Presence Of Endometriosis Research Articles

Clinical-anamnestic and ELISA predictors of recurrence of endometrial hyperplastic processes in combination with uterine fibroids

Endometrium hyperplastic processes (EHP) are characterized by high prevalence, high risk of malignancy and frequent recurrence.The objective: identify risk factors for recurrence in EHP in combination with uterine fibroids based on the study of clinical and anamnestic data and markers of oncogenesis.Materials and methods. The study examined 81 women with endometrial hyperplastic processes (34 women with simple endometrial hyperplasia without atypia and 47 women with complex endometrial hyperplasia without atypia), who were treated in the at the gynecological department of the “City Clinical Hospital No. 7” in Zaporizhia. Patients were divided into groups based on the presence of uterine fibroids (38 women without fibroids and 43 women with uterine fibroids). Patients underwent ultrasound examination on the MyLab50 device (Esaote, Italy) and video hysteroscopy (Karl Storz, Germany). Morphological examination was performed in the pathology department of the University Clinic of ZSMU. The level of markers of oncogenesis VEGF-A, Ki-67, APRIL, survinin and pPTEN in the serum was determined by ELISA assay using Elabscience reagents (USA). Statistical data processing was performed using statistical programs “Statistica 6.0 for Windows” (StatSoft Inc., № AXXR712D833214FAN5).Results. In the EHP group without uterine fibroids, recurrences were observed in 8 patients (21.5%) during the year. In women with EHP in combination with uterine fibroids during the year recurrences were observed in 13 patients (30.3%). In patients with EHP without concomitant uterine fibroids, reliable predictors of recurrence were the presence of adenomyosis (RR=4.58; CI=0.89–23.72; p<0.05), obesity (RR=7.0; CI=1,18–41,53; p<0,05), arterial hypertension (AH) (RR=6,0; CI=1,02–35,27; p<0,05), pathology of thyroid glands (RR=5,47; CI=1.04–28.89; p<0.05) and mammary gland pathology (RR=6.0; CI=1.02–35.27; p<0.05). In the presence of uterine fibroids, the reliable predictors of recurrence of EHP were the presence of adenomyosis (RR=4.50; CI=1.11–18.27; p<0.05), chronic endometritis (RR=4.40; CI=1.11–17.84; p<0.05), obesity (RR=7.39; CI=1.73–31.52; p<0.05), hypertension (RR=4.40; CI=1.11–17.48; p<0.05) and pathology of the mammary glands (RR=5.25; CI=1.28–21.57; p<0.05). Significant predictors of recurrence in women with EHP without uterine fibroids were elevated levels VEGF-A above 126 pg/ml (RR=12.0; CI=1.91–75.06; p<0.05), APRIL level greater than 36 pg/ml (RR=9.85; CI=1,61–60.24; p<0.05) and survinin more than 103 pg/ml (RR=15.0; CI=2.32–96.96; p<0.05). In patients with EHP in combination with uterine fibroids, a significant association with recurrence was associated with an increase in VEGF-A above 126.96 pg/ml (RR=10.95; CI=2.34–5.60; p<0.05) and APRIL levels greater than 41.36 pg/ml (RR=9.17; CI=1.99–42.04; p<0.05).Conclusions. With EHP without uterine fibroids during the year recurrences were observed in 21.5% of women, in the presence of uterine fibroids recurrences are found in 30.3% of women. The risks of recurrence of EHP in patients without uterine fibroids are increased in the presence of adenomyosis, hypertension, pathology of the mammary glands and thyroid gland. In women with uterine fibroids, the risk of recurrence of EHP is associated with the presence of adenomyosis, chronic endometritis, hypertension and breast pathology. Molecular-biological predictors of EHP recurrence in women without uterine fibroids were an increase in VEGF-A above 126 pg/ml, APRIL levels above 36 pg/ml and survinin above 103 pg/ml. The presence of uterine fibroids at the level of VEGF-A predictors above 126.96 pg/ml and the level of APRIL above 41.36 pg/ml is associated with an increased risk of recurrence of EHP.

