Endometriosis. Case report

Extragenital endometriosis (EGE) is the rarest variant of endometrioid disease. This is a process in which a benign growth of tissue similar to the endometrium in morphological and functional properties occurs outside the uterine cavity. The manifestation of the disease has an erased course characteristic of other diseases and patients are more likely to end up in non-core departments, which is accompanied by errors in treatment tactics. According to the data of T.V. Dresvyanskaya et al., the frequency of EGE is 68% of the number of all cases of detection of endometrioid disease. The article presents a case of successful surgical treatment of EGE of rare localization.

Gestagenes in the treatment of endometriosis: efficiency, safety, bioequivalence, transferability

Endometriosis is a chronic disease that requires long-term treatment, the goal of which is effectively use drugs and avoids repeated surgical interventions.The quality of patients’ life depends on the varying degrees of symptoms such as pelvic pain, dyspareunia, dysmenorrhea. Endometriosis causes infertility and perinatal complications. The symptoms of endometriosis often affect psychological and social well-being, and threaten the relationships, sexuality and mental health of women. Women with endometriosis have high levels of anxiety, depression, and other psychiatric disorders that can aggravate the severity of their pain.The existing statistics on the endometriosis incidence is underestimated given the diagnostic difficulties. So far, there are no final, only generally an accepted method of treating endometriosis, and in most cases, treatment is only eliminates the symptoms. Today, it is desirable to take a conservative approach to treatment, avoiding surgery, and hormone therapy is recommended to relieve pain associated with endometriosis. An individual approach is important in the management of patients with endometriosis, taking into account the reproductive plans and needs of woman. Medical treatment methods should be used as much as possible, for example, dienogest 2 mg (in particular, Savis drug). Dienogest is a derivative of 19-nortestosterone, which has an antiproliferative effect on the endometriosis foci.Savis is a drug specially formulated for the endometriosis treatment. Savis may be prescribed to relieve symptoms before and after surgery to prevent relapse. The safety profile of dienogest has been studied and data is constantly accumulating, given the popularity of its prescription.The effectiveness of dienogest should be assessed primarily by its effect on pain and quality of life, on maintaining fertility, and on the possibility of avoiding or postponing surgery. This is important for various forms of endometriosis: endometriomas, extragenital endometriosis, adenomyosis.

Persistent dysuria in women: etiological diagnostics and treatment

INTRODUCTION:Dysuria is a painful urination combined with its frequency and/or difficulty. Dysuria is observed in many urological diseases and is one of the most common reasons for treatment for urological cause. AIM:The aim of the study is to identify the etiological factors of dysuria in women and to evaluate a personalized approach to their treatment. MATERIALS AND METHODS:We analyzed the data of 368 women with chronical cystitis. The inclusion criteria for the study were the presence of dysuria (painful and frequent urination more than 8 times a day with or without difficulty), the prescription of urination disorders over one year old and age 18 and over. All patients underwent a comprehensive urological examination to identify the causes of urinary disorders. RESULTS:The Bacterial cystitis was confirmed only in 78 (21.2%) patients among all 368 women. In the remaining 290 (78.8%) patients, the causes of persistent dysuria were other diseases: bladder leukoplakia in 154 (41.8%), bladder pain syndrome/interstitial cystitis in 38 (10.3%), viral cystitis in 34 (9.3%), paraurethral formations in 29 (7.9%), neurogenic urinary dysfunction bladder in 25 (6.8%), urethral pain syndrome in 5 (1.4%) patients. Dysuria was also caused by postradiation cystitis (2 patients), secondary stones in the urinary bladder (2 patients), and one patient had extragenital endometriosis. CONCLUSIONS:The variety of reasons for the development of persistent dysuria in women requires careful examination of patients. Treatment should be carried out only after accurate verification of the diagnosis.

Mesenchymal Stromal Cells Isolated from Ectopic but Not Eutopic Endometrium Display Pronounced Immunomodulatory Activity In Vitro

A comparative analysis of the cell surface markers and immunological properties of cell cultures originating from normal endometrium and endometrioid heterotopias of women with extragenital endometriosis was carried out. Both types of cell cultures expressed surface molecules typical of mesenchymal stromal cells and did not express hematopoietic and epithelial markers. Despite similar phenotype, the mesenchymal stromal cells derived from the two sources had different immunomodulation capacities: the cells of endometrioid heterotopias but not eutopic endometrium could suppress dendritic cell differentiation from monocytes as well as lymphocyte proliferation in allogeneic co-cultures. A comparative multiplex analysis of the secretomes revealed a significant increase in the secretion of pro-inflammatory mediators, including IL6, IFN-γ, and several chemokines associated with inflammation by the stromal cells of ectopic lesions. The results demonstrate that the stromal cells of endometrioid heterotopias display enhanced pro-inflammatory and immunosuppressive activities, which most likely impact the pathogenesis and progression of the disease.

