Intraoperative Appearance of Endosalpingiosis: A Single-Center Experience of Laparoscopic Findings and Systematic Review of Literature

Background: Endosalpingiosis is assumed to be the second most common benign peritoneal pathology after endometriosis in women. Although recent studies indicate a significant association with gynecologic malignancies, many underlying principles remain unclear. This work aimed to systematically describe the intraoperative appearance of endosalpingiosis. Methods: Data and intraoperative videos of patients with histologically verified endosalpingiosis were retrospectively reviewed. The main outcome measures were macroscopic phenotype and anatomical distribution. Additionally, a systematic review searching PubMed (Medline) and Embase was conducted. Results: In the study population (n = 77, mean age 40.2 years (SD 16.4)), the mean size of lesions was 3.6 mm and the main visual pattern was vesicular (62%). The most frequent localization was the sacrouterine ligaments (24.7%). In the systematic review population (n = 1174 (210 included studies overall), mean age 45.7 years (SD 14.4)), there were 99 patients in 90 different studies with adequate data to assess the appearance of the lesions. The mean size of the lesions was 48.5 mm, mainly with a cystic visual pattern (49.5%). The majority of the lesions affected the ovaries (23.2%), fallopian tubes (20.4%), or lymph nodes (18.5%). Comparing this study to the literature population, the main differences concerned the size (p < 0.001) and main visual patterns (p < 0.001) of lesions. Conclusions: The usual intraoperative findings of endosalpingiosis appeared less impressive than described in the literature. In our study population, lesions of a few millimeters in size with a vesicular appearance were mostly seen, most frequently in the sacrouterine ligament area. Intraoperative recognition by the gynecologic surgeon and histologic diagnosis should play an important role in further understanding this entity, scientifically and clinically. Keywords: endosalpingiosis; endosalpingiosis distribution; endosalpingiosis morphology; laparoscopy; minimal-access surgery; mullerianosis

Popularity of endocrine endometriosis drugs and limited alternatives in the present and foreseeable future: A survey among 1420 affected women

Objectives: Endocrine drugs represent an important cornerstone of endometriosis therapy. Pharmaceutical alternatives with similar efficacy remain out of sight in the near future. Aim of this study is to investigate attitudes and perceptions concerning endocrine therapies among affected women. Study design: An online survey was distributed via social media in Austria, Germany, and Switzerland. Primary endpoints were satisfaction, attitudes and perceptions towards endocrine endometriosis drugs and secondary outcomes differences regarding demographic variables. Results: Of 1420 respondents, 63.5 % (n = 901) described their own attitude towards these drugs as rather negative. The most frequently reported unfavorable associations and experiences were sideeffects in general (85.5 %, n = 1181), change in libido (67.5 %, n = 932), hormone cycle disruptions (65.9 %, n = 910), and inefficiency at alleviating symptoms (38.2 %, n = 527). In total, 66.1 % (n = 935) were not satisfied with endocrine drugs for endometriosis. Age ≤ 30 years, living in a large city, and having an academic degree were significantly correlated to a more negative perception of these drugs and greater dissatisfaction with current endocrine endometriosis drugs. Conclusions: Among women with endometriosis - and particularly among those aged ≤30 years, being large-city residents, or holding an academic degree - there appears to be a relevant degree of rejection and wariness towards endocrine endometriosis drugs. Given the prevalence of endometriosis and the few pharmaceutical alternatives on the horizon, these data point a growing need for further research and development of non-hormonal drugs for the treatment of endometriosis. Keywords: Endometriosis; Endometriosis drug therapy; Endometriosis social media; Endometriosis survey

Examining the Influence on Perceptions of Endometriosis via Analysis of Social Media Posts: Cross-sectional Study

