RESUMEN

OBJECTIVE: To evaluate the implantation of menstrual endometrium and the early stages of evolution of endometriotic lesions. DESIGN: Experimental prospective study. SETTING: An academic research environment. ANIMALS: Ten nude mice. INTERVENTION(S): A minilaparotomy was performed to place fresh human menstrual endometrial samples in the peritoneal cavity. Removal of the transplants was performed successively on days 1, 3, and 5 by laparotomy. MAIN OUTCOME MEASURE(S): Adhesion of endometrial fragments and early stages of endometrial lesions was morphologically and immunohistochemically studied. RESULT(S): As early as day 1, stromal cells were found to be attached to the mesothelium. A progressive reorganization of epithelial and stromal cells into endometrial glands was observed. On day 5, cystic endometriotic lesions were characterized by more extensive proliferative activity in glandular cells and a higher VEGF score in stromal cells than that observed in previously removed transplants. CONCLUSION(S): Menstrual human endometrium is able to implant on intact mesothelium and to reorganize itself into structured glands and stroma under the influence of unknown factors. We suggest that stromal and glandular cells have two distinct roles: stromal cells are involved in the attachment process and glandular cells in the growth of the endometriotic lesion.

Asunto(s)

Endometriosis/etiología , Endometrio/patología , Endometrio/trasplante , Adulto , Animales , Endometriosis/patología , Endometrio/inmunología , Factores de Crecimiento Endotelial/metabolismo , Femenino , Humanos , Linfocinas/metabolismo , Menstruación , Ratones , Ratones Desnudos , Estudios Prospectivos , Trasplante de Tejidos , Factor A de Crecimiento Endotelial Vascular , Factores de Crecimiento Endotelial Vascular

RESUMEN

OBJECTIVE: To compare histologic and ultrastructural characteristics of fresh and frozen-thawed human ovarian cortical tissue grafted into nude mice. DESIGN: Experimental prospective study. SETTING: An academic research environment. PATIENT(S): Ovarian biopsy specimens were obtained from 13 women undergoing laparoscopy for tubal ligation or infertility. ANIMAL(S): Forty nude mice. INTERVENTION(S): A minilaparotomy was performed to place fresh and frozen-thawed ovarian grafts subcutaneously (sc) or intraperitoneally (ip). Removal of the ovarian grafts was performed at 24 days. MAIN OUTCOME MEASURE(S): [1] the follicular population, [2] fibrosis, [3] vascularization of the grafted tissue, and [4] ultrastructural evaluation. RESULT(S): A greater fibrosis relative surface area was noted in frozen-thawed transplanted tissue than in fresh transplants. Regardless of this fibrosis, a similar follicular density was observed in fresh and frozen-thawed ovarian tissue 24 days after transplantation. Active angiogenesis was proved by both immunohistochemical study of the vascular endothelial growth factor and morphometric study of the vascular network. Normal ultrastructural characteristics were noted in frozen-thawed ovarian biopsies. CONCLUSION(S): Angiogenesis allows implantation of the graft even if it has been cryopreserved and thawed similarly to implantation of fresh tissue. The greater fibrosis observed in grafts after cryopreservation and implantation does not seem to affect the primordial and primary ovocyte population and their ultrastructural characteristics, but further studies must be conducted to prove that after cryopreservation and transplantation, ovocytes may achieve full maturation and fertilization.

Asunto(s)

Ovario/trasplante , Ovario/ultraestructura , Animales , Criopreservación , Factores de Crecimiento Endotelial/biosíntesis , Femenino , Fibrosis/patología , Humanos , Linfocinas/biosíntesis , Ratones , Ratones Desnudos , Microscopía Electrónica , Neovascularización Fisiológica , Folículo Ovárico/ultraestructura , Ovario/irrigación sanguínea , Peritoneo , Trasplante Heterólogo , Factor A de Crecimiento Endotelial Vascular , Factores de Crecimiento Endotelial Vascular

