Aim： To evaluate the anti-proliferative activity and mitochondrial toxicity of gossypol in endometrioma cells maintained in short-term cultures. Methods： （A） Three endometrioma cell lines from patients were treate...Aim： To evaluate the anti-proliferative activity and mitochondrial toxicity of gossypol in endometrioma cells maintained in short-term cultures. Methods： （A） Three endometrioma cell lines from patients were treated with 25 or 50 nmol/L gossypol for up to 12 days. The effect of gossypol on the cell growth was recorded. （B） A phosphorescence oxygen analyzer was used to determine the effects of gossypol on mitochondrial oxygen consumption of six endometrioma cell lines from patients. （C） Cellular gossypol accumulations in three endometrioma cell lines from patients were measured by high-pressure liquid chromatography. Results： Proliferation of the endometrioma cells was inhibited by 25 and 50 nmol/L gossypol. Respiration of the endometrioma cells was inhibited by 10 μmol/L gossypol. Cellular gossypol was detected in the endometrioma cell lines that were treated for 24 h with l0 and 0.3 μmol/L gossypol. Conclusion： Gossypol invokes a potent toxicity on cultured endometrioma cells.展开更多
Ovarian endometrioma is a common form of endometriosis, which may cause infertility, dysmenorrhea and pelvic pain in women of reproductive age. Although surgery is the treatment of choice for endometriomas, recurrence...Ovarian endometrioma is a common form of endometriosis, which may cause infertility, dysmenorrhea and pelvic pain in women of reproductive age. Although surgery is the treatment of choice for endometriomas, recurrence poses a formidable frustration. This study investigated potential risk factors of endometriomas recurrence, aiming to better understand its pathogenesis. A total of 307 patients with endometriomas were followed up for an average of 28.6 months and the 1-, 2- and 3-year cumulative recurrence rate was 9.5%, 21.9%, and 29.2%, respectively. Twenty-one potential risk factors for endometriomas recurrence were evaluated using Cox＇s proportional hazards models. Total revised American Fertility Society （rAFS） score was significantly associated with higher recurrence （OR=1.858, 95% CI=1.122-3.075, P=0.016）, as well as younger age at surgery （OR=0.953, 95% CI=0.915-0.992, P=0.020）. Semiradical surgical treatment was defined as surgical removal of cyst plus hysterectomy with preservation of bilateral or unilateral ovary, and was a significant factor that was associated with lower recurrence than the conservative surgery （OR=0.318, 95% CI=0.107-0.951, P=-0.040）. Postopera- tive pregnancy was favorable factors for disease recurrence （OR=0.217, 95% CI=0.102-0.460, P=0.000）. The results suggest that endometrioma recurrence is inversely associated with age at surgery and postooerative preanancv, and may correlate with total rAFS score and conservative surgery method.展开更多
AIM: To evaluate endometrioma located at cesarean scatrix.METHODS: Medical data of 6 patients who presented to our institution with abdominal wall endometrioma were evaluated retrospectively and reviewed literature in...AIM: To evaluate endometrioma located at cesarean scatrix.METHODS: Medical data of 6 patients who presented to our institution with abdominal wall endometrioma were evaluated retrospectively and reviewed literature in this case series.The diagnostic approaches and treatment is discussed.RESULTS: All patients had a painful mass located at abdominal scars with history of cesarean section.The ages ranged from 31 to 34 and Doppler ultrasonography(US) detected hypoechoic mass with a mean diameter of 30 mm.Initial diagnosis was endometrioma in 4 and incisional hernia in 2 of 6 patients.Treatment was achieved with surgical excision in 5 patients,and one is followed by hormone suppression therapy with gonadotropin.CONCLUSION: Malignant or benign tumors of abdominal wall and incisional hernias should be kept in mind for diagnosis of endometrioma.Imaging methods like doppler US,computed tomography and magnetic resonance imaging should be used for differential diagnosis.Definitive diagnosis can only be made histopathologically.The treatment should be complete surgical excision and take care against intraoperative auto-inoculation of endometrial tissue in order to prevent recurrences.展开更多