Background: Social media platforms, such as Facebook and Instagram, are increasingly being used to share health-related information by "influencers," regular users, and institutions alike. While patients may benefit in various ways from these interactions, little is known about the types of endometriosis-related information published on social media. As digital opinion leaders influence the perceptions of their followers, physicians need to be aware about ideas and beliefs that are available online, in order to address possible misconceptions and provide optimal patient care. Objective: The aim of this study was to identify and analyze frequent endometriosis-related discussion topics on social media in order to offer caregivers insight into commonly discussed subject matter and aspects. Methods: We performed a systematic search using predefined parameters. Using the term "endometriosis" in Facebook's search function and a social media search engine, a list of Facebook pages was generated. A list of Instagram accounts was generated using the terms "endometriosis" and "endo" in Instagram's search function. Pages and accounts in English with 5000 or more followers or likes were included. Nonpublic, unrelated, or inactive pages and accounts were excluded. For each account, the most recent 10 posts were identified and categorized by two independent examiners using qualitative content analysis. User engagement was calculated using the numbers of interactions (ie, shares, likes, and comments) for each post, stratified by the number of followers. Results: A total of 39 Facebook pages and 43 Instagram accounts with approximately 1.4 million followers were identified. Hospitals and medical centers made up 15% (6/39) of the Facebook pages and 5% (2/43) of the Instagram accounts. Top accounts had up to 111,600 (Facebook) and 41,400 (Instagram) followers. A total of 820 posts were analyzed. On Facebook, most posts were categorized as "awareness" (101/390, 25.9% of posts), "education and research" (71/390, 18.2%), and "promotion" (64/390, 16.4%). On Instagram, the top categories were "inspiration and support" (120/430, 27.9% of posts), "awareness" (72/430, 16.7%), and "personal story" (72/430, 16.7%). The frequency of most categories differed significantly between platforms. User engagement was higher on Instagram than on Facebook (3.20% vs 0.97% of followers per post). On Instagram, the highest percentage of users engaged with posts categorized as "humor" (mean 4.19%, SD 4.53%), "personal story" (mean 3.02%, SD 4.95%), and "inspiration and support" (mean 2.83%, SD 3.08%). On Facebook, posts in the categories "awareness" (mean 2.05%, SD 15.56%), "humor" (mean 0.91%, SD 1.07%), and "inspiration and support" (mean 0.56%, SD 1.37%) induced the most user engagement. Posts made by hospitals and medical centers generated higher user engagement than posts by regular accounts on Facebook (mean 1.44%, SD 1.11% vs mean 0.88%, SD 2.71% of followers per post) and Instagram (mean 3.33%, SD 1.21% vs mean 3.19%, SD 2.52% of followers per post). Conclusions: Facebook and Instagram are widely used to share endometriosis-related information among a large number of users. Most posts offer inspiration or support, spread awareness about the disease, or cover personal issues. Followers mostly engage with posts with a humoristic, supportive, and awareness-generating nature. Health care providers should be aware about the topics discussed online, as this may lead to an increased understanding of the needs and demands of digitally proficient patients with endometriosis. Keywords: Facebook; Instagram; endometriosis; engagement; influencer; social medi

Intraoperative Appearance of Endosalpingiosis: A Single-Center Experience of Laparoscopic Findings and Systematic Review of Literature

Background: Endosalpingiosis is assumed to be the second most common benign peritoneal pathology after endometriosis in women. Although recent studies indicate a significant association with gynecologic malignancies, many underlying principles remain unclear. This work aimed to systematically describe the intraoperative appearance of endosalpingiosis. Methods: Data and intraoperative videos of patients with histologically verified endosalpingiosis were retrospectively reviewed. The main outcome measures were macroscopic phenotype and anatomical distribution. Additionally, a systematic review searching PubMed (Medline) and Embase was conducted. Results: In the study population (n = 77, mean age 40.2 years (SD 16.4)), the mean size of lesions was 3.6 mm and the main visual pattern was vesicular (62%). The most frequent localization was the sacrouterine ligaments (24.7%). In the systematic review population (n = 1174 (210 included studies overall), mean age 45.7 years (SD 14.4)), there were 99 patients in 90 different studies with adequate data to assess the appearance of the lesions. The mean size of the lesions was 48.5 mm, mainly with a cystic visual pattern (49.5%). The majority of the lesions affected the ovaries (23.2%), fallopian tubes (20.4%), or lymph nodes (18.5%). Comparing this study to the literature population, the main differences concerned the size (p < 0.001) and main visual patterns (p < 0.001) of lesions. Conclusions: The usual intraoperative findings of endosalpingiosis appeared less impressive than described in the literature. In our study population, lesions of a few millimeters in size with a vesicular appearance were mostly seen, most frequently in the sacrouterine ligament area. Intraoperative recognition by the gynecologic surgeon and histologic diagnosis should play an important role in further understanding this entity, scientifically and clinically

