BACKGROUND Endometriosis affects approximately 10%of reproductive-age women and is frequently associated with chronic pelvic pain.Patients with endometriosis often experience comorbid depression and anxiety,but the un...BACKGROUND Endometriosis affects approximately 10%of reproductive-age women and is frequently associated with chronic pelvic pain.Patients with endometriosis often experience comorbid depression and anxiety,but the underlying mechanisms connecting these conditions are unclear.AIM To assess the prevalence of depression and anxiety in endometriosis patients and explore neuroimmune mechanisms mediated via inflammatory biomarkers.METHODS A retrospective cohort study was conducted with 200 patients with endometriosis-associated chronic pain from June 2020 to December 2024.Depression and anxiety were assessed using validated psychological instruments.Inflammation biomarkers interleukin(ILs)(IL-6,IL-1β),tumor necrosis factor-alpha,C-reactive protein,and brain-derived neurotrophic factor were measured in serum.Pain severity was assessed using visual analog scales.Correlation and regression analyses were performed to examine relationships between inflammatory markers,pain severity,and psychological outcomes.RESULTS Among the 200 patients,42.5%exhibited clinically significant depression and 51.0%showed anxiety symptoms.Serum levels of IL-6,IL-1β,tumor necrosis factor-alpha,and C-reactive protein were significantly higher in patients with comorbid depression and anxiety compared with those without psychological symptoms(P<0.001).Brainderived neurotrophic factor levels were lower in the depression group.Pain severity positively correlated with inflammatory marker levels and with depression and anxiety scores.CONCLUSION Overall,the findings suggest that inflammatory factors mediate a neuroimmune mechanism linking endometriosisassociated chronic pain with depression and anxiety.Therapeutic targets for managing psychological comorbidities in patients with endometriosis through anti-inflammatory interventions should be explored,and an integrated treatment approach addressing both physical and psychological symptoms is emphasized.展开更多
Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data dat...Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs,published before August 31,2020.A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results The meta-analysis included ten studies(651 and 1,040 in the combined EP and uncomplicated EP groups,respectively).The spontaneous pregnancy rate,clinical pregnancy rate,and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs[Odd’s ratio(OR)=0.63,95%confidence interval(CI):0.50–0.80,P=0.0001;OR=0.63,95%CI:0.48–0.84,P=0.001;OR=0.63,95%CI:0.42–0.96,P=0.03],and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group[OR=3.10,95%CI:1.52–6.32,P=0.002].Conclusion EP may adversely affect pregnancy outcomes in patients with infertility and EMs.Even after surgical treatment,EP can still reduce natural pregnancy,clinical pregnancy,and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.展开更多
BACKGROUND Uterine adenomyosis and pulmonary endometriosis are exceptionally rare in adolescents and can pose significant diagnostic challenges due to their nonspecific clinical presentation and imaging features,which...BACKGROUND Uterine adenomyosis and pulmonary endometriosis are exceptionally rare in adolescents and can pose significant diagnostic challenges due to their nonspecific clinical presentation and imaging features,which may mimic malignancy.Here,we describe a case of adenomyosis-associated uterine rupture(secondary to hemorrhagic necrosis)and concurrent pulmonary endometriosis in a 16-year-old girl initially suspected of having advanced uterine cancer.CASE SUMMARY A 16-year-old girl presented with acute abdominal pain and oliguria.Imaging studies revealed a 15-cm ruptured uterine mass accompanied by hemoperitoneum and multiple pulmonary nodules suggestive of metastatic disease.Laboratory tests demonstrated severe anemia and markedly elevated tumor markers[cancer antigen(CA)-125:1063 U/mL;CA-19-9:1347 U/mL].Emergency laparotomy revealed adenomyosis-associated uterine rupture secondary to hemorrhagic necrosis,with no macroscopic abnormalities in other organs.A total abdominal hysterectomy was performed.Histopathological analysis confirmed uterine adenomyosis with hemorrhagic necrosis.Subsequent thoracoscopic wedge resections of the pulmonary lesions demonstrated histologically confirmed endometriosis.The patient has remained disease-free under treatment with oral dienogest.CONCLUSION This case of an adolescent patient highlights how benign gynecological conditions can mimic malignancy,necessitating broad differential diagnoses despite alarming presentations.展开更多
BACKGROUND Endometriosis is a clinical condition characterized by the presence of endometrial glands outside the uterine cavity.While its incidence remains mostly uncertain,endometriosis impacts around 180 million wom...BACKGROUND Endometriosis is a clinical condition characterized by the presence of endometrial glands outside the uterine cavity.While its incidence remains mostly uncertain,endometriosis impacts around 180 million women worldwide.Despite the presentation of several epidemiological and clinical explanations,the precise mechanism underlying the disease remains ambiguous.In recent years,researchers have examined the hereditary dimension of the disease.Genetic research has aimed to discover the gene or genes responsible for the disease through association or linkage studies involving candidate genes or DNA mapping techniques.AIM To identify genetic biomarkers linked to endometriosis by the application of machine learning(ML)approaches.METHODS This case-control study accounted for the open-access transcriptomic data set of endometriosis and the control group.We included data from 22 controls and 16 endometriosis patients for this purpose.We used AdaBoost,XGBoost,Stochasting Gradient Boosting,Bagged Classification and Regression Trees(CART)for classification using five-fold cross validation.We evaluated the performance of the models using the performance measures of accuracy,balanced accuracy,sensitivity,specificity,positive predictive value,negative predictive value and F1 score.RESULTS Bagged CART gave the best classification metrics.The metrics obtained from this model are 85.7%,85.7%,100%,75%,75%,100%and 85.7%for accuracy,balanced accuracy,sensitivity,specificity,positive predictive value,negative predictive value and F1 score,respectively.Based on the variable importance of modeling,we can use the genes CUX2,CLMP,CEP131,EHD4,CDH24,ILRUN,LINC01709,HOTAIR,SLC30A2 and NKG7 and other transcripts with inaccessible gene names as potential biomarkers for endometriosis.CONCLUSION This study determined possible genomic biomarkers for endometriosis using transcriptomic data from patients with/without endometriosis.The applied ML model successfully classified endometriosis and created a highly accurate diagnostic prediction model.Future genomic studies could explain the underlying pathology of endometriosis,and a non-invasive diagnostic method could replace the invasive ones.展开更多
