RESUMEN
BACKGROUND: Pelvic inflammatory phenomena have been suggested as critical players in the natural history of endometriosis. However, to what extent these events could affect the systemic immunologic status remains to be clarified. Here, we compared the gene expression profile in peripheral blood mononuclear cells from endometriosis patients in the severe diseased stage with the profile after a conventional surgical treatment for removal of endometriotic lesions and adhesions. METHODS: Microarray analysis included four patients suffering from severe endometriosis in which blood samples were obtained few days before the surgical intervention and again 6 months later. Real-time quantitative PCR analyses on a larger population were performed for some genes up-regulated in the diseased stage in a case-control approach. RESULTS: Among the 17,665 probe signals detected in the microarray, n = 26 genes resulted up-regulated and n = 15 were down-regulated in the diseased stage. Five genes up-regulated in diseased stage (FBJ Murine osteosarcoma viral oncogene homolog gene, dual specificity phosphatase 1, pre-B-cell colony enhancing factor 1, adrenomedullin and S100 calcium binding protein P) were exactly those shown as up-regulated in peripheral leukocytes of psoriasis patients in a very similar study design (diseased versus 'cured' stage), with a 5.2 × 10(-11) hypergeometric probability that this event could occur by chance. CONCLUSIONS: Endometriosis induces the expression of genes in peripheral leukocytes already identified in non-gynaecologic chronic inflammatory diseases, thus revealing the disease as a local affliction with relevant consequences at the systemic level. Although the commonality of gene expression with other inflammatory diseases prevents the use of these genes as non-invasive diagnostic markers, from a clinical standpoint, the idea that the surgical intervention may reduce the expression of peripheral leukocyte genes represents a novel finding.
Asunto(s)
Endometriosis/sangre , Leucocitos Mononucleares/citología , Psoriasis/sangre , Adulto , Animales , Estudios de Casos y Controles , Enfermedad Crónica , Endometriosis/metabolismo , Femenino , Perfilación de la Expresión Génica , Humanos , Inflamación , Leucocitos/citología , Ratones , Persona de Mediana Edad , Análisis de Secuencia por Matrices de Oligonucleótidos , Osteosarcoma/sangre , Osteosarcoma/metabolismo , Psoriasis/metabolismo , Reacción en Cadena en Tiempo Real de la Polimerasa/métodosRESUMEN
OBJECTIVE: To evaluate the rate of intrinsic ureteral endometriosis in patients presenting with severe ureteral endometriosis. DESIGN: Observational study between June 1992 and December 2007. SETTING: University tertiary referral center. PATIENT(S): Twenty-nine patients presenting deeply infiltrating endometriosis (DIE) with severe ureteral endometriosis. Severe ureteral endometriosis was defined as DIE lesions causing significant obstruction to the urinary flow with ureteral stenosis. INTERVENTION(S): Complete surgical exeresis of DIE lesions. MAIN OUTCOME MEASURE(S): Pre- and peroperative evaluation associated with histologic analysis. Intrinsic ureteral endometriosis was defined as presence of DIE lesions infiltrating the ureteral muscularis. RESULT(S): In a series of 627 patients with histologic proved DIE, we observed 29 (4.6%) patients with severe ureteral endometriosis. Ureteral lesions (n = 34) were right sided in 7 (24.1%) patients, left sided in 17 (58.6%) patients, and bilateral in 5 (17.3%) patients. Eleven (37.9%) patients presented intrinsic lesions. Out of the 34 ureteral lesions 13 (38.2%) were intrinsic. In cases of radical ureteral surgery (n = 21 patients; n = 24 ureteral lesions) intrinsic ureteral DIE was observed in 52.4% (11 cases) of the patients and in 54.2% (13 cases) of the ureteral lesions. CONCLUSION(S): The prevalence of intrinsic ureteral endometriosis is underestimated. This result must be taken into account when specifying the surgical modalities for patients presenting with severe ureteral endometriosis.
Asunto(s)
Endometriosis/epidemiología , Endometriosis/cirugía , Enfermedades Ureterales/epidemiología , Enfermedades Ureterales/cirugía , Procedimientos Quirúrgicos Urológicos , Adulto , Endometriosis/complicaciones , Endometriosis/patología , Femenino , Estudios de Seguimiento , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Persona de Mediana Edad , Enfermedades del Ovario/complicaciones , Enfermedades del Ovario/epidemiología , Periodo Posparto , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/patología , Complicaciones del Embarazo/cirugía , Prevalencia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Enfermedades Ureterales/complicaciones , Enfermedades Ureterales/patología , Procedimientos Quirúrgicos Urológicos/métodosRESUMEN
A 25-year-old woman with unoperated deep endometriosis of the uterosacral ligament suddenly experienced severe abdominal pain, hematuria, hemoperitoneum, and intrauterine death at 31 weeks' gestation. Surgical intervention revealed active hemorrhage arising from right uterine artery and interruption of the ureter in an area of previously documented but not treated endometriotic nodule. Histologic examination confirmed presence of decidualized endometriosis at this site. Urohemoperitoneum during pregnancy is a rare but possible complication in women carrying deep peritoneal endometriotic nodules.
