Is the presence of deep infiltrative endometriosis underestimated in the surgical management of endometriosis?

Objectives: The aim of the study was to determine the presence of deep infiltrative endometriosis (DIE) in the surgical management of endometriosis. Material and methods: Operation notes and histopathological reports of women with endometriosis were retrospectively analyzed in the Ege University Hospital between 2008 and 2018. A total of 191 women with suspicious of endometriosis but without clinical signs of DIE were enrolled in the study. Laparoscopic diagnosis of DIE was compared with histopathological reports. There was no histopathology before surgery. Endometriosis was suspected only based on symptoms. Results: A total of 213 lesions that were thought to be DIE were removed from 191 women with endometriosis. Among these 213 lesions, 179 specimens were reported as endometriosis and 34 lesions as fibro-adipose tissue. Forty-nine right uterosacral ligaments were excised, and endometriosis was detected in 44 out of 49 specimens. Histopathological examination of 45 left uterosacral ligaments revealed endometriosis in 35 specimens. Finally, 25 endometriotic nodules were removed from the recto-vaginal space, and 22 of these were verified as endometriosis by a pathologist. The positive predictive value of laparoscopic visualization for DIE in the group suspected of endometriosis but without any clinical findings of DIE was 84%. Conclusions: Women with the suspicious of endometriosis, qualified to surgery, because of infertility or pain, should be prudently investigated to confirm or to exclude coexistence of DIE even if no preoperative sign of DIE was observed to provide complete resection. Otherwise, DIE continues to grow, causes pain postoperatively, and complicates subsequent surgery

Fas Expression in Endometriomas, Endometrioid Carcinomas and Clear Cell Carcinomas of Ovaries

In this study we aimed to investigate the expression of Fas protein by immunohistochemistry between ovarian endometriomas and endometriosis related ovarian tumors, endometrioid and clear cell carsinomas. Ovarian endometriosis (n = 22), ovarian endometrioid adenocarsinomas (n = 12) and ovarian clear cell carsinomas (n = 8) histopathologic samples were included in this study. When we compared the epithelial Fas expression among three groups, we observed that endometriomas express significantly higher epithelial Fas than both ovarian tumors (P< 0.001). In conclusion, we suggest that in endometriosis related ovarian tumors apoptotic mechanisms might be more impaired than endometriomas and also decreased expression of Fas might be involved in the malign transformation of endometriosis

TENASCIN-C EXPRESSION IN ENDOMETRIOSIS

Objective: To investigate the expression of Tenascin-C (TN-C) in endometrium and endometriosis

Regulation of Monocyte Chemotactic Protein-1 Expression in Human Endometrial Endothelial Cells by Sex Steroids: A Potential Mechanism for Leukocyte Recruitment in Endometriosis

The main aim of this study is to describe the in vivo temporal and spatial expression of monocyte chemotactic protein 1 (MCP-1) in human endometrial endothelial cells (HEECs) and to compare the in vitro regulation of MCP-1 expression by sex steroids in HEECs from women with or without endometriosis. Eutopic endometrial tissues and endometriosis implants were grouped according to the menstrual cycle phase and were examined by immunohistochemistry for MCP-1 expression. No significant difference was observed for MCP-1 immunoreactivity in the endothelial cells of eutopic endometrium of women with endometriosis when compared to endometrium of women without endometriosis and to endometriosis implants. For in vitro studies, the purity of cultured HEECs (90%-95%) was confirmed by immunocytochemistry using endothelium-specific markers CD31 and CD146. The effects of estradiol (5 x 10(-8) mol/L), progesterone (10(-7) mol/L), or both on MCP-1 messenger RNA (mRNA) and protein levels were analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR) analysis and enzyme-linked immunosorbent serologic assay (ELISA), respectively. Sex steroids did not have significant effect on MCP-1 mRNA and protein expression in HEECs from women without endometriosis. However, we observed that the sex steroid treatment stimulated MCP-1 mRNA and protein expression in HEECs from women with endometriosis (P < .05). We postulate that the stimulation of chemokine expression by sex steroids in the endometrial endothelial cells in women with endometriosis may play a central role in recruiting mononuclear cells, therefore contributing to the inflammatory aspect of endometriosis