Deep infiltrating endometriosis is an often-painful disorder affecting women during their reproductive years that usually involves the structures of the pelvis and frequently the gastrointestinal tract.We present the ...Deep infiltrating endometriosis is an often-painful disorder affecting women during their reproductive years that usually involves the structures of the pelvis and frequently the gastrointestinal tract.We present the case of a 37-year-old female patient with an endometrial growth on the sigmoid colon wall causing pain,diarrhea and the presence of blood in the feces.The histology of the removed specimen also revealed the involvement of the utero-vesical fold,the recto-vaginal septum and a pericolic lymph node,which are all quite uncommon findings.To identify the endometrial cells,we performed immunohistochemical staining for CD10and the estrogen and progesterone receptors.展开更多
Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Up to 15% of women in their reproductive period are affected by this ...Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Up to 15% of women in their reproductive period are affected by this condition. Deep endometriosis is defined as endometriosis located more than 5 mm beneath the peritoneal surface. This type of endometriosis is mostly found on the uterosacral ligaments, inside the rectovaginal septum or vagina, in the rectosigmoid area, ovarian fossa, pelvic peritoneum, ureters, and bladder, causing a distortion of the pelvic anatomy. The frequency of bowel endometriosis is unknown, but in cases of bowel infiltration, about 90% are localized on the sigmoid colon or the rectum. Colorectal involvement results in alterations of bowel habits such as constipation, diarrhea, tenesmus, dyschezia, and, rarely, rectal bleeding.Differential diagnosis must be made in case of irritable bowel syndrome,solitary rectal ulcer syndrome,and a rectal tumor.A precise diagnosis about the presence,location,and extent of endometriosis is necessary to plan surgical treatment.Multidisciplinary laparoscopic treatment has become the standard of care.Depending on the size of the lesion and site of involvement,fullthickness disc excision or bowel resection needs to be performed by an experienced colorectal surgeon.Longterm outcomes,following bowel resection for severe endometriosis,regarding pain and recurrence rate are good with a pregnancy rate of 50%.展开更多
Introduction: Cutaneous endometriosis is an uncommon but well-known skin disorder that represents about 0.5% to 1% of all endometriosis. The objective of this case series is to report clinical presentation, diagnosis,...Introduction: Cutaneous endometriosis is an uncommon but well-known skin disorder that represents about 0.5% to 1% of all endometriosis. The objective of this case series is to report clinical presentation, diagnosis, and management of various forms of cutaneous endometriosis. Material and Methods: It was an observational, retrospective and descriptive review of cases presenting with cutaneous endometriosis among Cameroonian women managed at the gynaecological outpatient department of Yaounde Gynaeco-Obstetric and Pediatric Hospital. All the following parameters were analysed: age, parity, previous pelvic surgery, presenting symptoms and duration, associated symptoms, localizations, imaging, size of the lesion, other localization of endometriosis, management and histopathological results. Results: we reported 4 cases of cutaneous endometriosis, with 3 umbilical endometriosis and 1 abdominal scar endometriosis. Patient age ranged from 28 to 39 years with an average of 33 years. All patients described infertility (two primary and two secondary) and two had a history of abdominal surgery. All patients presented local cyclical signs such as pain, swelling, color change and bleeding. The duration of symptoms varied from 2 to 3 years and the size of lesions ranged from 2 to 3.5 cm for umbilical lesions and was 9 cm for abdominal scar endometriosis. In all cases, no imaging was required for the diagnosis, which was suspected on the basis of patient’s history and the cyclical nature of local signs, followed by wide surgical excision and confirmation on histopathology. Conclusion: Cutaneaous endometriosis is a rare benign condition. Umbilical endometriosis seems to be the main cutaneous localization and can be described as primary or secondary. Even if its diagnosis must be confirmed by histopathology, it should be considered in patient with cutaneous cyclic signs such as pain, swelling or bleeding with or without history of abdominal surgery.展开更多
Endometriosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% of females. It commonly affects pelvic structures including the bowel. Perforation of the colon by endometriosis...Endometriosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% of females. It commonly affects pelvic structures including the bowel. Perforation of the colon by endometriosis is very rare and the patients generally present with an asymptomatic or painful pelvic mass, often in the left iliac fossa. Our patient presented acutely unwell and her symptoms were more suggestive of pyelonephritis or diverticulitis. We therefore report an unusual cause of acute abdomen. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of the disease, concerning both surgeons and gynaecologists. In summary, intestinal endometriosis should be considered in the differential diagnosis of all post-menarche women with episodic gastrointestinal symptoms. A past history of endometriosis or co-existent gynaecological symptoms should increase the index of suspicion, and taparoscopy prior to formal laparotomy should be considered. Our patient, in retrospect, had a history of mild endometriosis, but we feel that this case serves as a reminder of a rare, but important, differential diagnosis of acute abdomen in females.展开更多
Endometriosis is an estrogen-dependent inflammatory disease,defined by the presence of functional endometrial tissue outside of the uterine cavity.This disease is one of the main gynecological diseases,affecting aroun...Endometriosis is an estrogen-dependent inflammatory disease,defined by the presence of functional endometrial tissue outside of the uterine cavity.This disease is one of the main gynecological diseases,affecting around 10%-15%women and girls of reproductive age,being a common gynecologic disorder.Although endometriosis is a benign disease,it shares several characteristics with invasive cancer.Studies support that it has been linked with an increased chance of developing endometrial ovarian cancer,representing an earlier stage of neoplastic processes.This is particularly true for women with clear cell carcinoma,low-grade serous carcinoma and endometrioid.However,the carcinogenic pathways between both pathologies remain poorly understood.Current studies suggest a connection between endometriosis and endometriosis-associated ovarian cancers(EAOCs)via pathways associated with oxidative stress,inflammation,and hyperestrogenism.This article aims to review current data on the molecular events linked to the development of EAOCs from endometriosis,specifically focusing on the complex relationship between the immune response to endometriosis and cancer,including the molecular mechanisms and their ramifications.Examining recent developments in immunotherapy and their potential to boost the effectiveness of future treatments.展开更多
