Julia Bartley

A pilot study to evaluate the clinical relevance of endometriosis-associated nerve fibers in peritoneal endometriotic lesions.

OBJECTIVE To investigate the clinical relevance of endometriosis-associated nerve fibers in the development of endometriosis-associated symptoms. DESIGN Prospective nonrandomized study. SETTING University hospital endometriosis center. PATIENT(S) Fifty-one premenopausal patients underwent surgical laparoscopy because of chronic pelvic pain, dysmenorrhea, or for ovarian cysts. Endometriosis was diagnosed in 44 patients. INTERVENTION(S) The preoperative and postoperative pain scores were determined using a standardized questionnaire with a visual analogue scale from 1-10. Patients with peritoneal endometriosis were divided into two groups depending on their preoperative pain score: group A with a pain score of at least 3 or more and group B with a pain score of 2 or less. Patients without peritoneal endometriosis were classified as group C and patients without endometriosis were classified as group D. Immunohistochemical analysis of neurofilament and protein gene product 9.5 were used for nerve fiber detection. Occurrence of endometriosis-associated nerve fibers was correlated with the severity of pelvic pain and/or dysmenorrhea. RESULT(S) Peritoneal endometriosis-associated nerve fibers were found significantly more frequently in group A than in group B (82.6% vs. 33.3%). CONCLUSION(S) The present study suggests that the presence of endometriosis-associated nerve fibers in the peritoneum is important for the development of endometriosis-associated pelvic pain and dysmenorrhea.

Estrogen and progestogen receptor positive endometriotic lesions and disseminated cells in pelvic sentinel lymph nodes of patients with deep infiltrating rectovaginal endometriosis: a pilot study

BACKGROUND Deep infiltrating endometriosis (DIE) shows similarities to malignant diseases. A recent study involving DIE patients found endometriosis in mesorectal lymph nodes (LNs) after segmental bowel resection. However, it is unclear whether this observation is a local phenomenon or a sign of systemic disease. Therefore, we conducted a prospective study to investigate the occurrence of endometriosis in pelvic sentinel lymph nodes (SLNs) in patients with DIE. METHODS Fourteen patients underwent primary surgery for symptomatic DIE. Combined vaginal laparoscopic-assisted resection of the rectovaginal septum was performed. Dye was injected into the visible/palpable nodule. SLNs were removed from the iliac region. In order to identify endometriotic cells, immunohistochemical analysis of estrogen and progestogen receptors, CD10 and cytokeratin was performed. RESULTS In 12 out of 14 patients with DIE, SLNs were detected. The localization of the SLN followed the typical LN spread of the upper vagina. In three patients, we could detect typical endometriotic lesions in the LNs. Ten out of 12 (83.3%) SLNs showed disseminated estrogen and/or progestogen positive cells. CONCLUSIONS By using immunohistochemistry, we could demonstrate endometriotic lesions and endometriotic-like cells in pelvic SLNs of patients with DIE suggesting the potential for lymphatic spread of the disease.

Clinical management and immunohistochemical analysis of umbilical endometriosis

PurposeTo established a strategy for diagnostic and therapeutic management of umbilical endometriosis and to determine the biological character.MethodsClinical examination, vaginal and abdominal ultrasound, magnetic resonance imaging of the abdominal wall and laparoscopy were performed on a 42-year-old woman with umbilical endometriosis. Surgery with umbilical reconstruction was performed by a new plastic surgery technique. Immunohistochemical analyses (against Ki 67, estrogen/progestogen receptor, CD10, smooth muscle actin, desmin, caldesmon, von Willebrandt factor, cyclooxygensae-2 and VEGF) were done to characterize the umbilical endometriotic lesion.ResultsThe extension of the endometriotic lesion necessitated total removal of the umbilicus. Umbilical reconstruction was performed by a new plastic surgery technique. The lesion did express CD10, estrogen and progestogen receptors, and did show a moderate proliferation rate. Furthermore, signs of metaplastic processes such as smooth muscle metaplasia and angiogenesis were detected. The endometriotic lesion was positive not only for smooth muscle actin, caldesmon and desmin, but also for COX-2 and VEGF.ConclusionBased on a case report and a literature review, we discuss the diagnostic and therapeutic management of umbilical endometriosis at our endometriosis research center. Furthermore, our data suggest that the umbilical endometriotic lesion originated from reactivated multipotent cells.

