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
<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
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
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
The use of trans-vaginal ultrasound (TVU) has become increasingly popular in diagnosing and treating infertility. TVU allows for a detailed examination of the female reproductive organs and can aid in identifying abno...The use of trans-vaginal ultrasound (TVU) has become increasingly popular in diagnosing and treating infertility. TVU allows for a detailed examination of the female reproductive organs and can aid in identifying abnormalities that may be contributing to infertility [1]. Additionally, TVU can assist in monitoring fertility treatments, such as in vitro fertilization. By TVS diagnosis of focal intrauterine lesions, uterine malformations and leiomyomas are easily delineated and nearly approaches the sensitivity of hysteroscopy. Abnormality of uterine cavity may affect fertility by inhibiting implantation [2]. TVS seems very accurate in the diagnosis of presence or extension of frank pelvic inflammatory disease and also promising in augmenting the outpatient diagnosis of PID among patients referred for lower abdominal pain. In addition to these conditions trans-vaginal sonography has also been described in the diagnosis of pelvic abscesses, pelvic mass, endometriomas, hydrosalpinx, intra uterine adhesions (Asherman’s syndrome), uterine hypoplasia and other developmental anomalies like mullerian or vaginal agenesis associated with infertility. In this study, it was established transvaginal sonography as a new and reliable diagnostic method by which was able to proceed accurately with more confidence in diagnosing infertility. The Study was a cross sectional study which was conducted at Combined Military Hospital (CMH), Cumilla. During the ultrasound exam, the Study physician evaluated 45 patients by TVS. Among 45 Patients, 8.89% of Leiomyoma, 11.11% of endometrioma, 6.67% of developmental abnormalities i.e. absent uterus, rudimentary uterus, ovarian agenesis, vaginal agenesis and short vagina. 15.56% of bulky uterus with PID, 24.44% of PCOD, 4.44% of retroverted uterus, 6.67% have adnexal cyst and 2.22% are found to have hydrosalpinx. The study found 20% (9 cases) of normal findings of pelvis. We found correlation between clinical findings and TVS findings subsequently 44.44% of leiomyoma, 71.43% of Endometrioma, 60% of Developmental anomaly, 69.23% of Normal Study, 77.78% of Bulky uterus with PID, 84.62% of PCOD, 66.67% of Retroverted Uterus, 60% of adnexal Cyst.展开更多
AIM: To highlight sonographic and clinical characteristics of scar endometrioma with special emphasis on size-related features. METHODS: Thirty women (mean age 30.6 years, range 20-42 years) with 33 scar endometriomas...AIM: To highlight sonographic and clinical characteristics of scar endometrioma with special emphasis on size-related features. METHODS: Thirty women (mean age 30.6 years, range 20-42 years) with 33 scar endometriomas (mean diameter 27.1 mm, range 7-60 mm) were consecutively studied by Sonography and Color Doppler examination prior to surgery. Pathological examination was available in all cases. RESULTS: The most frequent (24 of 33 nodules, 74%) sonographic B-mode aspect of endometrioma was that of an inhomogenously hypoechoic roundish nodule with fibrotic changes (in the form of hyperechoic spots or strands), a peripheral inflammatory hyperechoic ring, spiculated margins and a single vascular pedicle entering the mass at the periphery. On average, 1.6 cesarean sections were recorded per patient (range 1-3). The median interval between the last cesarean section and admission to hospital was 36 mo (range 12-120 mo) and the median duration of symptoms before admission was 25.7 mo (range 0.5-80 mo). 13 patients had 13 large endometriomas (≥ 30 mm) with a mean lesion diameter of 41.3 ± 9.02 mm (range 30-60 mm). Seventeen women had 20 small endometriomas with a mean lesion size of 18.2 ± 5.17 mm (range 7-26 mm). The mean interval between the last cesarean section and admission to hospital (66.0 mo vs 39.6 mo, P < 0.01) and the mean duration of symptoms before admission (43.0 mo vs 17.4 mo, P < 0.01) were significantly longer in patients with large endometriomas; in addition, a statistically significant higher percentage of patients with large implants had undergone previous inconclusive diagnostic examinations, including either computed tomography/magnetic resonance imaging/fine needle biopsy/laparoscopy (38.4% vs 0%, P < 0.05). On sonography, large endometriomas showed frequent cystic portions and fistulous tracts (P < 0.02), loss of round/oval shape (P < 0.04) along with increased vascularity (P < 0.04). CONCLUSION: Endometrioma near cesarean section scar is an often neglected disease, but knowledge of its clinical and sonographic findings may prevent a delay in diagnosis that typically occurs in patients with larger (≥ 3 cm) endometriomas.展开更多
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
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