BACKGROUND To describe the characteristics,diagnosis and surgical treatment of inguinal endometriosis(IEM).CASE SUMMARY We retrospectively analyzed 10 patients diagnosed with IEM at Beijing Chao-Yang Hospital from 201...BACKGROUND To describe the characteristics,diagnosis and surgical treatment of inguinal endometriosis(IEM).CASE SUMMARY We retrospectively analyzed 10 patients diagnosed with IEM at Beijing Chao-Yang Hospital from 2011 to 2019.Relevant features,symptoms,images,surgical treatment,hormonal therapy and follow-up were collected and discussed.A total of 10 cases of IEM diagnosed by surgery and pathology were characterized by a lesion on the right side(9/11);five patients had symptoms related to the menstrual cycle,and only 3 patients were clearly diagnosed before surgery.Ultrasonography was of little assistance in confirming the diagnosis,but magnetic resonance imaging showed specific,high-intensity patterns.Anatomically,most of the IEM lesions were located in the extraperitoneal ligament(10/11);nine patients had inguinal hernias(IH),five had concurrent or prior pelvic endometriosis,and four had infertility.The clinical results from extensive resection were satisfactory.CONCLUSION IEM is an extremely rare condition that can easily be misdiagnosed prior to surgery.A right IH may contribute to the formation of right-sided IEM,and extensive resection involving the round ligament and hernia sac is essential to prevent recurrence.展开更多
Endometriosis is a chronic and progressive gynecologic disorder that affects 10% - 50% of women of reproductive age worldwide. Chronic pain and infertility are the most debilitating problems associated with it requiri...Endometriosis is a chronic and progressive gynecologic disorder that affects 10% - 50% of women of reproductive age worldwide. Chronic pain and infertility are the most debilitating problems associated with it requiring both medical and surgical treatment. Laparoscopy is considered the gold standard for diagnosis and treatment. However, a 10% rate of conversion to laparotomy has been reported when performed by skilled laparoscopic surgeons and much higher in low volume less skilled surgeons. To improve surgical outcomes, robotic assistance is the logical next step in performing minimally invasive gynecological surgeries, especially in complex endometriosis cases. Enhanced 3D visualization and 10× magnification along with Endowrist instruments with seven degrees of freedom facilitates precise and careful dissection. Firefly technology using ICG green dye can improve detection of small and invisible lesions. Robotics is useful in deep infiltrating disease manifesting as lesions deeper than the superficial tissues of rectovaginal septum, vaginal fornix, pelvic sidewalls, parametrium, bowel or ureter and bladder. Trials show no increase in surgical time, blood loss, or intra- or postoperative complications and similar clinical outcome when robotics is compared with laparoscopy. At present, it is more appropriate to compare it with laparotomy rather than laparoscopy. Robotics can be used to manage recurrence of endometriosis after hysterectomy. Surgeons experienced in conventional laparoscopy can utilize robotic platform for deep infiltrating endometriosis for performing complex surgical dissection and achieving the surgical goals in mind and reduce conversions to open surgery. Robotic assistance can bridge the gap in performance of laparoscopic surgery in advanced endometriosis.展开更多
Endometriosis is defined as the presence of endometrial tissue that is located outside the uterine cavity, associated with fibrosis and inflammatory reaction. The most common atypical locations are the gastrointestina...Endometriosis is defined as the presence of endometrial tissue that is located outside the uterine cavity, associated with fibrosis and inflammatory reaction. The most common atypical locations are the gastrointestinal tract, urinary tract, lung, as well as abdominal surgical scars. Its diagnosis is still very difficult, especially when it manifests itself as an acute large bowel obstruction. We report the rare case of a 41-year-old patient diagnosed with acute colonic obstruction following a rectal tumor. She had undergone colonostomy even though colonoscopy biopsies were nonspecific, and a computed tomography (CT) scan was requested. It showed an adnexal heterogenous mass, therefore the patient had a laparotomy and a subtotal hysterectomy with bilateral salpingo-oophorectomy and a biopsy of the recto-colonic hinge. Histologic examination revealed a diagnosis of rectal endometriosis. The purpose of this work is to report a rare case of colonic endometriosis responsible for an acute large bowel obstruction.展开更多
A 36-year-old unmarried woman with no sexual history presented with 12 days of uncontrollable yellowish vaginal discharge,bloating,lower back pain,frequent urination,and urgency.Her menstrual cycles were regular with ...A 36-year-old unmarried woman with no sexual history presented with 12 days of uncontrollable yellowish vaginal discharge,bloating,lower back pain,frequent urination,and urgency.Her menstrual cycles were regular with moderate flow and worsening dysmenorrhea.Ultrasound and magnetic resonance imaging identified uterine and cervical masses.Laparoscopic surgery and postoperative gonadotropin-releasing hormone agonist injections led to significant lesion reduction.The patient is currently on oral dienogest acetate with ongoing follow-up.展开更多
Endometriosis is a condition characterized by the presence of endometrial tissue outside the uterine cavity. This tissue, found in the inner lining of the uterus, develops in other pelvic organs, such as the ovaries, ...Endometriosis is a condition characterized by the presence of endometrial tissue outside the uterine cavity. This tissue, found in the inner lining of the uterus, develops in other pelvic organs, such as the ovaries, fallopian tubes, peritoneum, and bowel. In cases of deep endometriosis, the appendix may be affected, and consequently, appendectomy becomes a perioperative possibility. From February 2018 to February 2023, the surgical team performed 133 laparoscopic procedures. The number of appendectomies by the time of the surgical procedure was 19.5% (26 cases), with 50% of these (13 cases) confirming the histological presence of appendiceal endometriosis (AE), no increasing of postoperative complications was noticed. This report is important to reinforce multidisciplinary training, review postoperative complications, and provide training in advanced pelvic surgery. Furthermore, it aims to emphasize that appendectomy performed during the surgical act is a safe and viable procedure that does not increase complication rates.展开更多
Endometriosis is defined as the presence of endometrial tissue outside the uterus. It is a benign pathology involving 15% of women of reproductive age. The sigmoid site represents 7% of endometriosis but it is the mos...Endometriosis is defined as the presence of endometrial tissue outside the uterus. It is a benign pathology involving 15% of women of reproductive age. The sigmoid site represents 7% of endometriosis but it is the most frequent area in the digestive tract. We report two cases of colonic endometriosis in which the initial diagnosis suspected a malignant disease. Respectively, the patients were 31 and 48 years old. The first patient complained about abdominal pain with symptoms of intestinal obstruction and was classified after radiological examination as an intrasigmoid tumor with bladder adhesion. The second patient was undergone for a radiological examination because of a bowel obstruction syndrom and a mass in the sigmoid colon was suspected. In both cases, sigmoid colon resection was performed and histological diagnosis was sigmoid endometriosis. Sigmoid endometriosis is rarely diagnosed before surgical excision. Suspicious bowel obstruction and malignant origin lead to large surgical excision. Histological examination is important to establish the diagnosis.展开更多
