Carcinosarcoma arising from atypical endometriosis in a cesarean section scar

Malignant change of endometriosis in a cesarean scar (CS) is rare. We report a case of carcinosarcoma arising from atypical endometriosis in a CS scar, which was successfully treated with complete excision of the lesion and repair of the abdominal wall defect with autologous skin-muscle flap graft. A 41-year-old woman presented with a recurrent endometriosis in a CS scar. Within 16 years it changed from benign to atypical endometriosis and finally to carcinosarcoma after three operations. Complete excision of the tumor was performed, with a big defect of abdominal wall successfully repaired by autologous pedicle skin-muscle graft. The diagnosis of carcinosarcoma arising from atypical endometriosis was confirmed histologically. The lesion recurred 6 months after the fourth operation. She died of disease 15 months after the fourth operation. This case demonstrated that long-standing recurrent scar endometriosis could undergo malignant changes and should be made aware. The primary treatment is complete surgical excision.     

子宫内膜异位症诊治中有争议的几个问题

子宫内膜异位症(EM)是一种雌激素依赖的慢性疾病,在育龄期女性中发病率达10％～15％.其病因不明,保守治疗后容易复发,难以根治,有恶变的风险.因此,EM需要长期管理. 国内外EM诊治指南中的很多建议都是基于专家共识[1],缺乏高质量的证据支撑.在EM患者的诊治中,很多问题还存在争议,需进一步明确.     

Multiple Nodule Removal by Disc Excision and Segmental Resection in Multifocal Colorectal Endometriosis

Study Objective

To report postoperative outcomes after dual digestive resection for deep endometriosis infiltrating the rectum and the colon.

Incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures

AIM: To report 11 cases of incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures. The diagnostic approaches and therapies for incisional endometriosis are also evaluated. METHODS: Eleven patients who presented with a painful nodule that was increasing in size during menstruation on the scar of a previous gynecologic procedure were examined retrospectively. RESULTS: All patients presented with a palpable painful lesion, located on the cesarean section incision, perineal episiotomy incision or the vaginal cuff after hysterectomy. All masses were increasing during menstruation and all patients had been having cyclical pain that worsened during menstrual periods. The mean age of the patients was 28.2 years. The onset of symptoms was referred at variable intervals after surgery ranging between 2 and 11 years (mean: 5.72 years). Ultrasound examination confirmed hypoechoic mass septated with cystic and solid components in the abdomen without intra-abdominal communications. All endometriotic masses were completely excised under general anesthesia. The excised masses were sent for microscopic examination which confirmed the diagnosis of endometriosis. CONCLUSION: Incisional endometriosis seems to be common in women who have had a cesarean section, although it does occur after other procedures and de novo. It is suggested that caution is exercised during gynecologic procedures to avoid transplantation of endometrium to the anterior abdominal wall. The preferred management is to excise the lesion completely even if this necessitates fascial excision.     

Long-term follow-up and recurrence rate after mesorectum-sparing bowel resection among women with rectovaginal endometriosis

Objective

To demonstrate the quality of a combined vaginal–abdominal surgical approach to rectovaginal endometriosis by analyzing long-term outcome and recurrence rates.

Methods

In a prospective cohort study in Berlin, Germany, women with endometriosis of the rectovaginal septum were enrolled between September 2004 and December 2012. Bowel infiltration was verified intraoperatively and treated by a nerve-sparing, mesentery-preserving vaginal–abdominal operative approach. Operative results were evaluated by assessing short- and long-term complications and recurrence rates.

Results

During the study period, 110 women underwent surgery. For 71 (64.5%) patients, bowel infiltration was confirmed intraoperatively. Overall, 15% of the patients had peri- or postoperative complications. No long-term complications occurred. After a median follow-up of 64 months, no recurrence in the rectovaginal septum was observed among the study patients. The recurrence of pelvic endometriosis was 15%.

Conclusion

The surgical nerve-sparing approach to rectovaginal endometriosis was confirmed to facilitate precise diagnosis and treatment with minimal morbidity and a long-term complication rate of 0%.     