Ibrutinib in Gynecological Malignancies and Breast Cancer: A Systematic Review

Ibrutinib is an orally available, small-molecule tyrosine kinase inhibitor. Its main purpose is to inhibit Bruton’s tyrosine kinase (BTK), an enzyme that is crucial in B cell development. It is FDA approved for the treatment of certain hematological malignancies. Several promising off-target drug effects have led to multiple, mostly preclinical investigations regarding its use in solid tumors. Unfortunately, data on its effectiveness in gynecological malignancies are limited, and (systematic) reviews are missing. The objective of this review was to summarize the existing literature and to analyze the evidence of ibrutinib as a treatment option in gynecological malignancies, including breast cancer. Studies were identified in MEDLINE and EMBASE using a defined search strategy, and preclinical or clinical research projects investigating ibrutinib in connection with these malignancies were considered eligible for inclusion. Our findings showed that preclinical studies generally confirm ibrutinib’s efficacy in cell lines and animal models of ovarian, breast, and endometrial cancer. Ibrutinib exerts multiple antineoplastic effects, such as on-target BTK inhibition, off-target kinase inhibition, and immunomodulation by interference with myeloid-derived suppressor cells (MDSCs), programmed death-ligand 1 (PD-L1), and T cell response. These mechanisms were elaborated and discussed in the context of the evidence available. Further research is needed in order to transfer the preclinical results to a broader clinical appliance

Die tief infiltrierende Endometriose – eine systematische Herangehensweise an Diagnostik und Operationsplanung

Obwohl die Endometriose zu den häufigen gynäkologischen Krankheitsbildern der Frau im reproduktionsfähigen Alter zählt, erfolgen die Diagnose und der Therapiebeginn häufig spät nach Beginn der Symptomatik. Die Erklärung liegt wahrscheinlich einerseits in der mannigfaltigen Ausprägung, den diffusen Beschwerden und der leider eher geringen Bekanntheit dieses Krankheitsbildes. Andererseits stellt die Diagnostik selbst eine Herausforderung dar. Insbesondere die tief infiltrierende Form der Endometriose ist schwerwiegend, bei welcher häufig eine chirurgische Therapie notwendig wird. Eine systematische Herangehensweise mit MRI-Bildgebung und präoperativer Einteilung mittels Enzian-Klassifikation kann das Vorgehen erleichtern und die Therapieplanung vereinfachen

Endosalpingiose – ein irrelevanter laparoskopischer Zufallsbefund?

Zusammenfassung. Bei der Endosalpingiose handelt es sich um ektopes Auftreten von Tubenepithel. Lange fand dieser Zufallsbefund wenig Beachtung, obwohl die Endosalpingiose nach der Endometriose die zweithäufigste benigne peritoneale Pathologie der Frau darstellt. Im Gegensatz zur Endometriose zeigt die Endosalpingiose einen Prävalenzanstieg mit dem Alter über die Menopause hinaus. Des Weiteren erscheint sie nicht chronisch-entzündlich und versursacht gemäss bisherigen Erkenntnissen keine chronischen Schmerzen oder Infertilität. Neuere epidemiologische sowie molekularpathologische Untersuchungen zeigen ein signifikant häufigeres Auftreten von Ovarial- und Endometriumtumoren bei Frauen mit Endosalpingiose. Diese Zusammenhänge sind nicht abschliessend geklärt. Allgemein anerkannte klinische Empfehlungen bei Nachweis einer Endosalpingiose existieren bisher nicht. Um den Krankheitswert der Endosalpingiose und ihre onkologischen Zusammenhänge besser zu verstehen, sollte diese Entität ins Bewusstsein der operativen Gynäkologie und involvierten Pathologie rücken. = Abstract. Endosalpingiosis refers to the ectopic presence of tubal epithelium. However, this incidental finding received little attention, although it is the second most common benign peritoneal pathology in women following endometriosis. In contrast to endometriosis, endosalpingiosis shows an increase in prevalence with age beyond the menopause. Furthermore, it does not appear to be chronically inflammatory and, according to research to this date, does not cause chronic pain or infertility. Recent epidemiological and molecular pathological studies show a significantly higher incidence of ovarian and endometrial tumors in women with endosalpingiosis. These correlations have not been conclusively clarified. Generally accepted clinical recommendations for the detection of endosalpingiosis do not yet exist. In order to better understand the disease value of endosalpingiosis and its oncological correlations, this entity should be brought to the attention of surgical gynecology and involved pathology. Résumé. L’endosalpingiose est une pathologie gynécologique. Elle est liée à la présence d’épithélium tubaire en dehors des trompes de Fallope. Cette découverte fortuite n’a longtemps reçu que peu d’attention, bien qu’il s’agisse de la pathologie péritonéale bénigne la plus fréquente chez la femme après l’endométriose. Contrairement à l’endométriose, la prévalence de l’endosalpingiose augmente avec l’âge au-delà de la ménopause. En outre, elle ne semble pas être une maladie inflammatoire et ne provoque – selon les connaissances actuelles – pas de douleurs chroniques ou l’infertilité. De récentes études épidémiologiques et de pathologie moléculaire montrent une association significative de tumeurs ovariennes et endométriales chez les femmes atteintes d’endosalpingiose. Mais jusqu’à maintenant ces corrélations n’ont pas encore été clarifiées de manière concluante. Il n’existe donc pas encore de recommandations cliniques généralement acceptées pour l’endosalpingiose. Afin de mieux comprendre la valeur pathologique de l’endosalpingiose et ses corrélations oncologiques, cette entité devrait être portée à l’attention des gynécologues et pathologes impliqués