BACKGROUND Rectosigmoid endometriosis is an underdiagnosed disease responsible for abdominal pain, transit disorders and rectal bleeding. Two surgical approaches,rectosigmoid bowel resection(segmental or patch) or int...BACKGROUND Rectosigmoid endometriosis is an underdiagnosed disease responsible for abdominal pain, transit disorders and rectal bleeding. Two surgical approaches,rectosigmoid bowel resection(segmental or patch) or intramuscular layer dissection(shaving), are available.AIM To assess whether the lesion features observed via preoperative rectosigmoid endoscopic ultrasonography(RS-EUS) might predict the need for bowel resection.METHODS This multicentric retrospective study was conducted on patients with rectosigmoid endometriosis who underwent a curative surgical procedure,evaluated by RS-EUS performed by two trained operators, between January 2012 and March 2018. A univariate statistical analysis was performed on nodules' RSEUS features(thickness, width, infiltration of the submucosae, presence of a bump into the digestive lumen and presence of multiple rectosigmoid localizations). A multivariate logistic regression was then performed on the significant results.RESULTS Of the 367 patients, 73 patients with rectosigmoid endometriosis were evaluated by RS-EUS and underwent rectosigmoid surgery. After the univariate analysis was completed, thickness, width and infiltration of the submucosae were identified as potential predictive factors for bowel resection. In a multivariate logistic regression model, only thickness appeared to be a significant [odds ratio(OR) = 1.49, 95% confidence interval(CI): 1.04-2.12, P = 0.028] predictive factor for bowel resection. Receiver operating characteristic analysis performed showed that a thickness over 5.20 mm might be used as cut-off with a sensitivity of 76%, a specificity of 81%, and an area under carve = 0.82. The cut-off values for 100%sensitivity and 100% specificity were 0.90 mm and 10.00 mm, respectively. A trend concerning width to predict the need for resection was also observed(OR1.12, 95%CI: 1.00-1.26, P = 0.054)CONCLUSION The presence of a rectosigmoid nodule of endometriosis greater than 5.20 mm thick on RS-EUS might predict the need for bowel resection.展开更多
The aim of this study was to investigate the expression of macrophage migration inhibitory factor （MMIF）, hypoxia-inducible factor- 1 α（HIF- 1α ）and vascular endothelial growth factor （VEGF） in the serum and e...The aim of this study was to investigate the expression of macrophage migration inhibitory factor （MMIF）, hypoxia-inducible factor- 1 α（HIF- 1α ）and vascular endothelial growth factor （VEGF） in the serum and endometrial tissues of patients with endometriosis （EM） and the clinical significance. Eighty EM patients [American Reproductive Association stage Ⅰ （n=20）, stage Ⅱ （n=22）, stage Ⅲ （n=21） and stage Ⅳ （n=17）] were enrolled and divided into mild （10- 14 points, n=28）, moderate （16-24 points, n=27） and severe （26-30 points, n=25） dysmenorrhea groups. The control group included 40 healthy women of childbearing age who underwent routine healthcare examinations in the enrolment period. The expression of MMIF, HIF- 1α and VEGF in the serum and endometrial tissues was measured by enzyme-linked immunosorbent assay and Western blotting, respectively. Meanwhile, the sensitivity and specificity of serum MMIF, HIF-1α, and VEGF when separately used as single indexes or jointly used as one index were examined as well. The results showed that serum concentrations of MMIF, HIF-1α, and VEGF were significantly higher in EM patients than in controls （P〈0.05）. The expression of all three proteins in both serum and endometrial tissues increased significantly with the R-AFS stage （P〈0.05） and with dysmenorrheal severity （P〈0.05）. The sensitivity and specificity of the combined detection of serum MMIF, HIF-1α, and VEGF levels were significantly higher than those of single index detection （P〈0.05）. In conclusion, the expression of MMIF, HIF-1α, and VEGF in the serum and endometrial tissues may be used to assess the stage of EM and the severity of dysmenorrhea. Combined evaluation of MMIF, HIF-1α, and VEGF significantly improves the diagnostic sensitivity and specificity.展开更多
Intrahepatic endometriosis is one of the rarest forms of atypical endometriosis; only eighteen cases have been reported in the English literature. We describe the case of a 32-year-old woman, who presented with persis...Intrahepatic endometriosis is one of the rarest forms of atypical endometriosis; only eighteen cases have been reported in the English literature. We describe the case of a 32-year-old woman, who presented with persistent, non-cyclical upper right quadrant abdominal pain, a central liver cyst, and no history of endometriosis. Three years previous, she was diagnosed with an intrahepatic cyst. The lesion progressed and two laparoscopic deroofing-operations were performed, yet the diagnosis of intrahepatic endometriosis was never reached. She presented in our clinic with further progress of the cyst as well as obstruction of the intrahepatic biliary system. The magnetic resonance imaging showed a 9.5 cm × 12 cm, lobulated intrahepatic cyst. We performed an ultrasonic pericystectomy. Immunostaining confirmed intrahepatic endometriosis. Only one of the previously described eighteen patients with intrahepatic endometriosis presented with cyclical pain in the upper right abdominal quadrant accompanying menstruation. This lack of a "typical" clinic makes it challenging to diagnose extragonadal endometriosis without histopathology. A previous history of endometriosis was described in only twelve cases, thus the diagnosis of this condition should not be limited to patients with a known history of endometriosis. Six of 18 patients were postmenopausal, demonstrating this condition is not limited to women of reproductive age. A preoperative diagnosis was only reached in seven of the previously described cases, highlighting the importance of preoperative biopsies. Yet due to the potential adverse effects, a transhepatic biopsy must be discussed individually. Although rare, intrahepatic endometriosis should always be considered as a differential diagnosis in women with recurrent hepatic cysts, regardless of age or previous medical history. In such cases, histology is essential and a pericystectomy should be performed as standard of care.展开更多
This case report describes a woman with spontaneous rectal perforation from decidualized endometriosis in pregnancy.A 37-year-old woman was admitted to our hospital at 30 wk of pregnancy with symptoms suggestive of py...This case report describes a woman with spontaneous rectal perforation from decidualized endometriosis in pregnancy.A 37-year-old woman was admitted to our hospital at 30 wk of pregnancy with symptoms suggestive of pyelonephritis,which persisted until 33 wk of gestation when delivery of a premature male baby was performed through a cesarean section. On postoperative day 2,an abdominal computed tomography showed free air in the peritoneal cavity and a pelvic abscess.Explorative celiotomy revealed a diffuse severe fecaloid peritonitis that originated from a 3-cm wide rectal perforation.A Hartmann operation was then performed.Histopathological findings wereconsistent with decidualization of the rectal wall.Only 20 cases of intestinal perforation due to endometriosis have been reported in the literature.This report is believed to be the first case of spontaneous rectal perforation from endometriosis in pregnancy,and it shows the potential occurrence of serious and unexpected complications of the disease.展开更多