RESUMEN

The objective of this study was to analyse the histological and immunohistochemical characteristics of cultured explants of human endometrium transplanted into nude mice. Biopsies of eutopic endometrium were taken from six patients during laparoscopic surgery and classified according to the phase of the cycle. All the explants were cultured with oestrogen and progesterone for 24 h before transplantation into 15 mice. Four mice were grafted with explants of menstrual endometrium, four with explants of late proliferative endometrium, and seven with explants of late secretory-premenstrual endometrium. Typical endometrial glands and stroma were observed in 87% of cases 3 weeks after the transplantation. All the grafts revealed histological characteristics of the proliferative phase, even when the endometrial biopsy was taken during the late secretory phase. Immunohistochemical studies revealed that the proliferation index was high, whatever the menstrual phase of the endometrial biopsy. An extensive vascular network developed at the interface between the graft and the surrounding tissue. Vascular endothelial growth factor (VEGF) positive stained cells were observed in all grafts, the VEGF score being significantly higher in epithelial cells than in stromal cells. In conclusion, human endometrial explants, cultured for 24 h, could be successfully transplanted into nude mice. Immunohistochemical studies proved that human cultured endometrial tissue could not only survive in nude mice but could also become very active and develop characteristics different from the tissue of origin. An active vascular network is a necessary condition for the survival of the graft and may be explained by the high VEGF content.

Asunto(s)

Técnicas de Cultivo/métodos , Endometrio/irrigación sanguínea , Endometrio/trasplante , Adulto , Animales , División Celular , Medios de Cultivo/química , Endometrio/metabolismo , Endometrio/patología , Factores de Crecimiento Endotelial/metabolismo , Estradiol/metabolismo , Femenino , Humanos , Antígeno Ki-67/metabolismo , Linfocinas/metabolismo , Ratones , Ratones Desnudos , Persona de Mediana Edad , Neovascularización Fisiológica , Cavidad Peritoneal/patología , Embarazo , Progesterona/metabolismo , Trasplante Heterólogo , Factor A de Crecimiento Endotelial Vascular , Factores de Crecimiento Endotelial Vascular

RESUMEN

The cell proliferation-associated antigen Ki 67 and the immunohistochemical content of oestrogen receptors (ER), progesterone receptors AB (PRAB) and progesterone receptors B (PRB) were evaluated in leiomyomata and adjacent myometrium during the menstrual cycle and in leiomyomata under gonadotrophin-releasing hormone agonist (GnRHa) therapy. The proliferative status of muscular cells was measured by evaluating the percentage of nuclei staining positive for Ki 67 (proliferation index). Quantitative analysis (QH-score) was carried out using advanced stereographic computer technology to investigate ER, PRAB and PRB. Leiomyoma and myometrial biopsies were taken from 30 patients undergoing hysterectomy or myomectomy because of symptomatic leiomyomata (subgroup I). Leiomyoma biopsies were taken from 10 patients suffering from symptomatic submucosal leiomyomata, after 2 month GnRH therapy (subgroup II). During the secretory phase, the proliferation index (Ki 67) was found to be higher in leiomyomata than in myometrium, but the difference was not significant. Oestrogen receptor content was significantly higher in leiomyomata than in myometrium only during the proliferative phase of the cycle. PRAB and PRB content were found to be higher in leiomyomata than in adjacent myometrium with a statistically significant dominance of PRAB over PRB. Under GnRHa therapy, a dramatic decrease was observed in PRAB and B content as well as Ki 67 but ER content remained comparable with the results obtained during the menstrual cycle. The results suggest that leiomyomata may be under the influence of progesterone which may play a major role in their growth.