Background: Endometriosis is an important cause of infertility and chronic pelvic pain. Our study aims to understand the cause and effect relationship of endometriosis with these two clinical presentations. Objectives...Background: Endometriosis is an important cause of infertility and chronic pelvic pain. Our study aims to understand the cause and effect relationship of endometriosis with these two clinical presentations. Objectives: 1) To study the correlation between stage of endometriosis with pain and infertility;2) To evaluate role of transvaginal ultrasound for diagnosis of endometriosis using laparoscopic diagnosis as gold standard. Methodology: Total of 89 women presenting with infertility and or pain and with laparoscopic findings of endometriosis were included in the study. The results were analysed by logistic regression. Results: The mean age of women was 29.67 years. Seventy three percent of patients had moderate to severe disease while 31.46% of patients with endometriosis were infertile. Symptom of pain could be categorised as dysmenorrhea (71.47%), dyspareunia (41.5%) and dyschezia (15.7%). There was no association of endometriosis stage with the pain type, duration of symptoms. Transvaginal ultrasound seems a reliable test for diagnosis of ovarian endometriosis and advanced stage disease. 87.5% of patients with ovarian endometrioma had advanced disease (higher than Stage II rAFS). Conclusion: No correlation was found between the stage of endometriosis and severity of symptoms. Presence of endometrioma on USG was associated with advanced stage of endometriosis.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
BACKGROUND Uterine rupture is a fatal medical complication with a high mortality rate.Most cases of uterine rupture occur in late pregnancy or during labor and are mainly related to uterine scarring due to previous su...BACKGROUND Uterine rupture is a fatal medical complication with a high mortality rate.Most cases of uterine rupture occur in late pregnancy or during labor and are mainly related to uterine scarring due to previous surgical procedures.Adenomyosis is a possible risk factor for uterine rupture.However,spontaneous uterine rupture due to severe adenomyosis in a non-gravida-teenaged female has not been reported in the literature to date.CASE SUMMARY A 16-year-old girl was referred to our hospital for acute abdominal pain and hypovolemic shock with a blood pressure of 90/50 mmHg.Radiologic studies revealed a huge endometrial mass with multiple nodules in the lung,suggesting lung metastasis.The patient underwent an emergency total hysterectomy and wedge resection of the lung nodules.Histologically,the uterus showed diffuse adenomyosis with glandular and stromal dissociation.Lung nodules were endometrioma with massive hemorrhage.Immunohistochemistry demonstrated that the tumor cells were positive for PAX8,ER,and PR expression,leading to a final diagnosis of pulmonary endometriosis and uterine adenomyosis.Following surgery,the patient remains in good condition without recurrence.CONCLUSION This is the first case of spontaneous uterine rupture due to adenomyosis in a nongravida adolescent.展开更多
Background: Conservative therapies of pelvic abscess are not highly effective and surgical treatment is usually required. This study reviewed cases of pelvic abscess treated at our hospital over a 3-year period to eva...Background: Conservative therapies of pelvic abscess are not highly effective and surgical treatment is usually required. This study reviewed cases of pelvic abscess treated at our hospital over a 3-year period to evaluate treatment efficacy. The medical records of 20 patients diagnosed with pelvic abscess and admitted to our hospital for treatment between November 2006 and December 2009 were retrospectively examined. Results: Mean age of the patients was 50 ± 16.6 years. Pelvic abscess occurred spontaneously in 13 patients and secondary to surgical manipulation in 7 patients. In the 13 patients with spontaneous abscess, 7 had undergone pelvic surgery and 2 had undergone insertion of an intrauterine contraceptive device. Concomitant endometriosis was present in 5 of the 13 (38.5%) patients. A positive bacterial culture from the abscess was obtained in 16 of 19 (84.2%) patients tested. Causative bacteria included 4 aerobic bacterial species detected in 7 patients and 11 anaerobic bacterial species detected in 10 patients. Although multiple antibiotics were administered in all cases, 19 of the 20 (95%) patients eventually required surgical intervention, which included total hysterectomy plus adnexectomy, drainage under laparotomy or drainage alone. Anaerobic bacteria were frequently detected as the causative bacteria. Conclusion: As treatment with antibiotics alone was ineffective in almost all cases, surgical treatment was required. Drainage might be the first-choice treatment for pelvic abscess to avoid invasive surgery.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