OBJECTIVE: To investigate the effect of herb-partitioned moxibustion(HPM) on pain and quality of life in women with endometriosis.METHODS: Thirty-six patients will be randomly assigned to a treatment group or a wait-l...OBJECTIVE: To investigate the effect of herb-partitioned moxibustion(HPM) on pain and quality of life in women with endometriosis.METHODS: Thirty-six patients will be randomly assigned to a treatment group or a wait-list control group. The treatment group will receive 12 sessions of HPM in the lower abdomen and lumbosacral region for 3 months. Wait-list participants will not receive any specific treatments until the trial is completed.RESULTS: The primary outcome measure is pain intensity assessed by a Visual Analogue Scale at baseline, months 1, 2, and 3 in the treatment period,and months 4, 5, and 6 in the follow-up period. Secondary outcome measures include quality of life assessed by the Short Form 36 Health Survey, change in CA125, change in cyst diameter(assessed by ultrasound examination), and rescue medication dosage.CONCLUSION: This study will provide evidence to confirm if HPM may be used as a therapeutic option for treating endometriosis.展开更多
文摘BACKGROUND Endometriosis affects approximately 10%of reproductive-age women and is frequently associated with chronic pelvic pain.Patients with endometriosis often experience comorbid depression and anxiety,but the underlying mechanisms connecting these conditions are unclear.AIM To assess the prevalence of depression and anxiety in endometriosis patients and explore neuroimmune mechanisms mediated via inflammatory biomarkers.METHODS A retrospective cohort study was conducted with 200 patients with endometriosis-associated chronic pain from June 2020 to December 2024.Depression and anxiety were assessed using validated psychological instruments.Inflammation biomarkers interleukin(ILs)(IL-6,IL-1β),tumor necrosis factor-alpha,C-reactive protein,and brain-derived neurotrophic factor were measured in serum.Pain severity was assessed using visual analog scales.Correlation and regression analyses were performed to examine relationships between inflammatory markers,pain severity,and psychological outcomes.RESULTS Among the 200 patients,42.5%exhibited clinically significant depression and 51.0%showed anxiety symptoms.Serum levels of IL-6,IL-1β,tumor necrosis factor-alpha,and C-reactive protein were significantly higher in patients with comorbid depression and anxiety compared with those without psychological symptoms(P<0.001).Brainderived neurotrophic factor levels were lower in the depression group.Pain severity positively correlated with inflammatory marker levels and with depression and anxiety scores.CONCLUSION Overall,the findings suggest that inflammatory factors mediate a neuroimmune mechanism linking endometriosisassociated chronic pain with depression and anxiety.Therapeutic targets for managing psychological comorbidities in patients with endometriosis through anti-inflammatory interventions should be explored,and an integrated treatment approach addressing both physical and psychological symptoms is emphasized.
文摘Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs,published before August 31,2020.A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results The meta-analysis included ten studies(651 and 1,040 in the combined EP and uncomplicated EP groups,respectively).The spontaneous pregnancy rate,clinical pregnancy rate,and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs[Odd’s ratio(OR)=0.63,95%confidence interval(CI):0.50–0.80,P=0.0001;OR=0.63,95%CI:0.48–0.84,P=0.001;OR=0.63,95%CI:0.42–0.96,P=0.03],and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group[OR=3.10,95%CI:1.52–6.32,P=0.002].Conclusion EP may adversely affect pregnancy outcomes in patients with infertility and EMs.Even after surgical treatment,EP can still reduce natural pregnancy,clinical pregnancy,and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.
文摘BACKGROUND Uterine adenomyosis and pulmonary endometriosis are exceptionally rare in adolescents and can pose significant diagnostic challenges due to their nonspecific clinical presentation and imaging features,which may mimic malignancy.Here,we describe a case of adenomyosis-associated uterine rupture(secondary to hemorrhagic necrosis)and concurrent pulmonary endometriosis in a 16-year-old girl initially suspected of having advanced uterine cancer.CASE SUMMARY A 16-year-old girl presented with acute abdominal pain and oliguria.Imaging studies revealed a 15-cm ruptured uterine mass accompanied by hemoperitoneum and multiple pulmonary nodules suggestive of metastatic disease.Laboratory tests demonstrated severe anemia and markedly elevated tumor markers[cancer antigen(CA)-125:1063 U/mL;CA-19-9:1347 U/mL].Emergency laparotomy revealed adenomyosis-associated uterine rupture secondary to hemorrhagic necrosis,with no macroscopic abnormalities in other organs.A total abdominal hysterectomy was performed.Histopathological analysis confirmed uterine adenomyosis with hemorrhagic necrosis.Subsequent thoracoscopic wedge resections of the pulmonary lesions demonstrated histologically confirmed endometriosis.The patient has remained disease-free under treatment with oral dienogest.CONCLUSION This case of an adolescent patient highlights how benign gynecological conditions can mimic malignancy,necessitating broad differential diagnoses despite alarming presentations.
基金approved by the Inonu University institutional review board for noninterventional studies(Approval No:2022/3842).
文摘BACKGROUND Endometriosis is a clinical condition characterized by the presence of endometrial glands outside the uterine cavity.While its incidence remains mostly uncertain,endometriosis impacts around 180 million women worldwide.Despite the presentation of several epidemiological and clinical explanations,the precise mechanism underlying the disease remains ambiguous.In recent years,researchers have examined the hereditary dimension of the disease.Genetic research has aimed to discover the gene or genes responsible for the disease through association or linkage studies involving candidate genes or DNA mapping techniques.AIM To identify genetic biomarkers linked to endometriosis by the application of machine learning(ML)approaches.METHODS This case-control study accounted for the open-access transcriptomic data set of endometriosis and the control group.We included data from 22 controls and 16 endometriosis patients for this purpose.We used AdaBoost,XGBoost,Stochasting Gradient Boosting,Bagged Classification and Regression Trees(CART)for classification using five-fold cross validation.We evaluated the performance of the models using the performance measures of accuracy,balanced accuracy,sensitivity,specificity,positive predictive value,negative predictive value and F1 score.RESULTS Bagged CART gave the best classification metrics.The metrics obtained from this model are 85.7%,85.7%,100%,75%,75%,100%and 85.7%for accuracy,balanced accuracy,sensitivity,specificity,positive predictive value,negative predictive value and F1 score,respectively.Based on the variable importance of modeling,we can use the genes CUX2,CLMP,CEP131,EHD4,CDH24,ILRUN,LINC01709,HOTAIR,SLC30A2 and NKG7 and other transcripts with inaccessible gene names as potential biomarkers for endometriosis.CONCLUSION This study determined possible genomic biomarkers for endometriosis using transcriptomic data from patients with/without endometriosis.The applied ML model successfully classified endometriosis and created a highly accurate diagnostic prediction model.Future genomic studies could explain the underlying pathology of endometriosis,and a non-invasive diagnostic method could replace the invasive ones.