Prognostic Factors of IVF&ICSI Cycle Cancellation in Patients with Endometriosis-Related Infertility

Objective: To elucidate the prognostic factors for intracytoplasmic sperm injection cycle cancellation in patients with endometriosis-related infertility. Study Design: This was a retrospective cohort study and conducted at the Assisted Reproductive Technology center of Uludag University School of Medicine, between the years 2011-2017. The electronic database was screened and infertile patients with endometriosis, without male factor infertility, systemic disease, or undefined adnexal mass, and aged <40 were selected. The endometriosis phenotype of all cycles was classified into three subgroups: superficial endometriosis, ovarian endometrioma and deep infiltrating endometriosis. Cycles were divided into two groups: Group I (Cycle Cancellation) vs. Group II (Embryo transferred). Results: Forty-four cycles were canceled and in 178 cycles, the embryo was able to be transferred. When the groups were compared age and day 3 FSH levels were statistically higher, and anti-Mullerian hormone and antral follicle count were statistically lower in Group I. The presence of adenomyosis was higher in Group I (64% vs. 40% p<0.01). The surgery rate with laparotomy was higher in Group I (54.5% vs. 13.5% p<0.01). Antral follicle count remained as the only independent factor associated with prognoses of the IVF cycle with binary logistic regression analysis. Cancellation rates were similar between the phenotypes of endometriosis. Conclusions: Poor ovarian reserve, advanced age, presence of adenomyosis, and history of laparotomy are negative prognostic factors associated with intracytoplasmic sperm injection cycle cancellation in endometriosis-related infertility. Antral follicle count is the only independent factor in predicting cycle cancellation. The phenotype of endometriosis does not affect the results.

Predicting various forms of endometriosis using artificial neural networks

Introduction. Endometriosis is a difficult-to-diagnose pathology due to the diversity of clinical manifestations and the lack of high-precision markers necessary for rapid noninvasive diagnosis and timely administration of pathogenetically justified treatment.The aim of this work was to develop a computer system that allows us to assess the probability of endometriosis with various localizations in women, based on artificial neural networks.Material and Methods. The neural network mathematical models were constructed and tested based on data from 110 patients with morphologically pre-confirmed endometriosis. Patients were divided into training and test samples. The models were built based on anamnestic data and results of proteomic and enzyme immunoassays in blood plasma samples.Results and Discussion. In the course of the study, four mathematical models of neural networks were constructed to predict the presence or absence of endometriosis in a woman and its localization if present. Based on these mathematical models, a computer system “Differential diagnosis of endometriosis” was developed. This system allowed to assess the probability and localization of endometriosis in a patient based on parameters obtained as a result of neural network training.Conclusion. The developed computer diagnostic system allowed predicting the presence of endometriosis and its localization with a probability over 80%, depending on the predicted localization, based on data about the patient and the results of her examination. This system may be used for differential diagnosis of endometriosis from other diseases of the female reproductive system, as well as for differential diagnosis of various endometriosis localizations.

Investigating the association of matrix metalloproteinase-2 gene variants with endometriosis in an Iranian population

Objectivesmatrix metalloproteinases including matrix metalloproteinase-2 play a key role in endometrial extra cellular matrix breakdown in endometriosis. Aberrant expression of matrix metalloproteinase-2 has been reported in eutopic and ectopic endometrial tissue of endometriosis patients so altered expression of matrix metalloproteinase-2 due to polymorphisms may lead to establishment and progression of endometriosis. In this study the association between -735 C/T (rs2285053) and −1575 G/A (rs243866) variants of matrix metalloproteinase-2 gene with presence of endometriosis in an Iranian population were investigated for the first time. Study designA case-control association study was conducted to investigate the role of MMP-2−735 C/T and _1575 G/A variants in development of endometriosis. Polymerase chain reaction-restriction fragment length polymorphism method was used to determine genotype frequencies of these variants in 100 endometriosis patients and 200 normal samples. Total genomic DNA was extracted from blood samples and single-nucleotide polymorphism flanking regions were amplified using designed specific primers. Enzymatic digestion was performed using Pag I and Hinf I restriction enzymes for rs2285053 and rs243866 variants, respectively. Statistical analysis was ascertained using statistical package for social science version 16 and “SHEsis” software. ResultsThere were no significant differences in genotype frequencies of rs2285035 (-735C/T) variant between case and control groups (CC + CT vs. TT p = 0.40; OR = 0.50, 95 % CI 0.100–2.551). There were also no significant differences for C allele frequencies in both case and control groups (p = 0.9). For variant rs243866 (−1575 G/A) the differences in genotype frequencies between case and controls group were determined to be significant (GG + GA vs. AA p = 0.041; OR = 6.46, 95 % CI 0.82–50.43). The frequency of G allele was significantly different in case and control groups (p = 0.037). ConclusionIn conclusion, existence of rs243866 variant in promoter region of matrix metalloproteinase-2 gene can increase the risk of endometriosis in Iranian women.

Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome.