Asunto(s)

División Celular , Inmunohistoquímica , Leiomioma/química , Receptores de Estrógenos/análisis , Receptores de Progesterona/análisis , Neoplasias Uterinas/química , Adulto , Femenino , Hormona Liberadora de Gonadotropina/agonistas , Hormona Liberadora de Gonadotropina/uso terapéutico , Humanos , Antígeno Ki-67/análisis , Leiomioma/patología , Ciclo Menstrual , Persona de Mediana Edad , Miometrio/química , Miometrio/citología , Neoplasias Uterinas/patología

RESUMEN

Angiogenesis is likely to be involved in the pathogenesis of endometriosis. According to the transplantation theory, when the exfoliated endometrium is attached to the peritoneal layer, the establishment of a new blood supply is essential for the survival of the endometrial implant and development of endometriosis. From the known angiogenic factors, vascular endothelial growth factor (VEGF) has emerged as a pivotally important regulator of normal angiogenesis and pathological neovascularization. The VEGF protein was evaluated immunohistochemically in the eutopic endometrium of 10 women without endometriosis (group I) at laparoscopy and the eutopic endometrium and peritoneal endometriotic lesions of 43 women with endometriosis (group II). VEGF histological scores were 9.7 +/- 4.3 and 4.0 +/- 2.6 respectively in the epithelium and stroma of the eutopic endometrium of group I women, and 10.3 +/- 2.3 and 3.6 +/- 2.3 respectively in women of group II. In red lesions, the VEGF scores were 11.1 +/- 3.0 in the epithelium and 5.1 +/- 3.0 in the stroma, and in black lesions were 8.6 +/- 2.7 and 1.6 +/- 1.6, respectively. Significantly lower values were observed in black lesions as compared with eutopic endometrium and red lesions, the values of which were similar. Scores were also evaluated according to the phase of the cycle. In eutopic as well as ectopic endometrium, no significant cyclic variations were observed throughout the cycle. However, VEGF content was found to be higher in the eutopic glandular epithelium of women with endometriosis during the late secretory phase, possibly suggesting a more likely tendency to implant. In contrast, significantly higher VEGF content was noted in red lesions as compared with black lesions. During all phases of the cycle, the VEGF content in stromal cells of red lesions was higher than in black lesions. Similarities in VEGF content were observed in the glandular epithelium of the eutopic endometrium of women with endometriosis and red lesions, suggesting that endometriosis probably arises from the peritoneal seeding of viable endometrial cells during retrograde menstruation and that red lesions can be considered as the first stage of implantation. After the attachment phase, the high VEGF levels could provoke an increase in the subperitoneal vascular network and facilitate implantation and viability in the retroperitoneal space. Lower VEGF levels in black lesions explain the decrease in both stromal vascularization, followed by fibrosis and inactivation of the implant.

Asunto(s)

Endometriosis/metabolismo , Endometrio/metabolismo , Factores de Crecimiento Endotelial/metabolismo , Linfocinas/metabolismo , Adulto , Endometriosis/fisiopatología , Endometrio/irrigación sanguínea , Endometrio/fisiopatología , Factores de Crecimiento Endotelial/análisis , Femenino , Humanos , Inmunohistoquímica , Linfocinas/análisis , Neovascularización Patológica , Factor A de Crecimiento Endotelial Vascular , Factores de Crecimiento Endotelial Vascular

RESUMEN

OBJECTIVE: To assess the proliferative activity of eutopic and ectopic endometrium throughout the menstrual cycle and its correlation to steroid receptor content. DESIGN: The immunohistochemical use of Ki 67 was applied to investigate the proliferation index. A recently advanced stereographic computer technology was used to investigate steroid receptors. SETTING: University hospital department of gynecology. PATIENT(S): Biopsies of eutopic endometrium, black and red peritoneal endometriotic lesions, and ovarian endometriomas were taken from infertile patients and classified according to the phase of the cycle. RESULT(S): In normal endometrium, the glandular proliferation index was highest during the proliferative phase and was statistically significantly reduced during the secretory phase. No proliferative activity was observed in the late secretory phase. No statistically significant differences were found between ectopic endometrium and eutopic endometrium except during the late secretory phase, when proliferative activity was still present in endometriotic tissue. The stromal proliferation index was similar in red lesions, ovarian endometriomas, and eutopic endometrium during the secretory phase. In normal endometrium, the highest concentrations of estrogen receptors (ERs) and P receptors (PRs) occurred in the epithelial and stromal cells during the late proliferative phase of the menstrual cycle. Estrogen receptor and PR content declined throughout the secretory phase. In ectopic endometrium, PR persisted in the glandular epithelium during the late secretory phase. Estrogen receptors persisted in the glandular epithelium and stroma of red peritoneal lesions and ovarian endometriomas during the late secretory phase. CONCLUSION(S): The high proliferative activity and the persistence of ERs and PRs in the stroma of red lesions and ovarian endometriomas emphasize the primordial role of the stroma in the development of endometriosis and suggest different mechanisms of proliferation control from those observed in eutopic endometrium.