Endometriosis outside the pelvic cavity is rare, but its most common extra-pelvic location is the abdominal wall, occurring most frequently after cesarean delivery. Fistula tracks through these lesions in the abdomina...Endometriosis outside the pelvic cavity is rare, but its most common extra-pelvic location is the abdominal wall, occurring most frequently after cesarean delivery. Fistula tracks through these lesions in the abdominal wall to the uterus are rare. However, a fistula between abdominal wall endometriosis to an endometrioma has not been reported. A 46-year-old multigravid woman presented with complaint of cyclical pain and bleeding from her cesarean delivery scar and pelvic pressure. Computed tomography revealed a complex, 16-cm left adnexal mass. Intraoperatively, a fistulous tract connecting a large endometrioma in the abdominal-pelvic cavity to the skin was noted and wide local excision of this track was performed in conjunction with aggressive surgical management of endometriosis throughout the pelvis. Pathologic analysis of the resected specimen confirmed the diagnosis. Although rare, endometrioma-cutaneous fistula should be included in the differential diagnosis of suspected abdominal wall endometriosis with concurrent adnexal mass for appropriate surgical planning.展开更多
Objective To evaluate the ovarian response to the gonadotrophin （Gn） in the COH and observe the outcome of lVF for the patients with endometriomas. Methods A retrospective analysis of 32 patients with endometrioma u...Objective To evaluate the ovarian response to the gonadotrophin （Gn） in the COH and observe the outcome of lVF for the patients with endometriomas. Methods A retrospective analysis of 32 patients with endometrioma undergoing IVFET. It included 71 cycles, and 59 cycles in 32 patients with tubal factor associated infertility were as the control. Results There were statistically significant differences between the two groups in the cancelling rate （P〈0.01）, the E： concentration in the day of hCG injection （P〈0.05）, retrieval eggs（P〈0.001）, rate of fertilization （P〈0.05）, rate of cleavage （P〈0.05）, obtained embryos （P〈0. 001）. There were no statistically significant differences in the clinical pregnancy rate, implantation rate and delivery rate, P all〉0.05. Conclusion The patients with endometriomas had a poor response to the Gn in the COH. The endometrial accessibility in patients with endometriomas seemed not to be affected by the presence of endometriomas. But considering the higher cancelling rate, the prognostic for the patients with endometriomas was worth than the patients with tubal factor associated infertility.展开更多
Endometriosis, a common gynecological condition, is defined as the presence of functioning endometrial tissue outside the uterine cavity. It often presents as a cyclic, hormonally stimulated pain in women during their...Endometriosis, a common gynecological condition, is defined as the presence of functioning endometrial tissue outside the uterine cavity. It often presents as a cyclic, hormonally stimulated pain in women during their reproductive years. While endometriosis is usually located within the pelvis, it may also occur at intraperitoneal, intestinal, perineal, and distant ectopic sites. Although often diffuse, a localized, focal mass of endometrial tissue is termed as an endometrioma. In rare occurrences, an endometrioma will present superficially to the peritoneum within the abdominal wall following gynecologic or obstetric surgery. The presence of an abdominal wall endometrioma within a cesarean section scar may pose a diagnostic dilemma, which is often misdiagnosed, and results in surgery referrals for treatment. The clinical symptoms and sonographic appearance of abdominal wall endometriomas occurring at cesarean section scars are highlighted in this case series.展开更多
<span style="font-family:Verdana;">Endometriosis is an estrogen dependent gynecological disorder, which can occur throughout the reproductive age of women, causing chronic pelvic pain, substantial morb...<span style="font-family:Verdana;">Endometriosis is an estrogen dependent gynecological disorder, which can occur throughout the reproductive age of women, causing chronic pelvic pain, substantial morbidity, and impaired fertility. It is clinically defined as the presence of ectopic endometrium resulting in sustained inflammatory reaction. In India</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> about 29,000,000 women suffer from endometriosis. Severe pelvic pain and recurrent endometriomas were observed even after surgery. We have conducted aspirations totally in 110 patients in which most of the patients were suffering from Stage III & Stage IV of endometriosis except for 7 patients for whom we have done as primary therapy for endometriomas. Among 110 </span><span style="font-family:Verdana;">patients</span><span