Decreased susceptibility of endometrial tissue to apoptosis may contribute to the pathogenesis of endometriosis. We investigate the role of survivin in the pathophysiology of endometriosis through the ability of ectopic and eutopic endometrial stromal cells (ESCs) to resist apoptosis. Ectopic ESCs were obtained from ovarian chocolate cysts in patients undergoing laparoscopic surgery (n = 22). Eutopic ESCs were isolated from endometrial tissue of cyclic premenopausal women undergoing hysterectomy for fibroids (n = 22). Purified stromal cells were studied in vitro. The number of surviving cells and activation of caspases were assessed by WST-8 assay and immunoblotting. Expression of inhibitor of apoptosis proteins (IAP) family members: cIAP1 (birc2), cIAP2 (birc3), XIAP (birc4), survivin (birc5) were examined using cDNA array and real-time RT-PCR. Effects of gene silencing by small inhibitor RNAs (siRNA) were examined by WST-8-assay, Annexin-V staining and immunoblotting. After staurosporine (SS) treatment, 55% of eutopic ESCs survived versus 70% of ectopic ESCs. Procaspase-3 or -7 was more intensely activated by SS treatment in eutopic than in ectopic ESCs (P < 0.01). mRNAs for IAP-family genes, such as cIAP-1, XIAP and survivin, were highly expressed in ectopic ESCs before SS treatment. The fold induction of survivin expression after SS treatment was higher in ectopic than eutopic ESCs (2.8 +/- 0.27 versus 0.69 +/- 0.07, respectively). Survivin gene silencing in SS-treated ectopic ESCs led to an increase of apoptotic cells (P < 0.05, versus control siRNA). We demonstrated that survivin plays a critical role in susceptibility of ESCs to apoptosis. Our results indicate that a survivin inhibitor may be effective as a novel treatment for endometriosis.

Varibaculum cambrienseInfections in Hong Kong, China, 2006

<i>Varibaculum cambriense</i>Infections in Hong Kong, China, 2006

ORIGINAL ARTICLE: TNFα Gene Silencing Reduced Lipopolysaccharide‐Promoted Proliferation of Endometriotic Stromal Cells

Problem We previously reported that lipopolysaccharide (LPS)‐promoted endometriotic stromal cell (ESC) proliferation by inducing TNFα production. The aim of this study was to investigate the efficacy of TNFα gene silencing on LPS‐treated ESCs.Method of study Endometriotic stromal cells (ESCs) and endometrial stromal cells (ESCs) (EMSCs) were obtained from ovarian chocolate cysts and uterine myoma, respectively. Using PCR array, LPS‐induced gene expression profiling after transfection of TNFα siRNA into ESCs was performed. Down‐regulated genes by TNFα silencing were examined using real‐time RT‐PCR. Effect of TNFα silencing was examined using ELISA and BrdU incorporation, respectively.Results In PCR array, TNFα silencing in ESCs repressed LPS‐induced expression of cIAP2 and IL‐8, NFκB pathway responsive genes. After adding LPS, the levels of cIAP2 and IL‐8 expression in ESCs were higher compared with those in EMSCs. TNFα silencing attenuated the LPS‐induced ESC proliferation.Conclusion Tumor necrosis factor α may be involved in cell proliferation of endometriotic tissues.

Exploring mechanisms for regulating growth and survival of ectopic endometriotic cells using comprehensive DNA microarray analysis