Asunto(s)

Endometriosis/patología , Inmunohistoquímica , Enfermedades del Ovario/patología , Enfermedades Peritoneales/patología , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Adulto , División Celular , Endometriosis/metabolismo , Epitelio/metabolismo , Femenino , Humanos , Ciclo Menstrual , Enfermedades del Ovario/metabolismo , Enfermedades Peritoneales/metabolismo , Células del Estroma/metabolismo

RESUMEN

OBJECTIVE: Laparoscopic procedure with excision of deep fibrotic endometriotic nodules of the rectovaginal septum and histological study of the lesions. SETTING: An academic teaching hospital. PARTICIPANTS: A series of 500 women undergoing laparoscopy for pelvic pain or infertility. RESULTS: Laparoscopic (n = 497) and laparotomic (n = 3) excision of endometriotic nodules resulted in considerable pain relief. Histologically the rectovaginal nodule was similar to an adenomyoma as it was a circumscribed nodular aggregate of smooth muscle and endometrial glands and stroma. The variations in oestrogen receptor and progesterone receptor content suggested a regulatory mechanism different from that of eutopic endometrium. CONCLUSION: This form of disease should be considered as an entity distinct from peritoneal and ovarian endometriosis, and originating from the Müllerian rests present in the rectovaginal septum.

Asunto(s)

Endometriosis/cirugía , Enfermedades del Recto/cirugía , Enfermedades Vaginales/cirugía , Endometriosis/metabolismo , Endometriosis/patología , Femenino , Humanos , Infertilidad Femenina/etiología , Infertilidad Femenina/terapia , Laparoscopía , Enfermedad Inflamatoria Pélvica/etiología , Enfermedad Inflamatoria Pélvica/cirugía , Receptores de Estrógenos/análisis , Receptores de Progesterona/análisis , Enfermedades del Recto/patología , Sensibilidad y Especificidad , Enfermedades Vaginales/metabolismo , Enfermedades Vaginales/patología

RESUMEN

OBJECTIVE: To compare histologically and stereologically the endometriotic nodule of the rectovaginal septum to peritoneal endometriosis. DESIGN: Morphometric investigation, cytokeratin and vimentin content, and steroid receptor evaluation were performed on endometriotic tissue from the peritoneum (n = 52) and rectovaginal nodules (n = 68). SETTING: An academic teaching hospital. PATIENTS: Biopsies were taken from 120 patients undergoing a laparoscopy for infertility and/ or pelvic pain (52 from typical black peritoneal endometriotic implants and 68 from endometriotic nodule of the rectovaginal septum). None of the patients were treated. RESULTS: Mitotic activity was found to be significantly different in peritoneal and rectovaginal endometriosis. The evaluation suggested that the stroma is not mandatory for the invasion of glandular epithelium in the rectovaginal nodule, which is, like a adenomyoma, a circumscribed nodular aggregate of smooth muscle and glandular elements. Cytokeratin and vimentin content as well as the estrogen receptor (ER) and P receptor (PR) content were significantly lower in both types of lesion when compared with eutopic endometrium. But vimentin immunoreactivity in epithelium, as well as the ER and PR content, were significantly lower in nodules when compared with black peritoneal lesions. CONCLUSION: It is suggested that the rectovaginal endometriotic nodule is a different disease from peritoneal endometriosis and must be called rectovaginal adenomyosis or rectovaginal adenomyoma. Its histopathogenesis probably is not related to the implantation of regurgitated endometrial cells but to the metaplasia of Müllerian rests.