style="font-family:;" "=""><span style="font-family:Verdana;">, 4 patients didn’t turn up for follow up after first aspiration. This pilot study conducted with 110 patients in Ponni Hospital and Fertility Research Centre, Madurai aimed to evaluate pregnancy outcome in 51 infertile patients, and to alleviate pelvic pain, to restore a healthy sexual life and to reduce the recurrence rate of Ovarian Endometriomas (OE) in 59 patients, who did not seek fertility, After using the newer sclerosing agent Leuprolide with Cefoperazone Sulbactam (LCS) under ultrasound guidance. This prospective pilot study resulted in a highly significant achievement in pregnancy where 41 patients conceived out of 51 patients (80.39%) only 6 are in ongoing treatment. Those who didn’t seek fertility were 59 of which 43 have </span><span style="font-family:Verdana;">completed family 1</span></span><span style="font-family:Verdana;">3</span><span style="font-family:Verdana;"> have one child</span><span style="font-family:Verdana;"> and 3 unmarried girls</span><span style="font-family:Verdana;">. 96.61% were relieved of pain and recurrence and restored healthy sexual life, 2 are in ongoing treatment. We have not encountered any adverse effects during this</span><span style="font-family:Verdana;"> treatment.</span>展开更多
Objective:To study the prevalence and associated factors of recurrent ovarian endometrioma after ovarian cystectomy.Methods:This retrospective study analyzed 303 patients who underwent cystectomy for ovarian endometri...Objective:To study the prevalence and associated factors of recurrent ovarian endometrioma after ovarian cystectomy.Methods:This retrospective study analyzed 303 patients who underwent cystectomy for ovarian endometrioma and had at least a 2-year follow-up at Srinagarind Hospital from January 2013 to December 2018.The patients were divided into the recurrent and nonrecurrent groups according to the findings from postoperative transvaginal ultrasonography 6 months after undergoing surgery.Nineteen factors were collected for risk evaluation.The prevalence of recurrent ovarian endometrioma and its 95%confident interval(CI)were calculated.Univariate and multivariable logistic regression analyses were performed to determine the association between factors and recurrence.Results:Recurrent ovarian endometrioma occurred in 33%(95%CI 27.7%-38.3%)patients.The median duration of followup was 36 months.during the median follow-up period of 36 months.Preoperative history of parity,preoperative infertility history,endometriosis surgery,moderate to severe dysmenorrhea,dyspareunia,intraoperative stage 4 according to revised American Society for Reproductive Medicine classification,presence of adenomyosis,and postoperative pain relief were associated factors based on univariate analysis.In contrast,infertility[odds ratio(OR)2.22,95%CI 1.14-4.33],moderate to severe dysmenorrhea(OR 2.13,95%CI 1.09-4.15),and postoperative pelvic pain relief(OR 0.22,95%CI 0.12-0.42)were independently associated factors based on multivariable logistic regression analysis.Conclusions:In our setting,preoperative infertility history and moderate to severe dysmenorrhea were associated with a higher recurrent ovarian endometrioma risk.In contrast,postoperative pain relief was significantly associated with lower recurrence risk.展开更多
Background: Endometrial cell implantation after abdominal surgery, mainly after caesarean section, may result in formation of endometrioma, which is usually described to be of various sizes, and adjacent to the surgic...Background: Endometrial cell implantation after abdominal surgery, mainly after caesarean section, may result in formation of endometrioma, which is usually described to be of various sizes, and adjacent to the surgical scar. Case: A 36-year old woman complaining of a mass of the abdominal wall with pain during the menstrual period, with a caesarean section 5 years earlier, presented a rounded tumour not contiguous to the Pfannenstiel’s laparotomy scar, of hard consistence, fixed and adherent to the deep abdominal wall structures, located on the left paramedian epigastric region. Magnetic Resonance imaging showed the nodule, involving the deep layers of the abdominal wall and the distance from the laparotomic scar. Surgical removal was performed with wide excision of the lesion, causing a large wall defect. After histological confirmation (endometriosis) by frozen section, reconstruction of the abdominal wall required prolene mesh grafting. After twelve months the patient is healthy. Conclusion: When abdominal wall endometrioma is located distant from the scar, perhaps more frequently after Pfannenstiel’s laparotomic incision, the differential diagnosis may be more difficult and MRI can help differentiating many of these lesions, and histological confirmation should be obtained intraoperatively, by frozen section, to allow an oncological resection if required.展开更多