Cesarean scar defect often causes postmenstrual abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, and infertility, which are collectively known as cesarean scar syndrome (CSS). Several studies have reported that hysteroscopic surgery can restore fertility in women with CSS. The study aimed to identify factors that influence subsequent pregnancy following hysteroscopic surgery. Therefore, we studied 38 women with secondary infertility due to CSS who underwent hysteroscopic surgery at Shiga University of Medical Hospital between July 2014 and July 2019. Our hysteroscopic procedure included inferior edge resection and superficial cauterization of the cesarean scar defect under laparoscopic guidance. Patients were followed up for 3 to 40 months after surgery. Surgery was successful in all cases and no complications were observed. Twenty-seven patients (71%) became pregnant (pregnant group), while 11 (29%) did not (non-pregnant group). Baseline characteristics of age, body mass index, gravidity, parity, previous cesarean section, presence of endometriosis, retroflex uterus, and preoperative residual myometrial thickness were not significantly different between the groups. However, the median residual myometrium thickness was significantly higher after surgery than before surgery in the pregnant group (1.9 [1.1-3.6] vs 4.9 [3.4-6.6] mm, P<0.0001), whereas this difference was not significant in the non-pregnant group. Of those who became pregnant, 85% conceived within 2 years of surgery. Although three pregnancies resulted in abortion and one is ongoing at the time of writing, 23 pregnancies resulted in healthy babies at 35-38 gestational weeks by scheduled cesarean sections with no obstetrical complications due to hysteroscopic surgery. The average birth weight was 3,076 g. Our findings support that hysteroscopic surgery is a safe and effective treatment for secondary infertility due to CSS. The thickness of the residual myometrium may be a key factor that influences subsequent pregnancy in women with CSS.

Thoracic Endometriosis: A Review Comparing 480 Patients Based on Catamenial and Non-Catamenial Presentation

Study Objective To revisit thoracic endometriosis cases in literature and compare symptoms, diagnosis, pathology, treatment and follow-up based on the catamenial or non-catamenial nature of the disease. Design A PubMed/MEDLINE search was conducted using the key words: diaphragm endometriosis, thoracic endometriosis, thoracic endometriosis syndrome, catamenial pneumothorax. Setting n/a Patients or Participants 480 cases of thoracic endometriosis were included in this review. 61 presented with non-catamenial symptoms and 419 had catamenial symptoms. Patients were compared based on the presence of chest pain, dyspnea, hemoptysis, pneumothorax history, pneumothorax type, use and types of imaging techniques, pre- and postoperative medication, type of surgery, presence of endometriosis in pathological evaluation, location of thoracic endometriosis, follow-up period and recurrence. Interventions Types of surgeries evaluated in this review were laparoscopy (LS), laparotomy (LT), video-assisted thoracoscopic surgery (VATS), thoracotomy. Measurements and Main Results A significantly higher number of patients presented with preoperative chest pain (79.7%), dyspnea (52.2%) and pneumothorax (78.9%) in the catamenial group (p <0.001). Pneumothorax occurred more frequently on the right side in both groups. 285 patients (68%) in the catamenial group received a positive imaging finding whereas this number was significantly less in the non-catamenial group (59%, p = 0.003). Majority of patients in both groups didn't receive any pre-/post-operative medication. VATS was the most common surgery in the catamenial group (56.6%). Whereas LT/LS was more frequently performed in the non-catamenial group (70.5%). Majority of the patients in both groups received a pathological finding of endometriosis Conclusion Catamenial and non-catamenial nature of the disease caused a significant difference in presenting symptoms, preoperative evaluation, surgical and medical treatment and recurrence. Although most of patients presented with catamenial disease, majority of the non-catamenial patients also received a positive pathological finding. Therefore, it is important to keep thoracic endometriosis in mind when dealing with patients with non-catamenial symptoms. To revisit thoracic endometriosis cases in literature and compare symptoms, diagnosis, pathology, treatment and follow-up based on the catamenial or non-catamenial nature of the disease. A PubMed/MEDLINE search was conducted using the key words: diaphragm endometriosis, thoracic endometriosis, thoracic endometriosis syndrome, catamenial pneumothorax. n/a 480 cases of thoracic endometriosis were included in this review. 61 presented with non-catamenial symptoms and 419 had catamenial symptoms. Patients were compared based on the presence of chest pain, dyspnea, hemoptysis, pneumothorax history, pneumothorax type, use and types of imaging techniques, pre- and postoperative medication, type of surgery, presence of endometriosis in pathological evaluation, location of thoracic endometriosis, follow-up period and recurrence. Types of surgeries evaluated in this review were laparoscopy (LS), laparotomy (LT), video-assisted thoracoscopic surgery (VATS), thoracotomy. A significantly higher number of patients presented with preoperative chest pain (79.7%), dyspnea (52.2%) and pneumothorax (78.9%) in the catamenial group (p <0.001). Pneumothorax occurred more frequently on the right side in both groups. 285 patients (68%) in the catamenial group received a positive imaging finding whereas this number was significantly less in the non-catamenial group (59%, p = 0.003). Majority of patients in both groups didn't receive any pre-/post-operative medication. VATS was the most common surgery in the catamenial group (56.6%). Whereas LT/LS was more frequently performed in the non-catamenial group (70.5%). Majority of the patients in both groups received a pathological finding of endometriosis Catamenial and non-catamenial nature of the disease caused a significant difference in presenting symptoms, preoperative evaluation, surgical and medical treatment and recurrence. Although most of patients presented with catamenial disease, majority of the non-catamenial patients also received a positive pathological finding. Therefore, it is important to keep thoracic endometriosis in mind when dealing with patients with non-catamenial symptoms.

