Edie Derian’s scientific contributions

Background: Endometriosis, defined as endometrial glands and stroma outside the endometrial cavity, affects up to 10% of reproductive age women. Implants outside of the pelvis, extrapelvic endometriosis, may occur in up to 15% of endometriosis patients. A patient with two rare manifestations of extrapelvic endometriosis; umbilical and thoracic including catamenial pneumothorax is presented. Case: A 43-year-old white woman had a history of intermittent umbilical bleeding beginning at age 23. She was diagnosed at age 42 with a right spontaneous pneumothorax occurring perimenstrually. Six months later, the patient had an umbilical 8-mm purple-bluish endometriotic papule excised. She has since experienced two additional menstrually related pneumothoraces. Conclusions: Histopathology of the umbilical lesion revealed endometriosis. Thoracoscopy at the time of the third pneumothorax showed multiple endometriotic lesions on the diaphragm, similar in appearance to pelvic lesions. Mechanical pleurodesis and partial apical pleurectomy were performed. The patient was started on gonadotropin-releasing hormone agonist, with a plan of hysterectomy and oophorectomy. A case is reported of a patient presenting with two rare manifestations of extrapelvic endometriosis: umbilical and thoracic. It allows a multispecialty review of endometriosis, the theories regarding the etiology, and treatments (including minimally invasive surgery) available for patients with extrapelvic endometriosis.

Background: Ectopic pregnancy, in which the gestational sac is outside the uterus, is the most common life-threatening emergency in early pregnancy. It affects approximately 2% of all pregnancies. Case Report: This article presents a case of ectopic pregnancy, treated with methotrexate, which failed medical management, and was noted to have trophoblastic tissue extruding from the midampullary portion of the fallopian tube, without associated hemorrhage. Conclusions: This underscores the 15%-20% failure rate with methotrexate and its potential risks, including tubal rupture. (J GYNECOL SURG 25:157)

Nonovarian endometriomas typically present as a slow-growing, painful abdominal mass in or around the site of a previous surgery. There can be considerable variation, however, because some masses grow rapidly and are not associated with pain whereas others cause patients significant discomfort and associated symptoms. The case of a 31-year-old woman, gravida 3 para 2, who had development of a uterine scar endometrioma after perforation during a dilation and evacuation, is examined. This is an unusual case considering the rate of uterine perforation at the time of gynecologic procedures and the lack of data related to the creation of nonovarian endometriomas.