Catamenial hemoptysis. Diagnosis with MRI

Thoracic endometriosis is a rare disorder. We report a case of a 26-year-old woman with a 4-year history of catamenial hemoptysis due to thoracic endometriosis which was diagnosed by MRI and treated successfully by means of video-assisted thoracoscopic wedge-resection of the solitary pulmonary lesion. Medical therapy with hormones was not necessary. There is no evidence of recurrence 10 months after the operation. This case demonstrates that MRI of the chest may be considered for the diagnostic work-up of patients with catamenial hemoptysis. It also shows that wedge-resection of pulmonary endometriosis foci by means of video-assisted thoracoscopy-an approach that has not been described in the literature thus far-is an effective therapy in localized peripheral pulmonary parenchymal endometriosis.     

A functional chimeric modular polyketide synthase generated via domain replacement

We report here a case in which for hemoptysis during menstruation (catamenial hemoptysis) right middle lobectomy was performed thoracoscopically under a preoperative diagnosis of pulmonary endometriosis with a successful outcome. The patient was a 27-year-old housewife who from the age of 24 years experienced hemoptysis during menstruation, and was diagnosed as having pulmonary endometriosis on the basis of detailed examinations including bronchoscopy and chest CT. From the age of 26 years hormone therapy was administered, but the hemoptysis recurred with the menstruation following its cessation. After admission to this department bronchoscopy performed at the time of menstruation revealed bleeding from right B4 while chest CT showed an abnormal shadow in right S4 b. Right middle lobectomy was then performed thoracoscopically under a diagnosis of right middle lobe endometriosis. In the resected specimen findings of pulmonary hemosiderosis, granulomatous phlebitis and micrometastases from a thyroid cancer were noted. The postoperative course was favorable with no further episodes of hemoptysis occurring. In this case histological proof of endometriosis could not be obtained, but the diagnosis of pulmonary endometriosis was strongly suggested by the clinical course and objective findings such as pulmonary hemosiderosis.     

Endometriosis of the bladder muscular layer as a cause of acute abdomen

OBJECTIVES: A case of acute abdomen arising from endometriosis of the bladder is described. The rarity of this condition prompted us to report on the present case and the problems encountered in making the differential diagnosis. METHODS/RESULTS: A patient with endometriosis of the muscle layer of the bladder mimicking acute gynecological abdomen is described. CONCLUSIONS: Endometriosis of the bladder is extremely rare and usually presents as urinary problems and rarely as acute abdomen.     

Massive hemoperitoneum from endometriosis of the fallopian tube. A case report

BACKGROUND: Endometriosis is a common gynecologic disease that usually presents with pelvic pain and infertility in the reproductive years. It can be complicated by bleeding, such as hematuria or hemoptysis; however, acute massive hemoperitoneum caused by tubal endometriosis without any concomitant disorder has not been reported previously. CASE: An unusual case of massive hemoperitoneum led to preshock as a result of bleeding from a tubal endometriosis implant in a previously healthy 29-year-old woman without previous history suggesting endometriosis. CONCLUSION: Although the most common gynecologic cause of hemoperitoneum in a reproductive-age woman is ruptured ectopic pregnancy, endometriosis should also be considered, especially after exclusion of pregnancy.     

Pleuro-pulmonary endometriosis and pulmonary ectopic deciduosis: a clinicopathologic and immunohistochemical study of 10 cases with emphasis on diagnostic pitfalls

The clinical and pathological features of nine cases of pleuro-pulmonary endometriosis and the first case of pulmonary ectopic deciduosis are presented. The patients were all women between the ages of 27 and 74 years (median, 36 years) who presented with symptoms of catamenial pleural pain, shortness of breath, hemoptysis, or radiographically detected lung masses. Clinically, six patients were multiparous, one patient had pelvic endometriosis, and four patients had undergone prior pelvic surgical procedures, including dilatation and curettage. Radiographically, eight patients had pulmonary infiltrates or nodules, and four patients had pneumothorax. Three cases involved the visceral pleura and one case the parietal pleura. The other six cases, including the single case of ectopic deciduosis, involved the lung parenchyma. Histologically, the single or multifocal lesions were well circumscribed or infiltrative, nodular, cystic, or nodulo-cystic, and showed the characteristic features of proliferative or secretory endometrium with numerous mullerian metaplastic changes. Mucin stains were negative in five cases of endometriosis and in the single case of ectopic deciduosis. Immunohistochemical studies were performed in these same six cases using antibodies to epithelial, mesenchymal, vascular, and neuroendocrine markers. The glandular epithelium was decorated with antibodies to pan-cytokeratin, CK7, BER-EP4, ER, and PR, whereas the stromal cells showed positive staining for vimentin, actin, smooth muscle actin, desmin, ER, and PR. Follow-up information obtained in seven patients showed all women without recurrences after 1 to 20 years. The current study highlights the importance of recognizing intrathoracic endometriosis and ectopic deciduosis and properly assessing small biopsy specimens to avoid a misdiagnosis of malignancy.     