Background: Umbilical endometriosis, a rare benign condition, is clinically difficult to differentiate from other diseases that result in the formation of an umbilical nodule. It is caused by the presence of ectopic e...Background: Umbilical endometriosis, a rare benign condition, is clinically difficult to differentiate from other diseases that result in the formation of an umbilical nodule. It is caused by the presence of ectopic endometrial tissue in the umbilicus, which overtly presents as a painful, discoloured swelling in the umbilicus. However, in our case the presentation wasn’t as obvious. The endometrial tissue was embedded within an umbilical hernia. Case Summary: Our patient was a 37-year-old female with a past medical/surgical history of a subtotal colectomy for ulcerative colitis in 2001 followed by an ileo-rectal anastomosis. 17 years later, she was referred to the surgical outpatient clinic from GP practice with a painful umbilical/incisional hernia surrounding the previous scar and just above the umbilicus, this pain, particularly worsening during her menstrual cycle. Multiple blood tests and ultrasound scans of her abdomen failed to diagnose a cause for her agony which mandated an elective excision of the swelling. This successfully resolved her symptoms. Conclusion: Umbilical endometriosis is a potential diagnosis in females with a painful umbilical swelling, imaging has no diagnostic role and excision is the definitive treatment.展开更多
Endometriosis is a condition that is commonly encountered in gynaecological practice. Endometriosis has varied, non-specific clinical presentations and its diagnosis sometimes poses a challenge to the clinician. We ha...Endometriosis is a condition that is commonly encountered in gynaecological practice. Endometriosis has varied, non-specific clinical presentations and its diagnosis sometimes poses a challenge to the clinician. We have encountered various women with clinical presentation highly suggestive of endometriosis. Further diagnosis using imaging and biopsy confirmed endometriosis. This paper presents our experience of endometriosis in our care of African women and a review of the literature on endometriosis. We want to highlight the various clinical presentations of endometriosis, appraise the various methods for diagnosis, discuss the treatment modalities available and evaluate the impact of this condition on women. We want to emphasize the fact that African women also suffer from this condition, and impress upon clinicians, the necessity for closer look for the condition, stimulate discussion and research into endometriosis in Africa as it seems this condition is “neglected or forgotten” in Africa.展开更多
We report the case of a 33 year old female who presented with endometriosis of the anterior abdominal wall following Caesarean Section at the surgical incision site. Abdominal Incisional Site Endometriosis can pose a ...We report the case of a 33 year old female who presented with endometriosis of the anterior abdominal wall following Caesarean Section at the surgical incision site. Abdominal Incisional Site Endometriosis can pose a diagnostic dilema owing to its relative rarity and vagueosity of symptoms, vis-a-vis, cyclical abdominal pain and occasional palpable mass associated with menstruation. A greater index of suspicion should be prompted in such patients especially if symptoms occur following pelvic surgery such as Caesarean Sections, hysterotomy, and myomectomy.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
Background:Ovarian cysts are uncommon gestational complications.Because of high-level progesterone,ovarian endometriomas may undergo decidualization during pregnancy,manifesting as enlarging cysts with papillae and ri...Background:Ovarian cysts are uncommon gestational complications.Because of high-level progesterone,ovarian endometriomas may undergo decidualization during pregnancy,manifesting as enlarging cysts with papillae and rich blood flow.Such cases can mimic malignant or borderline tumors,causing dilemmas in clinical management.Here,we present two cases of enlarging ovarian cysts during pregnancy with evidence suggesting decidualized endometrioma.The diagnosis and treatment are further discussed,which add to our limited knowledge and might help future clinical practice.Case summary:In the first case,a right ovarian cyst was detected by ultrasound in a 32-year-old pregnant woman.The cyst measured 4.2 cm in diameter at 7t6 weeks of gestation,and gradually increased to 9.6 cm7.6 cm5.6 cm at 37t5 weeks,with multiple solid papillae lining the inner wall.During cesarean section,an ovarian mass of approximately 9 cm in diameter was surgically removed,which was later identified by pathological review as an endometrioma with decidualization.The second case also presented as an enlarging ovarian mass during the first and second trimester.The size of the cyst peaked at 24t5 weeks of gestation,measuring 6.9 cm5.6 cm4.1 cm.But in the third trimester,the tumor slightly regressed.Careful follow-up was adopted after successful vaginal delivery,and the cyst was found to have undergone quick regression shortly after pregnancy.Both patients recovered well after delivery with no further complications.Conclusion:Endometriomas with decidualization during gestation may resemble borderline or malignant tumors.Close monitoring and proper management are essential for guiding clinical management.展开更多
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<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.