Eutopic endometrium from women with endometriosis does not exhibit neurotrophic properties

The role of neurotrophins in eutopic endometrium from endometriosis-patients was investigated in a prospective study using immunofluorescence-staining, Western blot and a neuronal growth assay. The nerve growth factor is expressed in primary endometrial cell culture from women with and without endometriosis. Western blot analysis of endometrial biopsies or uterine fluid from patients with and without endometriosis shows no difference in the neurotrophin expression. We could not find a difference between patients with and without endometriosis with regards to the neurite outgrowth of sensory ganglia when treated with conditioned cultured medium or uterine fluid. This result refutes the assumed neurotrophic properties of eutopic endometrium of patients with endometriosis.

Value of diagnostic procedures in rectovaginal endometriosis.

Rectovaginal endometriosis has the potential to infiltrate into the rectal wall. The recognition of infiltration prior to surgery is of utmost importance since only infiltrative disease should be treated by partial or complete rectal resection. This study compares different imaging procedures in rectovaginal endometriosis cases in an everyday clinical setting.

Histopathology‐based combined surgical approach to rectovaginal endometriosis

To describe a new surgical approach to rectovaginal endometriosis. Rectovaginal endometriosis can be infiltrative or superficial involving the bowel. Only infiltrative disease should be treated by intestinal resection. However, infiltration of endometriosis cannot be confirmed by preoperative imaging techniques.

Long-term follow-up and recurrence rate after mesorectum-sparing bowel resection among women with rectovaginal endometriosis

To demonstrate the quality of a combined vaginal–abdominal surgical approach to rectovaginal endometriosis by analyzing long‐term outcome and recurrence rates.

Gibt es weitere Testverfahren die Endometriose-assoziierten endometrialen Veränderungen zu charakterisieren?

Einleitung: Das eutope Endometrium von Patientinnen mit Endometriose (EM) weist im Vergleich zu nicht an EM erkrankten Frauen vielfaltige Unterschiede auf. So konnen beispielsweise Abweichungen in der Oberflachenstruktur des Epithels sowie Unterschiede in der Zellproliferation und den Apoptosemechanismen beobachtet werden. Ein besonders wichtiger Unterschied ist die Hochregulation der Aromatase, die mit einer lokalen Ostrogensynthese assoziiert ist. Weiterhin werden eine ganze Reihe von Proteinen (z.B. Metalloproteinasen, Adhasionsmolekule, Cyclooxygenase-2, Zytokinen) vermehrt gebildet, die weitere Veranderungen in der Funktion des Endometriums bedingen. Ein neues Kriterium in der Unterscheidung des Endometriums von Frauen mit und ohne EM sind Untersuchungen, die zeigen dass nur im Endometrium von Frauen mit EM Nervenfasern vorkommen sollen. Wichtige Komponenten in der Regulation der Neurogenese sind der Nervenwachstumsfaktor (NGF) und Ostrogen. Um weitere Endometriose-assoziierte endometriale Unterschiede, insbesondere neurotrophe Eigenschaften mit einem einfachen Testverfahren zu untersuchen, wurden in einer prospektiven Studie uterine Spulflussigkeiten hinsichtlich der Konzentration von Nervenwachstumsfaktoren und dem Ostrogengehalt analysiert. Materialen und Methoden: Gewinnung uteriner Spulflussigkeiten von Patientinnen mit EM (n=10) und ohne EM (n=3): uber einen Katheter wurden 5ml sterile 0,9% Kochsalzlosung im Cavum uteri installiert und uber Aspiration wieder gewonnen. Der Nachweis von NGF erfolgte mittels Western Blot Analyse, die Ostrogenkonzentration wurde mittels Elisa bestimmt. Ergebnisse: In der uterinen Spulflussigkeit von Frauen mit Endometriose konnte sowohl NGF als auch Ostrogen nachgewiesen werden. Vorlaufige Daten zeigen eine geringere NGF und Ostrogen Konzentration in der Spulflussigkeit von Frauen ohne EM im Vergleich zu der EM Gruppe. Diskussion: Die Gewinnung der uterinen Spulflussigkeit ist ein einfaches Verfahren, dass sowohl ambulant also auch im Rahmen operativer Eingriffe problemlos durchgefuhrt werden kann. Mithilfe dieses Verfahrens konnen endometriale Unterschiede von Patientinnen mit und ohne Endometriose ohne invasiven Eingriff analysiert werden. Der Nachweis von NGF und Ostrogen in der uterinen Spulflussigkeit gibt moglicherweise einen ersten Hinweis darauf, dass diese Faktoren mit an der Regulation der endometrialen Innervation beteiligt sein konnten.