Asunto(s)

Endometriosis/patología , Endometrio/patología , Enfermedades Peritoneales/patología , Enfermedades del Recto/patología , Enfermedades Vaginales/patología , Adenomioma/química , Adenomioma/diagnóstico , Adenomioma/patología , Biopsia , Diagnóstico Diferencial , Neoplasias Endometriales/química , Neoplasias Endometriales/diagnóstico , Neoplasias Endometriales/patología , Endometriosis/diagnóstico , Endometrio/química , Epitelio/química , Epitelio/patología , Femenino , Humanos , Inmunohistoquímica , Queratinas/análisis , Mitosis , Enfermedades Peritoneales/diagnóstico , Receptores de Estrógenos/análisis , Receptores de Progesterona/análisis , Enfermedades del Recto/diagnóstico , Enfermedades Vaginales/diagnóstico , Vimentina/análisis

RESUMEN

The management of large endometriomas was described in a series of 814 patients. Combined therapy using gonadotrophin-releasing hormone agonist (GnRHa) and carbon dioxide laser laparoscopy was proposed. Drainage and GnRHa for 12 weeks provoked a reduction of the endometrioma size up to 50% of the initial value. After vaporization of the internal wall, a cumulative pregnancy of 51% after 1 year was achieved. A recurrence rate of 8% was observed for a follow-up of 2-11 years. Histological data demonstrated that the epithelium covering the ovary which is the mesothelium can invaginate in the ovarian cortex. Some of the invaginations were seen to be continuous with endometrial tissue, strongly suggesting the metaplasia theory in the pathogenesis of ovarian endometrioma.

Asunto(s)

Endometriosis/tratamiento farmacológico , Endometriosis/cirugía , Hormona Liberadora de Gonadotropina/agonistas , Terapia por Láser , Enfermedades del Ovario/tratamiento farmacológico , Enfermedades del Ovario/cirugía , Terapia Combinada , Endometriosis/patología , Femenino , Goserelina/uso terapéutico , Humanos , Infertilidad Femenina/tratamiento farmacológico , Infertilidad Femenina/etiología , Infertilidad Femenina/cirugía , Metaplasia , Quistes Ováricos/tratamiento farmacológico , Quistes Ováricos/patología , Quistes Ováricos/cirugía , Enfermedades del Ovario/patología , Embarazo , Recurrencia

RESUMEN

This study was undertaken to evaluate the efficacy and safety of an intrauterine device designed for endometrial ablation by Nd-YAG laser interstitial hyperthermy. Eight hysterectomy specimens were treated in vitro with an output power of 30 W for 5 minutes; tissue temperatures, recorded by thermocouples, were plotted to draw time-temperature and time-distance curves. As a preliminary series, ten patients were treated, with the first five subjected to local temperature monitoring; all ten were followed-up for 6-17 months. Immediate and delayed (6 weeks) histologic data were obtained. The intramural temperature at 6 mm from the fibers ranged from 55-60C). In vivo, the cooling effect of the arterial blood flow lowered the serosal temperatures under 41C. The histologic data and the hysterographic pictures suggest that endometrial ablation was effective. This new device does not require distending medium, hysteroscopic control, or high-powered Nd-YAG laser machines. Preliminary long-term results suggest that the device could be used for endometrial ablation.

Asunto(s)

Ablación por Catéter/instrumentación , Endometrio/cirugía , Hipertermia Inducida/instrumentación , Terapia por Láser/instrumentación , Femenino , Humanos , Neodimio , Itrio