How and where to expect endosalpingiosis intraoperatively

Objective: To describe the anatomical distribution and intraoperative morphology of endosalpingiosis. Design: Retrospective observational video study. Setting: Data and intraoperative videos were reviewed by two independent reviewers at one referral center. The study was approved by the local ethics committee. Patient(s): A total of 77 patients with histologically proven endosalpingiosis from 2007-2020. Intervention(s): None. Main outcome measure(s): The primary endpoints were anatomical distribution and macroscopic phenotype. The secondary endpoints were demographic and clinical characteristics as well as associated diseases. Result(s): Of the 77 patients with endosalpingiosis, the mean age was 40.2 years (standard deviation, 16.4 years), mean body mass index 24.1 kg/m2 (standard deviation, 5.7 kg/m2), 59.7% (n = 46) were nulligravide, 70.1% (n = 54) nulliparous, 22.1% (n = 17) suffered of infertility, and 53.2% (n = 41) had at least one previous abdominal or vaginal surgery. Endometriosis was associated in 53.2 % (n = 41) and malignancies in 28.6% (n = 22, 7 endometrial cancers, 1 uterine carcinosarcoma, 8 borderline ovarian tumors, 5 epithelial ovarian cancers, and 1 yolk sac tumor of the ovary). Anatomic distribution and varying intraoperative phenotypes were demonstrated in the video presentation. Conclusion(s): In the majority of this population, endosalpingiosis was located in the pelvis. The higher prevalence of specific gynecologic tumors is consistent with previous results. In phenotype, most lesions appear to be less spectacular than prominent in the literature. For further studies on the relevance as a risk factor for malignancy and consequently clinical recommendations, sound knowledge about endosalpingiosis of laparoscopists as initial diagnosticians is crucial. Keywords: Endosalpingiosis; borderline ovarian tumor; endometrial cancer; endoscopy; epithelial ovarian cancer; laparoscopy; müllerianosis

Intraoperative Appearance of Endosalpingiosis: A Single-Center Experience of Laparoscopic Findings and Systematic Review of Literature

Background: Endosalpingiosis is assumed to be the second most common benign peritoneal pathology after endometriosis in women. Although recent studies indicate a significant association with gynecologic malignancies, many underlying principles remain unclear. This work aimed to systematically describe the intraoperative appearance of endosalpingiosis. Methods: Data and intraoperative videos of patients with histologically verified endosalpingiosis were retrospectively reviewed. The main outcome measures were macroscopic phenotype and anatomical distribution. Additionally, a systematic review searching PubMed (Medline) and Embase was conducted. Results: In the study population (n = 77, mean age 40.2 years (SD 16.4)), the mean size of lesions was 3.6 mm and the main visual pattern was vesicular (62%). The most frequent localization was the sacrouterine ligaments (24.7%). In the systematic review population (n = 1174 (210 included studies overall), mean age 45.7 years (SD 14.4)), there were 99 patients in 90 different studies with adequate data to assess the appearance of the lesions. The mean size of the lesions was 48.5 mm, mainly with a cystic visual pattern (49.5%). The majority of the lesions affected the ovaries (23.2%), fallopian tubes (20.4%), or lymph nodes (18.5%). Comparing this study to the literature population, the main differences concerned the size (p p < 0.001) of lesions. Conclusions: The usual intraoperative findings of endosalpingiosis appeared less impressive than described in the literature. In our study population, lesions of a few millimeters in size with a vesicular appearance were mostly seen, most frequently in the sacrouterine ligament area. Intraoperative recognition by the gynecologic surgeon and histologic diagnosis should play an important role in further understanding this entity, scientifically and clinically