Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules

The histological relationships between fibrotic tissue, endometriotic foci and nerves in the rectovaginal septum endometriotic or adenomyotic nodule were studied. This is considered to be one of the most severe forms of deep endometriosis. Masson's trichrome staining for fibrosis detection and immunohistochemistry with the S100 monoclonal antibody for nerve detection were performed in 28 rectovaginal endometriotic nodules from patients presenting with severe dysmenorrhoea and deep dyspareunia (23 patients with no other endometriotic location or potential cause of pain at laparoscopy and ultrasonography; five patients with multiple pelvic endometriotic localizations and other potential causes of pain at laparoscopy). Patients were allocated to two groups on the basis of their preoperative pain scores for pelvic pain, dysmenorrhoea and deep dyspareunia (group 1, score >7; group 2, score < or =7). For each symptom, the mean number of nerves and endometriotic lesions per high-power field and the mean largest diameter of the lesions were not statistically different in groups 1 and 2. The mean percentages of nerves located within the fibrosis of the nodule and within endometriotic lesions were significantly higher in group 1 than in group 2. Among nerves located within endometriotic lesions, there was a significantly higher proportion showing intraneurial and perineurial invasion by endometriosis in group 1 than in group 2. In rectovaginal endometriotic nodules, there was a close histological relationship between nerves and endometriotic foci, and between nerves and the fibrotic component of the nodule. We postulate that such topographical relationships could at least partially explain the strong association between this lesion and pain.     

Bladder endometriosis must be considered as bladder adenomyosis

Objective: To present data from a series of 17 cases of bladder endometriosis.

Design: Clinical study.

Setting: A university hospital department of gynecology.

Patient(s): Seventeen patients complaining of menstrual urinary symptoms and/or pelvic pain.

Intervention(s): Diagnosis and resection of a bladder adenomyotic nodule.

Main Outcome Measure(s): Histologic analysis and postsurgical outcome.

Result(s): Seventy-six percent of the patients reported menstrual mictalgia and pollakiuria, and 88% reported dysmenorrhea and dyspareunia. Cystoscopy, intravenous pyelography, and magnetic resonance imaging revealed a nodular mass in the anterior fornix adjacent to the uterine wall, developed in the vesical muscularis and involving the vesical mucosa in all cases but one. The bladder nodule was associated with a rectovaginal nodule in six cases (35%). Because recurrence was noted soon after cessation of medical therapy, surgical excision was proposed. The vesical mucosa was found to be intact in almost all cases, so extramucosal laparoscopic excision was the method of choice. Histologic examination proved that 90% of the nodule consisted of smooth muscle hyperplasia.

Conclusion(s): So-called bladder endometriosis is actually an adenomyotic nodule of the bladder which, from a histologic point of view, is similar to a rectovaginal adenomyotic nodule and frequently (35%) associated with it.     

Uterine rupture during pregnancy soon after a laparoscopic adenomyomectomy

Although laparoscopic adenomyomectomy may be a possible risk factor for uterine rupture in subsequent pregnancy, few reports have described it. A 35-year-old woman became pregnant 1 month after laparoscopic adenomyomectomy. At the 28th week, uterine contraction occurred, leading to intravenous ritodrine infusion. Severe abdominal pain and a non-reassuring fetal heart rate occurred abruptly and an emergency cesarean section was carried out. The uterus ruptured at the site of previous surgery of the uterine body, which was reconstructed. The mother and the infant did well postoperatively. We report the second case of uterine rupture during pregnancy subsequent to laparoscopic adenomyomectomy. A history of adenomyomectomy and a short interval to subsequent pregnancy may be risk factors for uterine rupture. (Reprod Med Biol 2007; 6 : 175–177)     

GnRHa对改善他莫西芬诱发子宫腺肌病小鼠模型内膜容受性的作用

目的:探讨促性腺激素释放激素激动剂(GnRHa)对腺肌病模型小鼠种植窗期内膜容受性的影响。方法:新生ICR小鼠滴喂他莫西芬建立子宫腺肌病模型,随机分为GnRHa降调的模型鼠组(A组)、模型对照鼠组(B组),并取同龄正常小鼠作为对照组(C组),每组8只,于100~115日龄处死,HE染色检测小鼠子宫病理变化;免疫组织化学CD31染色计算小鼠子宫微血管密度;免疫组织化学法检测种植窗期子宫内膜LIF表达及扫描电镜下观察胞饮突发育情况。结果:①口服他莫西芬法建立ICR小鼠子宫腺肌病模型造模率为100%,B组小鼠子宫肌层微血管密度高于A、C组,差异有统计学意义(P<0.05)。②种植窗期子宫内膜LIF蛋白水平A组和C组明显高于B组,差异有统计学意义(P<0.05);A、C组间无统计学差异(P>0.05)。③B组可见较多退化的胞饮突,分布稀疏,呈局灶性分布;A组的胞饮突较B组丰富但大小略不均;C组胞饮突分布较丰富且发育完全。结论:新生小鼠口服他莫西芬法可高效建立子宫腺肌病模型,GnRHa降调节能改善子宫腺肌病小鼠子宫内膜中LIF表达及胞饮突发育,从而提高子宫内膜容受性。     

MRI诊断子宫腺肌病的价值

目的 探讨MRI诊断子宫腺肌病的价值.方法 回顾性分析6例子宫腺肌病患者MRI和超声检查的资料,与术后病理结果对比,评估MRI对子宫腺肌病的诊断符合率.结果 B超诊断子宫腺肌病的灵敏度为52.5%、特异度为54.2%;MRI灵敏度为95.6%、特异度为100%;MRI检查既能定性,又能定位,而且此检查无创伤,方便快捷.结论 MRI为临床诊断子宫腺肌病提供了一种有价值的检查方法,对及时、正确治疗该病具有重要的临床意义.     