文摘The use of trans-vaginal ultrasound (TVU) has become increasingly popular in diagnosing and treating infertility. TVU allows for a detailed examination of the female reproductive organs and can aid in identifying abnormalities that may be contributing to infertility [1]. Additionally, TVU can assist in monitoring fertility treatments, such as in vitro fertilization. By TVS diagnosis of focal intrauterine lesions, uterine malformations and leiomyomas are easily delineated and nearly approaches the sensitivity of hysteroscopy. Abnormality of uterine cavity may affect fertility by inhibiting implantation [2]. TVS seems very accurate in the diagnosis of presence or extension of frank pelvic inflammatory disease and also promising in augmenting the outpatient diagnosis of PID among patients referred for lower abdominal pain. In addition to these conditions trans-vaginal sonography has also been described in the diagnosis of pelvic abscesses, pelvic mass, endometriomas, hydrosalpinx, intra uterine adhesions (Asherman’s syndrome), uterine hypoplasia and other developmental anomalies like mullerian or vaginal agenesis associated with infertility. In this study, it was established transvaginal sonography as a new and reliable diagnostic method by which was able to proceed accurately with more confidence in diagnosing infertility. The Study was a cross sectional study which was conducted at Combined Military Hospital (CMH), Cumilla. During the ultrasound exam, the Study physician evaluated 45 patients by TVS. Among 45 Patients, 8.89% of Leiomyoma, 11.11% of endometrioma, 6.67% of developmental abnormalities i.e. absent uterus, rudimentary uterus, ovarian agenesis, vaginal agenesis and short vagina. 15.56% of bulky uterus with PID, 24.44% of PCOD, 4.44% of retroverted uterus, 6.67% have adnexal cyst and 2.22% are found to have hydrosalpinx. The study found 20% (9 cases) of normal findings of pelvis. We found correlation between clinical findings and TVS findings subsequently 44.44% of leiomyoma, 71.43% of Endometrioma, 60% of Developmental anomaly, 69.23% of Normal Study, 77.78% of Bulky uterus with PID, 84.62% of PCOD, 66.67% of Retroverted Uterus, 60% of adnexal Cyst.
文摘AIM: To highlight sonographic and clinical characteristics of scar endometrioma with special emphasis on size-related features. METHODS: Thirty women (mean age 30.6 years, range 20-42 years) with 33 scar endometriomas (mean diameter 27.1 mm, range 7-60 mm) were consecutively studied by Sonography and Color Doppler examination prior to surgery. Pathological examination was available in all cases. RESULTS: The most frequent (24 of 33 nodules, 74%) sonographic B-mode aspect of endometrioma was that of an inhomogenously hypoechoic roundish nodule with fibrotic changes (in the form of hyperechoic spots or strands), a peripheral inflammatory hyperechoic ring, spiculated margins and a single vascular pedicle entering the mass at the periphery. On average, 1.6 cesarean sections were recorded per patient (range 1-3). The median interval between the last cesarean section and admission to hospital was 36 mo (range 12-120 mo) and the median duration of symptoms before admission was 25.7 mo (range 0.5-80 mo). 13 patients had 13 large endometriomas (≥ 30 mm) with a mean lesion diameter of 41.3 ± 9.02 mm (range 30-60 mm). Seventeen women had 20 small endometriomas with a mean lesion size of 18.2 ± 5.17 mm (range 7-26 mm). The mean interval between the last cesarean section and admission to hospital (66.0 mo vs 39.6 mo, P < 0.01) and the mean duration of symptoms before admission (43.0 mo vs 17.4 mo, P < 0.01) were significantly longer in patients with large endometriomas; in addition, a statistically significant higher percentage of patients with large implants had undergone previous inconclusive diagnostic examinations, including either computed tomography/magnetic resonance imaging/fine needle biopsy/laparoscopy (38.4% vs 0%, P < 0.05). On sonography, large endometriomas showed frequent cystic portions and fistulous tracts (P < 0.02), loss of round/oval shape (P < 0.04) along with increased vascularity (P < 0.04). CONCLUSION: Endometrioma near cesarean section scar is an often neglected disease, but knowledge of its clinical and sonographic findings may prevent a delay in diagnosis that typically occurs in patients with larger (≥ 3 cm) endometriomas.