OBJECTIVE: We previously reported that TNFα induced IL-8 expression in endometriotic stromal cells (ESCs). Bacterial endotoxin lipopolysaccaride (LPS), as an inducer of inflammation, enhanced TNFα and IL-8 production as well as cell proliferation in ESCs. On the other hand, altered apoptosis in endometriotic tissues is an aspect that illuminates the pathophysiology of endometriosis. To further define the nature of inflammatory reaction and abnormal survival of endometriotic cells, we sought to reveal the molecular mechanisms with regard to (a) the LPS induced-cell proliferation and (b) the resistance to apoptosis using cDNA microarray. DESIGN: Prospective study. MATERIALS AND METHODS: ESCs were obtained from the ovarian chocolate cysts. Eutopic endometrial stromal cells (EMSCs) were isolated from the endometrial tissue of premenopausal women who underwent hysterectomy for uterine myoma. LPS and staurosporine (SS) were exposed the cultured cells as the inflammatory reaction- and the apoptosis-inducing agent, respectively. Signaling pathway- or apoptosis related-gene expression profiles were analyzed using the pathway-focused cDNA microarray. Based on these microarray data, siRNAs directed against the target genes were transfected. The level of various gene and protein expression was evaluated by realtime RT-PCR, ELISA and western blotting. Cell proliferation was assessed by BrdU incorporation and WST-8 assay. RESULTS: ESCs exhibited the TNFα-induced cell proliferation and the ability to survive against SS exposure compared to EMSCs. In pathway finder array, knockdown of TNFα gene in ESCs repressed LPS-induced cIAP (inhibitor of apoptosis protein) -2 and IL-8 expression, the NFκB pathway responsive genes. After LPS addition, cIAP-2 and IL-8 expression in ESCs was higher than that in EMSCs. TNFα silencing also attenuated the LPS-induced ESCs proliferation. Adding NFκB inhibitor abolished these effects induced by TNFα silencing. On the other hand, in apoptosis gene array, cIAP-1, XIAP, and especially survivin, IAP family members, were highly expressed in ESCs. Survivin expression in ESCs after SS treatment was enhanced, whereas it was repressed in EMSCs, suggesting aberrant survivin expression in ESCs may be involved in the resistance to drug-induced apoptosis. EMSCs showed the potent activation of SS-induced caspase-3 or -7, whereas it was not detected in ESCs. CONCLUSIONS: TNFα and IAP family gene expression may be attributed to the mechanisms regulating mitosis and resistance to apoptosis in endometriotic tissues.

Appendiceal Endometriosis: A case Report and Literature Review

Appendiceal endometriosis is a very rare and usually asymptomatic condiction, but can result in severe complications such as intestinal perforation, massive gastrointestinal bleeding or intussusception. We report a case of endometriosis of the appendix presenting as acute appendicitis. The patient was a 36 year old nulliparouswomanwhowas scheduled formyomectomy for 20 weeks sized uterine firbroids. She however developed a right ovarian chocolate cyst, pelvic endometrial deposits and multiple uterine fibroids. Myomectomy and right ovarian cystectomywas done in addition to appendectomy. Histological examination revealed endometrial depositswithin an oedematous wall of the appendix and a diagnosis of endometroisis of the appendix causing acute appendicitis was made.We considered the relevant literature on appendiceal endometroisis and its association with endometrioma. We recommend routine evaluation of the appendix during pelvic surgery especially surgery for endometriosis. Keywords: Appendiceal endometroisis

A case of the early recurrence of the ovarian cancer arised from another ovary in the patient of ovarian chocolate cyst 8 months after operation

A case of the early recurrence of the ovarian cancer arised from another ovary in the patient of ovarian chocolate cyst 8 months after operation

Usefulness of CA19-9 versus CA125 for the diagnosis of endometriosis

Objective: To investigate the clinical value of the serum CA19-9 level in comparison with the serum CA125 level for diagnosing and determining the severity of endometriosis. Design: Retrospective study. Setting: Department of Comprehensive Reproductive Medicine in a university hospital. Patient(s): One hundred one women with endometriosis and 22 without endometriosis participated in this study. Intervention(s): Blood samples were collected before the operation (laparoscopy, oophrectomy, cystectomy, and/or hysterectomy), and tissue samples of ovarian chocolate cysts were collected during the operation. Main Outcome Measure(s): The serum CA19-9 and CA125 levels and the localization of these antigens in ovarian chocolate cysts. Result(s): The mean serum CA19-9 levels in patients at all stages of endometriosis were significantly higher than those in patients without endometriosis, and serum CA19-9 levels significantly correlated with the Revised American Fertility Society classification scores. Intense staining of CA19-9 was observed in 15 of the 20 samples of ovarian chocolate cysts. Conclusion(s): CA19-9 is a useful marker for determining the severity of endometriosis.