子宫腺肌症的MRI诊断价值探讨

目的探讨子宫腺肌病的MRI表现及MRI扫描的诊断价值。方法对19例经手术病理证实的子宫腺肌症患者行MRI检查并回顾性分析。结果19例中，弥漫性子宫腺肌症11例，子宫壁结合带弥漫性增厚，结合带与肌层分界不清；在T1WI上表现为等信号，在T2WI上表现为等或略低信号，混杂有散在多发点状高信号灶。局限性子宫腺肌症8例，表现为子宫体部或底部局限性增大，相应部位结合带增厚，与肌层分界不清，在T1WI上呈等信号，T2WI上呈略低信号，病灶信号可不均匀，中央部可有多发点状高信号。结论MRI能对子宫腺肌症作出明确诊断，矢状位T2WI是显示病变的最佳扫描序列。     

子宫腺肌病与子宫肌瘤的比较分析

目的 探讨子宫腺肌病与子宫肌瘤的临床特点,提高对子宫腺肌病术前诊断率.方法 以5年来妇产科子宫切除术后病理证实为子宫腺肌病的180例为A组;并随机选择同期子宫切除术后病理证实的子宫肌瘤患者200例为B组,对两组患者年龄分布、既往史、临床症状、术前诊断、B超声检查、血清CA125水平进行比较.结果 两组患者均好发于生育年龄妇女,常有月经过多或经期延长(P＞0.05).子宫腺肌病术前诊断率56.1%,出现痛经(80.6%)、性交疼痛(36.7%)较多,但继发性贫血少(17.7%);具有特征性的超声表现;血清CA125(74.5±68.3)U/mL,水平明显升高.结论 子宫腺肌病诊断的金标准是病理诊断,但其既往史、特有症状、B超改变、血清CA125水平增高仍是诊断该病的重要参考指标,并可与子宫肌瘤进行手术前鉴别.     

生存素在子宫腺肌病异位病灶中的表达及其意义

目的了解凋亡抑制蛋白生存素（Survivin）在子宫腺肌病患者病灶、在位内膜中的表达情况。方法采用免疫组化抗生物素蛋白一过氧化物酶染色法（SP法）检测子宫腺肌病患者（22例）异位病灶、在位内膜及对照组（30例子宫肌瘤）子宫内膜标本中生存素的表达并比较。结果生存素在研究组异位病灶中广泛表达，表达的强度显著高于其在位内膜和对照组子宫内膜，增殖期高于分泌期；研究组在位内膜的生存素表达也高于对照组内膜；无论是研究组在位内膜还是对照组子宫内膜中生存素的表达均不随月经周期变化。结论生存素的过度表达可能参与了子宫腺肌病的发生与发展过程。     

针刺治疗子宫腺肌症23例（英文）

目的:探讨针刺加TDP照射方法对于子宫腺肌症的疗效。方法:采用针刺加TDP照射方法治疗本病,选取太冲、太溪、三阴交,点刺合谷,腰腹发凉者加TDP神灯照射,并评定疗效。结果:23例患者中治愈16例,好转7例,无效0例,有效率100%。结论:针刺加TDP照射方法对于子宫腺肌症疗效显著。     

大黄-桃仁药对调控子宫腺肌病在位内膜线粒体稳态的机制研究

目的 探索大黄-桃仁药对对子宫腺肌病（adenomyosisi,AM）在位内膜线粒体稳态的调控机制。方法 同种异体垂体移植法构建AM小鼠模型,光镜及透射电镜（TEM）观察大黄-桃仁药对治疗前后子宫组织病理及超微结构改变;免疫荧光检测线粒体自噬通路PTEN诱导的推定激酶1(PTEN-induced putative kinase 1,PINK1)/帕金森蛋白（Parkinson protein,Parkin）蛋白表达。培养人永生化子宫内膜异位症在位内膜间质细胞hEM15A,观察大黄-桃仁药对处理前后细胞增殖能力、活性氧（reactive oxygen species,ROS）、抗氧化酶系、线粒体膜电位、线粒体自噬小体、线粒体自噬蛋白的变化。结果 病理切片显示,经大黄-桃仁药对治疗后,中、重度的浸润比例较模型组减少。TEM观察发现模型组子宫内膜上皮细胞及间质细胞线粒体肿胀、线粒体脊消失,部分形成线粒体自噬体;经大黄-桃仁药对治疗后子宫内膜上皮细胞及间质细胞线粒体数量增加,无明显肿胀、线粒体脊清晰可见。与对照组比较,造模后子宫内膜层PINK1、Parkin表达显著上调（P<0.001）...