文摘Deep infiltrating endometriosis is an often-painful disorder affecting women during their reproductive years that usually involves the structures of the pelvis and frequently the gastrointestinal tract.We present the case of a 37-year-old female patient with an endometrial growth on the sigmoid colon wall causing pain,diarrhea and the presence of blood in the feces.The histology of the removed specimen also revealed the involvement of the utero-vesical fold,the recto-vaginal septum and a pericolic lymph node,which are all quite uncommon findings.To identify the endometrial cells,we performed immunohistochemical staining for CD10and the estrogen and progesterone receptors.
文摘Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Up to 15% of women in their reproductive period are affected by this condition. Deep endometriosis is defined as endometriosis located more than 5 mm beneath the peritoneal surface. This type of endometriosis is mostly found on the uterosacral ligaments, inside the rectovaginal septum or vagina, in the rectosigmoid area, ovarian fossa, pelvic peritoneum, ureters, and bladder, causing a distortion of the pelvic anatomy. The frequency of bowel endometriosis is unknown, but in cases of bowel infiltration, about 90% are localized on the sigmoid colon or the rectum. Colorectal involvement results in alterations of bowel habits such as constipation, diarrhea, tenesmus, dyschezia, and, rarely, rectal bleeding.Differential diagnosis must be made in case of irritable bowel syndrome,solitary rectal ulcer syndrome,and a rectal tumor.A precise diagnosis about the presence,location,and extent of endometriosis is necessary to plan surgical treatment.Multidisciplinary laparoscopic treatment has become the standard of care.Depending on the size of the lesion and site of involvement,fullthickness disc excision or bowel resection needs to be performed by an experienced colorectal surgeon.Longterm outcomes,following bowel resection for severe endometriosis,regarding pain and recurrence rate are good with a pregnancy rate of 50%.
文摘Introduction: Cutaneous endometriosis is an uncommon but well-known skin disorder that represents about 0.5% to 1% of all endometriosis. The objective of this case series is to report clinical presentation, diagnosis, and management of various forms of cutaneous endometriosis. Material and Methods: It was an observational, retrospective and descriptive review of cases presenting with cutaneous endometriosis among Cameroonian women managed at the gynaecological outpatient department of Yaounde Gynaeco-Obstetric and Pediatric Hospital. All the following parameters were analysed: age, parity, previous pelvic surgery, presenting symptoms and duration, associated symptoms, localizations, imaging, size of the lesion, other localization of endometriosis, management and histopathological results. Results: we reported 4 cases of cutaneous endometriosis, with 3 umbilical endometriosis and 1 abdominal scar endometriosis. Patient age ranged from 28 to 39 years with an average of 33 years. All patients described infertility (two primary and two secondary) and two had a history of abdominal surgery. All patients presented local cyclical signs such as pain, swelling, color change and bleeding. The duration of symptoms varied from 2 to 3 years and the size of lesions ranged from 2 to 3.5 cm for umbilical lesions and was 9 cm for abdominal scar endometriosis. In all cases, no imaging was required for the diagnosis, which was suspected on the basis of patient’s history and the cyclical nature of local signs, followed by wide surgical excision and confirmation on histopathology. Conclusion: Cutaneaous endometriosis is a rare benign condition. Umbilical endometriosis seems to be the main cutaneous localization and can be described as primary or secondary. Even if its diagnosis must be confirmed by histopathology, it should be considered in patient with cutaneous cyclic signs such as pain, swelling or bleeding with or without history of abdominal surgery.
文摘Endometriosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% of females. It commonly affects pelvic structures including the bowel. Perforation of the colon by endometriosis is very rare and the patients generally present with an asymptomatic or painful pelvic mass, often in the left iliac fossa. Our patient presented acutely unwell and her symptoms were more suggestive of pyelonephritis or diverticulitis. We therefore report an unusual cause of acute abdomen. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of the disease, concerning both surgeons and gynaecologists. In summary, intestinal endometriosis should be considered in the differential diagnosis of all post-menarche women with episodic gastrointestinal symptoms. A past history of endometriosis or co-existent gynaecological symptoms should increase the index of suspicion, and taparoscopy prior to formal laparotomy should be considered. Our patient, in retrospect, had a history of mild endometriosis, but we feel that this case serves as a reminder of a rare, but important, differential diagnosis of acute abdomen in females.
文摘Endometriosis is an estrogen-dependent inflammatory disease,defined by the presence of functional endometrial tissue outside of the uterine cavity.This disease is one of the main gynecological diseases,affecting around 10%-15%women and girls of reproductive age,being a common gynecologic disorder.Although endometriosis is a benign disease,it shares several characteristics with invasive cancer.Studies support that it has been linked with an increased chance of developing endometrial ovarian cancer,representing an earlier stage of neoplastic processes.This is particularly true for women with clear cell carcinoma,low-grade serous carcinoma and endometrioid.However,the carcinogenic pathways between both pathologies remain poorly understood.Current studies suggest a connection between endometriosis and endometriosis-associated ovarian cancers(EAOCs)via pathways associated with oxidative stress,inflammation,and hyperestrogenism.This article aims to review current data on the molecular events linked to the development of EAOCs from endometriosis,specifically focusing on the complex relationship between the immune response to endometriosis and cancer,including the molecular mechanisms and their ramifications.Examining recent developments in immunotherapy and their potential to boost the effectiveness of future treatments.