Specificity of the lactate dehydrogenase isoenzyme index as a preoperative screen for uterine sarcoma before myomectomy

To evaluate the applicability of the Uterine mass Magna Graecia (UMG) risk index (elevation defined by a lactate dehydrogenase isoenzyme index >29) in women undergoing surgery for benign fibroids and to determine whether other factors were associated with an elevated index. An elevated UMG index has been reported to be associated with an increased risk of uterine sarcoma in Italian women. Retrospective cohort study. University fibroid center. All women presenting from July 1, 2013, through June 30, 2019, with fibroids who had lactate dehydrogenase isoenzymes collected and surgery performed. Calculation of UMG index. Applicability of UMG index. Of 272 patients initially identified, 179 met inclusion criteria, 163 with UMG index ≤29 and 16 with UMG index >29. There were no cases of uterine sarcoma. Race, age, and presence of endometriosis, adenomyosis, or degenerating fibroids were not predictors of elevated UMG index. Body mass index (BMI) was positively associated with elevated UMG index. Specificity of UMG index to exclude uterine sarcoma was 91.1% (163/179) and higher in non-obese (BMI<30; 95.1%) than obese women (85.5%). A previously reported UMG index cutoff of 29 had a specificity of 91.1% (higher with normal BMI and lower when obese) in our patient population. Although lower than previously reported, the index could be a useful initial method of preoperative screening of women with symptomatic fibroids. Higher BMI appears to be associated with elevated UMG indices, increasing the false-positive rate in obese women.

Mental stress promotes the proliferation of endometriotic lesions in mice

Endometriosis is a condition in which tissue similar to the womb lining begins to grow in other sites, such as the ovaries or fallopian tubes. Endometriosis can cause pelvic pain, adhesion formation, and infertility. Here, we investigated the relationship between deterioration of endometriosis and inflammation of intraperitoneal adipose tissue in mice. We created a mouse model of endometriosis, then subjected these mice to stress loading. In the experimental mice, we measured protein expression levels of prostaglandin-E2, monocyte chemoattractant protein-1, and tumor necrosis factor-α using ELISA kits. We used quantitative real-time polymerase chain reaction to measure mRNA expression levels of inflammation-related enzymes and cytokines in lesions and adipose tissues. This study sugest that endometriotic lesions may progress in the presence of psychological stress in the presence of endometriosis. In addition, inflammation of the adipose tissue around the uterus may be involved in the development of endometriosis. However, this needs further consideration. Reducing or avoiding stress as much as possible may prevent the progression of endometriosis.

Contemporary prescriptions pattern of different dose levonorgestrel-releasing intrauterine systems in an Italian service for family planning

Objective Current research informations fail to adequately inform about when levonorgestrel-releasing intrauterine system (LNG-IUS) 52 mg is used instead of other lower dose LNG-IUSs (13.5 and 19.5 mg) and other long-acting reversible contraceptives (LARCs) in clinical practice. Methods A retrospective cohort study was performed in a third-level Service for Family Planning of Modena University hospital about all the first modern contraceptives prescriptions in the whole year 2019 performed by the same group of physicians. All women included underwent a detailed transvaginal ultrasound (TVUS) at prescription and a second evaluation within 3 months when they were still using the prescribed method. Results To 69/160 (43.1%) women a short-acting reversible contraceptive (SARC), while to 91/160 (56.9%) a LARC was prescribed. Women with a LARC prescription were older than them with a short-acting (SARC) (p < .0001). Women with LNG-IUS 52 mg prescription were significantly the oldest (42.9 ± 5.3), while those with intrauterine copper device and lower dose LNG-IUS were of similar age (36.5 ± 7.3 and 34.9 ± 2.3), significantly lower (p < .005). Women with implant prescription had the same age as SARC, being the youngest (30.7 ± 8.9 and 31.0 ± 9.5) (p < .0001). Women with LNG-IUS 52 mg prescription mg presented with bigger uterine volume (p = .001). In multivariate analyses, the LNG-IUS 52 mg prescription was significantly linked only to age (OR 1.24; 95% CI 1.11–1.37, p < .0001) and presence of adenomyosis (OR 4.56; 95% CI 1.45-14.33, p = .009). Conclusions The use of LNG-IUS 52 mg instead of other LARCs is preferred for older women, with uteri of increased volume due to adenomyosis, suggesting a possible differential use of available LNG-IUSs in the contemporary clinical practice.