RESUMEN

Recently advanced computerized technology was applied to the investigation of morphometric, immunohistological and three-dimensional changes of the endometrial mucosa in order to evaluate quantitatively the effects of three doses of a new slow-release vaginal progesterone on the endometrium in post-menopausal women. A total of 20 menopausal women, deprived of ovarian function, were given oestrogen for 12 days and a combined therapy of oestrogen (administered orally) and progesterone for another 12 day period. Progesterone was administered vaginally through a new gel (Crinone) utilizing a bioadhesive, biocompatible polymer as a base to achieve a sustained release effect. An endometrial biopsy was taken before treatment, after oestrogen-only treatment and after the oestro-progestogen therapy. Before treatment, all the patients exhibited an atrophic endometrium. After oestrogen-only treatment, typical proliferative changes occurred: an increase in the endometrium thickness, an increase in the mitotic index, numerous cylinder-like glands and no coiled glands, and high concentrations of oestrogen receptors (ER) and progesterone receptors (PR). After the oestro-progestogen therapy, whatever the dose of progesterone given, a secretory transformation of the endometrial mucosa occurred, mitotic activity decreased significantly, more ramified and coiled glands were observed, and a decrease in PR content was noted in epithelial and stromal nuclei, and a decrease in PR content was also observed in epithelial nuclei but not in stromal nuclei. Accurate new techniques of image analysis have shown that crinone therapy could eliminate the proliferative effects of oestrogen treatment in post-menopausal women, despite doses as low as 45 mg of progesterone administered vaginally every other day. The results suggest that the sustained release effects of Crinone are clinically relevant.

Asunto(s)

Endometrio/anatomía & histología , Endometrio/metabolismo , Estrógenos/uso terapéutico , Progesterona/administración & dosificación , Capilares/anatomía & histología , Preparaciones de Acción Retardada , Método Doble Ciego , Endometrio/efectos de los fármacos , Estradiol/sangre , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Índice Mitótico , Progesterona/sangre , Receptores de Esteroides/metabolismo , Vagina

RESUMEN

A computerized morphometrical investigation was performed on endometriotic tissue from the peritoneum (n = 225) and rectovaginal nodules (n = 65) to compare histologically and stereologically the rectovaginal septum endometriotic nodule to peritoneal endometriosis. Mitotic activity, stromal vascularization and the epithelium/stroma ratio were found to be significantly different in peritoneal and rectovaginal endometriosis. The evaluation revealed a major role of glandular epithelium in rectovaginal nodules where the stroma sometimes appeared absent around glandular epithelium. The study demonstrated opposite effects of gonadotrophin-releasing hormone agonists (GnRHa) and lynestrenol on the two lesions. Indeed, in peritoneal endometriosis, after GnRHa therapy, our study demonstrated a lower rate of mitosis and poor stromal vascularization. The same drug was unable to induce the same effects in the nodule although, in contrast, lynestrenol has a strong effect on nodule vascularization. In conclusion, it is suggested that the rectovaginal adenomyotic nodule is a specific disease, different from peritoneal endometriosis. It is not the consequence of 'deep infiltrating' endometriosis but can probably develop from Mullerian rests present in the rectovaginal septum.

Asunto(s)

Endometriosis/patología , Peritoneo/patología , Vagina/patología , Biopsia , Endometriosis/tratamiento farmacológico , Endometrio/irrigación sanguínea , Epitelio/patología , Femenino , Hormona Liberadora de Gonadotropina/análogos & derivados , Hormona Liberadora de Gonadotropina/uso terapéutico , Humanos , Linestrenol/uso terapéutico , Mitosis

RESUMEN

OBJECTIVE: To evaluate quantitatively cytokeratin and vimentin staining in glandular and stromal cells of eutopic and ectopic endometrium. DESIGN: The investigation of cytokeratin and vimentin was carried out using the new computerized technology of image analysis. SETTING: University Hospital, Department of Gynecology. PATIENTS: Biopsies were taken from patients undergoing a laparoscopy for infertility (29 endometrial biopsies and 31 biopsies of peritoneal endometriosis). None of them were treated. RESULTS: Cyclic variations of cytokeratin and vimentin staining were noted in eutopic endometrium. The cytokeratin and vimentin staining pattern consistently was lower in ectopic endometrium than in eutopic endometrium. CONCLUSIONS: Endometriotic epithelial and stromal cells undergo a complex program of differentiation giving them histochemical characteristics similar to those observed in endometrium. Such a concomitant expression of antigenicity indicates their close relationship with their mesodermal müllerian origin.