文摘BACKGROUND To describe the characteristics,diagnosis and surgical treatment of inguinal endometriosis(IEM).CASE SUMMARY We retrospectively analyzed 10 patients diagnosed with IEM at Beijing Chao-Yang Hospital from 2011 to 2019.Relevant features,symptoms,images,surgical treatment,hormonal therapy and follow-up were collected and discussed.A total of 10 cases of IEM diagnosed by surgery and pathology were characterized by a lesion on the right side(9/11);five patients had symptoms related to the menstrual cycle,and only 3 patients were clearly diagnosed before surgery.Ultrasonography was of little assistance in confirming the diagnosis,but magnetic resonance imaging showed specific,high-intensity patterns.Anatomically,most of the IEM lesions were located in the extraperitoneal ligament(10/11);nine patients had inguinal hernias(IH),five had concurrent or prior pelvic endometriosis,and four had infertility.The clinical results from extensive resection were satisfactory.CONCLUSION IEM is an extremely rare condition that can easily be misdiagnosed prior to surgery.A right IH may contribute to the formation of right-sided IEM,and extensive resection involving the round ligament and hernia sac is essential to prevent recurrence.
文摘Endometriosis is a chronic and progressive gynecologic disorder that affects 10% - 50% of women of reproductive age worldwide. Chronic pain and infertility are the most debilitating problems associated with it requiring both medical and surgical treatment. Laparoscopy is considered the gold standard for diagnosis and treatment. However, a 10% rate of conversion to laparotomy has been reported when performed by skilled laparoscopic surgeons and much higher in low volume less skilled surgeons. To improve surgical outcomes, robotic assistance is the logical next step in performing minimally invasive gynecological surgeries, especially in complex endometriosis cases. Enhanced 3D visualization and 10× magnification along with Endowrist instruments with seven degrees of freedom facilitates precise and careful dissection. Firefly technology using ICG green dye can improve detection of small and invisible lesions. Robotics is useful in deep infiltrating disease manifesting as lesions deeper than the superficial tissues of rectovaginal septum, vaginal fornix, pelvic sidewalls, parametrium, bowel or ureter and bladder. Trials show no increase in surgical time, blood loss, or intra- or postoperative complications and similar clinical outcome when robotics is compared with laparoscopy. At present, it is more appropriate to compare it with laparotomy rather than laparoscopy. Robotics can be used to manage recurrence of endometriosis after hysterectomy. Surgeons experienced in conventional laparoscopy can utilize robotic platform for deep infiltrating endometriosis for performing complex surgical dissection and achieving the surgical goals in mind and reduce conversions to open surgery. Robotic assistance can bridge the gap in performance of laparoscopic surgery in advanced endometriosis.
文摘Endometriosis is defined as the presence of endometrial tissue that is located outside the uterine cavity, associated with fibrosis and inflammatory reaction. The most common atypical locations are the gastrointestinal tract, urinary tract, lung, as well as abdominal surgical scars. Its diagnosis is still very difficult, especially when it manifests itself as an acute large bowel obstruction. We report the rare case of a 41-year-old patient diagnosed with acute colonic obstruction following a rectal tumor. She had undergone colonostomy even though colonoscopy biopsies were nonspecific, and a computed tomography (CT) scan was requested. It showed an adnexal heterogenous mass, therefore the patient had a laparotomy and a subtotal hysterectomy with bilateral salpingo-oophorectomy and a biopsy of the recto-colonic hinge. Histologic examination revealed a diagnosis of rectal endometriosis. The purpose of this work is to report a rare case of colonic endometriosis responsible for an acute large bowel obstruction.
基金supported by Foundation for Discipline Construction of Fujian Medical University Union Hospital(2100201).
文摘A 36-year-old unmarried woman with no sexual history presented with 12 days of uncontrollable yellowish vaginal discharge,bloating,lower back pain,frequent urination,and urgency.Her menstrual cycles were regular with moderate flow and worsening dysmenorrhea.Ultrasound and magnetic resonance imaging identified uterine and cervical masses.Laparoscopic surgery and postoperative gonadotropin-releasing hormone agonist injections led to significant lesion reduction.The patient is currently on oral dienogest acetate with ongoing follow-up.
文摘Endometriosis is a condition characterized by the presence of endometrial tissue outside the uterine cavity. This tissue, found in the inner lining of the uterus, develops in other pelvic organs, such as the ovaries, fallopian tubes, peritoneum, and bowel. In cases of deep endometriosis, the appendix may be affected, and consequently, appendectomy becomes a perioperative possibility. From February 2018 to February 2023, the surgical team performed 133 laparoscopic procedures. The number of appendectomies by the time of the surgical procedure was 19.5% (26 cases), with 50% of these (13 cases) confirming the histological presence of appendiceal endometriosis (AE), no increasing of postoperative complications was noticed. This report is important to reinforce multidisciplinary training, review postoperative complications, and provide training in advanced pelvic surgery. Furthermore, it aims to emphasize that appendectomy performed during the surgical act is a safe and viable procedure that does not increase complication rates.
文摘Endometriosis is defined as the presence of endometrial tissue outside the uterus. It is a benign pathology involving 15% of women of reproductive age. The sigmoid site represents 7% of endometriosis but it is the most frequent area in the digestive tract. We report two cases of colonic endometriosis in which the initial diagnosis suspected a malignant disease. Respectively, the patients were 31 and 48 years old. The first patient complained about abdominal pain with symptoms of intestinal obstruction and was classified after radiological examination as an intrasigmoid tumor with bladder adhesion. The second patient was undergone for a radiological examination because of a bowel obstruction syndrom and a mass in the sigmoid colon was suspected. In both cases, sigmoid colon resection was performed and histological diagnosis was sigmoid endometriosis. Sigmoid endometriosis is rarely diagnosed before surgical excision. Suspicious bowel obstruction and malignant origin lead to large surgical excision. Histological examination is important to establish the diagnosis.
文摘BACKGROUND Rectosigmoid endometriosis is an underdiagnosed disease responsible for abdominal pain, transit disorders and rectal bleeding. Two surgical approaches,rectosigmoid bowel resection(segmental or patch) or intramuscular layer dissection(shaving), are available.AIM To assess whether the lesion features observed via preoperative rectosigmoid endoscopic ultrasonography(RS-EUS) might predict the need for bowel resection.METHODS This multicentric retrospective study was conducted on patients with rectosigmoid endometriosis who underwent a curative surgical procedure,evaluated by RS-EUS performed by two trained operators, between January 2012 and March 2018. A univariate statistical analysis was performed on nodules' RSEUS features(thickness, width, infiltration of the submucosae, presence of a bump into the digestive lumen and presence of multiple rectosigmoid localizations). A multivariate logistic regression was then performed on the significant results.RESULTS Of the 367 patients, 73 patients with rectosigmoid endometriosis were evaluated by RS-EUS and underwent rectosigmoid surgery. After the univariate analysis was completed, thickness, width and infiltration of the submucosae were identified as potential predictive factors for bowel resection. In a multivariate logistic regression model, only thickness appeared to be a significant [odds ratio(OR) = 1.49, 95% confidence interval(CI): 1.04-2.12, P = 0.028] predictive factor for bowel resection. Receiver operating characteristic analysis performed showed that a thickness over 5.20 mm might be used as cut-off with a sensitivity of 76%, a specificity of 81%, and an area under carve = 0.82. The cut-off values for 100%sensitivity and 100% specificity were 0.90 mm and 10.00 mm, respectively. A trend concerning width to predict the need for resection was also observed(OR1.12, 95%CI: 1.00-1.26, P = 0.054)CONCLUSION The presence of a rectosigmoid nodule of endometriosis greater than 5.20 mm thick on RS-EUS might predict the need for bowel resection.