Asunto(s)
Endometriosis/complicaciones , Muerte Fetal/etiología , Hemoperitoneo/complicaciones , Complicaciones Cardiovasculares del Embarazo/etiología , Complicaciones del Embarazo , Adulto , Arterias , Dilatación Patológica , Progresión de la Enfermedad , Femenino , Humanos , Embarazo , Uréter/patología , Útero/irrigación sanguíneaRESUMEN
OBJECTIVE: It has been hypothesized that bladder endometriotic nodules are an independent form of endometriosis that should be considered a distinct clinical entity. If this is true, the frequency of nonvesical endometriotic lesions in affected patients should be similar to the prevalence of the disease in the general population (about 10%). The aim of the study was to evaluate the presence of other forms of endometriosis in patients with bladder endometriotic nodules. DESIGN: Case series. SETTING: Two gynecologic surgical units. PATIENT(S): Fifty-eight women with large bladder endometriotic nodules. INTERVENTION(S): To evaluate the concomitant presence of other forms of endometriosis. MAIN OUTCOME MEASURE(S): Presence of superficial peritoneal implants, ovarian endometriomas, adhesions, and extravesical deep peritoneal endometriosis. RESULT(S): The presence of superficial peritoneal implants, ovarian endometriomas, adhesions, and extravesical deep peritoneal endometriosis was observed in 58.6% (95% confidence interval [CI]: 45.2-71.2), 44.8% (95% CI: 32.2-58.2), 81.0% (95% CI: 68.4-89.6), and 27.6% (95% CI: 16.7-40.8) of cases, respectively. The presence of at least one of them was documented in 87.9% of cases (95% CI: 76.7-94.3). CONCLUSION(S): Endometriotic nodules of the bladder are frequently associated with other forms of pelvic endometriosis. This result does not support the vision that bladder endometriotic nodules should be considered an independent form of the disease.
Asunto(s)
Endometriosis/fisiopatología , Endometriosis/cirugía , Enfermedades de la Vejiga Urinaria/fisiopatología , Enfermedades de la Vejiga Urinaria/cirugía , Adulto , Cesárea , Endometriosis/clasificación , Endometriosis/patología , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Resultado del Tratamiento , Enfermedades de la Vejiga Urinaria/patologíaRESUMEN
Although population-based studies have unequivocally reported an increased risk of ovarian cancer in women with endometriosis, the biological evidence supporting the idea of endometriosis as a preneoplastic condition is scanty and not well substantiated. The fundamental features of human neoplasms (monoclonal growth, genetic changes, mutations in tumour suppressor genes and replicative advantage) have been evaluated in endometriotic lesions but results obtained are discordant. It is plausible that ectopic glands may expand monoclonally but the entity of this phenomenon is debated. According to some allelotyping studies, from one-third to one-half of endometriosis lesions would harbour somatic genetic changes in chromosomal regions supposed to contain genes involved in ovarian tumourigenesis, especially for the endometrioid histotype. These findings would be consistent with the progression model for carcinogenesis from the benign precursor to ovarian cancer but they could not be unequivocally replicated. Gene mutational studies are rare in this context. A single group has found missense mutations and deletions of PTEN gene in about 20% of ovarian endometriotic cysts. Moreover, in a model of genetically engineered mice harbouring an oncogenic allele of K-ras resulting in benign lesions reminiscent of endometriosis, a conditional deletion of PTEN caused the progression towards the endometrioid tumour. Based on these data, the causal link between endometriosis and ovarian endometrioid/clear cell carcinomas remains to be defined both in terms of entity of association and of underlying molecular mechanisms.
Asunto(s)
Endometriosis/genética , Endometriosis/patología , Neoplasias Ováricas/etiología , Animales , Aberraciones Cromosómicas , Análisis Citogenético , Femenino , Genes Supresores de Tumor , Humanos , Hibridación Fluorescente in Situ , Pérdida de Heterocigocidad , Ratones , Mutación , Oncogenes/genética , Neoplasias Ováricas/patología , Fosfohidrolasa PTEN/genética , Proteína p53 Supresora de Tumor/genéticaRESUMEN
To determine whether the ovarian trauma consequent to the laparoscopic removal of a cyst could result in the development of a humoral immunity, antiovarian antibodies were assayed in serum samples obtained from 40 women before and after cystectomy.
Asunto(s)
Formación de Anticuerpos/inmunología , Autoanticuerpos/sangre , Laparoscopía , Quistes Ováricos/inmunología , Quistes Ováricos/cirugía , Ovario/inmunología , Adulto , Cistectomía , Femenino , HumanosRESUMEN
Endometriosis is an estrogen-dependent disorder mostly occurring in reproductive-age women. Various therapies have been used in an attempt to treat endometriosis, including ovarian suppression therapy, surgical treatment or a combination of these strategies. However, in general, substantial surgery remains the primary treatment option for endometriosis at all stages. Recently, aromatase inhibitors and anti-estrogens have been proposed as novel potential candidates. The rationale for the use of aromatase inhibitors is mostly related to the high aromatase expression in endometriotic cysts and extra-ovarian endometriotic implants. Among anti-estrogens, raloxifene has been investigated in animal models with good results, but in premenopausal women, the compound does not seem to suppress estrogen production.
Asunto(s)
Inhibidores de la Aromatasa , Endometriosis/tratamiento farmacológico , Inhibidores Enzimáticos/uso terapéutico , Antagonistas de Estrógenos/uso terapéutico , Femenino , HumanosRESUMEN
OBJECTIVE: To discuss current ideas about therapy for endometriosis derived from new observations generated by using molecular biology techniques and in vivo animal models of disease. METHOD(S): The MEDLINE database was reviewed for English-language articles on new drugs that affect the endocrine or immunologic system, the possibility that endometriosis has multiple forms, and the association of endometriosis with cancer. Specific attention was given to in vivo studies in animals or humans. CONCLUSION(S): Among the novel potential candidate drugs, aromatase inhibitors and raloxifene should be considered for treatment of postmenopausal women with endometriosis. Notable observations have emerged from studies of immunomodulators and antiinflammatory agents in animal models of disease. These findings must be confirmed in women. The histogenesis of ovarian endometriomas is still unclear, thus limiting new experimental approaches to this form of disease. Given the low but established risk for malignant transformation of endometriosis, efforts should be directed toward identification of susceptibility loci for the disease and its potential transformation into cancer.