Asunto(s)

Endometriosis/metabolismo , Endometrio/metabolismo , Procesamiento de Imagen Asistido por Computador , Queratinas/metabolismo , Ciclo Menstrual , Vimentina/metabolismo , Adulto , Femenino , Humanos , Inmunohistoquímica , Valores de Referencia , Coloración y Etiquetado

RESUMEN

Both the electrical current of the resectoscope and the energy of the Nd:YAG laser have been effective tools in the destruction of endometrial tissue to a sufficient depth to avoid regeneration. GnRH-agonist therapy effects a decrease in the total uterine cavity area which facilitates surgical treatment and reduces the risk of fluid overload syndrome. The recurrence rate of meno/metrorrhagia is higher when the uterine cavity is more than 10 cm2. The use of GnRH-agonists represents an adjunct for preoperative reduction of submucosal myomas so that subsequent hysteroscopic myomectomy is possible. A two-step hysteroscopic therapy combined with GnRH-agonist therapy is performed when the largest portion of the submucosal myoma is located in the uterine wall. In cases of numerous submucosal and intramural myomas, a laparoscopic supracervical hysterectomy is performed because of the high risk of recurrence after the hysteroscopic procedure.

Asunto(s)

Histeroscopía , Terapia por Láser , Leiomioma/cirugía , Hemorragia Uterina/cirugía , Neoplasias Uterinas/cirugía , Adulto , Femenino , Hormona Liberadora de Gonadotropina/agonistas , Hormona Liberadora de Gonadotropina/uso terapéutico , Humanos , Terapia por Láser/instrumentación , Terapia por Láser/métodos , Selección de Paciente , Premedicación , Resultado del Tratamiento

RESUMEN

A series of 231 cases of deep-infiltrating endometriosis of the rectovaginal septum is presented. Laparoscopic procedures with excision of deep fibrotic endometriotic nodules were performed in all cases. In three cases, the bowel lumen was entered. No other peri-operative complications were observed. Three cases of urinary retention were reported. The nodule resection resulted in considerable pain relief. Histologically, the rectovaginal nodule was similar to an adenomyoma. Indeed it was a circumscribed nodular aggregate of smooth muscle and endometrial glands. This form of disease must be considered as a specific disease which originates from the Mullerian rests present in the rectovaginal septum and we suggest that it be called 'rectovaginal adenomyosis'.

Asunto(s)

Endometriosis/cirugía , Laparoscopía , Enfermedades del Recto/cirugía , Enfermedades Vaginales/cirugía , Endometriosis/complicaciones , Endometriosis/patología , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Infertilidad Femenina/etiología , Laparoscopía/efectos adversos , Laparoscopía/métodos , Dolor Pélvico , Radiografía , Enfermedades del Recto/diagnóstico por imagen , Enfermedades del Recto/patología , Enfermedades Vaginales/diagnóstico por imagen , Enfermedades Vaginales/patología

RESUMEN

OBJECTIVE: To evaluate estrogen receptors (ER) and progesterone receptors (PR) content in glandular and stromal cells of eutopic and ectopic endometrium. DESIGN: A recently advanced stereographic computer technology was applied for the investigation of steroid receptors. SETTING: University hospital department of gynecology. PATIENTS: Biopsies of endometrium and typical peritoneal endometriotic lesions were taken from 19 infertile patients with laparoscopically proved endometriosis. Endometrial biopsies were also taken from 15 patients without endometriosis. All of them were untreated. RESULTS: In normal endometrium, the highest concentrations of ER and PR occurred in the epithelial and stromal cells during the late proliferative phase of the menstrual cycle. Estrogen receptor and PR content declined throughout the secretory phase. Progesterone receptor content was found not to be significantly decreased in the stroma during the early secretory phase and quite high in the late secretory phase. In peritoneal endometriotic lesions, the highest concentrations of ER and PR were found during the late proliferative phase. When compared with normal endometrium, a lower ER content ans a similar PR content were observed, and the cyclic changes in peritoneal endometriosis lesions were also similar. CONCLUSION: A new computerized technology for the evaluation of ER and PR in eutopic and ectopic endometrium. Although the ER content was found to be lower in endometriotic tissue when compared with endometrium, the cyclic pattern was similar in both eutopic and ectopic endometrium. Progesterone receptor content was similar in both tissues, except during the late secretory phase in ectopic glandular epithelium in which a high persistent PR content was observed.