文摘The aim of this study was to investigate the expression of macrophage migration inhibitory factor （MMIF）, hypoxia-inducible factor- 1 α（HIF- 1α ）and vascular endothelial growth factor （VEGF） in the serum and endometrial tissues of patients with endometriosis （EM） and the clinical significance. Eighty EM patients [American Reproductive Association stage Ⅰ （n=20）, stage Ⅱ （n=22）, stage Ⅲ （n=21） and stage Ⅳ （n=17）] were enrolled and divided into mild （10- 14 points, n=28）, moderate （16-24 points, n=27） and severe （26-30 points, n=25） dysmenorrhea groups. The control group included 40 healthy women of childbearing age who underwent routine healthcare examinations in the enrolment period. The expression of MMIF, HIF- 1α and VEGF in the serum and endometrial tissues was measured by enzyme-linked immunosorbent assay and Western blotting, respectively. Meanwhile, the sensitivity and specificity of serum MMIF, HIF-1α, and VEGF when separately used as single indexes or jointly used as one index were examined as well. The results showed that serum concentrations of MMIF, HIF-1α, and VEGF were significantly higher in EM patients than in controls （P〈0.05）. The expression of all three proteins in both serum and endometrial tissues increased significantly with the R-AFS stage （P〈0.05） and with dysmenorrheal severity （P〈0.05）. The sensitivity and specificity of the combined detection of serum MMIF, HIF-1α, and VEGF levels were significantly higher than those of single index detection （P〈0.05）. In conclusion, the expression of MMIF, HIF-1α, and VEGF in the serum and endometrial tissues may be used to assess the stage of EM and the severity of dysmenorrhea. Combined evaluation of MMIF, HIF-1α, and VEGF significantly improves the diagnostic sensitivity and specificity.
文摘Intrahepatic endometriosis is one of the rarest forms of atypical endometriosis; only eighteen cases have been reported in the English literature. We describe the case of a 32-year-old woman, who presented with persistent, non-cyclical upper right quadrant abdominal pain, a central liver cyst, and no history of endometriosis. Three years previous, she was diagnosed with an intrahepatic cyst. The lesion progressed and two laparoscopic deroofing-operations were performed, yet the diagnosis of intrahepatic endometriosis was never reached. She presented in our clinic with further progress of the cyst as well as obstruction of the intrahepatic biliary system. The magnetic resonance imaging showed a 9.5 cm × 12 cm, lobulated intrahepatic cyst. We performed an ultrasonic pericystectomy. Immunostaining confirmed intrahepatic endometriosis. Only one of the previously described eighteen patients with intrahepatic endometriosis presented with cyclical pain in the upper right abdominal quadrant accompanying menstruation. This lack of a "typical" clinic makes it challenging to diagnose extragonadal endometriosis without histopathology. A previous history of endometriosis was described in only twelve cases, thus the diagnosis of this condition should not be limited to patients with a known history of endometriosis. Six of 18 patients were postmenopausal, demonstrating this condition is not limited to women of reproductive age. A preoperative diagnosis was only reached in seven of the previously described cases, highlighting the importance of preoperative biopsies. Yet due to the potential adverse effects, a transhepatic biopsy must be discussed individually. Although rare, intrahepatic endometriosis should always be considered as a differential diagnosis in women with recurrent hepatic cysts, regardless of age or previous medical history. In such cases, histology is essential and a pericystectomy should be performed as standard of care.
基金Supported by A grant from the University of Cagliari,Italy
文摘This case report describes a woman with spontaneous rectal perforation from decidualized endometriosis in pregnancy.A 37-year-old woman was admitted to our hospital at 30 wk of pregnancy with symptoms suggestive of pyelonephritis,which persisted until 33 wk of gestation when delivery of a premature male baby was performed through a cesarean section. On postoperative day 2,an abdominal computed tomography showed free air in the peritoneal cavity and a pelvic abscess.Explorative celiotomy revealed a diffuse severe fecaloid peritonitis that originated from a 3-cm wide rectal perforation.A Hartmann operation was then performed.Histopathological findings wereconsistent with decidualization of the rectal wall.Only 20 cases of intestinal perforation due to endometriosis have been reported in the literature.This report is believed to be the first case of spontaneous rectal perforation from endometriosis in pregnancy,and it shows the potential occurrence of serious and unexpected complications of the disease.
基金Supported by Zhejiang Provincial Administration of Traditional Chinese Medicine:Herb-partitioned in Pelvic and Sacral Region for Endometriosis:a Randomized Contorlled Trial(No.2016ZQ022)National Key R&D Program of China:Innovative Research of Key Problems for Meridians Based on the Heart and Lung Meridians(No.2018YFC1704600)Zhejiang Province Top Discipline of Chinese Medicine(No.ZTK2017A02)。
文摘OBJECTIVE: To investigate the effect of herb-partitioned moxibustion(HPM) on pain and quality of life in women with endometriosis.METHODS: Thirty-six patients will be randomly assigned to a treatment group or a wait-list control group. The treatment group will receive 12 sessions of HPM in the lower abdomen and lumbosacral region for 3 months. Wait-list participants will not receive any specific treatments until the trial is completed.RESULTS: The primary outcome measure is pain intensity assessed by a Visual Analogue Scale at baseline, months 1, 2, and 3 in the treatment period,and months 4, 5, and 6 in the follow-up period. Secondary outcome measures include quality of life assessed by the Short Form 36 Health Survey, change in CA125, change in cyst diameter(assessed by ultrasound examination), and rescue medication dosage.CONCLUSION: This study will provide evidence to confirm if HPM may be used as a therapeutic option for treating endometriosis.