Long-term use of gonadotropin-releasing before IVF in women with endometriosis

WOS: 000246880100013PubMed ID: 17495647Purpose of review To discuss the relationship between endometriosis and infertility, the impact of endometriosis on assisted reproductive techniques and also the benefits of prolonged use of gonadotropin-releasing hormone analogue before IVF in women with endometriosis. Recent findings The available evidence suggests that endometriosis is strongly associated with infertility. Many studies indicate lower pregnancy and implantation rates even in assisted reproductive cycles in women with endometriosis. It is well known that medical suppression of endometriosis does not appear to be warranted for endometriosis-associated infertility. Prolonged pretreatment with gonadotropin-releasing hormone analogue before IVF has been reported to improve clinical pregnancy rates in infertile women with endometriosis. Summary Based on the recently published data, infertile women with endometriosis may benefit from long-term pretreatment of gonadotropin-releasing hormone analogue prior to IVF

Expression of interleukin-8 and monocyte chemotactic protein 1 in women with endometriosis

WOS: 000264143500007PubMed ID: 18314120Objective: To investigate the expression and localization of interleukin-8 (IL-8) and monocyte chemotactic protein 1 (MCP-1) in women with and without endometriosis. Design: Comparative immunohistochemical study. Setting: Academic medical center. Patient(s): Ectopic (n = 24) and homologous eutopic endometrium (n = 24) from women with endometriosis and endometrium from women without endometriosis (n = 27) were used for immunohistochemical analysis of IL-8 and MCP-1. Intervention(s): Tissue sections were immunostained with antihuman IL-8 and MCP-1 antibodies. Main Outcome Measure(s): Microscopic evaluation to assess the presence and localization of IL-8 and MCP-1 throughout the menstrual cycle in both eutopic endometrial and endometriotic tissues of women with endometriosis and comparison with normal endometrium. Result(s): In normal endometrium. secretory phase samples expressed higher levels of epithelial IL-8 than in proliferative phase samples. Epithelial MCP-1 expression was similar in both proliferative and secretory phases. Proliferative phase samples showed higher epithelial IL-8 and MCP-1 expressions in eutopic endometrium of women with endometriosis compared with that of normal women. Immunoreactivities of both chemokines were significantly increased in the epithelial cells of ectopic endometrial tissues compared with those of normal endometrium. Conclusion(s): These findings Suggest that IL-8 and MCP-1 may be involved in the pathogenesis of endometriosis. (Fertil Steril (R) 2009;91:687-93. (C) 2009 by American Society for Reproductive Medicine.)Turkish Scientific and Technical Research Institution (TUBITAK) training awardTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK)Supported by a Turkish Scientific and Technical Research Institution (TUBITAK) training award to Murat Ulukus

Follicular dynamics and apoptosis following unilateral oophorectomy.

Ovarian physiology has been based on the assumption that the mammalian ovary has a constant germ cell pool. According to this accepted doctrine primordial follicles, which are limited in number, are depleted through ovulation or atresia. Therefore, the primary goal of this study was to examine the follicle dynamics and morphologic apoptotic changes following unilateral oophorectomy. In order to evaluate the short-, mid-, and long term effects of unilateral oophorectomy, three groups of rats were included in the study. One ovary was removed from each rat on day 0 and used as a control. In group A (n = 7), the remaining ovaries were removed via relaparatomy on the 7(th) day, group B (n = 8), the remaining ovaries were removed via relaparatomy on the 14th day, and group C (n = 8), the remaining ovaries were removed via relaparatomy on the 42nd day. The changes in the number of primordial, primary, and growing follicles and the difference in apoptotic index were assessed. Even after 10-12 oestrus cycles (in group C) following unilateral oophorectomy, follicle reserve did not show a decrease in the remaining ovary. However, within the growing follicle the ovulatory rate increased. Atretic follicles were elevated contrary to the belief that reproductive functions are compensated as a result of the reduction in atresia. The observations suggest that the number of primordial follicles remains relatively constant