A 17-year-old nulligravida woman presented to the emergency department complaining of a six months’ history of severe dysmenorrhea. The patient underwent a laparoscopic excision of a right ovarian endometrioma in ano...A 17-year-old nulligravida woman presented to the emergency department complaining of a six months’ history of severe dysmenorrhea. The patient underwent a laparoscopic excision of a right ovarian endometrioma in another hospital one year ago, 24 months after menarche at 14 years of age. Transvaginal ultrasonography, magnetic resonance imaging, hysteroscopy as well as laparo- scopy revealed a unicornuate uterus with a noncommunicating right rudimentary horn, a dilated right fallopian tube and a novel 40 mm right ovarian endometrioma. An excision of the right fallopian tube, the rudimentary horn and the endometrioma was performed. Since endometriosis may be originated by retrograde menstruation, an obstructive müllerian malformation should be ruled out at the diagnosis of endometriosis, particularly in adolescents. It may lead clinicians to provide an initial definitive treatment for avoidingrapid recurrent endometriosis.展开更多
Introduction: The purposes were to clarify the magnetic resonance imaging (MRI) findings of malignant ovarian lesions arising from endometriomas, and to compare the lesions’ histopathology and MRI characteristics. Ma...Introduction: The purposes were to clarify the magnetic resonance imaging (MRI) findings of malignant ovarian lesions arising from endometriomas, and to compare the lesions’ histopathology and MRI characteristics. Materials and Methods: Between May 2004 and December 2012, 140 patients, all of whom were diagnosed as having an endometrioma by using MR imaging, underwent surgery. We compared the MR characteristics including size and signal intensity of the tumor and mural nodules, the thickness of the septum, and the thickness of the wall with the pathological diagnoses. The attached angles of the mural nodules to the cyst wall were also evaluated. Results: Among the 179 lesions, preoperative MR imaging diagnosed 153 benign and 26 malignant. Based on the pathological results, 169 were diagnosed as benign and 10 were diagnosed as malignant. Finally, preoperative MR imaging correctly diagnosed 152 benign (group 1) and nine malignant (group 2), misdiagnosed 17 benign as malignant (group 3) and misdiagnosed one malignant as benign (group 4). As for mural nodules, there was a significant difference between groups 1 and 2 in the mean maximum diameter of the mural nodules. An acute attached angle was shown in 1 of 7 in group 1, in 11 of 16 in group 2, and in 14 of 22 in group 3. We also compared benign group with malignant group on the final pathological findings. As for mural nodules, there was a significant difference between groups 1 + 3 and group 2 in the mean maximum diameter of the mural nodules. On dynamic study, there were 22 enhanced mural nodules (75.9%) on group 1 + 3. Conclusion: Most of endometriomas preoperatively diagnosed as benign were pathological benign lesions. Endometriomas that contain many enhanced mural nodules with papillary shape, larger size, showing hypointense on T1WI, hyperintense on T2WI and showing an acute attached angle may have malignant potential.展开更多
文摘Aim： To evaluate the anti-proliferative activity and mitochondrial toxicity of gossypol in endometrioma cells maintained in short-term cultures. Methods： （A） Three endometrioma cell lines from patients were treated with 25 or 50 nmol/L gossypol for up to 12 days. The effect of gossypol on the cell growth was recorded. （B） A phosphorescence oxygen analyzer was used to determine the effects of gossypol on mitochondrial oxygen consumption of six endometrioma cell lines from patients. （C） Cellular gossypol accumulations in three endometrioma cell lines from patients were measured by high-pressure liquid chromatography. Results： Proliferation of the endometrioma cells was inhibited by 25 and 50 nmol/L gossypol. Respiration of the endometrioma cells was inhibited by 10 μmol/L gossypol. Cellular gossypol was detected in the endometrioma cell lines that were treated for 24 h with l0 and 0.3 μmol/L gossypol. Conclusion： Gossypol invokes a potent toxicity on cultured endometrioma cells.