Significance of cyclooxygenase-2 in malignant transformation of ovarian chocolate cysts

Objective: It is known that ovarian chocolate cysts are frequently found with epithelial ovarian cancers, most frequently with endometrioid adenocarcinoma and clear cell adenocarcinoma in particular. It has been reported that in colon cancer the inducive form of prostaglandin (PG) synthase, cyclooxygenase-2 (COX-2), is overexpressed in cancer tissues. COX-2 expression decreases and the prognosis is improved in colon cancer patients taking aspirin. This study was planned to investigate the expression of COX-2 in ovarian chocolate cysts and ovarian cancer and tried to find the interrelationship among the groups.

Menstrual cycle-specific inhibition of endometrial stromal cell proliferation by oncostatin M

We have investigated the possible roles of oncostatin M (OSM), which is a member of the interleukin-6 family of cytokines, in endometrial and endometriotic stromal cell growth. Endometrial and endometriotic stromal cells were collected from the uterus or ovarian chocolate cysts. We observed the expression of mRNA transcripts for OSM, OSM receptor subunit beta, leukaemia inhibitory factor receptor subunit (LIFR), and glycoprotein 130 in endometrial and endometriotic stromal cells. We also examined the effects of OSM (0-50 ng/ml) and LIF (0-10 ng/ml) on endometrial and endometriotic stromal cell proliferation and evaluated the effects of OSM on endometrial stromal cell differentiation. The presence of 10-50 ng/ml OSM significantly suppressed endometrial stromal cell growth in secretory phase tissue but not in proliferative phase tissue. In contrast, stromal cells in endometriotic tissues were resistant to the inhibitory effects of OSM. Addition of LIF did not influence the growth of endometrial stromal cells. We also showed that 10 ng/ml OSM stimulated markers of differentiation causing increased prolactin secretion and cyclooxygenase-2 gene expression in endometrial stromal cells from the secretory phase. These results suggest that OSM may play a pivotal role in regulating the growth and differentiation of endometrial cells. Endometriotic cells may behave differently from normal endometrial cells in terms of the inhibitory response to OSM.

Distribution of cyclooxygenase-2 in eutopic and ectopic endometrium in endometriosis and adenomyosis.

The objective of this study was to determine the distribution of cyclooxygenase-2 (COX-2) in eutopic and ectopic endometria in endometriosis and adenomyosis. The subjects were 35 patients with endometriosis diagnosed by laparoscopy, 33 patients with histologically confirmed adenomyosis and 50 female controls with normal fecundity. Expression of COX-2 was immunohistochemically investigated in tissues from eutopic endometrium and myometrium and ectopic endometrium of the wall of ovarian chocolate cysts using polyclonal antibody. Surface epithelial cells, endometrial glandular epithelial cells or stromal cells were assessed. Cells were semi-quantitatively assessed on a scale of 1 to 5 using a nomogram created from positive cell count and the degree of staining. COX-2 expression in surface and glandular epithelia of the control group varied markedly during the menstrual cycle. It was lowest in the early proliferative phase and gradually increased thereafter. It remained high throughout the secretory phase. However, in patients with endometriosis, expression of COX-2 in glandular epithelium was higher than that in the control group, though it varied throughout the menstrual cycle. On the other hand, there was no variation in expression of COX-2 in the adenomyosis group during the menstrual cycle, and it was lower than that in the endometriosis group in all phases. Pronounced COX-2 expression was observed in glandular cells from ectopic endometrial tissue of ovarian chocolate cyst walls in all cases regardless of the menstrual phase. In summary, increased COX-2 expression in eutopic and ectopic endometria was believed to be strongly correlated with pathological abnormalities in these disorders.