Asunto(s)

Endometriosis/metabolismo , Endometrio/metabolismo , Inmunohistoquímica/métodos , Enfermedades Peritoneales/metabolismo , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Adulto , Femenino , Humanos , Coloración y Etiquetado

Asunto(s)

Endometriosis/patología , Peritoneo/patología , Biopsia , Simulación por Computador , Endometrio/irrigación sanguínea , Femenino , Hormona Liberadora de Gonadotropina/agonistas , Humanos , Modelos Anatómicos

RESUMEN

OBJECTIVE: To evaluate the role of GnRH agonist (GnRH-a) and/or drainage in the management of large endometriomas. DESIGN: This prospective clinical study was conducted in a parallel and randomized design. SETTING: Department of Gynecology, Cliniques Universitaires St. Luc, Brussels, Belgium. PATIENTS: Eight infertile women with laparoscopically confirmed ovarian endometriotic cysts. After laparoscopic drainage of the ovarian cyst, patients were randomized. Patients in group I (n = 40) received no therapy. Patients in group II (n = 40) received GnRH-a therapy for 12 weeks. A second-look laparoscopy was performed after 12 weeks in each woman. RESULTS: After drainage, a quick recurrence of the endometrial cyst was observed in only group I. Indeed, the score and the cyst size were similar to the values observed before the first laparoscopy. In group II, a significant decrease in score and cyst diameter was observed. Ovarian biopsies revealed significant reduction in the stromal vascularization and a significant reduction in the mitotic activity in the group of women treated with GnRH-a. CONCLUSION: The quick recurrence of the ovarian cyst after drainage proved that drainage alone is ineffective. Drainage followed by GnRH-a was effective in the reduction of cyst size and the glandular mitotic activity.

Asunto(s)

Drenaje , Endometriosis/terapia , Goserelina/uso terapéutico , Quistes Ováricos/terapia , Enfermedades del Ovario/terapia , Adulto , Biopsia , Endometriosis/patología , Femenino , Humanos , Laparoscopía , Quistes Ováricos/patología , Enfermedades del Ovario/patología , Ovario/patología , Estudios Prospectivos

Asunto(s)

Danazol/uso terapéutico , Endometriosis/cirugía , Goserelina/uso terapéutico , Terapia por Láser/métodos , Leiomioma/cirugía , Menorragia/cirugía , Neoplasias Uterinas/cirugía , Endometrio/cirugía , Femenino , Estudios de Seguimiento , Hemostasis Endoscópica , Humanos , Histeroscopía , Cuidados Preoperatorios , Resultado del Tratamiento

RESUMEN

To evaluate the stromal vascularization of different appearances of peritoneal endometriosis, biopsies were taken from peritoneal areas with endometriosis in a series of 135 infertile women and classified as typical (black), red, or white lesions. The number of capillaries per mm2 of stroma, their mean surface area, and the ratio of capillaries/stroma surface area, and the mitotic activity were analyzed in typical, red, and white lesions. Significant differences were found between the different subgroups. The higher vascularization and mitotic activity observed in red lesions suggested the hypothesis that such lesions are very active and probably the first stage of early implantation of endometrial glands and stroma. The poor vascularization and the absence of mitosis observed in white lesions suggested that these lesions are much less active than red lesions and are a quiescent stage of the disease. Our study proves that the "activity" of peritoneal endometriosis is related to the vascularity. This concept must be considered in the further discussion of American Fertility Society Endometriosis Classification. Typical, red and white lesions are three different stages of the peritoneal disease and their relative relation to infertility is also probably different.

Asunto(s)

Endometriosis/patología , Neoplasias Peritoneales/irrigación sanguínea , Neoplasias Peritoneales/patología , Epitelio/irrigación sanguínea , Femenino , Humanos , Índice Mitótico , Peritoneo/irrigación sanguínea , Células del Estroma/patología