基金supported by the National Science Foundation for Young Scientists of China(No.81000240)
文摘Ovarian endometrioma is a common form of endometriosis, which may cause infertility, dysmenorrhea and pelvic pain in women of reproductive age. Although surgery is the treatment of choice for endometriomas, recurrence poses a formidable frustration. This study investigated potential risk factors of endometriomas recurrence, aiming to better understand its pathogenesis. A total of 307 patients with endometriomas were followed up for an average of 28.6 months and the 1-, 2- and 3-year cumulative recurrence rate was 9.5%, 21.9%, and 29.2%, respectively. Twenty-one potential risk factors for endometriomas recurrence were evaluated using Cox＇s proportional hazards models. Total revised American Fertility Society （rAFS） score was significantly associated with higher recurrence （OR=1.858, 95% CI=1.122-3.075, P=0.016）, as well as younger age at surgery （OR=0.953, 95% CI=0.915-0.992, P=0.020）. Semiradical surgical treatment was defined as surgical removal of cyst plus hysterectomy with preservation of bilateral or unilateral ovary, and was a significant factor that was associated with lower recurrence than the conservative surgery （OR=0.318, 95% CI=0.107-0.951, P=-0.040）. Postopera- tive pregnancy was favorable factors for disease recurrence （OR=0.217, 95% CI=0.102-0.460, P=0.000）. The results suggest that endometrioma recurrence is inversely associated with age at surgery and postooerative preanancv, and may correlate with total rAFS score and conservative surgery method.
文摘AIM: To evaluate endometrioma located at cesarean scatrix.METHODS: Medical data of 6 patients who presented to our institution with abdominal wall endometrioma were evaluated retrospectively and reviewed literature in this case series.The diagnostic approaches and treatment is discussed.RESULTS: All patients had a painful mass located at abdominal scars with history of cesarean section.The ages ranged from 31 to 34 and Doppler ultrasonography(US) detected hypoechoic mass with a mean diameter of 30 mm.Initial diagnosis was endometrioma in 4 and incisional hernia in 2 of 6 patients.Treatment was achieved with surgical excision in 5 patients,and one is followed by hormone suppression therapy with gonadotropin.CONCLUSION: Malignant or benign tumors of abdominal wall and incisional hernias should be kept in mind for diagnosis of endometrioma.Imaging methods like doppler US,computed tomography and magnetic resonance imaging should be used for differential diagnosis.Definitive diagnosis can only be made histopathologically.The treatment should be complete surgical excision and take care against intraoperative auto-inoculation of endometrial tissue in order to prevent recurrences.
文摘Endometriosis outside the pelvic cavity is rare, but its most common extra-pelvic location is the abdominal wall, occurring most frequently after cesarean delivery. Fistula tracks through these lesions in the abdominal wall to the uterus are rare. However, a fistula between abdominal wall endometriosis to an endometrioma has not been reported. A 46-year-old multigravid woman presented with complaint of cyclical pain and bleeding from her cesarean delivery scar and pelvic pressure. Computed tomography revealed a complex, 16-cm left adnexal mass. Intraoperatively, a fistulous tract connecting a large endometrioma in the abdominal-pelvic cavity to the skin was noted and wide local excision of this track was performed in conjunction with aggressive surgical management of endometriosis throughout the pelvis. Pathologic analysis of the resected specimen confirmed the diagnosis. Although rare, endometrioma-cutaneous fistula should be included in the differential diagnosis of suspected abdominal wall endometriosis with concurrent adnexal mass for appropriate surgical planning.
文摘Objective To evaluate the ovarian response to the gonadotrophin （Gn） in the COH and observe the outcome of lVF for the patients with endometriomas. Methods A retrospective analysis of 32 patients with endometrioma undergoing IVFET. It included 71 cycles, and 59 cycles in 32 patients with tubal factor associated infertility were as the control. Results There were statistically significant differences between the two groups in the cancelling rate （P〈0.01）, the E： concentration in the day of hCG injection （P〈0.05）, retrieval eggs（P〈0.001）, rate of fertilization （P〈0.05）, rate of cleavage （P〈0.05）, obtained embryos （P〈0. 001）. There were no statistically significant differences in the clinical pregnancy rate, implantation rate and delivery rate, P all〉0.05. Conclusion The patients with endometriomas had a poor response to the Gn in the COH. The endometrial accessibility in patients with endometriomas seemed not to be affected by the presence of endometriomas. But considering the higher cancelling rate, the prognostic for the patients with endometriomas was worth than the patients with tubal factor associated infertility.