Organization of the Cytoskeleton in Ectopic Foci of the Endometrium with Rare Localization

(1) Background: Endometriosis is a common pathology of the female reproductive system, often accompanied by pain and decreased fertility. However, its pathogenesis has not been sufficiently studied regarding the role of the cytoskeleton. In this study, we describe two clinical cases involving rare localization of extragenital endometriosis (umbilicus) and compare them with genital endometriosis of different localization (ovaries and uterus), as well as eutopic endometrium obtained with separate diagnostic curettage without confirmed pathology. (2) Methods: The relative content of actin and tubulin cytoskeleton proteins was determined by Western blotting, and the expression of genes encoding these proteins was determined by RT-PCR in the obtained intraoperative biopsies. The content of 5hmC was estimated by dot blot experiments, and the methylase/demethylase and acetylase/deacetylase contents were determined. (3) Results: The obtained results indicate that the content of the actin-binding protein alpha-actinin1 significantly increased (p < 0.05) in the groups with endometriosis, and this increase was most pronounced in patients with umbilical endometriosis. In addition, both the mRNA content of the ACTN1 gene and 5hmC content increased. It can be assumed that the increase in 5hmC is associated with a decrease in the TET3 demethylase content. Moreover, in the groups with extragenital endometriosis, alpha- and beta-tubulin content was decreased (p < 0.05) compared to the control levels. (4) Conclusions: In analyzing the results, further distance of ectopic endometrial foci from the eutopic localization may be associated with an increase in the content of alpha-actinin1, probably due to an increase in the expression of its gene and an increase in migration potential. In this case, a favorable prognosis can be explained by a decrease in tubulin content and, consequently, a decrease in the rate of cell division.

Extragenital endometriosis as a cause of catamenial pneumothorax in women: own experience

Introduction. Catamenial pneumothorax is one of the most difficult to diagnose types of spontaneous pneumothorax in women. The cause of the latter is ectragenital localization of endometriosis. To date, there is no clear pathogenetically determined treatment and treatment algorithm for the management of this category of patients. Objective: to analyze and structure our own experience in the treatment of catamenial pneumothorax. Materials and methods. For the period 2011–2020 in the Thoracoabdominal Department of the SI "Zaytcev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine" 7 women with catamenial pneumothorax were on inpatient treatment. Results. After additional examination, all patients underwent draining of the pleural cavity with Bulau as the first stage after the diagnosis was established. At the second stage, all patients underwent minimally invasive surgical interventions – videothoracoscopic resection of the endometriosis-affected areas of the costal parietal pleura and diaphragm, mechanical pleurarasion and pleurodesis, using fibrin-collagen plates in the areas of diaphragm defects. There were no postoperative complications or deaths. Conclusion. In the treatment of extragenital endometriosis complicated by catamenial pneumothorax, not only thoracic surgeons, but also obstetrician-gynecologists should take part in order to create multidisciplinary commissions aimed primarily at determining the pathogenetically determined treatment tactics. Key words: extragenital endometriosis, catamenial pneumothorax, videothoracoscopy, surgical treatment.

Intestinal endometriosis: features of clinical and morphological diagnostics

A clinical observation of the combined endometriotic lesion of the small intestine and the appendix is given below. Extragenital endometriosis is a rare pathology in which endometrioid heterotopies develop outside the reproductive system organs. At about 1825% of women suffering from the pelvic organs endometriosis, the intestines are involved in the pathological process. In this regard, it is believed that in most cases its lesion is secondary while the primary lesion of the intestine with endometriosis is rarely observed and occurs as a result of hematogenous introduction of endometrial elements into the intestinal wall. Of all parts of the intestine, endometriosis most often affects the rectum and sigmoid colon (7080%), then the jejunum, less often the cecum. The most rare gastrointestinal tract endometriosis localization is the appendix, the frequency of its lesion is 0.8%. It was carried out in a clinicopathologic analysis of 14 endometriosis cases in various parts of the intestine (4 cases of the small intestine lesions, 2 rectosigmoid part of the large intestine, 2 rectum, 2 sigmoid colon, 3 appendix, 1 combined lesion of the small intestine and the appendix). In most cases, the clinical diagnosis of extragenital endometriosis is difficult, and as a rule women come with complaints typical of acute surgical pathology: intestinal obstruction, appendicitis. An important role in differential diagnosis is given to the ultrasound examination of the pelvic organs and abdominal cavity, magnetic resonance imaging, endoscopic research methods, as well as the connection of clinical symptoms with the menstrual cycle.

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.