Menstrual cycle–specific inhibition of the proliferation of endometrial stromal cells by interleukin 6 and its soluble receptor

Objective: This study investigated the possible roles of interleukin 6 and soluble interleukin 6 receptor in the growth of endometrial and endometriotic cells. Study Design: Endometrial and endometriotic stromal cells were collected from the uterus or from ovarian chocolate cysts. We examined the effects of interleukin 6, soluble interleukin 6 receptor, and a combination of both factors on the proliferation of endometrial and endometriotic stromal cells. The action of sex steroids on the interleukin 6 regulation of the growth of stromal cells was also evaluated. The gene expressions of interleukin 6 receptor and glycoprotein 130 were examined in endometrial and endometriotic cells by reverse transcription-polymerase chain reaction. Results: Interleukin 6 had no effect on the growth of stromal cells in tissue from the proliferative phase. In contrast, the addition of concentrations of ≥100 pg/mL interleukin 6 induced significant inhibition of stromal cell proliferation in tissue from the secretory phase. Similarly, the addition of soluble interleukin 6 receptor caused significant suppression in the growth of endometrial stromal cells in tissue from the secretory phase but not the proliferative phase. On the other hand, stromal cells of endometriotic tissues were resistant to interleukin 6, showing no inhibitory response. Although the combination treatment did not affect the proliferation of stromal cells of the proliferative phase and of endometriotic tissues, 10 pg/mL interleukin 6 inhibited proliferation of stromal cells of the secretory phase in the presence of 1 ng/mL soluble interleukin 6 receptor. Treatment with estradiol and progesterone for 10 days newly induced the inhibitory response to interleukin 6 in the endometrial cells from the proliferative phase. Expressions of transcripts of interleukin 6 receptor and glycoprotein 130 were observed in the endometrial cells from the proliferative and secretory phases and in endometriotic cells. Conclusions: Interleukin 6 may play a central role in regulation of the growth of endometrial cells as a mediator of endocrine action. Endometriotic cells may behave differently from their normal counterparts in terms of the inhibitory regulation exerted by interleukin 6. (Am J Obstet Gynecol 1999;180:1088-94.)

A randomized comparative study of the effect of leuprorelin acetate depot and danazol in the treatment of endometriosis: S.-P. Chang; H.-T. Ng Chin Med J (Taipei) 1996 57/6 (431–437)

Administration of superactive agonistic analog of gonadotropin-releasing hormone (GnRH) has shown to induce a paradoxic and reversible suppression of gonadotropins, so that gonadal steroid concentrations are suppressed and hypoestrogenemia is induced. In order to compare the efficacy and safety of leuprorelin acetate depot (LA) and danazol in the treatment of endometriosis, we conducted this study.A total of forty-five patients with pelvic endometriosis of different severity at laparoscopy with biopsy of peritoneal implants (n = 33) and surgical procedure (enucleation of ovarian chocolate cysts, cystectomy, or fulguration, n = 12) were included in the study and followed during the 20 weeks of treatment. LA 3.75 mg was injected subcutaneously every 28 days, while the daily oral dose of danazol was 800 mg.Both treatments were associated with a lowering of severity score. There was a consistent decrease in women with stage IV disease in the LA group and an increase in patients with stage I disease in the danazol group, but no difference was found between both treatments. Hot flushing was the most common side effect reported in 97% of LA but occurred only in 13% of danazol-treated patients. In contrast, the androgenic, anabolic side effects of weight gain and myalgia were common in those receiving danazol. The CA-125 levels were significantly lower in both treatment groups compared with their pretreatment levels (p < 0.01). During the five months of the LA treatment, biochemical evaluation revealed no pathologic alternation. Only total protein albumin, alkaline phosphatase, total bilirubin, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, uric acid and calcium increased significantly. Danazol was also associated with adverse metabolic effects and significantly increased low-density lipoprotein-cholesterol concentrations (p < 0.05). In the fourth week, serum estradiol (E2) levels decreased to nearly castrated levels (13.87 +/- 1.63 pg/ml) in all patients treated with LA, and remained at this level thereafter. On the contrary, a slight but significant increase of the serum E2 levels was noted during the danazol treatment. After five months of treatment with LA, no significant changes in bone density were observed at the femoral neck or the anteroposterior (AP) view of lumbar spine, but there was a significant loss in bone density at the lateral view of lumbar spine (-7.1%, p < 0.05).Both LA and danazol are effective in the treatment of endometriosis. The hypoestrogenic side effects of LA may be better tolerated than the androgenic, anabolic effects of danazol. However, the danazol treatment costs less than LA and has no significant side effect with osteoporosis.