Abrao MS, Podgaec S, Dias JA Jr, et al. Deeply infiltrating endometriosis affecting the rectum and lymph nodes

Hospital Sirio Libanes, Potengy, Rio Grande do Norte, Brazil
Fertility and sterility (Impact Factor: 4.59). 10/2006; 86(3):543-7. DOI: 10.1016/j.fertnstert.2006.02.102
Source: PubMed


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.

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    • "The association of markers in a panel has shown better results in predicting endometriosis than the same markers alone in individual series (Seeber et al., 2008; Agic et al., 2008; Vodolazkaia et al., 2012). We previously reported that endometriosis may mimic cancer owing to regional lymph node involvement in the disease and therefore hypothesized that the cancer-related chemokines responsible for the spread of neoplasms into lymph nodes – CXCL12 (SDF-1␣ and ␤-stromal cell derived factor-1 ␣ and ␤), CCL19 (MIP-3␤-macrophage inflammatory protein-3␤), and CCL21 (6Ckine) – may also play a role in endometriosis and be used as putative markers for the disease (Abrão et al., 2006; Mechsner et al., 2008; Zlotnik, 2006; Raman et al., 2007). Therefore, we decided to assess the ␣-chemokines – CXCL8, CXCL12 – as well as the ␤-chemokines – CCL2, CCL5, CCL19 and CCL21 – using multiplex assay Luminex ® xMAP ® technology, which is capable of measuring several analytes at the same time in a single sample of 25 ␮l in volume. "
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    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.
    Full-text · Article · Feb 2015 · Journal of Reproductive Immunology
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    • "However, recent histological analyses have indicated that the lymphatic spread of endometriosis is not a rare phenomenon in women with endometriosis [3, 10]. As in the present case, endometriosis in the extra-abdominal cavity often manifests as a mass and is a known risk factor for lymph node endometriosis [11]. This complicates diagnostic procedures, which indicate the presence of a mass with swollen lymph nodes in such cases, leading clinicians to suspect the presence of a malignant tumor with lymph node metastasis. "
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    ABSTRACT: Endometriosis is defined as the presence of endometrium-like tissues at extrauterine sites, most commonly in the abdominal cavity. Lymph node endometriosis is a rare but clinically important type of endometriosis that can mimic lymph node metastasis of a malignant tumor. (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) is a useful tool for diagnosing malignant tumors, although it occasionally shows false positive results in tissues with high metabolic activity caused by severe inflammation. In the present report, we describe a case of lymph node endometriosis that mimicked lymph node metastasis of a malignant tumor and showed a positive result on (18)F-FDG PET/CT. The findings of the present case suggest that lymph node endometriosis could present as swollen lymph nodes with (18)F-FDG PET/CT-positive results and provide important information for determining an appropriate treatment strategy.
    Full-text · Article · Aug 2014
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    • "The classification of endometriosis is changing from a local disorder to a complex disease as new molecular mechanisms are being discovered [2]. The endometriotic process is classified as an estrogen-dependent inflammatory disease similar to cancer due to its capability to invade surrounding tissues, to promote angiogenesis, inflammation, and apoptosis in favor of the new endometriotic tissue survival [31–36]. Estrogen production plays a central role in the pathology of endometriosis enhancing the survival of the endometriotic tissue, and together with prostaglandins and cytokines, mediating pelvic pain and infertility [37, 38]. "
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    ABSTRACT: Estrogen receptor alpha has a central role in human fertility by regulating estrogen action in all human reproductive tissues. Leukemia inhibitory factor (LIF) expression, a cytokine critical for blastocyst implantation, is mediated by estrogen signaling, so we hypothesized that ESR1 gene polymorphisms might be candidate risk markers for endometriosis-related infertility and in vitro fertilization (IVF) failure. We included 98 infertile women with endometriosis, 115 infertile women with at least one IVF failure and also 134 fertile women as controls. TaqMan SNP assays were used for genotyping LIF (rs929271), MDM2 (rs2279744), MDM4 (rs1563828), USP7 (rs1529916), and ESR1 (rs9340799 and rs2234693) polymorphisms. The SNP ESR1 rs9340799 was associated with endometriosis-related infertility (P < 0.001) and also with IVF failure (P = 0.018). After controlling for age, infertile women with ESR1 rs9340799 GG genotype presented 4-fold increased risk of endometriosis (OR 4.67, 95% CI 1.84-11.83, P = 0.001) and 3-fold increased risk of IVF failure (OR 3.33, 95% CI 1.38-8.03, P = 0.007). Our results demonstrate an association between ESR1 rs9340799 polymorphism and infertile women with endometriosis and also with women who were submitted to IVF procedures and had no blastocyst implantation.
    Full-text · Article · Dec 2013 · Disease markers
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