Deeply infiltrating endometriosis affecting the rectum and lymph nodes
ABSTRACT To analyze morphologic aspects of bowel endometriosis.
Prospective study of 35 consecutive cases of bowel endometriosis.
Multidisciplinary group practice and teaching hospital.
Thirty-five patients with bowel endometriosis were assessed between September 2003 and June 2005.
Histologic analysis of 35 tissue samples removed at laparoscopic rectosigmoidectomy.
We performed an evaluation of lesion size, number of lesions present in the bowel, intestinal wall layers affected by the endometriotic lesion, circumference of the intestinal loop affected by the endometriotic lesion, and presence of lymph nodes with foci of endometriosis.
Analysis of the surgical samples revealed lymph nodes in the pericolic adipose tissue of 19 (54%), cases and in 5 of these cases (26.3%), endometriosis had affected the lymph nodes. When the thickness of the endometriotic lesion reached 1.75 cm, lymph nodes of all patients were affected, and all patients in whom more than 80% of the circumference of the intestinal loop was affected by endometriosis presented with positive lymph nodes.
This study raises doubts about whether this form of the disease can still be considered a clinically benign disease.
- SourceAvailable from: Giuliano Moyses Borrelli[Show abstract] [Hide abstract]
ABSTRACT: Chemokines have been associated with endometriosis. Our study was aimed at evaluating the levels of six chemokines - CXCL8 (IL-8), CXCL12 (SDF-1), CCL2 (MCP-1), CCL5 (RANTES), CCL19 (MIP-3β), and CCL21 (6-Ckine) - in the peritoneal fluid (PF) of patients with and controls without endometriosis by multiplexed cytokine assay. In this retrospective case-control study conducted at the Charité University Hospital, patients (n=36) and controls (n=27) were enrolled. The patients were separated into groups according to stage of the disease: I-II (n=21), III-IV (n=15), and according to clinical findings: peritoneal endometriosis (PE; n=7), deep-infiltrating endometriosis (DIE) affecting the retrocervical area (n=13) or the bowel/rectovaginal site (n=14). The subjects were also separated according to the cycle phase: follicular (n=14) or luteal (n=8) and the previous use (n=25) or not (n=38) of hormones. PF was collected from all subjects (n=63) consecutively during laparoscopy. The concentration of chemokines in the PF was assessed using Luminex(®) x-MAP(®) technology. Sensitivity and specificity were calculated. A model of multiple logistic regressions estimated the odds of endometriosis for each combination of the chemokines detected. We observed significantly higher concentrations of IL-8 (p<0.001), MCP-1 (p=0.014), and MIP-3β (p=0.022) in the PF of women with endometriosis than in the controls. A joint evaluation revealed that elevated levels of the three chemokines had a positive endometriosis prediction value of 89.1%. The combined assessment of MCP-1, MIP-3β, and IL-8 concentration in PF improved the likelihood of identifying patients with endometriosis. Future studies should investigate this panel in peripheral blood samples. Copyright © 2015. Published by Elsevier Ireland Ltd.Journal of Reproductive Immunology 02/2015; 109. DOI:10.1016/j.jri.2015.01.003 · 2.37 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Epidemiological data indicate that endometriosis increases the risk of epithelial ovarian cancer (EOC), but the mechanism of cancer transition is unknown. Results from genome-wide association studies (GWAS) and transcriptome sequencing have demonstrated that genes located in the 1p36 region are important in both endometriosis and endometriosis-associated cancer development. Therefore, we tested the hypothesis that SNPs in two tumor-suppressor genes (CHD5 and ARID1A) in the 1p36 region are associated with endometriosis. Allele frequencies of SNPs were investigated in 1685 Caucasian women consisting of 947 women with endometriosis and 738 controls. Peripheral blood samples were retrieved, DNA extracted and allelic frequencies of SNPs in two tumor-suppressor genes (CHD5 and ARID1A) were analyzed using TaqMan Open Array technique. Associations were observed for 3 SNPs in the CHD5 gene: rs1883603 (OR 1.31, 95% CI 1.00-1.71), rs9434741 (OR 1.41, 95% CI 1.16-1.71) and rs17436816 (OR 1.24, 95% CI 1.02-1.50). After correction for multiple comparisons, rs9434741 (CHD5) remained significantly associated with endometriosis (p<0.01). No associations were detected for ARID1A. In this Caucasian population, endometriosis seems to be associated with the tumor-suppressor gene CHD5. Our findings support recent data, suggesting that the 1p36 region plays an important role in endometrios. To validate these data, replication in an independent population is warranted.Gynecologic Oncology 08/2012; 127(2):398-402. DOI:10.1016/j.ygyno.2012.08.013 · 3.69 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: 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. 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. 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. 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.Human Reproduction 10/2008; 23(10):2202-9. DOI:10.1093/humrep/den259 · 4.59 Impact Factor