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.
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Background: Endometriosis is an important cause of infertility and chronic pelvic pain. Our study aims to understand the cause and effect relationship of endometriosis with these two clinical presentations. Objectives: 1) To study the correlation between stage of endometriosis with pain and infertility;2) To evaluate role of transvaginal ultrasound for diagnosis of endometriosis using laparoscopic diagnosis as gold standard. Methodology: Total of 89 women presenting with infertility and or pain and with laparoscopic findings of endometriosis were included in the study. The results were analysed by logistic regression. Results: The mean age of women was 29.67 years. Seventy three percent of patients had moderate to severe disease while 31.46% of patients with endometriosis were infertile. Symptom of pain could be categorised as dysmenorrhea (71.47%), dyspareunia (41.5%) and dyschezia (15.7%). There was no association of endometriosis stage with the pain type, duration of symptoms. Transvaginal ultrasound seems a reliable test for diagnosis of ovarian endometriosis and advanced stage disease. 87.5% of patients with ovarian endometrioma had advanced disease (higher than Stage II rAFS). Conclusion: No correlation was found between the stage of endometriosis and severity of symptoms. Presence of endometrioma on USG was associated with advanced stage of endometriosis.
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.
基金the Chonnam National University Hospital Biomedical Research Institute,No.BCRI22011.
文摘BACKGROUND Uterine rupture is a fatal medical complication with a high mortality rate.Most cases of uterine rupture occur in late pregnancy or during labor and are mainly related to uterine scarring due to previous surgical procedures.Adenomyosis is a possible risk factor for uterine rupture.However,spontaneous uterine rupture due to severe adenomyosis in a non-gravida-teenaged female has not been reported in the literature to date.CASE SUMMARY A 16-year-old girl was referred to our hospital for acute abdominal pain and hypovolemic shock with a blood pressure of 90/50 mmHg.Radiologic studies revealed a huge endometrial mass with multiple nodules in the lung,suggesting lung metastasis.The patient underwent an emergency total hysterectomy and wedge resection of the lung nodules.Histologically,the uterus showed diffuse adenomyosis with glandular and stromal dissociation.Lung nodules were endometrioma with massive hemorrhage.Immunohistochemistry demonstrated that the tumor cells were positive for PAX8,ER,and PR expression,leading to a final diagnosis of pulmonary endometriosis and uterine adenomyosis.Following surgery,the patient remains in good condition without recurrence.CONCLUSION This is the first case of spontaneous uterine rupture due to adenomyosis in a nongravida adolescent.
文摘Background: Conservative therapies of pelvic abscess are not highly effective and surgical treatment is usually required. This study reviewed cases of pelvic abscess treated at our hospital over a 3-year period to evaluate treatment efficacy. The medical records of 20 patients diagnosed with pelvic abscess and admitted to our hospital for treatment between November 2006 and December 2009 were retrospectively examined. Results: Mean age of the patients was 50 ± 16.6 years. Pelvic abscess occurred spontaneously in 13 patients and secondary to surgical manipulation in 7 patients. In the 13 patients with spontaneous abscess, 7 had undergone pelvic surgery and 2 had undergone insertion of an intrauterine contraceptive device. Concomitant endometriosis was present in 5 of the 13 (38.5%) patients. A positive bacterial culture from the abscess was obtained in 16 of 19 (84.2%) patients tested. Causative bacteria included 4 aerobic bacterial species detected in 7 patients and 11 anaerobic bacterial species detected in 10 patients. Although multiple antibiotics were administered in all cases, 19 of the 20 (95%) patients eventually required surgical intervention, which included total hysterectomy plus adnexectomy, drainage under laparotomy or drainage alone. Anaerobic bacteria were frequently detected as the causative bacteria. Conclusion: As treatment with antibiotics alone was ineffective in almost all cases, surgical treatment was required. Drainage might be the first-choice treatment for pelvic abscess to avoid invasive surgery.