文摘Endometriosis, a common gynecological condition, is defined as the presence of functioning endometrial tissue outside the uterine cavity. It often presents as a cyclic, hormonally stimulated pain in women during their reproductive years. While endometriosis is usually located within the pelvis, it may also occur at intraperitoneal, intestinal, perineal, and distant ectopic sites. Although often diffuse, a localized, focal mass of endometrial tissue is termed as an endometrioma. In rare occurrences, an endometrioma will present superficially to the peritoneum within the abdominal wall following gynecologic or obstetric surgery. The presence of an abdominal wall endometrioma within a cesarean section scar may pose a diagnostic dilemma, which is often misdiagnosed, and results in surgery referrals for treatment. The clinical symptoms and sonographic appearance of abdominal wall endometriomas occurring at cesarean section scars are highlighted in this case series.
文摘<span style="font-family:Verdana;">Endometriosis is an estrogen dependent gynecological disorder, which can occur throughout the reproductive age of women, causing chronic pelvic pain, substantial morbidity, and impaired fertility. It is clinically defined as the presence of ectopic endometrium resulting in sustained inflammatory reaction. In India</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> about 29,000,000 women suffer from endometriosis. Severe pelvic pain and recurrent endometriomas were observed even after surgery. We have conducted aspirations totally in 110 patients in which most of the patients were suffering from Stage III & Stage IV of endometriosis except for 7 patients for whom we have done as primary therapy for endometriomas. Among 110 </span><span style="font-family:Verdana;">patients</span><span style="font-family:;" "=""><span style="font-family:Verdana;">, 4 patients didn’t turn up for follow up after first aspiration. This pilot study conducted with 110 patients in Ponni Hospital and Fertility Research Centre, Madurai aimed to evaluate pregnancy outcome in 51 infertile patients, and to alleviate pelvic pain, to restore a healthy sexual life and to reduce the recurrence rate of Ovarian Endometriomas (OE) in 59 patients, who did not seek fertility, After using the newer sclerosing agent Leuprolide with Cefoperazone Sulbactam (LCS) under ultrasound guidance. This prospective pilot study resulted in a highly significant achievement in pregnancy where 41 patients conceived out of 51 patients (80.39%) only 6 are in ongoing treatment. Those who didn’t seek fertility were 59 of which 43 have </span><span style="font-family:Verdana;">completed family 1</span></span><span style="font-family:Verdana;">3</span><span style="font-family:Verdana;"> have one child</span><span style="font-family:Verdana;"> and 3 unmarried girls</span><span style="font-family:Verdana;">. 96.61% were relieved of pain and recurrence and restored healthy sexual life, 2 are in ongoing treatment. We have not encountered any adverse effects during this</span><span style="font-family:Verdana;"> treatment.</span>
文摘Objective:To study the prevalence and associated factors of recurrent ovarian endometrioma after ovarian cystectomy.Methods:This retrospective study analyzed 303 patients who underwent cystectomy for ovarian endometrioma and had at least a 2-year follow-up at Srinagarind Hospital from January 2013 to December 2018.The patients were divided into the recurrent and nonrecurrent groups according to the findings from postoperative transvaginal ultrasonography 6 months after undergoing surgery.Nineteen factors were collected for risk evaluation.The prevalence of recurrent ovarian endometrioma and its 95%confident interval(CI)were calculated.Univariate and multivariable logistic regression analyses were performed to determine the association between factors and recurrence.Results:Recurrent ovarian endometrioma occurred in 33%(95%CI 27.7%-38.3%)patients.The median duration of followup was 36 months.during the median follow-up period of 36 months.Preoperative history of parity,preoperative infertility history,endometriosis surgery,moderate to severe dysmenorrhea,dyspareunia,intraoperative stage 4 according to revised American Society for Reproductive Medicine classification,presence of adenomyosis,and postoperative pain relief were associated factors based on univariate analysis.In contrast,infertility[odds ratio(OR)2.22,95%CI 1.14-4.33],moderate to severe dysmenorrhea(OR 2.13,95%CI 1.09-4.15),and postoperative pelvic pain relief(OR 0.22,95%CI 0.12-0.42)were independently associated factors based on multivariable logistic regression analysis.Conclusions:In our setting,preoperative infertility history and moderate to severe dysmenorrhea were associated with a higher recurrent ovarian endometrioma risk.In contrast,postoperative pain relief was significantly associated with lower recurrence risk.