Effect of Elagolix on Menstrual Blood Loss in Women With Uterine Fibroids and Adenomyosis [15B

INTRODUCTION: Evaluate the efficacy of elagolix with add-back therapy on menstrual blood loss (MBL) and safety in women with uterine fibroids (UF), heavy menstrual bleeding (HMB) and adenomyosis. METHODS: Pooled data from two investigational, IRB approved, 6-month, randomized, double-blind, placebo-controlled phase 3 studies, Elaris UF-1 and UF-2, was used to conduct a subset analysis in premenopausal women (18–51 years) with HMB (&gt;80mL MBL/cycle) associated with UF and baseline adenomyosis diagnosed by ultrasound and/or MRI. Primary endpoint was the proportion of women with &lt;80mL MBL during the final month and ≥50% reduction in MBL from baseline to final month. Secondary and other efficacy endpoints included proportion of women who achieved amenorrhea or suppression of bleeding during the final month. MBL was assessed with alkaline hematin method. Adverse events (AEs) and bone mineral density (BMD) were monitored. RESULTS: Of 790 women treated, 126 (16%) had adenomyosis at baseline. Proportion of responders for the primary endpoint was significantly greater (P&lt;.001) for elagolix+E2/NETA [76.8% (95% CI 65.84, 87.82)] compared to placebo [12.1% (95% CI 0.97, 23.15)]. Responder rate was significantly greater (P&lt;.001) for elagolix+E2/NETA versus placebo for amenorrhea and suppression of bleeding. These results, along with AEs and mean change in lumbar BMD from baseline to month 6, were consistent with the all-subject group. CONCLUSION: In women with HMB associated with UF and co-existing adenomyosis at baseline, elagolix +E2/NETA significantly reduced MBL versus placebo similar to the all-subject group suggesting that elagolix is effective in reducing HMB in women with UF despite the presence of adenomyosis.

Clinical and immunological aspects of early reproductive losses in patients with adenomyosis

Aim. To evaluate the clinical and immunological features of the early gestational period in patients with adenomyosis.Materials and methods. The study included 110 patients with first spontaneous pregnancy in 6–9 weeks. 75 pregnant women with a history of grade 1 adenomyosis were divided into two groups: group 1 comprised 43 patients with a threatened miscarriage, group 2 included 32 patients without a threat of pregnancy termination. Group 3 (control) included 35 pregnant women without a burdened history with a physiological pregnancy course. The cytokine profile of peripheral blood and cervical mucus was studied, as well as the level of LL-37 (cathelicidin) antimicrobial peptide.Results. A pro-inflammatory shift of the cytokine balance as well as increased pro-angiogenic activity, determined by the VEGF-R2 / VEGF-A ratio, were observed in pregnant women with grade 1 adenomyosis during a physiologically ongoing pregnancy in the 1st trimester. A threatened miscarriage in the presence of adenomyosis is accompanied by statistically significant changes in the cytokine profile, a decrease in pro-angiogenic activity and an increased level of LL-37 in cervical mucus.Conclusion. Pregnancy with adenomyosis of the 1st degree, in the absence of other risk factors, is complicated by a threatened miscarriage in more than half of cases. The revealed clinical and immunological aspects of early reproductive losses require further in-depth study, since these signs may indicate the presence of chronic endometritis in patients with adenomyosis not determined by non-invasive research methods.

21: A posterior uteroperitoneal fistula: AN unexpected finding

This video shows the surgical evaluation of a posterior uteroperitoneal defect resulting in excision of a fistula tract and repair in multiple layers. Uteroperitoneal fistulas are rare and when discovered are typically anterior in the location of a uterine scar. We present a unique case of a spontaneous posterior uteroperitoneal fistula in a patient who presented for evaluation of pelvic pain, dysmenorrhea and secondary infertility. She had a prior history of one uncomplicated cesarean section. During evaluation of her secondary infertility, imaging was performed that revealed findings suggestive of a fistula. The patient underwent robotic-assisted operative laparoscopy that revealed a four-centimeter mass on the right posterior aspect of the uterus independent from her adnexa. Concomitant hysteroscopy revealed normal endometrium and no evidence of a fistula. During chromopertubation, extravasation was seen into the peritoneal cavity from this mass. The mass and fistula tract were excised to the level of the endometrium without a connection found from her cesarean scar. Reconstruction was performed in multiple layers. She also had endometriotic lesions intraperitoneally in locations distant from the mass. The patient had significant improvement in her symptoms postoperatively. We present a unique case of a suspected spontaneous posterior uteroperitoneal fistula in the presence of endometriosis without evidence of a connection to her prior hysterotomy scar. Possible etiologies of this include an undiagnosed hysterotomy extension that went unrepaired or a result of chronic inflammation from deep infiltrating endometriosis. As in our case, successful treatment of symptoms resulting from an uteroperitoneal fistula requires removal of the fistula tract. The constellation of pelvic pain, dysmenorrhea, post-menstrual bleeding, and infertility should raise suspicion for an uteroperitoneal fistula.