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Background: Umbilical endometriosis, a rare benign condition, is clinically difficult to differentiate from other diseases that result in the formation of an umbilical nodule. It is caused by the presence of ectopic endometrial tissue in the umbilicus, which overtly presents as a painful, discoloured swelling in the umbilicus. However, in our case the presentation wasn’t as obvious. The endometrial tissue was embedded within an umbilical hernia. Case Summary: Our patient was a 37-year-old female with a past medical/surgical history of a subtotal colectomy for ulcerative colitis in 2001 followed by an ileo-rectal anastomosis. 17 years later, she was referred to the surgical outpatient clinic from GP practice with a painful umbilical/incisional hernia surrounding the previous scar and just above the umbilicus, this pain, particularly worsening during her menstrual cycle. Multiple blood tests and ultrasound scans of her abdomen failed to diagnose a cause for her agony which mandated an elective excision of the swelling. This successfully resolved her symptoms. Conclusion: Umbilical endometriosis is a potential diagnosis in females with a painful umbilical swelling, imaging has no diagnostic role and excision is the definitive treatment.
文摘Endometriosis is a condition that is commonly encountered in gynaecological practice. Endometriosis has varied, non-specific clinical presentations and its diagnosis sometimes poses a challenge to the clinician. We have encountered various women with clinical presentation highly suggestive of endometriosis. Further diagnosis using imaging and biopsy confirmed endometriosis. This paper presents our experience of endometriosis in our care of African women and a review of the literature on endometriosis. We want to highlight the various clinical presentations of endometriosis, appraise the various methods for diagnosis, discuss the treatment modalities available and evaluate the impact of this condition on women. We want to emphasize the fact that African women also suffer from this condition, and impress upon clinicians, the necessity for closer look for the condition, stimulate discussion and research into endometriosis in Africa as it seems this condition is “neglected or forgotten” in Africa.
文摘We report the case of a 33 year old female who presented with endometriosis of the anterior abdominal wall following Caesarean Section at the surgical incision site. Abdominal Incisional Site Endometriosis can pose a diagnostic dilema owing to its relative rarity and vagueosity of symptoms, vis-a-vis, cyclical abdominal pain and occasional palpable mass associated with menstruation. A greater index of suspicion should be prompted in such patients especially if symptoms occur following pelvic surgery such as Caesarean Sections, hysterotomy, and myomectomy.
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.
基金the National Key Technology R&D Program of China(2019YFC1005200 and 2019YFC1005201).
文摘Background:Ovarian cysts are uncommon gestational complications.Because of high-level progesterone,ovarian endometriomas may undergo decidualization during pregnancy,manifesting as enlarging cysts with papillae and rich blood flow.Such cases can mimic malignant or borderline tumors,causing dilemmas in clinical management.Here,we present two cases of enlarging ovarian cysts during pregnancy with evidence suggesting decidualized endometrioma.The diagnosis and treatment are further discussed,which add to our limited knowledge and might help future clinical practice.Case summary:In the first case,a right ovarian cyst was detected by ultrasound in a 32-year-old pregnant woman.The cyst measured 4.2 cm in diameter at 7t6 weeks of gestation,and gradually increased to 9.6 cm7.6 cm5.6 cm at 37t5 weeks,with multiple solid papillae lining the inner wall.During cesarean section,an ovarian mass of approximately 9 cm in diameter was surgically removed,which was later identified by pathological review as an endometrioma with decidualization.The second case also presented as an enlarging ovarian mass during the first and second trimester.The size of the cyst peaked at 24t5 weeks of gestation,measuring 6.9 cm5.6 cm4.1 cm.But in the third trimester,the tumor slightly regressed.Careful follow-up was adopted after successful vaginal delivery,and the cyst was found to have undergone quick regression shortly after pregnancy.Both patients recovered well after delivery with no further complications.Conclusion:Endometriomas with decidualization during gestation may resemble borderline or malignant tumors.Close monitoring and proper management are essential for guiding clinical management.