重视子宫内膜异位症手术治疗的恰当性和彻底性

子宫内膜异位症（内异症）定义为子宫内膜腺体和间质生长在子宫腔以外的不同部位。它们既可以生长于盆、腹腔内，也可以生长于盆腹腔以外，形成病灶，累及不同组织和器官，引起一系列症状和体征，不同程度地影响患者的生活质量和生育能力。 浏览更多请关注本刊微信公众号及当期杂志。     

Relationship between Catamenial Pneumothorax or Non-catamenial Pneumothorax and Endometriosis

Study Objective

To evaluate the clinical characteristics of women presenting with catamenial pneumothorax and compare them with those with noncatamenial pneumothorax.

重视子宫内膜异位症手术治疗的恰当性和彻底性

        子宫内膜异位症（内异症）定义为子宫内膜腺体和间质生长在子宫腔以外的不同部位。它们既可以生长于盆、腹腔内，也可以生长于盆腹腔以外，形成病灶，累及不同组织和器官，引起一系列症状和体征，不同程度地影响患者的生活质量和生育能力。 浏览更多请关注本刊微信公众号及当期杂志。     

Establishing the accuracy and acceptability of abdominal ultrasound to define the foetal head position in the second stage of labour: a validation study

Background

Deep infiltrating endometriosis (DIE) is associated with severe painful symptoms and represents a complex management challenge.

Objective

To analyse the effect of pregnancy on deep infiltrating lesions and related symptomatology.

Study design

As part of a longitudinal study performed over the past 3 years to determine the efficacy of hormonal treatment in treating women with DIE, we identified three cases of advanced pelvic endometriosis, all with DIE (deep recto-vaginal and recto-sigmoid involvement) where patients achieved spontaneous pregnancies. They were followed up by transvaginal ultrasound (TV-US). The main outcome measures were analysis of the size and echographic pattern of deep infiltrating lesions of endometriosis and evaluation of clinical symptoms during pregnancy.

Results

We observed modifications in lesion size and pattern. In the two patients observed in the third trimester, the lesions were more homogeneous with less evident limits of nodules and band-like echoes, less fibrotic-like. All patients showed complete resolution of symptoms during pregnancy.

Conclusions

The hormonal environment produced by pregnancy might determine significant modifications of endometriotic lesions and reduce painful symptoms. As surgery for DIE is difficult, complex and can lead to major complications, the achievement of a pregnancy-specific hormonal state, through pregnancy or hormonal treatment, may be a valid option in selected cases.     

Subhepatic retroperitoneal endometrioma: Report of a case

A 38-year-old woman with a history of pelvic endometriosis was referred to our surgical department for the treatment of a cystic lesion most probably originating from the liver. At the laparotomy a solitary cyst was found in the retroperitoneum, connected to the inferior surface of the liver, and was resected. Histopathological examination of the resected specimen revealed that it was an endometriotic cyst. The occurrence of endometriotic cyst in the upper abdomen is very rare: there are no published reports of an endometriotic cyst in that anatomic location. The literature on this subject is reviewed.     

不同类型子宫内膜异位症临床特点及意义分析

目的:分析腹膜型、卵巢型及混合型子宫内膜异位症临床特点,探讨不同类型可能的发病机制。方法:统计中国医科大学附属盛京医院2011年12月至2012年12月经手术证实为盆腔子宫内膜异位症的446例患者,根据不同类型将所有患者分为:腹膜型组137例(30.7%)、卵巢型组48例(10.8%)、混合型组261例(58.5%)3组,比较各组间临床特点的差异。结果:腹膜型和混合型以双侧多见(62.8%,62.1%),卵巢型以单侧多见(81.3%)(P0.05);腹膜型易于其他手术时同时发现(94.9%),卵巢型和混合型多以子宫内膜异位症为指征行手术(95.8%,100.0%)(P0.05);腹膜型多无症状(93.4%),卵巢型及混合型更易引起痛经(75.0%及67.0%)(P0.05);腹膜型及卵巢型多存在于早期(100.0%及85.4%),混合型多存在于晚期(65.5%)(P0.05)。结论:经血逆流导致的内膜种植学说可能是子宫内膜异位症发病机制的基础学说,腹膜型子宫内膜异位症可能为盆腔子宫内膜异位症的先期病变。