14: Coincidental appendectomy in the surgical management of women with endometriosis and pelvic pain

The purpose of this study is to describe the rate of appendiceal endometriosis (AppE) in women having coincidental appendectomy at time of gynecologic surgery for pelvic pain, stage I-II endometriosis, or stage III-IV endometriosis. Coincidental appendectomy as standard of care in surgery for endometriosis and chronic pelvic pain has not been widely adopted largely due to uncertainty as to the prevalence of appendiceal pathology and procedure safety. This is a retrospective case series in which data were obtained by review of an internal database, with validation of data through chart review, tracking women having coincidental appendectomy during surgery for endometriosis or pelvic pain. All patients were from an academic tertiary referral hospital in the Northeastern United States between March 2013 and June 2019. Our primary outcome is the association between surgically documented endometriosis and AppE. Secondary outcomes include AppE association with other pathology and complications associated with coincidental appendectomy. Six hundred nine consecutive women were included in the analysis. Intraoperative findings were evaluated categorically in the following groups: no endometriosis (n = 56, 9%), stage I-II endometriosis (n = 409, 67%), or stage III-IV endometriosis (n = 144, 24%). AppE was present in 14.6% of women and was significantly associated with the indication for appendectomy. AppE was present in 3.6% of women with no endometriosis, 8.3% with stage I-II endometriosis, and 37.5% with stage III-IV endometriosis. When compared to negative appendiceal pathology, AppE was significantly associated with endometriosis (OR 4.7, CI 2.4, 9.1, p < 0.001), and was not associated with the presence of adenomyosis or fibroids alone. There was no association between AppE and age or BMI. There were no intraoperative or postoperative complications related to coincidental appendectomy up to 12 weeks postoperative. Women with endometriosis have an increased risk of AppE, greatest with stage III-IV endometriosis. Given the high prevalence of AppE in this population and the minimal complication risk with coincidental appendectomy, it should form part of complete endometriosis excision for these patients.

4:21 PM Abstract No. 174 Uterine artery embolization for fibroids versus fibroids and adenomyosis

To compare outcomes following uterine artery embolization (UAE) for patients with fibroids versus those with fibroids and adenomyosis A total of 145 patients underwent UAE at a single institution between August 2016 and June 2019. A retrospective review was performed of patient demographics, pre procedure MRI findings, and post procedure clinical and MRI outcomes. Statistical analysis was used to compare patients with fibroids only versus those with a combination of fibroids and adenomyosis. Eight patients were excluded due to lack of complete MRI studies available in PACS. Of the eligible patients, 103 had fibroids only and 34 patients had a combination of fibroids and adenomyosis. 81.4% of patients in the fibroid only group presented with menorrhagia vs. 91.2% in the combination group (P = 0.179). Significantly fewer patients with combination fibroids and adenomyosis presented with bulk symptoms, 67.6% vs. 85.1% in the fibroids only group (P = 0.025). There was no difference in demographics, uterine volume (P = 0.727) or amount of embolic material used during the UAE (P = 0.092) between groups. Clinical follow-up was available for 72 fibroid only patients and 23 combination patients with no difference in outcomes between the two groups. Menorrhagia improved in 91.4% of the fibroid only group vs. 82.6% in the combination group (P = 0.236) and bulk symptoms improved in 81.9% of the fibroid only group vs. 94.4% in the combination group (P = 0.191). Post-procedure MRI was available for 58 fibroid only patients and 15 combination patients and demonstrated no significant difference in the degree of nonenhancement (NE) when graded on a 4 tier scale of 100% NE, >90% NE, >80% NE and <80% NE (P = 0.226). Of the patients with adenomyosis, 86.7% (13/15) had improvement in the appearance of adenomyosis on post procedure MRI. This demonstrates that the presence of adenomyosis does not have an impact on the clinical or imaging success rate of uterine artery embolization when treating patients with a combination of fibroids and adenomyosis.

