Perineal endometriosis. A case report

Perineal endometriosis was found unexpectedly in a 32-year-old woman with primary infertility. Since there had been no prior perineal trauma, the transport of endometrium through a venous or lymphatic route could have accounted for the location of the endometriosis.     

Inguinal endometriosis: A systematic review

Inguinal endometriosis is a very rare entity with uncertain pathophysiology, that poses several diagnostic and therapeutic challenges. This study aimed to summarize published literature on the diagnosis and treatment of this condition. Thus, a systematic literature search was conducted in PubMed/MEDLINE, Scopus and the Cochrane Library. An effort was made to numerically analyze all parameters included in case reports and retrospective analyses, as well. The typical and atypical features of this condition, investigations used, type of treatment and histopathology were recorded. More specifications about the surgical treatment, such as operations previously performed, type of surgery and treatment after surgery have been acknowledged. Other sites of endometriosis, the presence of pelvic endometriosis and the follow-up and recurrence have been also documented. Overall, the search yielded 61 eligible studies including 133 cases of inguinal endometriosis. The typical clinical presentation includes a unilateral inguinal mass, with or without catamenial pain. Transabdominal or transvaginal ultrasound was typically used as the first line method of diagnosis. Groin incision and exploratory surgery was the treatment indicated by the majority of the authors, while excision of part of the round ligament was reported in about half of the cases. Chemotherapy and radiotherapy were initiated in cases of coexisting endometriosis-related neoplasia. Inguinal recurrence or malignant transformation was rarely reported. The treatment of inguinal endometriosis is surgical and a long-term follow-up is needed. More research is needed on the effectiveness of suppressive hormonal therapy, recurrence rate and its relationship with endometriosis-associated malignancies.     

会阴子宫内膜异位症20例分析

会阴子宫内膜异位症２０例，年龄２６￣４８岁，平均３５．１岁。１８例发生于会阴侧切伤口，首发症状至侧切时间为１个月￣９年，平均３．５年。主要临床表现为会阴侧切艰痕硬结处周期性疼痛及肿胀，部分患者伴性交痛，１例硬结处溃破出血。另２例中１例发生于分娩时的会阴裂伤处；１例于首发症状前５年已行全子宫切除术，表现为阴道少量出血，阴道左侧壁后方有一硬结。１９例行异位病灶切除术，１例累及肛门括约肌，切除病灶后修补     

Immunoscintigraphy of ovarian endometriosis. A preliminary study

CA-125 is a membrane antigen detected in the serum of some women with gynaecological disease including endometriosis. We attempted to use a radioiodinated anti-CA-125 monoclonal antibody, OC-125, to image ovarian endometriosis using immunoscintigraphy. Two women with significant endometriosis and normal serum CA-125 levels had positive immunoscintigraphy. In one woman, all areas of endometriosis were imaged; in the other, endometriosis in one affected ovary was seen, but uptake in the other ovary was less than the extent of the disease.     

Immunoscintigraphy of ovarian endometriosis. A preliminary study

Summary. CA-125 is a membrane antigen detected in the serum of some women with gynaecological disease including endometriosis. We attempted to use a radioiodinated anti-CA-125 monoclonal antibody, OC-125, to image ovarian endometriosis using immunoscintigraphy. Two women with significant endometriosis and normal serum CA-125 levels had positive immunoscintigraphy. In one woman, all areas of endometriosis were imaged; in the other, endometriosis in one affected ovary was seen, but uptake in the other ovary was less than the extent of the disease.     

Diagnosis and treatment of endometriosis. A review

The correct approach for endometriosis management is still unclear. This review explores recent data concerning diagnosis and treatment of endometriosis, trying to define guidelines for the most appropriate diagnostic approach and therapeutic regimen. At present, laparoscopy is still considered the gold standard in endometriosis diagnosis. The risks and the diagnostic limitations of laparoscopy and the inaccuracy of clinical examination justify the considerable efforts made to improve the diagnosis with imaging techniques. The therapeutic approach is still far from being defined as causal and focuses on management of clinical symptoms of the disease rather than on the disease itself. A first-line medical therapy should be tried in patients with pelvic pain not asking for a pregnancy. Surgical treatment is considered the best treatment for women with pain and or pelvic mass who wish to become pregnant in a short time. For infertile patients, medical therapy has a limited role. The 2 treatment options include surgery or in vitro fertilization (IVF). According to our results, it seems that correct management of infertile women with endometriosis is a combination of surgery and IVF in women who did not obtain post-surgery pregnancy spontaneously.     

Treatment of endometriosis with an antigonadotropin, Danazol. A laparoscopic and histologic evaluation.

Antigonadotropin (Danazol) was administered to 39 patients with endometriosis diagnosed at laparoscopy and confirmed by laparoscopic biopsy. None of the patients had surgical resection of the lesion prior to the treatment. While on the drug, all patients developed evidence of ovarian suppression both in regard to ovulation and steroidogenesis. The results were evaluated by repeat laparoscopy and biopsy. The extent of the disease was documented before and after treatment by photography and drawing. There was marked decrease in the extent of endometriosis after treatment: 59% of patients had no evidence of disease, 26% had peritoneal adhesions and hemosiderin deposits but no active endometriosis, and 15% had residual endometriosis. Histology in the latter group revealed atrophic changes in the uterine and ectopic endometrium and the evidence of a healing process.     

Pleuroperitoneal endometriosis.

A nearly unique case is presented of pleural and peritoneal endometriosis with bloody pleural effusion and 4700 cc of bloody ascites. Theories of pathogenesis, differential diagnosis, and treatment are discussed. This represents another of the protean manifestations of endometriosis to complement the many others described in the literature.