Pleural fluid accumulation due to intra-abdominal endometriosis: a case report and review of the literature

A case is presented of massive ascites and right sided pleural effusion caused by endometriosis. The final diagnosis was not made for a considerable time. Massive ascites and a right sided pleural effusion caused by endometriosis is rare, with fewer than 10 reports in the literature worldwide. Physicians should be aware of this potentially tentially treatable cause, having excluded other possibilities such as malignancy and tuberculosis.     

Allelotyping of endometriosis with adjacent ovarian carcinoma reveals evidence of a common lineage

Endometriosis is a common gynecological disease in which tissue similar to the endometrium proliferates at sites outside the uterine cavity. Malignant transformation of endometriosis to endometrioid and clear cell ovarian carcinomas has been documented in histological studies, but no molecular genetic evidence exists to support that endometriosis is the clonal precursor of such malignancies. We examined 14 cases of endometriosis synchronous with ovarian cancer for loss of heterozygosity on 12 chromosome arms, X chromosome inactivation, and TP53 mutation to determine whether they shared genetic alterations. In all four of the cases where the carcinoma had arisen within endometriosis and in five of the seven cases where the carcinoma was adjacent to the endometriosis, common genetic lesions were detected, consistent with a common lineage. A TP53 mutation was also detected in one case of endometriosis adjacent to carcinoma. These findings support the numerous histological observations that endometrioid and clear cell ovarian carcinomas may arise through malignant transformation of endometriotic lesions.     

CT and MRI appearances of sarcomatous change in chronic pelvic endometriosis

Endometriosis is a relatively common condition in pre-menopausal women. Rarely, endometrial malignancy may arise in and co-exist with endometriosis. In this case report, the findings on CT and MRI which indicated this development are described. Multiple image-guided biopsies showed features consistent with endometriosis and the diagnosis was not confirmed histopathologically until formal laparotomy and open biopsy.     

Malignant endometriosis

Presentation of two case reports of severe and multiple urinary tract involvement by endometriosis due to the low frequency of this disorder. Although this is a benign condition, the term "malignant" endometriosis has been used because of the significant consequences it may have for the urinary tract, since it may compromise both excretory systems with a likely vital risk.     

Scanning electron microscopic and immunohistochemical studies of pelvic endometriosis

The pathogenesis of pelvic endometriosis has been studied by using scanning electron and light microscopy, observing the surface structure of bluish lesions obtained from 26 patients during laparotomy. Paraffin sections included another 17 tissue samples of endometriosis, based on immunohistochemical responses to epithelial membrane antigen, keratin and vimentin. Ultrastructurally, the surface epithelial cells could not be detected in 13 out of 17 pelvic peritoneal endometriosis samples. In one case in which the surface peritoneal cells were seen histologically to dip into the subperitoneal stroma, many surface peritoneal infoldings were observed, and ciliated cells were detected at the edge of these infoldings. Ovarian endometriosis was composed of three types of cells, none of which had any cilia. These findings were observed in continuity with adjacent normal mesothelial cells. No characteristic structure of the endometrial surface was observed for the bluish lesion, but the gland surface of endometriosis located in the subperitoneal stroma initially had ciliated cells. The immunoreactions in both the columnar mesothelial cells with surface peritoneal infoldings and the glands of endometriotic tissues were similar to those of normal endometrial glands, but different from those of normal mesothelial cells. Pelvic endometriosis might originate by a process of metaplasia from the pelvic peritoneum.     

Mucosal changes in the large bowel with endometriosis: a possible cause of misdiagnosis of colitis?

Endometriotic deposits are not uncommon in the large bowel of women. Because the symptoms produced by endometriosis may lead to investigation by colorectal endoscopic biopsy, the aims of this study were to assess the range of mucosal abnormalities that may occur and to determine whether this could represent a significant potential diagnostic problem. We found mucosal changes in eight of 10 cases of colorectal endometriosis; however, the abnormalities (ulceration, gland architectural disturbance, crypt abscess formation, increased inflammatory cell presence, and smooth muscle fibers between glands in the mucosa) were focal and directly related to endometrial deposits. In one case an abnormal colonic biopsy specimen from a patient with endometriosis supported the erroneous clinical diagnosis of Crohn's disease. Comparing a group of women with endometriosis to a group with adenomyosis of the uterus showed that although more women with endometriosis have endoscopic large bowel biopsies, there was no significant excess of biopsy specimens showing inflammatory changes. Our conclusion is that the endometriosis of the large bowel can masquerade as inflammatory bowel disease or ischemic changes and the possibility should be borne in mind, particularly in cases with atypical clinical features or very focal histological changes.     

Endometriosis in the round ligament of the uterus as a cause of inguinal pain

Within one year three patients, women aged 31, 28 and 26 years, presented with a cyclic painful small mass in the inguinal region. Histopathological examination of the resected specimen showed a pattern consistent with an extra-abdominal localization of endometriosis in the round ligament. The patients' complaints disappeared after surgical resection. It is concluded that in case of a painful mass in the inguinal region in a fertile woman endometriosis of the round ligament should be considered.     