High glypican-3 expression characterizes a distinct subset of ovarian clear cell carcinomas in Canadian patients: an opportunity for targeted therapy

The expression frequency and distribution of glypican-3 (GPC3) was retrospectively assessed by immunohistochemistry in 316 accurately phenotyped ovarian clear cell carcinoma (OCCC) specimens from Canadian patients. The study aimed to evaluate the prevalence of this biomarker in OCCC in a mixed-ethnicity Canadian population and to evaluate associations of GPC3 expression with clinicopathological parameters. Tissue microarrays with napsin A or HNF1β positive and WT1-negative OCCC specimens were evaluated using a GPC3 antibody clone 1G12. Membranous, cytoplasmic, and Golgi pattern GPC3 expression was noted in 184 of 316 (58.2%) cases; 63 of 316 (20%) cases showed high GPC3 expression (>50% of tumor cells were positive). GPC3 expression was not associated with age, stage, and residual disease after primary surgery. High GPC3 expression did not correlate with a specific morphological pattern or the presence of endometriosis. Furthermore, GPC3 expression was not significantly associated with survival in the entire cohort. Statistically significant association of high GPC3 expression was noted with higher body mass index, napsin A positivity, estrogen receptor (ER) negativity, and ARID1A retention. In a stratified analysis by ARID1A status, high GPC3 expression was significantly associated with unfavorable outcomes in cases with loss of ARID1A (n=10; log rank p=0.0048). Women diagnosed with OCCC and high GPC3 expression were also more likely to receive adjuvant chemotherapy. Considering the tumor-specific membranous expression of GPC3 in 58% of cases and high interobserver reproducibility, GPC3 immunohistochemistry is a robust predictive test for inclusion in clinical trials for GPC3-targeted therapies for OCCC.

Coexistence of uterine adenomyosis is not associated with a better prognosis in endometrioid-type endometrial cancer

Prognostic value of accompanying adenomyosis in endometrial cancer is the subject of interest due to their common etiology and co-occurrence frequency. However, it is still unclear whether adenomyosis has a role in the prognosis of endometrial cancer. The aim of this study was to determine the effects of adenomyosis on the prognosis of patients with endometrial cancer. In this study, medical records of 552 patients with endometrioid endometrial cancer who underwent surgery between 2007 and 2017 were retrospectively reviewed. The patients were divided into two groups based on the presence or absence of adenomyosis, and these two groups were compared in terms of the clinicopathological factors and survival outcomes of patients. Of these patients, 103 (18.7%) had adenomyosis, and the remaining 449 (81.3%) did not. The endometrial cancer patients with adenomyosis exhibited earlier stages (p< 0.001), lower tumor grades (p< 0.001), tumor sizes ≤ 2cm (p= 0.002), myometrial invasion < 50% (p< 0.001), and negative lymphovascular space invasion (p< 0.001). The 5-year overall survival rate was comparable between the adenomyosis and non-adenomyosis groups (95 vs. 89.1%, respectively; p= 0.085). The presence of adenomyosis was significantly associated with a higher 5-year disease-free survival rate (95.1 vs. 87.9%; p= 0.047), but adenomyosis did not remain as a prognostic factor in multivariate analysis. The results of our study showed that the endometrioid endometrial cancer patients with adenomyosis are significantly associated with smaller tumor sizes, less myometrial invasion, lower tumor grades, less lymphovascular space invasion, and earlier FIGO stages. Nevertheless, adenomyosis was not found to be an independent prognostic factor for endometrioid endometrial cancer.

Natural Orifice Transluminal Endoscopic Surgery-assisted Vaginal Hysterectomy versus Total Laparoscopic Hysterectomy: A Single-center Retrospective Study Using Propensity Score Analysis.

Objectives:The aim of this study is to evaluate the safety and efficacy of natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy (NOTES-AVH) compared with total laparoscopic hysterectomy (TLH).Materials and Methods:The population was a cohort of women who underwent NOTES-AVH and TLH for a nonprolapsed uterus and benign gynecological disease between October 2015 and December 2017 at Rajavithi Hospital, Thailand. Study outcomes included operative time, the requirement of blood transfusion, perioperative complications, and postoperative pain. Factors applied for propensity score matching included age, body mass index, parity, underlying disease, previous abdominal surgery, preoperative diagnosis, presence of endometriosis, and uterine weight. Mean difference (MD) and risk ratio with 95% confidence interval (CI) were calculated to represent relative measures of the comparison.Results:Among the 50 pairs, there were no differences in operative time (MD 15.9 min; 95% CI − 9.3–41.1), intraoperative complications (relative risk [RR] 0.33; 95% CI 0.04–3.10) or requirement of blood transfusion (RR 1.50; 95% CI 0.26–8.60) between the NOTES-AVH and TLH groups. NOTES-AVH was associated with lower intensity of postoperative pain (MD − 1.5 at 6-h; 95% CI − 0.8–2.2 and MD − 1.0 at 24-h; 95% CI − 0.4–−1.6) and shorter length of stay (MD − 0.3 day; 95% CI − 0.1–0.7 day).Conclusion:NOTES-AVH was safe and feasible for an alternative approach for hysterectomy. This technique was superior to TLH in that no abdominal incision was required, and postoperative pain was less intense.