文摘Background: Endometrial cell implantation after abdominal surgery, mainly after caesarean section, may result in formation of endometrioma, which is usually described to be of various sizes, and adjacent to the surgical scar. Case: A 36-year old woman complaining of a mass of the abdominal wall with pain during the menstrual period, with a caesarean section 5 years earlier, presented a rounded tumour not contiguous to the Pfannenstiel’s laparotomy scar, of hard consistence, fixed and adherent to the deep abdominal wall structures, located on the left paramedian epigastric region. Magnetic Resonance imaging showed the nodule, involving the deep layers of the abdominal wall and the distance from the laparotomic scar. Surgical removal was performed with wide excision of the lesion, causing a large wall defect. After histological confirmation (endometriosis) by frozen section, reconstruction of the abdominal wall required prolene mesh grafting. After twelve months the patient is healthy. Conclusion: When abdominal wall endometrioma is located distant from the scar, perhaps more frequently after Pfannenstiel’s laparotomic incision, the differential diagnosis may be more difficult and MRI can help differentiating many of these lesions, and histological confirmation should be obtained intraoperatively, by frozen section, to allow an oncological resection if required.
文摘A 17-year-old nulligravida woman presented to the emergency department complaining of a six months’ history of severe dysmenorrhea. The patient underwent a laparoscopic excision of a right ovarian endometrioma in another hospital one year ago, 24 months after menarche at 14 years of age. Transvaginal ultrasonography, magnetic resonance imaging, hysteroscopy as well as laparo- scopy revealed a unicornuate uterus with a noncommunicating right rudimentary horn, a dilated right fallopian tube and a novel 40 mm right ovarian endometrioma. An excision of the right fallopian tube, the rudimentary horn and the endometrioma was performed. Since endometriosis may be originated by retrograde menstruation, an obstructive müllerian malformation should be ruled out at the diagnosis of endometriosis, particularly in adolescents. It may lead clinicians to provide an initial definitive treatment for avoidingrapid recurrent endometriosis.
文摘Introduction: The purposes were to clarify the magnetic resonance imaging (MRI) findings of malignant ovarian lesions arising from endometriomas, and to compare the lesions’ histopathology and MRI characteristics. Materials and Methods: Between May 2004 and December 2012, 140 patients, all of whom were diagnosed as having an endometrioma by using MR imaging, underwent surgery. We compared the MR characteristics including size and signal intensity of the tumor and mural nodules, the thickness of the septum, and the thickness of the wall with the pathological diagnoses. The attached angles of the mural nodules to the cyst wall were also evaluated. Results: Among the 179 lesions, preoperative MR imaging diagnosed 153 benign and 26 malignant. Based on the pathological results, 169 were diagnosed as benign and 10 were diagnosed as malignant. Finally, preoperative MR imaging correctly diagnosed 152 benign (group 1) and nine malignant (group 2), misdiagnosed 17 benign as malignant (group 3) and misdiagnosed one malignant as benign (group 4). As for mural nodules, there was a significant difference between groups 1 and 2 in the mean maximum diameter of the mural nodules. An acute attached angle was shown in 1 of 7 in group 1, in 11 of 16 in group 2, and in 14 of 22 in group 3. We also compared benign group with malignant group on the final pathological findings. As for mural nodules, there was a significant difference between groups 1 + 3 and group 2 in the mean maximum diameter of the mural nodules. On dynamic study, there were 22 enhanced mural nodules (75.9%) on group 1 + 3. Conclusion: Most of endometriomas preoperatively diagnosed as benign were pathological benign lesions. Endometriomas that contain many enhanced mural nodules with papillary shape, larger size, showing hypointense on T1WI, hyperintense on T2WI and showing an acute attached angle may have malignant potential.