Endometriosis of the lung diagnosed with videothoracoscopy

A case of non symptomatic pulmonary endometriosis appearing as multiple nodules on chest X ray and chest CT scan is reported. 43 year old woman was admitted to surgical department because of suspicion of neoplastic dissemination of unknown origin. Non invasive diagnostic procedures were not effective. Diagnosis of pulmonary endometriosis was established with thoracoscopy with lung sampling, confirmed with histopathologic evidence.     

Endometriosis and uterine leiomyomata with ovarian granulosa cell tumour

We report the first known case of right endometrial cyst and multiple uterine leiomyomata complicated by an ovarian granulosa cell tumour of adult type. A 42 year old woman had an adult type left granulosa cell tumour. Laparoscopy 13 years earlier had revealed a small endometrial implant on the peritoneum, without uterine leiomyomata or bilateral ovarian tumours. Findings in this case suggest that the aetiology of endometriosis and uterine leiomyomata are related to the presence of an oestrogen-secreting neoplasm and that the presence of a state of hyperoestrogenaemia due to granulosa cell tumour over several years might have stimulated the development of endometriosis and leiomyomata.     

Cystic endometriosis of the upper abdominal organs. Report on three cases and review of the literature

A 34-year-old woman with signs and symptoms of an acute abdomen was found to have a hepatic cyst on NMR- and CT-scan. With the tentative diagnosis of a liver hematoma, a right hemihepatectomy was performed. Histologically, an endometrial cyst of the liver was found. A second case of cystic endometriosis in the liver was revealed ultrasonographically in a 62-year-old woman, complaining of rightsided epigastrical pain. A 28-year-old woman was admitted to the hospital because of recurrent epigastric pain. A cystic tumor of the pancreas could be visualized ultrasonographically and was interpreted as a postinflammatory pseudocyst. Histological examination of the distal pancreatectomy specimen revealed cystic endometriosis. The clinicopathological features of hepatic and pancreatic endometriosis are discussed and the literature concerning these extremely rare lesions is reviewed.     

Intestinal endometriosis

Pelvic endometriosis affects 5 to 10% of all menstruating women, and of these 3% to 34% have intestinal involvement. Commonly, intestinal endometrial lesion affects only the serosa. Although the invading endometrial tissue may extend into the intestinal wall, it does not usually reach the mucosa. The majority of the patients are asymptomatic. The most common symptom is lower recurrent abdominal pain. It has been estimated that 0,9% of women with intestinal endometriosis have obstructive symptoms. Occasionally deeper and more extensive intestinal wall involvement results in cyclic menstrual rectal bleeding. The authors describe a case with obstructive symptoms associated to rectal bleeding. This is an uncommon finding. Histological confirmation of deep muscular and mucosal involvement was obtained. This case led us to some considerations about the diagnostic difficulties and therapeutic possibilities in the present.     

KCNE1 mutations cause jervell and Lange-Nielsen syndrome

The third reported case of pelvic gliomatosis found within foci of endometriosis is documented 16 years after the removal of a benign cystic teratoma. Grossly at laparoscopy the lesions appear as typical deep fibrotic endometriotic implants.     

Squamous cell carcinoma in ovarian endometriosis. A case report

A primitive squamous cell carcinoma of the ovary arose in ovarian endometriosis. The patient underwent a radical hysterectomy and radiotherapy. The other few similar reported cases had a poor prognosis. In our case the patient died 11 months after surgery.     

Hospital utilization of Saskatchewan people with fetal alcohol syndrome

Endometriosis is defined as the presence of both functioning endometrial glands and stroma outside their usual location lining the uterine cavity. It has been identified in virtually all tissues and organs of the female body with the exception of the spleen. There have been many theories proposed regarding the etiology and pathogenesis of endometriosis. One is the transport of cells through lymphatics and blood vessels. A 44-year-old female suffering from an episode of endometriosis of the umbilicus, left inguinal, uterus, and bilateral ovaries in association with a Múllerian anomaly is presented. Histopathological findings of a skin biopsy from her umbilicus showed aggregated cells within the lymphatic vessel of the upper dermis. This case provides evidence suggesting that cutaneous endometriosis could occur by transport of endometrial cells through lymphatics or blood vessels.     

Palliation of recurrent endometriosis with radiotherapeutic ablation of ovarian remnants

OBJECTIVE: To review the use of radiotherapy for relieving the symptoms of recurrent endometriosis caused by functioning ovarian remnants. DESIGN: Retrospective study (case report). PATIENT(S): A woman with recurrent endometriosis of 14 years' duration. INTERVENTION(S): After hysterectomy and bilateral oophorectomy, hormonal management, and multiple explorations for recurrent endometriosis, cycling ovarian remnants were confirmed histologically. Pelvic irradiation was used to ablate this tissue. A dose of 15 Gy in 10 daily fractions was given through anterior and posterior opposed fields using 18-mV photons. RESULT(S): The patient had a prompt increase in FSH levels associated with castration levels of serum E2. A review of the literature on the use of radiotherapy in this clinical situation is presented. CONCLUSION(S): Radiotherapy should be considered in selected patients when ovarian castration is not a viable surgical option and hormonal therapies have failed.