A Patient with Tubo-Ovarian Abscess with Endometriosis after Transvaginal Oocyte Retrieval

Ultrasound-guided oocyte retrieval is a standard procedure for ovum pick up (OPU) during in vitro fertilization. Possible complications include tubo-ovarian abscesses (TOAs) in the fallopian tubes, and endometriosis may be associated with increasing the severity of pelvic infection. A 35-year-old woman who had been treated for infertility and endometriosis presented with abdominal pain that appeared several days after OPU. There were no significant changes in the size of both ovaries and fallopian tubes. A week later, transvaginal echography revealed right oviduct enlargement. Because conservative treatment with antibiotics before this revelation had not been successful, laparoscopy was performed for abscess drainage and/or excision of the adnexa. Intraoperative findings were an abscess in the right adnexa involving the ovary and fallopian tube. Preservation of the right fallopian tube was difficult due to the risk of prolonged infection, and a right appendectomy was performed. The diagnosis was a right TOA. Severe cases of pelvic infection after OPU may cause infertility. The presence of endometriosis may aggravate the infection, but the relationship between the extent of the endometriosis and the severity of the infection is not known. Even if the endometriosis is mild, as it was in this patient, surgical treatment should be considered if a severe infection occurs after OPU and conservative treatment is not effective.

Endometriosis and Pregnancy: A Single Institution Experience.

Endometriosis may compromise the physiological course of pregnancy. The aim of this prospective observational study was to evaluate whether endometriosis causes a higher prevalence of obstetric and neonatal complications as well as a higher risk of caesarean section and to detect a possible correlation between the presence, type, and location of endometriosis and obstetric complications, previous surgery, and pregnancy outcome, as well as the influence of pregnancy on the course of the disease. We compared two cohorts of women with spontaneous pregnancy, with and without endometriosis. Obstetric and neonatal outcomes, mode of delivery, presence, type, and location of endometriotic lesions and the effect of pregnancy on the disease were analyzed. A total of 425 pregnancies were evaluated: 145 cases and 280 controls. Patients with endometriosis showed a higher incidence of miscarriage, threatened miscarriage, threatened preterm labor, preterm delivery, placental abruption, and a higher incidence of caesarean section. A significant correlation with pregnancy-induced hypertension and preeclampsia was found in the presence of adenomyosis. No difference in fetal outcome was found. One case of hemoperitoneum during pregnancy was observed. Pregnancy in women with endometriosis carries a higher risk of obstetric complications, such as miscarriage, threatened miscarriage, preterm labor, preterm birth, and a higher caesarean section rate. Endometriosis does not seem to influence fetal well-being.

Differential Expression of KRAS and SIRT1 in Ovarian Cancers with and Without Endometriosis.

Accumulating research shows that ovarian cancer progression can be influenced by both gene mutations and endometriosis. However, the exact mechanism at hand is poorly understood. In the current study, we explored the expression of KRAS and SIRT1, two genes previously identified as altered in endometriosis and ovarian cancer. Human endometrial samples were obtained from regularly cycling women with endometriosis, ovarian cancer, and endometriosis-associated ovarian cancer between 18 and 50 of age undergoing hysterectomy, and immunohistochemical analyses were performed. The cytoplasmic expression of KRAS was low in eutopic endometrium from women without endometriosis or ovarian cancer; however, it was elevated in those who have been diagnosed with endometriosis, as well as ovarian cancer with or without the presence of endometriosis. Nuclear and cytoplasmic SIRT1 expression was also low within endometrium without either disease. However, nuclear SIRT1 expression was increased in those with endometriosis and ovarian cancer associated with endometriosis. Nuclear but not the cytoplasmic expression of SIRT1 correlated with KRAS expression in ovarian cancers associated with endometriosis. These results suggest roles of KRAS and SIRT1 in endometriosis and endometriosis-associated ovarian cancer. Cytoplasmic KRAS expression proves to be a key biomarker in both diseases, while nuclear SIRT1 may be a new biomarker specific to those with endometriosis and those with both endometriosis and ovarian cancer. Further research of these genes could aid in determining the pathogenesis of both diseases and help in clarifying the development of endometriosis-associated ovarian cancer.