Transcoelomic and Lympho-Hematogenous Dissemination of Endometrioid Heterotopias – the Mechanism of Extragenital Endometriosis Formation

Endometriosis nowadays still a disease with an undisclosed pathogenesis. This article demonstrates and explains the possibility of different variants of dissemination of endometrioid cells in the body with the formation of foci of extragenital endometriosis in organs and tissues remote from the pelvis, complementing and confirming the theory of utero-peritoneal reflux in the development of endometriosis as the most reasonable. Endometrioid heterotopias have a more developed lymphatic network compared to the normal endometrium due to active lymphangiogenesis, and, having a tendency to invasive growth, endometrioid heterotopia is a source of endometrioid cells spreading along the direction of lymph outflow from the most typical locations (pelvic organs) with damage to the inguinal and pelvic lymph nodes. Lymphatic dissemination in adenomyosis is observed in every fourth patient, which requires revision of the surgery protocol with excision of regional lymph nodes to prevent relapses. The presence of cases of pulmonary endometriosis and endometrioid liver cysts makes hematogenic dissemination of endometriosis from the primary source in the pelvic region obvious. The most frequent localizations of endometrioid heterotopias are located near the corresponding venous plexuses of the small pelvis, the outflow from which occurs mainly through the inferior vena cava, without anatomical obstacles for hematogenic dissemination of endometrioid cells with subsequent lung damage. For liver involment, it is likely that endometriosis in the distal parts of the colon is important, the venous outflow from which is directed to the portal vein system. Endometriosis of the diaphragm – is an example transcoelomic spread with predominant location on the right dome of the diaphragm, as the right subphrenic space communicates with the pelvic cavity through the right lateral channel, which justifies the possibility of such involments of the diaphragme in context of the theory of uteroperitoneal reflux.Thus, the theory of menstrual regurgitation and the theory of hemato-lymphatic dissemination are components of a single pathogenetic model of the distribution of endometrioid cells in the body.

Endometriosis of the Lung: Case Report and Literature Review

Background: Lung endometriosis is an extremely rare gynecological disease. Literature reports suggest that most patients will show generic symptoms such as hemoptysis, pneumothorax, and hemopneumothorax, which can often result in misdiagnosis. There are case reports of 18 patients with lung endometriosis describing clinical manifestation, imaging changes, treatment and prognosis. To provide further information on this rare disease, we present a case of pulmonary endometriosis and a review of lung endometriosis.Case presentation: We report on a 19-year-old female who was admitted to hospital due to repeated menstrual hemoptysis for 3 months. Computed tomography during menstruation showed patchy high-density shadows sized approximately 0.5 cm × 0.5 cm × 0.5 cm in the right middle lobe of the lung. Following menstruation, hemoptysis and changes on CT imaging disappeared. Thoracoscopic right middle lobectomy, right lower lung repair, and closed thoracic drainage were performed. Postoperative histopathology confirmed lung endometriosis. There was no recurrence of symptoms after 6 months of follow-up. Conclusions: We review the literature on factors associated with lung endometriosis, diagnosis, and treatment options. We propose that the diagnosis for lung endometriosis should be made by comprehensively integrating patient reproductive history, clinical and imaging details as well as histopathology. Surgical resection appears to be an effective treatment for lung endometriosis.

Catamenial pneumothorax due to pulmonary endometriosis

Endometriosis is a chronic condition causing menstrual pain, irregular bleeding and infertility among women. Although usually in the pelvis, it can manifest in atypical places. We describe a 39-year old woman with a previous endometriosis diagnosis who presented three times on the second menstrual day with dyspnea and chest pain. Imaging showed right-sided pneumothorax on all three occasions. Thoraco­scopy revealed endometriosis-like lesions. Histology was suggestive of endometriosis. After treatment with chemical pleurodesis and hormonal suppression she has remained symptom-free. Diagnosis should be obtained by concomitant thoraco- and laparoscopy with biopsies to verify the disease and give a basis for appropriate treatment.

Endometriosis of the lung: case report and literature review

Background:Lung endometriosis is an extremely rare gynecological disease. Literature reports suggest that most patients will show generic symptoms such as hemoptysis, pneumothorax, and hemopneumothorax, which can often result in misdiagnosis. There are case reports of 18 patients with lung endometriosis describing clinical manifestation, imaging changes, treatment and prognosis. To provide further information on this rare disease, we present a case of pulmonary endometriosis and a review of lung endometriosis.Case presentation:We report on a 19-year-old female who was admitted to hospital due to repeated menstrual hemoptysis for 3 months. Computed tomography during menstruation showed patchy high-density shadows sized approximately 0.5 cm × 0.5 cm × 0.5 cm in the right middle lobe of the lung. Following menstruation, hemoptysis and changes on CT imaging disappeared. Thoracoscopic right middle lobectomy, right lower lung repair, and closed thoracic drainage were performed. Postoperative histopathology confirmed lung endometriosis. There was no recurrence of symptoms after 6 months of follow-up. Conclusions: We review the literature on factors associated with lung endometriosis, diagnosis, and treatment options. We propose that the diagnosis for lung endometriosis should be made by comprehensively integrating patient reproductive history, clinical and imaging details as well as histopathology. Surgical resection appears to be an effective treatment for lung endometriosis.

Respiratory patient experience of measures to reduce risk of COVID-19: findings from a descriptive cross-sectional UK wide survey

ObjectivesTo assess the experience of people with long-term respiratory conditions regarding the impact of measures to reduce risk of COVID-19.DesignAnalysis of data (n=9515) from the Asthma UK and British Lung Foundation partnership COVID-19 survey collected online between 1 and 8 April 2020.SettingCommunity.Participants9515 people with self-reported long-term respiratory conditions. 81% female, age ranges from ≤17 years to 80 years and above, from all nations of the UK. Long-term respiratory conditions reported included asthma (83%), chronic obstructive pulmonary disease (10%), bronchiectasis (4%), interstitial lung disease (2%) and ‘other’ (<1%) (eg, lung cancer and pulmonary endometriosis).Outcome measuresStudy responses related to impacts on key elements of healthcare, as well as practical, psychological and social consequences related to the COVID-19 pandemic and social distancing measures.Results45% reported disruptions to care, including cancellations of appointments, investigations, pulmonary rehabilitation, treatment and monitoring. Other practical impacts such as difficulty accessing healthcare services for other issues and getting basic necessities such as food were also common. 36% did not use online prescriptions, and 54% had not accessed online inhaler technique videos. Psychosocial impacts including anxiety, loneliness and concerns about personal health and family were prevalent. 81% reported engaging in physical activity. Among the 11% who were smokers, 48% reported they were planning to quit smoking because of COVID-19.ConclusionsCOVID-19 and related social distancing measures are having profound impacts on people with chronic respiratory conditions. Urgent adaptation and signposting of services is required to mitigate the negative health consequences of the COVID-19 response for this group.